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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.

Reports

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ASPE Data Point

Nurse Staffing Estimates in US Nursing Homes, May 2024

In April 2024, CMS issued the Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting final rule which established new minimum nurse staffing requirements for nursing homes by nurse type.
ASPE Issue Brief

Medicaid Home and Community-Based Services Section 1915(c) Waiver Policy Flexibilities During the COVID-19 Public Health Emergency: State Agency, Provider, and Consumer Experiences Issue Brief

States may use Appendix K to modify their existing Medicaid home and community-based services (HCBS) 1915(c) waiver programs during emergency situations. During the COVID-19 public health emergency, states used Appendix K to make temporary changes to access and eligibility, payment, services, and other aspects of their waiver programs.
Research Brief

Changes in Ownership of Skilled Nursing Facilities from 2016 to 2021: Variations by Size, Occupancy Rate, Penalty Amount, and Type of Ownership

Stakeholders, researchers, and policymakers have identified varying nursing home ownership structures and ownership transactions as potentially influencing the quality of care delivered to vulnerable residents.
Report

Medicare Advantage Coverage Among Individuals Receiving Federal Housing Assistance

Prior research from the U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Planning and Evaluation (ASPE) and U.S. Department of Housing and Urban Development (HUD) Office of Policy Development and Research (PD&R) show older adults receiving federal housing assistance face disproportionately high rates of chronic conditions and health care utilization.
ASPE Issue Brief

Trends and Disparities in Pandemic Telehealth Use among People with Disabilities

This Issue Brief explores telehealth use for people and Medicare beneficiaries with disabilities and examines questions on the use of audio-only telehealth during the second and third years of the coronavirus disease 2019 (COVID-19) pandemic.
ASPE Issue Brief

Improving Data on the Workforce Delivering Home and Community-Based Services

On April 25, 2024, HHS and DoL released recommendations, in the form of an Issue Brief, to improve data infrastructure on the workforce delivering home and community-based services (HCBS) in response to President Biden’s
Fact Sheet

ASPE’s Recent Contributions to Achieving Health and Well-Being Equity

ASPE serves as a facilitator for HHS to advance equity in several ways.
ASPE Issue Brief

Medicare Enrollees and the Part D Drug Benefit: Improving Financial Protection through the Low-Income Subsidy

The Inflation Reduction Act’s (IRA) expanded financial assistance in Medicare’s Low-Income Subsidy (LIS) Program would have benefited nearly 461,000 Partial LIS enrollees had the provision been in effect in 2020. An additional 2.9 million Part D enrollees who were eligible but not enrolled in LIS would also have benefited from the program.
ASPE Data Point

HHS Standard Values for Regulatory Analysis

The U.S. Department of Health and Human Services (HHS) analyzes the benefits, costs, and other impacts of significant proposed and final rulemakings, consistent with the requirements of several executive orders and statutes. HHS develops these analyses according to technical guidance published by the U.S.
Research Brief

Child Care Workers’ Experience of Economic Hardship During the COVID-19 Pandemic, from 2021 to 2022

This brief shares findings from an analysis using U.S. Census Household Pulse Survey data to examine child care workers’ experience of economic hardship from 2021 to 2022 along different measures of economic hardship, across time, by race and ethnicity, and whether child care workers lived with young children. We find: