Abstract

The service delivery environment in the US has changed radically in the past 25 years, shifting away from nursing homes as the primary site of service delivery to a variety of service options, including assisted living, adult day services, and other home- and community-based services, particularly for individuals who are able to pay for services. Access to publically financed HCBS, however, varies dramatically by state.

Public policy at the national level continues to encourage a shift away from nursing homes and toward HCBS – most recently, by incentivizing coordination between the Medicare program (which serves older and disable people) and the Medicaid program, which funds LTC services for people who qualify as poor. The potential of this renewed push toward integration remains unclear, however.

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