The AARP Public Policy Institute (PPI) recognizes that family caregivers are an essential part of the social, health, and economic fabric of the United States—providing an economic value of $470 billion in unpaid contributions. Read on to learn about the work PPI is doing to support family caregivers. 

High-Performance Revisited: Examining Long-Term Services and Supports System Performance

Each edition of the Long-Term Services and Supports (LTSS) State Scorecard has measured and ranked LTSS systems in every state against an objective, data-driven set of metrics, or indicators. In advance of the forthcoming 2023 edition, a new paper discusses our approach and reflects on what has changed since the Scorecard was first published. Read

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. Read

LTSS Choices: Increasing Independent Living Choices through Coordinating Affordable Housing and Medicaid: Housing as an Indicator in the 2020 Long-Term Services and Supports State Scorecard

This paper highlights how three states have addressed concerns about housing and services for Medicaid and state-funded LTSS beneficiaries by linking affordable housing properties with LTSS and other supportive services. Read

LTSS Choices: 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. Read

Family Caregiver Considerations for the Future of Hospital at Home Programs

The declaration of the COVID-19 public health emergency (PHE) accelerated an already burgeoning movement of health care into the home. An increasing number of health care systems are choosing to invest in homebased care in new and innovative ways, and consumers are using these services at unprecedented levels. The Hospital at Home (HaH) model shifts care into the home setting and delivers acute hospital-level care to eligible patients where they live instead of in a hospital. Read

LTSS Choices: 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. Read

LTSS Choices: 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. It reviews the challenges LTSS workers face, summarizes experts’ recommendations for reform, and offers examples from some OECD countries that are innovating to improve the situation for their LTSS workforce. Read

LTSS Choices: 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). It explores the evidence of the impact of restorative services and reviews roughly 20 years of evidence related to the efficacy of these services by summarizing international and country-specific studies. It concludes with recommendations for policy makers. Read

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

This report examines the role played by Medicaid managed care organizations (MCOs) delivering Medicaid managed long-term services and supports (MLTSS) during the pandemic, including some of the “on-the-ground” experiences of MCOs and other stakeholders as the crisis unfolded. We explore the challenges states and MCOs faced, efforts to meet the needs of recipients of MLTSS, and lessons learned. Read

LTSS Choices: 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, focusing on the experiences of some countries that have had relatively few deaths in their residential care facilities: how they prepare for pandemics in general, how they responded to the pandemic and how their long-term care infrastructure improved outcomes. It also covers international experts’ recommendations for improving how nursing homes and assisted living facilities respond to infectious disease. Read

LTSS Choices: 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. Read

LTSS Choices: Paying Family Caregivers to Provide Care during the Pandemic-and Beyond

Medicaid is the primary funder of long-term services and supports (LTSS) in the United States. It provides those services and supports either through institutional care (i.e., nursing home care) or home- and community-based services (HCBS). This report explains that one cost-effective HCBS option with multiple advantages is to pay family members to provide care for older people and adults with physical disabilities. Read

Caring Locally for Caregivers: How State and Local Laws Protect Family Caregivers from Discrimination

Workplace discrimination against employees who care for adult family members, called Family Responsibilities Discrimination (FRD) or caregiver discrimination, is an escalating problem that can disadvantage employees and put employers at legal risk. This report details the ways in which state and local laws fill in the gaps left by federal law by prohibiting employment discrimination that occurs because of family caregiving. Read

Managing a Paid Job and Family Caregiving is a Growing Reality

The 2020 Caregiving in the U.S. report revealed an increase of more than 5 million employed family caregivers since 2015. This report takes a deeper look into the Caregiving in the US data at the nearly 30 million Americans who are caring for an ill friend or family member while also working at a paying job. It highlights the impacts and challenges of managing both responsibilities, and it identifies what’s changed since 2015. Read

Caregiving in the United States 2020

Just released by The National Alliance for Caregiving (NAC) and AARP: Caregiving in the U.S. 2020.  This 2020 update reveals an increase in the number of family caregivers in the United States of 9.5 million from 2015 to 2020.

