Long-Term Services and Supports: In Brief (CRS Report for Congress)
| Release Date |
April 22, 2014 |
| Report Number |
R43495 |
| Report Type |
Report |
| Authors |
Kirsten J. Colello, Specialist in Health and Aging Policy |
| Source Agency |
Congressional Research Service |
Summary:
[Summary will be suppressed] Long-term services and supports (LTSS) refer to a broad range of health and health-related services and supports that are needed by individuals over an extended period of time. The need for LTSS affects persons of all ages and is generally measured by limitations in an individuals ability to perform daily personal care activities (e.g., eating, bathing, dressing, walking) or activities that allow individuals to live independently in the community (e.g., shopping, housework, meal preparation). Most individuals with LTSS needs prefer to remain in their own homes with the assistance of informal providers such as family members or friends, if available. The most recent published data estimating the number of Americans in need of LTSS indicate that about 10.9 million individuals living in the community need LTSS, or 4.1% of the community-resident population. It was estimated another 1.8 million individuals needing LTSS live in an institutional setting, such as a nursing home.
LTSS include a variety of services and supports to assist an individual in maintaining an optimal level of functioning and/or improving his or her quality of life. Examples include a home health aide administering medication, a contractor building a wheelchair ramp onto a home, or a nursing facility where a person resides. LTSS also vary in cost and intensity, depending on the individuals underlying conditions, the severity of his or her disabilities, the setting in which services are provided, and the caregiving arrangement (i.e., informal care versus formal care).
Formal, or paid, LTSS are a significant component of personal health care spending in the United States. In 2012, of the $2.4 trillion spent on all U.S. personal health care services, $324.2 billion (13.7%) was spent on LTSS. Spending for LTSS includes payments for services in nursing facilities and residential mental health and substance abuse facilities. Spending also includes LTSS provided in an individuals own home, such as home health services as well as a wide range of home and community-based services (HCBS), including personal care, homemaker or chore services (e.g., housework or meal preparation), and adult day health services. A substantial amount of LTSS is also provided by informal caregiversfamily and friendswho provide care without compensation. As a result, spending on LTSS may be underestimated, as spending data do not include uncompensated care provided by informal caregivers.
Given that the majority of LTSS are publicly funded with federal dollars, LTSS financing may be an important issue for Congress. This report provides an overview of LTSS, including who needs LTSS, how need for LTSS is determined, who provides LTSS, and how much LTSS costs.
