LTSS Choices

LTSS Choices: A Series on Transforming Long-Term Services & Supports

Published December 4, 2020

This report introduces the AARP Public Policy Institute’s LTSS Choices initiative: A series of reports, blogs, videos, podcasts, and virtual convenings that seek to spark ideas for immediate, intermediate, and long-term options for transforming LTSS, that is, long term services and supports, also known as long-term care. The series will explore innovative models and evidence-based solutions at both the national and international levels. It will reveal that some solutions are already in use and available to be scaled, while other emerging innovations, too new to have an evidence base, are nevertheless ripe for sparking important conversations, investment, and research. The series aims to stimulate both creative thinking and systems-level change to transform and modernize the delivery of LTSS.

LTSS Choices Framework

The series will address the four pillars of the LTSS system, the four basic requirements for people who need LTSS. How these four pillars come together is the opportunity for transformation. People need 1) a place to live, 2) services and supports, 3) a workforce to provide those services and supports, and 4) community integration, or connection to others in their community. 

About 10 percent of Americans who need these services currently live in nursing homes, which do provide housing, services and a workforce but typically not in the best possible way to meet consumer preferences.   The majority of the 14 million adults needing LTSS live in their own homes or with family, yet face many challenges in making it work. In between these two choices lie residential options of various kinds that combine the four pillars in different ways; some such options already exist today and can be scaled. States that have worked for many years to offer LTSS choices now offer such options as adult foster/family care, assisted living programs, housing with services, and others. This series examines what options can be refreshed and scaled, and what new options can be imagined.

Driving and Restraining Forces

LTSS Choices will also explore the forces working to drive change, and forces working to restrain change in evolving the LTSS system. These opposing forces will impact any effort to improve and expand LTSS choice, as well as larger system design issues such as access, quality measurement and oversight, cultural competence, financing, and coordination with broader health care and social services systems. Considering drivers and resisters to change, we will assess each choice within this broader system context. To what extent could a model be made equitably available to those who would choose it? How is it operated and financed? How can quality be assured? To what extent can it be integrated with health care and social systems? For example, regarding that last element—interaction and articulation with the health care and social systems—a high-performing LTSS system includes recognition of and support for family caregivers, making LTSS choices and family caregiving closely connected.


LTSS Choices: A Series on Transforming Long-Term Services & Supports

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Suggested Citation

Reinhard, Susan. LTSS Choices: A Series on Transforming Long-Term Services & Supports. Washington, DC: AARP Public Policy Institute, December 4, 2020.


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