Even with a rapidly-aging American population, many still lack basic knowledge about LTSS (Long-Term Services and Supports). That leaves the vulnerable and their families ill-prepared for the associated costs and in a position to see their needs and preferences unmet. Here we will discuss the basics of LTSS and why these services are essential.
What is LTSS? LTSS are long-term care services used by seniors and individuals of all ages with functional limitations and chronic illnesses. Individuals looking to benefit from LTSS generally need assistance with activities of daily living to live safely and independently while maintaining a high quality of life in their preferred setting. This applies to those with physical disabilities, intellectual and developmental disabilities, mental health disabilities, and chronic health conditions alike.
LTSS covers a wide range of care, including:
- Eating and drinking without assistance
- Taking baths
- Personal grooming and getting dressed
- Ambulating (the ability to move and walk independently from one position to another)
- Getting up and down from a seated position
- Using the toilet
- Managing medication and money
Where is LTSS provided? LTSS was traditionally provided in institutional settings like nursing homes and intermediate care facilities. In recent years, there has been a growing trend to provide LTSS at home and in community-based settings, such as adult day services, assisted living facilities, and personal care services.
This shift towards home and community-based care means that family and friends provide a significant portion of LTSS. So providing more support for family carers is essential, as it improves the overall care for individuals receiving LTSS.
Who funds LTSS? LTSS is funded by different payor sources, such as:
- Medicaid: Eligible to individuals of all ages who need assistance with disabilities and chronic illnesses
- Medicare: Eligible to seniors age 65 or older or younger individuals with disabilities or certain diseases
- Private insurance: Eligible to individuals who have taken out a private long-term care insurance policy
- LTSS program grants: Eligible to LTSS programs for a limited time to assist with planning and development so that LTSS programs can provide care and support for the community
By far, the largest funder of LTSS is Medicaid’s Managed Long-Term Services and Supports (MLTSS)—a program between state Medicaid programs and managed care plans. MLTSS involves funding managed care plans for long-term services and supports, including institutional-based and home and community-based services.
How does LTSS help? LTSS aids seniors and younger individuals by:
- Providing support for people with needs related to aging, disability, and chronic illness
- Improving the general well-being of older adults and people with disabilities living at home, resulting in better health and more independence
- Providing carer assistance to home caregivers, such as counseling, training, support groups, and respite care
- Meeting community needs through support groups to preserve individuals’ dignity and cultural traditions while allowing them to continue living at home and in their communities
- Creating personalized LTSS programs so communities can reflect on their unique needs, values, culture, and community expectations
Now that we have a better understanding of the basics of LTSS, we will dive deeper into the meaning of LTSS and the challenges the sector faces.
LTSS Meaning and Challenges
What does LTSS mean? The given LTSS meaning is: A range of services and assistance catering to individuals of senior age or those with chronic illnesses and disabilities that require assistance for daily activities.
Because LTSS provides essential care to those who need long-term care, the LTSS sector naturally must grapple with a number of challenges that could potentially impact the well-being of patients, such as:
- Limited funding: Long-term care services are incredibly high and often paid out of pocket. While Medicaid plays a crucial role in making long-term care more affordable and accessible (for those who qualify,) some people only become eligible for Medicaid after using up their savings on long-term care expenses. Of course, the government is doing its part. In 2020, the government spent over $400 billion on LTSS, accounting for approximately 10% of National Health Care Expenditures. Medicaid covered 54% of the costs. But individuals still ended up paying 13% out-of-pocket, and private insurance paid 8%. Other payors covered the remaining 26%. It is safe to assume that these costs will likely increase in the coming years.
- A shift in emphasis: More than half of the spending on LTSS now goes toward home and community-based services. This marks a significant shift in beneficiary preference from institutions to non-institutional settings. It allows the sector to continue to provide services in less restrictive settings and benefits home and community-based LTSS services. But it also impacts the amount of funding and resources for institutions, leading to a lower quality of care.
- Tracking spending: Data on how much the managed care plans cost are often unavailable, making it challenging to determine the precise allocation of costs between premiums and actual services. While most Medicaid LTSS funds are used to support seniors over 65 and those with disabilities, states still directly bear most LTSS costs. This is partly because the utilization of managed care for LTSS (MTSS) has increased over time, with states paying premiums for managed care plans.
- High per-person cost: Medicaid spends significantly more per person on seniors and people with disabilities than other enrollees. This is due to increased spending on fee-for-service LTSS and higher premiums for managed care. The result is Medicaid enrollees spending a substantial amount of LTSS funds for the entire population.
- Limited home and community-based services: States must provide institutional care and home health services under Medicaid. But most home and community-based services are considered optional. This means that optional home and community-based services, like personal care and therapies, are often provided through waivers, which allow states to expand eligibility and target specific populations. However, some states limit the number of people served and use waitlists when demand exceeds available slots, limiting the availability of the services.
