Promising Practices and Other Resources

To live successfully in the community and mitigate the risk of needing to move to an institutional setting, low-income older adults and younger people with disabilities who require long-term services and supports (LTSS) need both affordable, stable housing and appropriate services. This report is a collaboration between LeadingAge LTSS Center @UMass Boston and the AARP Public Policy Institute examining the role of affordable housing in a well-balanced LTSS system. It offers solutions that consider the bigger picture, specifically the widespread shortage of HCBS workers in tandem with unaffordable housing. 

Assistive Technology (AT) refers to any item, device, piece of equipment, or system that can increase, maintain, or improve functional capabilities for older adults and individuals of all ages with disabilities. It includes a wide range of technologies, from smart home and vehicle automation, to devices that enable communication with health care providers, or with people and programs to reduce social isolation. AT programs which run in partnership with state, local, and community organizations enable people with disabilities and older adults, caregivers and others working with them, to learn about, access and acquire AT. These programs, however, which can be real game changers and even life savers for so many families and individuals, are underutilized.

This report describes promising and emerging innovations on the use of alternative funding strategies, such as local property tax levies, to address the growing need for programs to better serve older adults. It examines how communities in three different states are utilizing local funding streams to support services for older adults. These states have instituted levy-supported initiatives to supplement services, including home-delivered and congregate meals, personal care and homemaker services, home repair support, medical and nonmedical transportation, and emergency response systems, for older adults. These promising and emerging innovations can help people with long-term services and supports needs continue to live in their own homes and communities. 

The report highlights state progress toward establishing a high-performing ADRC/NWD System by comparing results from the previous Scorecard and highlighting key themes.  The report also provides promising practices state examples and lessons learned across five states (AL, GA, MA, OH, and SD) and highlights action taken by Nevada and Virginia to address the COVID crisis.

This paper describes the key findings and emerging trends in self-direction based upon data and information collected in the 2019 National Inventory of Publicly Funded Self-Directed Long-Term Services and Supports (LTSS) Programs in the United States.  The National Inventory was conducted to support the development of the Self-Direction indicator in the 2020 LTSS State Scorecard which reports national and state-level data on the number of people receiving self-directed services per 1,000 people with any disability in the state. 

This paper describes promising practices on the use of presumptive eligibility to improve access to long-term services and supports (LTSS) in five states. These states can presume financial eligibility for Medicaid LTSS, and some of these states also can fast-track the determination process to arrange for timely home- and community-based services. These promising practices can help people with LTSS needs live in their own homes and communities.

Mobility managers are transportation coordinators for older adults, people with disabilities, veterans, and other members of the riding public. This paper highlights who mobility managers are and what they do—and why they are important now and in the future. It highlights emerging innovations from five case studies.

This paper highlights how state-funded home- and community-based services programs in 9 states are supporting low-income older adults and/or people with physical disabilities and their family caregivers to live with maximum independence at home. The paper also features a state’s emerging innovation to provide tailored services and supports for “near poor” older adults and their family caregivers.

This paper describes how four states used innovative strategies to develop and expand self-directed services programs, coordinate and personalize service options, promote stakeholder engagement and outreach, and implement training programs to expand opportunities for individuals to self-direct their LTSS.

This emerging innovations paper highlights examples of how progressive managed care plans are supporting family caregivers who are caring for plan members with long-term services and supports needs. This paper is the first ever to provide insights directly from managed care leaders about family caregiver supports.

Drawing on legal analysis, in-depth interviews with advocates and unemployment insurance officials, and analysis of available data, this paper presents detailed information on the policies and practices in place in state unemployment insurance programs that provide potential temporary financial assistance to family caregivers.

Demand for home and community-based services (HCBS) is expected to continue to increase over time as the 65+ population grows larger and older and has a greater need for long-term services and supports. More than 80 percent of adults have expressed a desire to remain in their homes and communities as they age and prefer a home setting over a nursing home or other institutional setting.  

HCBS includes a wide range of services and supports provided at home (e.g. personal/home care, home health services, home modifications) and in the community (e.g. transportation, meal services, and adult day services).

The $12.7 billion investment in state Medicaid HCBS programs from the American Rescue Plan Act has the capacity to transform state HCBS systems in the coming years. This fact sheet serves as a primer on the current state of home and community-based long-term services and supports for older adults and highlights successful models for expanding these services.

