title: Re-imagining long-term services and supports: towards livable environments, service capacity, and enhanced community integration, choice, and quality of life for seniors.
abstract: In the half century since enactment of the 1965 Great Society programs, accomplishments were gradually made to improve access to and quality of long-term services and supports (LTSS), including: mitigation of financial and care abuses in nursing facilities (NFs); substantial rebalancing of LTSS towards consumer-preferred home-and-community-based services (HCBS); increasing flexible consumer-centered HCBS including payment to family caregivers; and more assisted-living and housing options for seniors with heavy care needs. A unified planning and advocacy agenda across age and disability type and greater consumer transparency fueled progress. Nonetheless, LTSS is a broken system; persistent problems interfere with substantial and necessary change. These include; over-emphasis on safety for LTSS consumers; inattention to physical environments in all settings; regulatory and professional rigidity; and poor communication and information. Our recommendations are aimed at builders and designers, LTSS professionals, regulators, and educators/trainers; the last may be crucial in forging new consensus and over-coming entrenched beliefs. Policy recommendations include relatively narrow steps-for example, requiring single occupancy in all NFs and assisted living settings financed with public dollars-to broad reworking of the prerequisites for livable age-friendly (and dementia-friendly) communities and for a capable, flexible LTSS workforce.
authors.affiliation: Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis. kanex002@umn.edu.
authors.forename: Rosalie A
authors.initials: RA
authors.lastname: Kane
authors.affiliation: Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis.
authors.forename: Lois J
authors.initials: LJ
authors.lastname: Cutler
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers; D002755:Choice Behavior; D003153:Community Health Services / Q000458:organization & administration; D062309:Community Integration; D004777:Environment; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006299:Health Services for the Aged / Q000458:organization & administration*; D006801:Humans; D008134:Long-Term Care / Q000458:organization & administration* / Q000639:trends; D011640:Public Policy; D011788:Quality of Life; D012946:Social Welfare
keywords: Paid caregivers; Physical environments; Public policy; Regulations; White House Conference on Aging