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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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Preliminary Outcome Evaluation of the Balancing Incentive Program

July 31, 2016
Printer Friendly Version in PDF Format (33 PDF pages)

Later-Life Household Wealth Before and After Disability Onset

July 31, 2016
To assess the financial impact on families of LTSS needs and the potential for families to set aside funds to cover future LTSS spending, this brief examines later-life household wealth before and after disability onset.

Final Process Evaluation of the Balancing Incentive Program

April 30, 2016
This is a follow-up to three earlier evaluation reports on the Balancing Incentive Program. The Balancing Incentive Program, legislated in the 2010 Affordable Care Act (ACA), offered states temporary enhanced federal financial participation for Medicaid home and community-based services (HCBS).

Health Coverage for Homeless and At-Risk Youth

April 11, 2016
This fact sheet explores eligibility for health care coverage, including through Medicaid and the Children’s Health Insurance Program (CHIP), for youth experiencing or at risk of homelessness. It provides information on subpopulations of youth who are likely to be eligible for health care coverage, which services are covered, and how to enroll.

Evaluation of the Medicaid Health Home Option for Beneficiaries with Chronic Conditions: Progress and Lessons from the First States Implementing Health Home Programs, Annual Report - Year Four

March 31, 2016
This report presents findings from the first four years of the five-year evaluation of Medicaid health homes, a new integrated care model authorized in Social Security Act Section 1945 and created by Section 2703 of the Affordable Care Act. The model is designed to target high-need, high-cost beneficiaries with chronic conditions or serious mental illness.

Study of Costs Associated with Community Activities under the Communities Putting Prevention to Work (CPPW) Initiative

March 24, 2016
The Centers for Disease Control and Prevention’s (CDC’s) Communities Putting Prevention to Work (CPPW) program funded 44 communities and states under the American Recovery and Reinvestment Act (ARRA) to implement community-based tobacco and obesity prevention interventions.

How Much Nursing Home Care Can Home Equity Finance?

February 29, 2016
Older adults who have income and assets have choices should they need long-term services and supports (LTSS). In this paper we estimate the extent to which older adults could potentially use home equity to help pay for nursing home care. By estimating the relationship between home equity and care costs, we provide an upper bound on how much assistance with LTSS home equity might purchase.

Does Home Care Prevent or Defer Nursing Home Use?

January 31, 2016
Are chronically disabled elders residing in the community who use home and community-based services (HCBS) less likely to end up in a nursing home? The 2004 National Long-Term Care Survey (NLTCS), a nationally representative sample of Americans aged 65 and older, was linked to follow-up years of Medicare/Medicaid claims and other administrative data.

Support and Services at Home (SASH) Evaluation: Second Annual Report

December 31, 2015
This memorandum describes the ongoing implementation and impacts of a program the Support and Services at Home (SASH) program. The program is intended to improve health and decrease health care expenditures among elderly residents of affordable housing developments.

REPLICATION: Community Action Partnership of San Luis Obispo County, Inc.

December 21, 2015
Community Action Partnership of San Luis Obispo County (Community Action Partnership) is one of nine organizations selected to participate in the Teen Pregnancy Prevention Replication Study. The study is a rigorous five-year evaluation of replications of evidence-based interventions aimed at preventing teen pregnancy, sexually-transmitted infections (STIs), and other sexual risk behaviors.