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Ensuring the quality of services for home care is difficult. No quality measures can assess every service delivered daily in hundreds of thousands of private homes across the country.

In 2021, an estimated 58.7 million adults age 18 and older in the U.S. had a mental illness. That is 22.8 percent of all adults. Prevalence among those over age 50 is 15 percent. 

The care provided in long-term services and supports (LTSS) settings is only as good as the personnel who provide it.

Federal and state governments have tried to change budget rules to control government spending. Budget rules have also been used to impose fiscal discipline.

The primary source of public financing for long-term services and supports (LTSS) is the joint federal and state Medicaid program.

Grandparents and other relatives play an important caregiving role in family well-being. Support from extended family is especially vital in families with low incomes.

The mainstay of local taxation is the tax on real estate, known as the property tax. It is used to fund an array of critical state and local services, most notably public schools.

How to improve the tax code is the subject of much debate. Proponents of reform often call for increasing fairness and simplicity. But people define those concepts in different ways. 

Policymakers use the tax system to raise revenue and to promote social policy goals. For example, tax breaks may be provided to encourage home ownership.

Several recent legislative efforts in Congress have included proposals that would cap the federal contribution (overall in a block grant or per person in a per capita cap) to Medicaid.