Long-Term Care

One goal of long-term care policy is to increase the use of HCBS and to reduce reliance on institutional care. The use of nursing homes as measured by the number of residents in facilities on a single day has declined over the past two decades. Despite the centrality of this issue for balancing efforts, there has been no systematic effort to examine the reasons. This report begins to fill the gap by conducting descriptive analyses of factors. In most cases, analyses were to extend to 2007.

States increasingly require criminal background checks for home care workers to protect vulnerable adults from harm. While 46 states mandate some type of background check for Medicaid-funded workers, there is no uniform protocol for screening and disqualifying candidates. Developing sound policies and practices is challenging due to costs, database problems & time constraints. The paper offers an up-to-date assessment of practices, policy considerations & research and guidance on moving forward.

The second in a series, this report explores the cross-payer effects of providing Medicaid long-term supports and services on Medicare acute care resource use. Patterns of Medicaid eligibility, as well as resource use under both Medicare and Medicaid, are examined primarily within the context of service use-based groups that can be used to set rates for Medicaid capitation payments for managed long-term care.

In the webinar, Dr H. Stephen Kaye and colleagues Dr. Mitch LaPlante and Dr. Charlene Harrington discuss their published paper. Learn how increased Medicaid spending on home and community-based services affects overall long-term care costs. The paper analyzes the short-term versus long-term cost savings from HCBS expansion.

Spending on HCBS has grown in recent years, but little is known about what effect alternatives have on overall costs. An analysis of state data from 1995-2005 shows that for two population groups, spending growth was greater for states offering limited noninstitutional services than for states with large, well-established noninstitutional programs. Expansion of HCBS appears to entail a short-term increase in spending, followed by a reduction in institutional spending and long-term cost savings.

Looking for quick talking points on how the expansion of home and community-based long term care services can significantly help address the health care needs of many older adults? A new Fact Sheet provides examples and data on why HCBS is a critical component of Health Reform.

What are the policy options for Medicaid HCBS? This fact sheet suggests: broadening the scope of covered services, enhancing federal Medicaid matches to states to expand HCBS, allowing Medicaid HCBS beneficiaries to retain more assets to pay for home modifications or health services not covered by Medicaid, and allowing Medicaid HCBS waiver programs to serve people with lower levels of functional disability than those required for people in nursing homes.

More than 10 million Americans require long-term care supports and services yet the system for delivering and paying for this assistance is deeply flawed. The national health reform debate allows policymakers to reconsider long-term care as well. This paper assesses proposals to restructure the delivery and financing of long-term care services.

Achieving comprehensive health reform has emerged as a leading priority. In Congress, a number of comprehensive reform proposals have been announced as the debate proceeds. This interactive side-by-side compares the leading comprehensive reform proposals across a number of key characteristics and plan components. Users can choose one or more proposals and one or more topics for comparison.

This policy brief presents four options that merit serious consideration in the current health care reform discussions. The first two options would improve long-term care for people with low incomes and limited financial resources. Review ideas on expanding Medicaid support for home and community-based services and improve coordination of medical and long-term care for Medicare-Medicaid “Dual Eligibles”. Poll results also gauge interest in reform if long-term services and supports were included.