Summary: Public dissatisfaction with the existing long-term care system is mounting. Long-term care is seen widely as both expensive and failing to meet the needs of the disabled. In particular, many people take issue with long-term care's bias in favor of institutional rather than home and community-based services. This discussion paper was prepared for a GAO forum on long-term care issues. The views presented, although not necessarily the official position of GAO, are an attempt to pull together a wide variety of evidence and expert opinion on the key issues in long-term care reform. GAO touches on the key elements of innovative long-term care programs in the United States and abroad that have developed a wider range of home and community-based services. These key elements include (1) service flexibility to meet the unique needs of individuals, (2) high standards of organizational accountability to taxpayers for money spent and the quality of services delivered, and (3) effective cost controls to stay within the budgets decided upon by elected officials.
