On the Verge: The Transformation of Long-Term Services and Supports


As the impact of the Great Recession lingers, the demand for publicly funded long-term care services continues to increase. The growing number of older adults coupled with the economic downturnhas forced policymakers and state officials across the country to transform the way long-term services and supports (LTSS) are financed and delivered. The AARP Public Policy Institute produced this report to analyze the findings of a survey conducted on 48 states and the District of Columbia regarding their plans for reforming LTSS programs for older adults in order to maximize program accessibility and capacity. Additionally, the Public Policy Institute created a presentation and webinar that correspond to the full research report and further discuss the survey findings.

Key Points

The report provides a snapshot of the major issues and state actions taken to transform LTSS programs, as well as a comprehensive analysis of Medicaid and non-Medicaid LTSS financing among the states surveyed. Each state has different strategies for dealing with the economic crisis and the increasing number of older adults, though multiple patterns and commonalities among state agencies and older individuals were seen in the survey responses.

Trends observed in the survey include:

  1. Transformation of the Financing and Delivery of LTSS: Many states are significantly restructuring service delivery systems to increase efficiencies and reduce costs.
  2. Increasing Demand for Publicly Funded Services: More than half of the states surveyed reported increased demands for Aging and Disability Resource Centers (ADRC), information and referrals, and respite care services.
  3. Continued Commitment to Home and Community-Based Services and Maintaining Current Service Levels: Twenty-nine states increased Medicaid expenditures for home and community-based service (HCBS) programs from FY 2010 to FY 2011 and 20 states reported a decline in the number of Medicaid nursing facility residents.

How to Use

Policymakers, local officials, and community planners can use the report to gain an understanding of the strategies certain states are implementing or plan to implement in order to transform long-term services and supports and accommodate the needs of the growing older adult population. The presentation and webinar can also be used to better understand the major economic issues facing state agencies in their efforts to reform financing and delivery options for long-term care services and supports.

View the full report: On the Verge: The Transformation of Long-Term Services and Supports (PDF – 4.2 MB)

In-Brief: (PDF – 214 KB)

Presentation: (PDF – 1.2 MB)

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