LTSS and Older Adults

Elderly woman's hands folded in her lapDeveloping policy and data around home and community-based services

Long term services and supports (LTSS) help meet the needs of seniors by assisting with activities of daily living. They are crucial to helping older adults live independently in the community and avoid the need for a nursing home. But while there has been a pronounced move away from institutional care for the elderly, our knowledge about the scope of need for these services has not kept up. Smart Policy Works is engaged in several efforts to promote data-driven policies to guide the way our programs grow to reflect need as the population ages.

Key to the shift away from institutionalization, which began in the 1960s, was government funding for LTSS. Nearly 57% of all Medicaid LTSS spending in fiscal year 2016 went for home and community-based services (HCBS), with some states reaching levels well above that. Because Medicaid is the largest payer of these services, states are the primary entities tasked with improving LTSS access and delivery.

As active members of the LTSS taskforce (created by Public Act 098-0825) of Illinois’ Medicaid Advisory Committee, we helped identify, collect, and analyze data documenting the number and type of LTSS providers, identify gaps in data reporting, and propose steps to determine the scale and scope of race/ethnicity disparity in the provision of LTSS services.

We are planning research and data analysis to estimate unmet need and identify disparities in access to long term services and supports among older adults in Illinois. Existing data sets tell us how many people access the services currently, but not how many need them, where they are, or their demographic profile. Developing this kind of data will become essential as the population ages and the movement to “age in place” gains more momentum.

We also work with community health centers, managed care organizations, and state agencies to strengthen processes for connecting seniors to LTSS. Research suggests people may decide not to use LTSS for reasons including cultural factors, trust of having someone unfamiliar in their home, difficulty finding providers, and not recognizing your own need for services. But many people – including some healthcare providers – may not be aware of the services, or may be deterred by assumptions about cost. This could present a barrier to people receiving care in the community. Additionally, we want to understand factors like racial equity in aging, including disparities in service access.

Interested? Read “Community Health Centers Could Improve LTSS Access
Help at Home Comes to Medicare


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