Transforming LTSS Systems: State Trends & Bipartisan Reform Opportunities

As the nation’s population of older adults rapidly grows, the demand for long-term services and supports (LTSS) is on the rise. LTSS is comprised of institutional care and home and community-based services (HCBS). Most older adults want to remain in the community. However, the United States lacks a national solution to advance high-performing LTSS systems. To address this, BPC evaluated state LTSS system trends using AARP’s LTSS State Scorecards data, which is the only data source comparing LTSS systems across states since 2009. With that information, we have created an infographic outlining existing gaps in LTSS systems and opportunities for bipartisan federal policy reforms to improve those systems.

AARP’s LTSS State Scorecards provide a helpful framework for defining the key dimensions of a high-performing LTSS system. While these dimensions continue to evolve in response to a robust stakeholder engagement process, they include: (1) quality of life and quality of care; (2) affordability and access; (3) choice of setting and provider; (4) support for family caregivers; and (5) effective transitions. AARP’s work to develop the LTSS State Scorecard began in 2009 and has culminated in four editions (2011, 2014, 2016, and 2020), with a new scorecard set for release on September 28, 2023. The findings and conclusions expressed herein are a result of our approach and methodology, and do not necessarily reflect the policy views of BPC, its founders, its funders, its board of directors, or other organizations that engaged with BPC on this work.

BPC will release a follow-up brief in Spring 2024 using new data from the fifth edition of AARP’s LTSS State Scorecard.

Acknowledgments: BPC would like to thank The SCAN Foundation for its generous support of this work. BPC would also like to thank AARP for their engagement on this work.