By Sean Slone

States have begun exploring a variety of strategies and policies that seem likely to transform long-term care in the years ahead. The Council of State Governments has learned from states’ success and compiled a “Long-Term Care Policy Guide” as a resource for state policymakers.

The “Long-Term Care Policy Guide” is the result of a nine-month partnership between CSG and the Commonwealth Fund, a national, private foundation based in New York City that supports independent research on health care issues and makes grants to improve health care practice and policy.

The partnership involved the formation of an interbranch task force made up of state policymakers from eight states (Arizona, Georgia, Hawaii, Indiana, Minnesota, New York, Pennsylvania and Virginia). At least one state legislator and executive branch official representing an agency affiliated with long-term care from each state participated on the task force. Throughout the task force’s eight virtual meetings in 2022, as well as one state-curated conversation for each participating state, its members, subject matter experts and stakeholders examined three focus areas in long-term care that are highlighted in this guide. These focus areas include:

  • Addressing State Regulation of Long-Term Services and Supports Facilities

Long-term services and supports facilities including nursing homes and other places that care for older Americans and people with disabilities in congregate care settings experienced significant challenges during the COVID-19 pandemic. In addition to high concentrations of fatalities during the pandemic’s early days, many saw an epidemic of neglect, social isolation and loneliness among residents due to staffing challenges and restricted visitation policies.

  • Optimizing American Rescue Plan Act Spending on Home- and Community-Based Services Under Medicaid

A two-decade shift toward serving more people in home- and community-based settings was given a significant boost by the American Rescue Plan Act of 2021, which provided states an increase in the federal government’s share of total Medicaid costs. As a result, states are now deploying $12.7 billion to expand eligibility and increase access to these services.

  • Revitalizing the Direct Care Workforce and Supporting Family Caregivers

The shift toward serving more people in the aforementioned settings comes just as states are also facing an unprecedented employment crisis in the direct care workforce — the group that cares for residents across a variety of long-term care settings. There are also concerns about the burden shouldered by often-unpaid caregivers in the home who are caring for a family member or loved one.

Numerous enacted state strategies are explored throughout each focus area in the guide. In addition, the three following state initiatives are highlighted as extended case studies:

  • Illinois’ 2022 legislation to overhaul how the state assesses and reimburses nursing facilities and link future funding to staffing levels and quality of care.
  • Minnesota’s American Rescue Plan Act spending plan for home- and community-based services, which spreads $680 million across more than 50 initiatives.
  • New York’s increase to the hourly minimum wage for home health care workers.

The long-term care policy guide can serve as a roadmap of potential opportunities for state policymakers. Some opportunities may require additional discussion and further assessment on a state-by-state basis in the years ahead, especially as the lessons of the pandemic and policy goals for the future of long-term care come more sharply into focus.

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