The American long-term care (LTC) system has changed over the last several years as the need for care has increased steadily with the aging of the boomer generation. The biggest of these changes is that several states have contracted with large, for-profit insurance companies to administer Medicaid LTC services. In several states, these for-profit companies have displaced the non-profit organizations that have long been part of the Aging Network at the state and local level.
The current publicly supported LTC system is a mix of nursing home, assisted living and in-home supportive services. This mix has slowly but steadily been shifting in the direction of home and community-based services (HCBS) over the last 20 years. This shift is largely in response to the at least partially proven cost effectiveness of community-based alternatives to nursing home care and the overwhelming preference for them by both older and younger impaired persons rather than living in a nursing home.
The following paper, published in the Journal of Aging & Social Policy describes these changes in the public LTC system and discusses their implications for the availability and quality of LTC services for Medicaid beneficiaries.