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States must demonstrate to CMS that their methods to ensure backup workers are available to all individuals who receive Medicaid-funded home- and community-based services are effective. 

Federal and state governments should ensure that people with dementia and other mental disorders receive necessary treatment and LTSS in the most appropriate and integrated setting of their choice.

PASRR rules must recognize that people with serious mental illness may not show significant change but still may have unmet mental health needs. 

LTSS consumers should have access to a full range of mental health services.

Funds should be provided for education and training for long-term services and supports (LTSS) workers, especially those in short supply, such as certified nursing assistants. 

Policymakers should remove barriers to the effective use and hiring of APRNs, such as nurse practitioners, in all LTSS settings.

Federal and state governments must ensure that Medicaid and other public program reimbursements are sufficient to pay wages and benefits that will attract and retain LTSS workers.

Policymakers should require a comprehensive national background check prior to employment for all LTSS workers.