Examining state efforts in rebalancing long term service and supports from institutional to home and community based services

Open Access
Bailey, Lauren Mccaslin
Area of Honors:
Health Policy and Administration
Bachelor of Science
Document Type:
Thesis Supervisors:
  • Mark Sciegaj, Thesis Supervisor
  • Caprice Knapp, Honors Advisor
  • home and community based services
  • long-term care
  • cost effectiveness
  • emotional significance
  • transition
Background: The United States population is aging, putting an increased demand on long-term service and supports (LTSS). Furthermore, an increasing number of elders requiring LTSS will seek services in the comfort of their home for as long as possible, rather than moving into an institutional setting. The purpose of this study is to observe and analyze three areas of rebalancing long- term care for three states with the hopes of determining commonalities in funding projections, barriers to rebalancing, and more. Methods: This study utilizes case studies and interviews to gather data. Preliminary screening was done with the AARP 2014 State Scorecard Summary of LTSS System Performance Across Dimension. The scorecard measures all 50 states and the District of Columbia in five areas of LTSS performance, giving them rankings per category and an overall category compared to the other states. Three states were chosen based on their rankings. Oregon was selected as the high performing state, ranking 3rd; New Jersey for the middle performing state, ranking 26th; and Kentucky for the bottom performing state, ranking 51st. Next, three people per state were selected for interviewing. The contacts included each state’s AARP director, the Medicare director, and the secretary on aging. Each contact would be asked the same set of questions specific to their state, providing unique answers around the same themes. Results: All three states believe home and community based services are the future of long-term care and what aging citizens in their states prefer. However, Kentucky is the only state the funds more institutional based care. Funding is a large element impacting a state’s ability to commit to rebalancing long-term service and supports. Oregon described the most programs to provide money for home and community based services and also was cohesive in coordinating future projects. New Jersey is at the forefront for state funded programs for caregiver’s emotional needs.