Overview from CRS on Long-Term Services and Supports (LTSS)
- Spending on long-term services and supports (LTSS)1 is a significant component of personal health care spending in the United States.
- Of the $2.4 trillion spent in 2012 on all U.S. personal health care services, $324.2 billion, or 13.7%, was spent on formal, or paid, LTSS.
- Spending for LTSS includes services in both institutional settings—nursing facilities and intermediate care facilities for individuals with intellectual and developmental disabilities (ICFs/IDD)—and a wide range of home and community-based services such as home health, personal care, and adult day health services.
- The majority of spending on formal, or paid, LTSS is publicly financed by federal, state, and local governments through programs such as Medicaid, Medicare, the Veterans Health Administration (VHA), and the State Children’s Health Insurance Program (CHIP), among others.
- For 2012, Medicaid (combined federal and state spending) was the single largest payer, at $136.3 billion, or 42.0%, of spending on LTSS.
- However, LTSS spending may be underestimated as spending data do not include informal, or uncompensated, care provided by family caregivers.
- The probability of needing LTSS increases with age. As the older population continues to increase in size, and as individuals continue to live longer post-retirement, the demand for health care services and LTSS is also expected to increase.
- In 2012, an estimated 43 million individuals were age 65 and older. Over the next 50 years, that number is projected to increase to 92 million in 2060. In addition, advances in medical and supportive care may allow younger persons with disabilities to live longer lives.
- With respect to public LTSS financing, policy makers are generally concerned with issues of access, cost, and quality of care. For example, federal requirements as well as state decisions concerning eligibility for, or coverage of, certain LTSS determine who receives access to publicly financed LTSS. These requirements and decisions also determine the care settings and the services that may be provided.
- Costly LTSS may exhaust an individual’s financial resources, which may lead to reliance on public support.
CRS: Medicaid Financial Eligibility for Long-Term Services and Supports March 7 2017
AARP: Long-Term Support and Services March 2017
CRS: Long-Term Care Services for Veterans Feb 14 2017
GAO: Long-Term Care Workforce Sept 15 2016
Improving the Balance – The Evolution of Medicaid Expenditures for Long-Term Services and Supports June 3 2016
Nonpartisan Long-Term Care Financing Collaborative (LTCFC) Announces Final Recommendations Feb 22 2016
- The Collaborative proposes: clear private and public roles for long-term care financing; a new universal catastrophic long-term care insurance program. This would shift today’s welfare-based system to an insurance model; redefining Medicaid LTSS to empower greater autonomy and choice in services and settings; encouraging private long-term care insurance initiatives to lower cost and increase enrollment; and increasing retirement savings and improving public education on long-term care costs and needs.
CRS: Who Pays for Long-Term Services and Supports (LTSS) – A Fact Sheet July 27 2015
CRS: Long-Term Services and Supports in Brief April 22 2014
CBO: Rising Demand for Long-Term Services and Supports for Elderly People June 2013
- By 2050, one-fifth of the total U.S. population will be elderly (that is, 65 or older), up from 12 percent in 2000 and 8 percent in 1950.
- The number of people age 85 or older will grow the fastest over the next few decades, constituting 4 percent of the population by 2050, or 10 times its share in 1950.
- That growth in the elderly population will bring a corresponding surge in the number of elderly people with functional and cognitive limitations. Functional limitations are physical problems that limit a person’s ability to perform routine daily activities, such as eating, bathing, dressing, paying bills, and preparing meals. Cognitive limitations are losses in mental acuity that may also restrict a person’s ability to perform such activities.
- On average, about one-third of people age 65 or older report functional limitations of one kind or another; among people age 85 or older, about two-thirds report functional limitations. One study estimates that more than two-thirds of 65-year-olds will need assistance to deal with a loss in functioning at some point during their remaining years of life.
- If those rates of prevalence continue, the number of elderly people with functional or cognitive limitations, and thus the need for assistance, will increase sharply in coming decades.
- The term long-term services and supports (LTSS) refers to the types of assistance provided to people with functional or cognitive limitations to help them perform routine daily activities. That assistance is provided in several different forms and venues.
- About 80 percent of elderly people receiving such care live in the community.
- The remaining 20 percent obtain assistance in institutional settings.
- Of those living in the community, a small number live in residential communities catering to the needs of elderly people, but most, including many reporting three or more functional limitations, live in private homes.
- In the community, elderly people with functional limitations receive assistance primarily from family members and friends (generally unpaid and referred to as informal care); they may also pay for assistance (so-called formal care) from long-term care workers, such as home health aides.
- In contrast, elderly people with severe functional and cognitive limitations, who may require around-the clock assistance, often live in institutional settings.