Position Paper
Long Term Services and Support

Aging Life Care Managers® … coordinating services to optimize health and quality of life.

The Aging Life Care Association® (ALCA), formerly National Association of Professional Geriatric Care Managers, is an organization of practitioners who use a holistic, client-centered approach to caring for older adults or others facing ongoing health or other challenges of aging and/or disabilities. ALCA is committed to maximizing the independence and autonomy of clients and strives to ensure the highest quality and most cost-effective health and human services. Members help clients and their families cope with challenges faced by people with disabilities and older adults through education, advocacy, counseling, and service delivery.

Long Term Services and Support

Long-term services and supports (LTSS) are currently a range of programs which include home-based, community-based, and institutional care. Coordination, cost, quality, and site of delivery vary widely from state to state. LTSS evolved out of federal legislation beginning with Medicare, Medicaid and the Older Americans Act of 1965, was further enhanced by the Americans with Disabilities Act of 1990, and the Olmstead Act of 1999. The Olmstead Act, through its integration mandate, states that “consumers in need of care and assistance because of limitations due to physical, mental, or emotional conditions shall have services delivered in their or their family’s choice of the least restrictive setting.” Courts have held this to be true no matter the age of the person under consideration.

Both public and private sources cover the costs of LTSS, with Medicaid serving as the primary payer, Medicare provides limited coverage, but only on a short-term basis. Since few people have private long-term care insurance, individuals who use LTSS for a sustained period face high out-of-pocket costs.

I. Financing

ALCA supports:

  1. Individuals who require LTSS to have fair and equitable access to such care commensurate to what is provided for acute medical care.
  2. Public education about the need for LTSS and the availability of financing options.
  3. Effective integration of LTSS policies into our nation’s overall health care policies.
  4. Involvement of both the private and public sectors in providing for quality LTSS.
  5. The expansion of comprehensive Medicare benefits to include vision, dental, and hearing for all recipients, and the ability of Medicare to negotiate lower drug prices.
  6. Adequate funding of Medicaid and other government programs to accommodate the growing need for long-term assistance and care.
  7. Medicaid to be retained as a safety net available to people in all settings, including their own homes, and to help protect against spousal and generational impoverishment, until comprehensive affordable long-term care financing is in place and available to everyone.
  8. Essential support of formal and informal caregivers to meet the growing number of care recipients. Examples such as: affordable childcare, child tax credits, increased salaries for caregivers, paid family and medical leave for family caregivers, and bereavement leave, and affordable health insurance for caregivers that is not attached to employment should be provided.
  9. Unpaid family caregivers to not risk long term impoverishment and reduced Social Security benefits from being out of the workforce while providing unpaid care.

II. Delivery System

ALCA Supports:

  1. The development of innovative community-based approaches to help older adults and people with disabilities remain in the community and to ensure smooth transitions in care as envisioned by the Affordable Care Act.
  2. A comprehensive range of community and facility-based health, social, transportation and support services within each community or rural area with special attention to the language and cultural differences and needs of the communities they serve.
  3. The coordination of services and caregiver education and training to be provided by Aging Life Care™ / care managers.
  4. The right of competent older adults to make their own care decisions and to be provided with educational support and information to make those decisions.
  5. Family caregivers and other responsible individuals for those unable to make independent decisions to be provided with education regarding available support services and be included in care decisions along with the older or disabled adult.
  6. Paid caregivers, whether working in the home, privately or with an agency, or in a facility to be paid a living wage, with benefits and additional compensation that reflects their education and experience, for the essential services they provide to the care recipients, their families, and communities.

Resources:
www.LongTermCare.gov
www.medicaid.gov/medicaid/long-term-services-support/index/html

Resolutions Approved by the NAPGCM Board of Directors October 22, 1998.
Reviewed, changed and updated by Public Policy Committee, September 8, 2008.
Reviewed, changed and updated by Public Policy Committee, December 16, 2008.
Revision by Public Policy Committee 6.1.09, Approved by NAPGCM Board of Directors 7.30.09
Revision by Public Policy Committee 9.10.12, Approved by NAPGCM Board of Directors 10.18.12
Revision by Public Policy Committee 3.8.22 Approved by ALCA Board of Directors April 6, 2022