Long-term Services and Supports (LTSS): A Growing Challenge for an Aging America

Abstract

Most of us do not think about performing the everyday tasks of living, nor can we even imagine ourselves with a disability. But for 11 million older adults, assistance with tasks of daily living such as dressing, bathing, house- keeping, and shopping have become a part of their life (Freedman & Spillman, 2014). Since the majority of Americans do not anticipate the need for long-term ser- vices and supports (LTSS), most of us are not prepared financially, psychologically, environmentally, or socially for a long-term disability. Yet as we advance in age, the likelihood that we will experience a moderate or severe disability requiring assistance increases. For example, the proportion of older people with one activity limitation who report receiving assistance increases from less than 16% for individuals aged 65–69 to more than 75% for the population aged 90 years and older (Freedman & Spillman, 2014). Because most Americans do not plan for the likelihood that we will need formal assistance because of a disability, many of us (almost 2.1 million people over the age of 65 in 2010) (Medicaid and CHIP Payment and Access Commission [MACPAC], 2014) end up using the public assistance Medicaid program as the safety net for LTSS. With Medicaid approaching one-quarter of the typical state’s budget, reliance on Medicaid has become an increasingly challenging issue for states. As the older population with disabilities increases—projected to more than double between now and 2040—today’s challenges will become tomorrow’s crisis unless as a nation we plan and prepare for the potential changes.