Long-term services and supports are used by individuals of all ages with functional limitations and chronic illnesses who need assistance to perform routine daily activities. These are basic activities of daily living: eating, dressing, using the toilet, bathing, getting out of bed, and crossing the room to sit in a chair. Then there is another category of function with tasks called instrumental activities of daily living such as writing checks, paying bills, cleaning the house, cooking, and going shopping.
Millions of Americans of all ages with intellectual and developmental disabilities, mental health disabilities, physical disabilities, and/or disabling chronic health conditions need access to long-term care services. The number of Americans needing access to LTSS is expected to grow substantially in the coming decades (See: Demand for Long-Term Services and Supports Will Rise).
LTSS are provided in institutional settings, such as nursing facilities, as well as in home and community-based settings. Over time, there has been a shift towards providing care in home and community-settings instead of institutions due to patient preferences and the Olmstead Supreme Court decision against the unjustified institutionalization of people with disabilities under the Americans with Disabilities Act. A majority of long-term care is provided by friends and relatives in home and community-based settings.
The fundamental goal of LTSS is to help individuals with functional limitations go about their daily lives safely while maintaining quality of life and maximizing independence in their preferred community setting. With access to care and supports, seniors and individuals with disabilities are better able to make choices about where they live and how they spend their time. Devastating and costly health incidents – such as falls and malnutrition – can often be prevented with proper services and supports such as personal assistance, home modifications for mobility impairments, and home meal delivery programs. But without access to appropriate, high-quality care, individuals with functional limitations may suffer further health deterioration, which in turn causes unnecessary health care spending as well as unfavorable outcomes for them.
For more detailed information, see these Academy reports:
- Designing Universal Family Care: State-Based Social Insurance Programs for Early Childcare, Paid Family and Medical Leave, and Long-Term Services and Supports, Final Report of the Study Panel on Caregiving
- Medicaid and Federal Funding Caps: Implications for Access to Health Care and Long-Term Services and Supports among Vulnerable Americans
- Long-Term Services and Supports, Report to the New Leadership and the American People on Social Insurance and Inequality
- The Aging Network in Transition: Hanging in the Balance
- Social Insurance: A Critical Base for Financing Long-Term Services and Supports
- Long-Term Services and Supports: Meeting the Needs of Elders, Families and the Workforce Through Social Insurance
- Long-Term Services and Supports as Part of Health Care Reform: Relief for the Invisible Uninsured?, Health and Income Security Brief No. 12