1. THE COMMONWEALTH FUND Issues in Long-term Supports and Services: Getting Ready for an Aging America Mary Jane Koren, M.D., M.P.H. Vice President The Commonwealth Fund mjk@cmwf.org www.commonwealthfund.org

2. 2 Long-Term Supports and Services: What are they? For whom? And, where are they provided? Long-term supports and services (LTSS) –Include a range of personal care services, congregate support programs, assistive equipment and environmental modifications –Typically, are expected to be needed for extended periods of time i.e. more than 90 days LTSS helps elderly persons with physical or cognitive impairments and younger people with disabilities Sites where services and supports can be provided –In the persons home, –In the surrounding community, or –In residential settings, e.g. nursing homes or assisted living

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4. 4 State of the states: Findings from the LTSS State Scorecard (www.longtermscorecard.org )www.longtermscorecard.org Wide variation in performance – and even the highest ranking states have things that need improvement Poverty and high rates of disabilities present challenges Highest ranking states have enacted policies that result in high performance –Medicaid programs serve more people in need and offer people choices of LTSS beyond just nursing homes –Single point of system entry provides vital information to help consumers make decisions and simplifies access –Support for family caregivers through legal protections and other services to address caregiver needs LTSS costs are beyond the means of even most middle-income families

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7. 7 Federal policy considerations While there is no unified approach to the provision of LTSS federal policymakers could take the lead in –Developing common definitions of services –Creating uniform measures for determining states effectiveness in coordinating the delivery of primary, acute and LTSS –Strengthening data collection requirements to monitor quality and assess value received for public expenditures Federal policies could provide states with incentives and financial assistance to improve their LTSS systems, e.g. shared savings programs