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Long-Term Services & Supports, Long-Term Care

ASPE conducts research, analysis, and evaluation of policies related to the long-term care and personal assistance needs of people of all ages with chronic disabilities. ASPE’s work also highlights the financing, delivery, organization, and quality of long-term services and supports, including those supported or financed by private insurers, Medicaid, Medicare, and the Administration for Community Living (ACL). This includes assessing the interaction between health care, post-acute care, chronic care, long-term care, and supportive services needs of persons with disabilities across the age spectrum; determining service use and program participation patterns; and coordinating the development of long-term care data and policies that affect the characteristics, circumstances, and needs of people with long-term care needs, including older adults and people with disabilities. 

Most Older Adults Are Likely to Need and Use Long-Term Services and Supports

More than one-half of older adults, regardless of their lifetime earnings, are projected to experience serious LTSS needs and use some paid LTSS after turning 65. 

Older adults with limited lifetime earnings are more likely to develop serious LTSS needs than those with more earnings. 

However, fifty-six percent of older adults in the top lifetime earnings quintile receive some paid LTSS, and the likelihood of nursing home care does not vary much by lifetime earnings. Learn more.


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ASPE Issue Brief

Caregiving for People with Non-Alzheimer's Dementias Issue Brief

This is the PDF version of a Reference Paper prepared for the National Research Summit on Care, Services, and Supports for Persons with Dementia and Their Caregivers (also called the Research Summit on Dementia Care).

Evaluation of the Medicaid Health Home Option for Beneficiaries with Chronic Conditions: Evaluation of Outcomes of Selected Health Home Programs, Annual Report - Year Five

Medicaid health homes, authorized by Section 1945 of the Social Security Act, allows states to coordinate care and integrate services for Medicaid beneficiaries with multiple chronic physical, mental, or behavioral health conditions.

Support and Services at Home (SASH) Evaluation: Highlights from the First Four Years Research Summary

This Research Summary describes the primary features of the SASH program and summarizes the main findings of the evaluation to date.  [7 PDF pages]

Support and Services at Home (SASH) Evaluation: Evaluation of the First Four Years

This evaluation report describes the implementation and impacts of a program intended to improve health status and slow the growth of health care expenditures among older adults living in affordable housing properties. The Support and Services at Home (SASH) program connects participants with community-based services and promotes coordination of health care.
Report, Report to Congress

Report to Congress: Social Risk Factors and Performance Under Medicare's Value-Based Purchasing Programs

This report, mandated by the Improving Medicare Post-Acute Care Transformation Act of 2014 or the IMPACT Act (P.L. 113-185), requires the Secretary, acting through the Assistant Secretary for Planning and Evaluation (ASPE), to conduct research on issues related to socioeconomic status (SES) in Medicare’s value-based payment programs.

Advancing Integrated Care: Lessons from Minnesota

This brief discusses how integrated care has taken shape in the State of Minnesota, highlights findings from a study of beneficiaries in the integrated care program in Minnesota, and discusses how the state is using demonstration authority to further build on this successful model.

Health Plan Choice and Premiums in the 2017 Health Insurance Marketplace

This issue brief presents analysis of Qualified Health Plan (QHP) data in the individual market Marketplace for states that use the Marketplace platform and State-Based Marketplaces where data is available.  It examines plan affordability in 2017 after taking into account premium tax credits and also examines the plan choices that new and returning consumers will have for 2017. 

Transition Rates from the Community to Nursing Home Care among Older Adult Medicaid Enrollees, 2006-2009

This study is a follow-up to earlier research conducted with 2006 and 2009 Medicaid (MAX) data on interstate variations on the extent of the "re-balancing" of Medicaid long-term services and supports (LTSS) from nursing home care toward greater reliance on home and community-based services (HCBS).

What Do People Know About Long-Term Services and Supports?

Previous research demonstrates that lack of planning for the potential need for long-term services and supports (LTSS) is associated with lack of knowledge about these services. People who do not have a firm understanding of their longevity risks, probability of needing and using LTSS, and the associated costs for services may be less likely to plan for their future LTSS needs.

Choosing Long-Term Care Insurance Policies: What Do People Want?

Long-term services and supports (LTSS) are expensive. The average private pay cost of a private room nursing home stay in 2014 was about $88,000 a year. Although this cost is insurable through private long-term care (LTC) insurance, coverage is low.