What's Needed to Improve
Long-Term Supports and Services?

The delivery of long-term services is not coordinated between providers of different payment systems. There is also no comprehensive system for coverage or care coordination. Many consumers do not have access to the least restrictive level of care to meet their needs, either because it is not affordable, or because the supports and services are simply not available in the community.

Health reform establishes a number of programs that will help. These include incentives for states to expand home- and community-based services in Medicaid and other programs that will extend existing grants or demonstrations, increase care coordination, and invest in the long-term care workforce. But more efforts are needed in many areas. (For more on what health reform will do, see Long-Term Services and Supports in Health Reform.)

• Greater access to home- and community-based services in Medicaid: For the foreseeable future, Medicaid will be a major payer for long-term services. However, access to home- and community-based services is not consistent across the states, in large part because this is an optional, not mandatory, Medicaid service. Programs in health reform, such as the Community First Choice Option, could significantly improve this situation.
  
  
• Sustainable financing systems: Financing solutions that are affordable, reliable, and sustainable for individuals, states, and the federal government are needed.
  
  
• Care coordination: Individuals who are eligible for both Medicare and Medicaid use a lot of long-term services resources, but payment and care is not well-coordinated across these systems. The result is often inappropriate care that is provided at a higher cost than necessary.
  
  
• Workforce and caregiver issues: Programs need to be designed that will increase the supply of direct care workers and ensure adequate pay and benefits for these individuals, who are charged with the important job of providing care to our loved ones. Better supports—training and respite care—are also needed for informal caregivers, who are a critical part of the long-term services system.
  
  
• Quality care and adequate supports: Systems need to be in place and adequately funded to ensure that quality care is being provided in all settings—from nursing homes to community settings like adult groups homes. To better support those who are able to live in the community, communities must have adequate transportation and a greater supply of appropriate and accessible housing.