For policy measures, we found that three measures were significantly related to LTSS system performance indicators (Table III.4). First, the number of people consumer-directing services per 1,000 adults age 18 and older was significantly associated with higher rates of HCBS spending and use. Consumer-direction was measured differently in 2006, but it was also found to be significantly correlated with higher rates of HCBS balance in the previous analysis. Availability of small LTSS ID/DD facilities and residential-living options were also significantly associated with higher rates of HCBS expenditures and use, suggesting the importance of alternative living options for people who want to remain in the community but are unable to remain in traditional home settings.18
18 Higher payment rates for adult day services were significantly associated with higher rates of HCBS spending but not associated with rates of HCBS use.