Long Term Services and Supports

Everyone faces the risk of needing long-term services and supportsLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. ( LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. ), but it is impossible to predict who will need that assistance, when, or for how long. Many people will be able to get by with the help of their families, but a significant number will require expensive paid services over long periods.

An estimated 7.3 million adults in the community and in nursing homes require assistance to perform basic activities of daily livingSkills necessary for daily care of oneself such as bathing and showering, personal hygiene and grooming, toilet hygiene and self-feeding. such as bathing and dressing due to physical, cognitive or mental impairments. About 11.9 million require help with instrumental activities of daily livingSkills necessary for daily care of oneself such as bathing and showering, personal hygiene and grooming, toilet hygiene and self-feeding. , such as paying bills and riding a public bus.

LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. encompass a broad range of assistance needed by people of all ages who are unable to function independently. These include assistance with self-care and household tasks; certain nursing and medical care; care management, habilitation and rehabilitation, and social services; assistive technology and home modification; and services to help people with disabilities maintain employment. Services may be provided in the home, in community settings such as adult day service centers, assisted living and other supportive housing A setting for long-term services and supports that includes board and care homes, assisted living facilities, and group homes that provide or arrange for services and help with activities of daily living (see separate entry) in a residential setting. settings, and in nursing facilities. Services are provided by family members, friends, and other paid caregivers. LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. also includes the supports provided to unpaid caregivers, such as care consultation, education and training, counseling, support groups, and respite care. The uncompensated long-term care services provided by friends and family caregivers People who provide long-term services and supports to family members, relatives, friends, and neighbors. Some family caregivers are unpaid; others are paid through government programs, private funds, or long-term care insurance policies. (to other adults) are worth about $470 billion per yearfar more than the value of paid services. Therefore, supporting family caregivers People who provide long-term services and supports to family members, relatives, friends, and neighbors. Some family caregivers are unpaid; others are paid through government programs, private funds, or long-term care insurance policies. in ways that allow them to continue to provide care is a crucial part of maintaining and expanding LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. services.

Many people needing the type of care often provided by friends and family caregivers People who provide long-term services and supports to family members, relatives, friends, and neighbors. Some family caregivers are unpaid; others are paid through government programs, private funds, or long-term care insurance policies. pay out-of-pocket for some or all of them, accounting for about 19 percent of total LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. expenditures.

LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. can be very expensive, and most families do not have the wealth or LTC insurance to cover those costs. Recent data show the median annual cost of a private-pay nursing facility stay was $97,455 for a private room and $85,775 for a shared room. The median hourly rate charged by agencies for certified home health aide services not covered by MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). was $22; it was $21 for licensed homemaker servicesThese services include meal preparation, cleaning, laundry, shopping, and other household chores; they may  include informal monitoring of clients’ health and functional status. . The median annual cost for a private one-bedroom unit in assisted living was $45,000, while the cost of adult day services averaged $70 per day.

Although LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. can be expensive and unpredictable, the U.S. has no comprehensive system to address the potential risks to families who might face unforeseen and unabsorbable costs. Unfortunately, the structures for both funding and providing these services in the U.S. are fragmented, uncoordinated, and costly. LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. costs are not covered by MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). , the primary health insurance for most Americans 65 and over. MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets.  , which provides health care coverage for people with low incomes, is the largest public payer of LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. . However, to be eligible, participants must meet stringent income and asset criteria. Finally, less than 10 percent of LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. expenditures are paid for by long-term care insurance which can be expensive and difficult for many Americans to acquire.

Many people cannot afford such insurance. Others are denied coverage because of medical underwritingA process in which a health insurer uses an applicant's medical history to decide whether to offer a policy and whether the policy will include pre-existing condition exclusions and/or a premium that's higher than the standard rate. ; that is, insurance companies charge higher premiums or deny coverage to people who have preexisting health conditions that may increase their chances of needing services. Long-term care (LTC) insurance may also lack important consumer protections and may not cover the particular LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. that a person needs. Also, while MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). does not pay for LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. , MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets.  and some other federal programs do cover LTC under limited circumstances (For more see Public-Sector Approaches to Financing Long-Term Services and Supports in this chapter).

Due to the high cost of LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. and limited third-party coverage, many older people fear impoverishment and becoming a burden to their families. As the baby boom generation ages, the need for services will increase at a time where there will be fewer family caregivers People who provide long-term services and supports to family members, relatives, friends, and neighbors. Some family caregivers are unpaid; others are paid through government programs, private funds, or long-term care insurance policies. to provide such care. The uncertainty of needing LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. , and the potentially catastrophic cost burdens associated with it, lends itself to a social insurance solution where risk and costs are shared. Spreading risk widely is the best way to expand coverage and lower per-person costs. If everyone contributes, then everyone is protected. For these reasons, social insurance must play an important role in reform efforts and must cover a range of LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. in home, community, and institutional settings.

Without this kind of solution, programs will operate in isolation and fail to best serve the millions of people with health care and LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. needs. For too long LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. have lacked a holistic focus to help people overcome the full range of obstacles to living in the least restrictive setting possible and maximize their potential for self-determination. A person- and family-centered LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. policy would serve the needs of care recipients, support family and friends in their caregiving role, and create efficiencies in public spending. A system that starts with the needs of the individual would address personal care, nutrition, housing (including home modification), mobility, and medical needs. The result is fewer people in institutions and more in their homes and communities. In 2010, the ratio of potential caregivers age 45–64 to those at high risk of needing care (age 80 and older) was 7:1. By 2030, that ratio is projected to decline sharply to 4:1 and to further fall to less than 3:1 in 2050. By that time, all baby boomers will be in the high-risk years of late life. Higher divorce rates and childlessness will further complicate the availability of family care. Surveys indicate that most people who need LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. strongly prefer to remain in their homes, especially if they need less than 24-hour help. If they need to move to receive services, people strongly prefer to live in an assisted living residenceA residential care setting that provides meals, housekeeping, activities, help with activities of daily living, and health-related services. These settings are regulated by the state and vary considerably in the type and level of care they provide. or other residential settings, rather than a nursing facility. Despite large increases in the older population, the number of people in nursing facilities declined from 1.5 million to 1.3 million from 2003 to 2016. Further declines are likely in the near future due to increased service options for older people with disabilities and the growth of home careA range of services provided in the home, including health-related care, personal care, and supportive services. and assisted living. Also driving the trend are increased use of technology and increased public funding for home- and community-based servicesLong-term services and supports provided in individuals’ homes or in community settings, including adult day services, assisted living and other residential care settings. . Addressing all these needs will require providing consumers with a robust range of information and assistance in understanding what services are available and how to pay for them. All states now operate Aging and Disability Resource CentersState-operated organizations that provide information about and access to all of the long-term services and supports available to older adults and people with disabilities. Also known as Single Point of Entry and No Wrong Door systems. ( ADRCsState-operated organizations that provide information about and access to all of the long-term services and supports available to older adults and people with disabilities. Also known as Single Point of Entry and No Wrong Door systems. ) as a single source of information and assistance about services for older adults and people with disabilities, regardless of their income or type of disability. A critical function of ADRCsState-operated organizations that provide information about and access to all of the long-term services and supports available to older adults and people with disabilities. Also known as Single Point of Entry and No Wrong Door systems. is conflict-free care management services; that is, advice from well-trained care managers who act without self-interest or financial reward with regard to the services they recommend.

Found in Long Term Services and Supports