State Long-Term Care Progress: A Blueprint for Federal Solutions

Despite rising demand and increased spending, the nation’s long-term care system does not adequately meet Americans’ needs. Long-term care remains unaffordable and inaccessible for many, often limits consumer choice, and lacks comprehensive data collection to effectively monitor quality and safety. Moreover, the system fails to sufficiently reduce and prevent disparities, fully support family caregivers, and ensure consumers have access to essential services that facilitate long-term care, such as safe and affordable housing.

Over the years, state and federal policy reforms have driven improvements in the nation’s long-term care system, but the growing population of older adults and the escalating demand for long-term services and supports (LTSS) call for further reforms to ensure a high-performing system nationwide. LTSS refers to a broad range of health and health-related care to assist individuals with performing daily tasks (e.g., bathing, eating, or medication management). Due to age, chronic illness, or disability, individuals receive these services in both institutional settings, such as nursing homes, and in their homes or communities.

Responding to the critical need for enhanced LTSS, the Bipartisan Policy Center analyzed data from AARP’s LTSS State Scorecards from 2011-2023 to identify federal policy reforms that would address persistent challenges in the nation’s LTSS system. These Scorecards identify state innovations that federal policymakers can scale or encourage among states. This brief builds upon earlier discoveries from our infographic and summarizes findings from BPC’s analysis. The brief also highlights some states’ experiences tackling persistent obstacles and provides policy opportunities for federal reforms to create a high-performing LTSS system.

BPC’s analysis found:

• Bipartisan interest exists to pursue federal reforms that seek to solve challenges within the 2023 Scorecard’s five dimensions of LTSS system performance—issues ranging from affordability and access to community integration.
• Federal policy reforms can encourage state innovation and build on lessons learned from innovative state efforts to address LTSS challenges.
• To support states’ efforts to improve their LTSS systems, federal policymakers should prioritize policy reforms that foster state innovation and increase states’ flexibilities.

Acknowledgments: Supported by a grant from The SCAN Foundation. The SCAN Foundation is dedicated to creating a society in which seniors receive medical treatment and human services that are integrated in the setting most appropriate to their needs. For more information, please visit www.TheSCANFoundation.org. BPC would like to thank The SCAN Foundation, as well as Brian O’Gara, for his contributions to this brief, and the stakeholders who participated in interviews.