The COVID-19 pandemic has swept the nation, killing more than 184,000 residents and staff of nursing homes and other long-term care facilities. The AARP Public Policy Institute, in collaboration with the Scripps Gerontology Center at Miami University in Ohio, created the AARP Nursing Home COVID-19 Dashboard to provide four-week snapshots of the virus’ infiltration into nursing homes and impact on nursing home residents and staff, with the goal of identifying specific areas of concern at the national and state levels in a timely manner. This dashboard has tracked five categories of impact since summer 2020 and will be updated every month to track trends over time.  This month’s dashboard also includes, for the first time, data on the vaccination rates of nursing home residents and health care staff.

People who need long-term services and supports want alternatives to nursing homes as living options.  Adult Family Care (AFC), which is not as well known among consumers as home care and assisted living, gives older adults and people with disabilities a viable alternative. In AFC, sometimes called adult foster care or adult family homes, residents live full-time in a house or other small residential setting where they receive assistance with activities of daily living, personal care, and help with medications and other health care tasks, in collaboration with health care professionals. 

More than 40 years ago, Oregon and Washington were the first states to establish AFCs as an option for both private pay residents and those receiving public funds. And while most states have subsequently added AFC to their array of long-term residential care options, many have had difficulty recruiting providers and consumers. This report, written for consumers, advocates, and state policy staff, summarizes some of the key features of AFC as well as ideas for expanding its availability.  

Workplace discrimination against employees who care for adult family members, called Family Responsibilities Discrimination (FRD) or caregiver discrimination, is an escalating problem that can disadvantage employees and put employers at legal risk. This report details the ways in which state and local laws fill in the gaps left by federal law by prohibiting employment discrimination that occurs because of family caregiving.

AARP fought for public reporting of nursing home COVID-19 cases and deaths. Using this data, the AARP Public Policy Institute, in collaboration with the Scripps Gerontology Center at Miami University in Ohio, created the AARP Nursing Home COVID-19 Dashboard to provide four-week snapshots of the infiltration of the virus into nursing homes and its impact on residents and staff, with the goal of identifying specific areas of concern at the national and state levels in a timely manner.

The September 24, 2020 webcast release contextualized the LTSS Scorecard in the current policy environment, highlighted high-level findings, and showcased successful state strategies.

The rise of Uber and Lyft has exacerbated insurance challenges for volunteer drivers. Insurance agents often have difficulty distinguishing between people using their personal vehicles to make money and those using them to provide transportation as volunteers. This confusion comes just as the demand for volunteer-provided transportation is rapidly increasing. State legislators and the insurance industry need to get involved to remove barriers to this invaluable form of volunteerism. This paper explores these challenges volunteer drivers face in the age of ridesharing. 

The Commonwealth Fund's 2020 Scorecard on State Health System Performance assesses all 50 states and the District of Columbia on 49 measures of access to health care, quality of care, service use and costs of care, health outcomes, and income-based health care disparities.

Building a Master Plan for Aging: Key Elements from States Planning for an Aging Population

This Insight on the Issues discusses the availability of assisted living and residential care, which represent a critical component of the long-term services and supports (LTSS) system for older adults who cannot live alone, but do not require the skilled care provided by nursing homes. In 2010, states reported a total of 51,367 licensed residential care settings with a total capacity of 1,233,690 beds—a dramatic increase from an estimated 1,046,631 beds in 2007. (July 2012)

This Insight on the Issues examines respite care, or temporary relief for caregivers from caregiving tasks. It is the service strategy most commonly offered to support family caregivers and is available in all 50 states. However, definitions of respite vary among programs and states, and quality and completeness of reported data are often lacking, making rigorous comparison among states impossible. This report describes the main sources of publicly funded respite care and presents data for the year 2007. (July 2012)

This report presents the findings from a case study of Connecticut, which is a high-performing state undertaking a systematic effort to shift its reliance on nursing homes to the use of more home- and community-based services. The study was conducted following the release of the 2014 State Long-Term Services and Supports Scorecard 1 to understand factors that lead to improved performance on measures of long-term services and supports (LTSS) for older adults and people with physical disabilities. 

Unnecessary and avoidable care transitions, which occur when people are moved from one care setting to another, can result in adverse outcomes, especially among older adults and people with multiple chronic condition. The 2014 State Scorecard on Long-Term Services and Supports is excellent tool for measuring state progress in care transitions.

This case study of Mississippi was conducted following the release of the 2014 State Scorecard on Long-Term Services and Supports to understand factors that lead to improved performance on measures of long-term services and supports (LTSS) for older adults and people with physical disabilities.

This exploratory study looks at the relationship between caregiving and well-being. The analysis finds that caregivers, particularly women, were more likely to experience stress and worry than non-caregivers, and less likely to feel as if they had enough time and were well-rested. The paper presents findings and issues for future research.