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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.

The federal government and the states should require providers to hold residents’ beds for them during temporary absences as long as the residents’ fees continue to be paid. 

The federal government and the states should enact laws that establish the right of residents in nursing facilities and residential care settings—or their legally recognized decision-makers—to use