- Staff shortages exacerbated by the pandemic: The COVID-19 pandemic worsened the workforce shortages in healthcare and LTSS. From February 2020 to December 2020, the LTSS sector alone lost approximately 342,000 jobs, a five percent decline. This has resulted in the termination of some Medicaid home and community-based programs. At the same time, caregivers still in the field have reported feeling overwhelmed, staff burnout, salary dissatisfaction, and difficult working conditions. This has led some to leave the industry.
As the LTSS sector recovers from the pandemic, the challenges above will persist, especially as the population ages. In the sections below, we will discuss what the LTSS sector does to support seniors and people with disabilities and how the industry can enhance its services to provide better assistance and quality of care nationwide.
Contact us here to see how our long-term care software can aid LTSS operations.
10 Long-Term Services and Supports (MLTSS) Principles
LTSS (Long-term Services and Supports) encompasses a broad spectrum of care, including healthcare, personal care, assistance with daily activities, and support for independent living. To ensure a smooth transition of LTSS while improving beneficiaries’ experience, the CMS has developed ten fundamental principles to provide more clarity behind the LTSS meaning, creating more robust MLTSS programs for better assistance and quality of care.
- Account for planning and transitions
Effective MLTSS systems require careful planning, stakeholder input, education, and quality standards to ensure a smooth transition and ongoing implementation. It’s essential to allow enough time for planning and learning to ensure high-quality care is given to patients.
- Engage stakeholders
This principle involves beneficiaries, providers, and advocacy groups and is crucial for successfully implementing an MLTSS program. By engaging with stakeholders through education resources and transparency, advisory groups can gather relevant insights to improve MLTSS programs while ensuring programs receive critical feedback for continuous improvement.
- Provide home and community-based services
Medicaid beneficiaries have the right to receive services in integrated settings. MLTSS programs should, therefore, deliver community-based long-term services and supports materials that align with the LTSS meaning in nursing in both home and community settings. MLTSS programs should also promote community participation to ensure community goals are addressed, integrated, and met.
- Payment structures must support goals
Payment to managed care plans should support program goals by encouraging high-quality services in community-based settings. This also helps to promote community integration and use performance-based incentives and penalties to achieve better care in health goals, beneficiary experience, and cost reduction.
- Support beneficiaries
All beneficiaries, especially vulnerable ones, require support and education throughout their MLTSS experience. Independent support resources like enrollment services, counseling, and advocacy groups help beneficiaries understand their rights and responsibilities and resolve disputes with managed care plans.
- Prioritize person-centered care
MLTSS should prioritize meeting beneficiaries’ medical and non-medical needs so they can live independently and with a high quality of life. Active participation in service planning, meaningful choices, comprehensive needs assessment, and self-direction of services are essential to fostering independence, providing more personalized care, and catering to an individual’s needs.
- Provide comprehensive and integrated service
Managed care plans should cover all necessary services, including physical health, behavioral health, and community-based and institutional LTSS. This allows for comprehensive person-centered service planning across various settings.
If the MLTSS program does not cover some services, individual states can include provisions for coordination and referral. This ensures that the beneficiary’s service plan remains comprehensive and person-centered while accounting for all necessary services.
- Ensure that providers are qualified
MLTSS plans need a network of qualified providers to meet beneficiary needs, including access to services that support community integration. States should ensure adequate capacity, expertise, continuity of care, and practical provider training in the managed care networks.
- Protect participants
Robust safeguards, monitoring, and critical incident management are essential to protecting vulnerable populations when transitioning to MLTSS. This means that program design, contracts, appeals processes, and welfare assurances should be addressed to deal with the vulnerabilities of participants so they can have appropriate access to care.
- Ensure quality standards
A quality MLTSS program combines existing LTSS and managed care quality systems. A comprehensive quality strategy should consider beneficiary outcomes, including acute care, primary care, behavioral health, and LTSS. In addition, states may need to evaluate resources to ensure appropriate staffing for quality oversight.
It should be mentioned that the above-mentioned ten principles are merely guiding principles. If an MLTSS program is to succeed, it must constantly strive to integrate the care for beneficiaries while demonstrating CMS compliance.
The LTSS Family Portal: Improving Caregiver Support
As we conclude our exploration of LTSS, it has become clear that the growing demand for LTSS in America poses significant challenges for individuals and the healthcare system. The delivery of LTSS is shifting towards home and community-based settings, which has made it essential to recognize the support needed for family caregivers.
One way to aid family caregivers is by enabling a family portal so they can more easily communicate with healthcare providers. This allows all relevant parties to share documents and files, answer questions, and communicate concerns to ensure patients receive the best care.
By addressing these challenges, the LTSS sector can enhance and expand its services and, ultimately, provide better support for the LTSS workforce, family caregivers, and LTSS patients.
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