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Guide to CAMHS | Mental Health Services | YoungMinds

Long-term services and supports LTSS encompass the broad range of paid and unpaid medical and personal care services that assist with activities of daily living such as eating, bathing, and dressing and instrumental activities of daily living such as preparing meals, managing medication, and housekeeping. They are provided to people who need such services because of aging, chronic illness, or disability, and include services such as nursing facility care, adult daycare programs, home health aide services, personal care services, transportation, and supported employment.

More than 6 million people use paid long-term services and supports LTSS delivered in home and community settings and more than 2 million people use LTSS delivered in institutional settings, according to CBO estimates.

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An unknown, but likely larger number of people, use unpaid LTSS provided by family, friends, or neighbors. Virtually all people ages 65 and older and about 8 million people under age 65 with disabilities have Medicare, but Medicare generally does not cover LTSS. See Box 1 for more information. To qualify for coverage of LTSS under Medicaid, people must meet state-specific eligibility requirements regarding their levels of income, wealth, and functional limitations. In addition to long-standing questions about the costs, affordability, and coverage of LTSS, there are also longstanding challenges finding enough workers to provide LTSS for people who need such services, and the COVID pandemic exacerbated those issues considerably.

To address workforce shortages in nursing facilities, the Administration finalized a rule that would create new staffing requirements in nursing facilities, require state Medicaid agencies to report on the percent of Medicaid payments for institutional long-term services and supports that are spent on compensation for direct care workers and support staff, and provide funding for individuals to enter careers in nursing facilities.

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In addition to federal action, many states have adopted payment rate increases for nursing facilities and HCBS providers with the goal of boosting staffing levels, as reported to KFF in a survey. The prices of health care services are quite high, but a greater percentage of people who use LTSS pay full price for that care when compared to other health care services.

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