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States should establish a resident’s right to alternative forms of dispute resolution, such as mediation, provided the states do not inhibit or discourage residents or their families from resolving

Policymakers should enact and strictly enforce antidiscrimination and civil rights laws.

Federal regulations should promote home-care quality assurance standards guided by flexible consumer-oriented principles.

Higher levels of government should provide adequate resources when mandating functions to lower levels of government.

States should be required to conduct annual scheduled surveys assessing clients’ experience and involvement in care plans and outcomes.

States should extend the purview of their existing ombudsman programs to include long-term services and supports delivered in homes. 

States should require agencies to establish grievance and appeals procedures and provide consumers with written notice of their right to voice grievances. 

States should require that home-care providers adequately train family caregivers who agree to use technology (such as home dialysis, tube feeding, and continuous intravenous infusion).

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.