Long-Term Services and Supports (LTSS) is a system designed to assist individuals with long-term needs resulting from chronic conditions, disabilities, or aging. LTSS helps people maintain their functional capacity, independence, and overall quality of life over an extended period. This support focuses on daily living rather than treating acute illnesses. The network of care helps individuals manage their lives when physical or cognitive limitations restrict their ability to care for themselves.
The Scope of Long-Term Services and Supports
LTSS encompasses a wide array of services divided into two categories: Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). ADLs are foundational self-care tasks essential for basic physical functioning, including bathing, dressing, eating, toileting, and transferring.
The services are often non-medical, focusing on hands-on support rather than skilled nursing or medical treatment. This assistance compensates for functional limitations, allowing a person to remain safely in their living environment. Support levels range from minimal assistance to full support, depending on the individual’s impairment.
IADLs represent more complex tasks required for independent living within a community, often involving higher-level cognitive and organizational skills. These tasks include managing personal finances, preparing meals, handling transportation, and household chores.
A decline in the ability to perform IADLs often signals a need for supportive services, even if ADLs are manageable. LTSS addresses these functional needs, helping individuals avoid institutionalization and maintain community connection.
Diverse Settings for Care Delivery
LTSS is delivered across various settings, reflecting a trend toward person-centered care that maximizes independence. While care was historically concentrated in institutional settings, there is now a significant shift toward community-based options. Institutional settings include licensed nursing facilities and intermediate care facilities, which provide 24-hour skilled nursing care for those with intensive needs.
The preference for Home and Community-Based Services (HCBS) allows people to receive necessary care while remaining in their own homes or home-like environments. HCBS involves personal care aides assisting with ADLs and IADLs in the residence.
Other community-based options include adult day care programs, which offer supervision and health services during the day, and assisted living facilities, which provide housing, support services, and some health care.
The delivery system aims to match the service intensity to the individual’s needs. States utilize Medicaid waivers to expand HCBS availability, often providing services like home modifications, transportation, and respite care for unpaid family caregivers. This flexibility ensures individuals can transition support levels as their functional status changes.
Eligibility and the Populations Served
LTSS serves a diverse population of all ages experiencing long-term functional limitations. Primary user groups include adults over 65 with multiple chronic conditions and younger individuals with physical, intellectual, or developmental disabilities. Eligibility is determined by a comprehensive functional assessment, not age alone.
These assessments use standardized tools to measure an individual’s inability to perform ADLs or IADLs. Cognitive impairments, such as those caused by dementia, also factor into eligibility because they require substantial supervision to ensure safety.
The functional screening determines the “level of care” required, often comparing it to the needs met in a nursing facility. This determination is necessary to access paid LTSS. Individuals must demonstrate that their condition necessitates consistent, long-term assistance rather than short-term medical rehabilitation.
Funding Sources for LTSS
Financing LTSS is complex because neither private health insurance nor the federal Medicare program generally covers long-term custodial care. Medicare only covers short-term skilled nursing or rehabilitation services following a qualifying hospital stay, leaving most long-term care expenses to other sources.
The largest public payer of LTSS is Medicaid, the joint federal and state program for low-income individuals. To qualify for Medicaid-funded LTSS, a person must meet strict financial eligibility requirements for income and assets. Many people must “spend down” personal savings and assets to meet these limits.
A large portion of LTSS costs is paid out-of-pocket by individuals and their families. High annual costs quickly deplete personal savings. Private long-term care insurance exists to cover these expenses, but usage remains low compared to the overall need. The financial landscape relies on a combination of personal wealth, insurance, and public assistance.