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A Series on Advancing Transformation in Long-Term Services and Supports

About the Series

AARP Public Policy Institute has launched LTSS Choices—a multifaceted project with an overarching mission to catalyze the transformation and modernization of the nation’s long-term care system into one that meets the dynamic needs and preferences of consumers and their families.

This series of reports, blogs, videos, podcasts, and virtual convenings seeks to spark ideas for immediate, intermediate, and long-term options for reforming LTSS.  It will showcase current models that could be ramped up now as well as potential innovative models that may take time to fully create. It will emphasize evidence-based solutions and identify regulatory and funding barriers that limit the widespread use of promising practices.

About the LTSS Choices Team

Paying Family Caregivers to Reduce Reliance on Nursing Homes


Spotlight Reports

This is an action-oriented series. We aim to stimulate systems-level change to transform and modernize the delivery of LTSS.

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CAPABLE: A Model of Empowering Older Adults to Remain Independent

This paper highlights the Community Aging in Place—Advancing Better Living for Elders (CAPABLE) model, designed to keep older adults in the community and to improve their ability to remain independent.



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Coordinating Housing, Health and LTSS Through Home-Based Care Management

This report describes and evaluates the SASH (Support and Services at Home) program in Vermont as one model of HBCM programs. Founded in 2009, SASH now partners with 70 organizations, including hospitals, community-based organizations, and academic institutions in sites across the state.



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Empowered Direct Care Worker: Lessons from the Green House Staffing Model

This paper describes the most widely researched model in the small-house nursing homes category: THE GREEN HOUSE®. Authors discuss how the Green House staffing model improves the quality of work life for staff and promotes positive outcomes for residents and whether any of these tactics can be adopted by nursing homes that are not yet able to change their housing structures.



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Home and Community-Based Services for Older Adults

This report serves as a primer on the current state of home and community-based long-term services and supports for older adults and highlights successful models for expanding these services.



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Presumptive Eligibility for Medicaid Home and Community-Based Services Can Expand Consumer Choice

This report explores how presumptive eligibility can empower consumers to access publicly funded home- and community-based services (HCBS) without lengthy determination delays.




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Nursing Homes & COVID-19

This report will highlight insights from a comprehensive synthesis of the current state and federal reports on nursing homes in light of COVID-19, with a specific focus on alternative recommendations and solutions regarding current nursing home infrastructure and policies.


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LTSS Choices: From Ideation to Standard Practice: Scaling Innovations in Long-Term Services and Supports

Five promising innovations currently in the long-term services and supports (LTSS) system are becoming more commonplace. This paper discusses these innovative programs and the diffusion of innovation, or scaling-up process, underlying them




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International Review of Experts' Recommendations for Reforming the Long-Term Services and Supports Workforce

This report describes the LTSS workforce in the Organisation for Economic Cooperation and Development (OECD), of which the United States is a member country. 




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The Role of Medicaid Managed Long-Term Services and Supports during the COVID-19 Pandemic

This report examines the roles played by Medicaid managed care organizations (MCOs) delivering Medicaid managed long-term services and supports (MLTSS) during the pandemic.



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Adult Family Care - A Viable Alternative to Nursing Homes

People who need long-term services and supports want alternatives to nursing homes as living options.  Adult Family Care (AFC), which is not as well known among consumers as home care and assisted living, gives older adults and people with disabilities a viable alternative.




Advancing Transformation in Long-Term Services and Supports

This report will lay out the framework guiding AARP's exploration of LTSS Choices, focusing on the four pillars of housing, services, workforce, and community integration. In addition, it describes the systemic features and the driving and restraining forces that impact the success and replicability of different models.



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Increasing Independent Living Choices through Affordable Housing & Medicaid: 2020 Long-Term Services & Supports State Scorecard

This paper highlights three state programs that proactively link housing with services as the platform for helping low-income LTSS beneficiaries successfully remain in their communities.




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Promoting Choices through Restorative Services: International Innovations

This report highlights a multidisciplinary intervention that strengthens a person’s ability to function called restorative services (sometimes called reablement or restorative care).



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International Review of Innovations to Protect Nursing Home Residents from Infectious Diseases such as COVID-19

This report reviews the international community’s experience with the COVID-19 pandemic in nursing homes, which has varied substantially across different countries.



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Paying Family Caregivers to Provide Care During the Pandemic-and Beyond

This report will demonstrate the critical importance of policies enabling family caregivers to be paid to support older adults and people with physical disabilities in the era of COVID-19 and beyond.



St. John's Green Home in Rochester NY

Courtesy of St. John's Green Home, Rochester, N.Y.

Small House Nursing Homes 

This report will look at the evidence on small-house nursing homes, with a particular focus on the model known as Green House homes. It will also examine key features of the Green House (housing, services, workforce, and community integration) and discuss challenges and opportunities for expanding availability to Green House homes and other small-house nursing homes. 



More from AARP

AARP Nursing Home COVID-19 Dashboard

AARP fought for public reporting of nursing home COVID-19 cases and deaths. Using this data, the AARP Public Policy Institute, in collaboration with the Scripps Gerontology Center at Miami University in Ohio, created the AARP Nursing Home COVID-19 Dashboard.



Long-Term Services and Supports Scorecard

A project of AARP, the Commonwealth Fund and the SCAN Foundation, the Long-Term Services and Supports Scorecard provides data on five key dimensions of state LTSS system performance: affordability and access; choice of setting and provider; quality of life and quality of care; support for family caregivers; and effective transitions. It assesses each state’s performance as a whole and on 26 individual indicators.

Contact Us

We invite ideas and opportunities to collaborate. For all questions and inquiries, please contact us at