Family caregivers now encompass more than one in five Americans. The study also reveals that family caregivers are in worse health compared to five years ago. As the demand for caregiving rises with an aging population, there is an opportunity for the public and private sectors to work together to develop solutions to support family caregivers and those under their care.  Read

Recognition of Family Caregivers in Managed Long-Term Services and Supports

Based on a study of managed long-term services and supports (MLTSS) programs, this report examines provisions in MLTSS contracts that are important for the support of family caregivers. The study comprised the review of 31 MLTSS programs for older adults and adults with physical disabilities in 23 states in 2019. Read

Fast-tracking Approval for Publicly Funded LTSS: Presumptive Eligibility 

Part of the Long-Term Services & Supports State Scorecard Promising Practices, this paper examines Presumptive Eligibility programs in five states -- Michigan, Ohio, Rhode Island, Vermont, and Washington – comparing key features and making recommendations for effective programs that increase access to Long-Term Services and Supports. Read

Valuing the Invaluable 2019 Update: Charting a Path Forward 

Part of a series of papers on the economic value of family caregiving, this report updates national and individual state estimates of the economic value of family caregiving using the most current data available. In 2017, about 41 million family caregivers in the United States provided an estimated 34 billion hours of care to an adult with limitations in daily activities. The estimated economic value of their unpaid contributions was approximately $470 billion. Read

Long-Term Services and Supports

In 2018, about 14 million adults of all ages needed long-term services and supports (LTSS). This fact sheet takes a closer look at what LTSS encompass, who needs these services, who provides care and where it’s provided, what paid LTSS cost, and who pays for LTSS. Read

Emerging Innovations: Mobility Managers

Mobility managers are transportation coordinators for older adults, people with disabilities, veterans, and other members of the riding public. This paper highlights who mobility managers are and what they do—and why they are important now and in the future. It highlights emerging innovations from five case studies. Read

Home- and Community-Based Services Beyond Medicaid: How State-Funded Programs Help Low-Income Adults with Care Needs Live at Home

This paper highlights how state-funded home- and community-based services programs in 9 states are supporting low-income older adults and/or people with physical disabilities and their family caregivers to live with maximum independence at home. The paper also features a state’s emerging innovation to provide tailored services and supports for “near poor” older adults and their family caregivers.  Read

Older Americans Act

Older Americans Act funding is failing to keep up with inflation and America’s growing older population. Funding supports critical services including meals to help millions of older Americans age in place.  Read

Breaking New Ground: Supporting Employed Family Caregivers with Workplace Leave Policies

Trends suggest that in the coming years an increasing share of family caregivers will be in the labor force, facing the dual demands of employment and caregiving responsibilities for aging relatives. Read

Across the States 2018: Profiles of Long-Term Services and Supports 

Across the States 2018: Profiles of Long-Term Services and Supports is the 10th edition of the AARP Public Policy Institute’s state long-term services and supports (LTSS) reference report. Read

Disrupting the Marketplace: The State of Private Long-Term Care Insurance, 2018 Update

The long-term care insurance (LTCI) industry is undergoing a transformation and is responding to consumer concerns about the high cost and complexity of LTCI by developing alternative products that are more affordable and flexible to meet the coverage needs consumers.  This report includes facts and figures on LTCI and information on the emerging market for short-term care products. Read

Millennials: The Emerging Generation of Family Caregivers

Millennials comprise about 1 in 4 family caregivers, and are the most diverse caregiving generation. This report is the first to look comprehensively at Millennials in the caregiving context. Read. 

