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Policymakers should expand opportunities for people to volunteer in their communities. This includes older adults and people with disabilities.

Federal policymakers should develop a comprehensive system for financing Long-Term Services and Supports (LTSS) that includes a new social insurance program to provide a basic level of LTSS.

Ideally, the federal government should finance LTSS through a universal, comprehensive, and publicly administered program such as Medicare or similar social insurance program of shared risk. 

States should require that all beds in a nursing facility be certified for Medicaid and Medicare as a condition for the facility’s participation in Medicaid. 

States should require adequate numbers of appropriately trained staff to ensure a high quality of care.

Quality measures: Participant preferences and satisfaction should be used as key quality measures.

The Centers for Medicare & Medicaid Services, the states, and all other regulators should vigorously enforce all regulations in long-term services and supports (LTSS) facilities and home care w

The federal government and the states should provide incentives (including, but not limited to, grants and loans) for new, affordable models of LTSS.