Podcast: Millennial Caregivers

 “Prepare to Care” podcast, host Marie-Pierre spoke to Wendy Fox-Grage, Senior Policy Advisor with AARP’s Public Policy Institute, and Isabel Longoria from the AARP Houston office. Both share their insights and favorite resources as a millennial caregiver. Learn More

Taking It to the Next Level:  Using Innovative Strategies to Expand Options for Self-Direction

Evidence shows that self-direction is an effective way to provide long-term services and supports (LTSS).  Part of a series of innovative and promising practices reports to the LTSS State Scorecard, this paper describes how four states used innovative strategies to develop and expand self-directed services programs, coordinate and personalize service options, promote stakeholder engagement and outreach, and implement training programs to expand opportunities for individuals to self-direct their LTSS. Read

Giving States A Tool To Improve Long-Term Services and Supports

AARP’s Long-Term Services and Supports (LTSS) State Scorecard aims to pick up the pace of improving LTSS by providing comparable state data to benchmark performance, measure progress, identify areas for improvement, and improve lives. Read

No Wrong Door: Supporting Community Living for Veterans

This paper describes promising practices on how aging and disability agencies, Veterans Affairs Medical Centers, and Veteran Benefits Offices have forged partnerships to better support Veterans in community living. Read

Emerging Innovations in Managed Long-Term Services and Supports for Family Caregivers

This emerging innovations paper highlights examples of how progressive managed care plans are supporting family caregivers who are caring for plan members with long-term services and supports needs. This paper is the first ever to provide insights directly from managed care leaders about family caregiver supports. Read

Patient and Family Advisory Councils in Hospitals: Building Partnerships to Improve Care

This Spotlight describes the history and emergence of patient and family advisory councils (PFACs) in hospitals, and highlights how hospitals are engaging patients and families in PFACs and what engagement activities are being adopted. It also recommends how PFACs can be broadened to include the unique perspectives of family caregivers of older adults into quality improvement activities. Read

Long-Term Services and Supports Scorecard Promising Practices Paper: State Strategies to Reduce the Risk of Long-Term Nursing Home Care

After Hospitalization describes strategies used in four highly ranked or significantly improved states—including Minnesota—to reduce the risk of long-term nursing home care after a hospitalization. The paper also includes a toolkit of resources that can help others learn more and potentially replicate these practices, as well as contact information for experts. Read

From Research to Standard Practice: Advancing Proven Programs to Support Family Caregivers of Persons Living with Dementia

Caregiver support services can make a real difference in the daily lives of people with dementia and their family caregivers. This paper examines what is known about effective programs to support family caregivers, with a focus on evidence-based programs for family caregivers of persons living with dementia.  Read

Stretching the Medicaid Dollar: Home and Community-Based Services Are a Cost-Effective Approach to Providing Long-Term Services and Supports

Redirecting more resources to provide Medicaid-funded home and community-based services (HCBS) instead of nursing facility services is cost-effective compared with nursing facilities. In addition, HCBS are more responsive to the preferences of older adults and people with disabilities to remain in their homes and communities, and have the potential to improve the quality of life of people receiving these critical services. Read

No Wrong Door: Person- and Family-Centered Practices in Long-Term Services and Supports

The paper provides concrete examples of how seven No Wrong Door Systems—sometimes called Aging and Disability Resource Centers—are promoting person- and family-centered practice. Read

Medicaid: A Program of Last Resort for People Who Need Long-Term Services and Supports

Medicaid is a lifeline for millions of children and adults with disabilities and older people who depend on the program for health care and assistance with long-term services and supports (LTSS) such as toileting, bathing, and dressing. Medicaid is the nation’s largest publicly funded health and LTSS insurance program for people with low incomes. Read

Long-Term Support and Services Fact Sheet

This fact sheet looks at what LTSS encompasses, who provides that care, and lastly who are the major payers. Read

Family Caregivers & Managed Long-Term Services and Supports

This is the first major research paper in this emerging field of managed long-term services and supports (LTSS) that addresses family caregivers’ needs. Family caregivers of people with self-care needs often make it possible for the members of managed care plans to live at home rather than in institutions. Read