Long-Term Care Reform:

States' Views on Key Elements of Well-Designed Programs for the Elderly

HEHS-94-227: Published: Sep 6, 1994. Publicly Released: Sep 12, 1994.

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Pursuant to a congressional request, GAO obtained state agencies' views on how best to design and administer public programs to provide home- and community-based long-term care services for the elderly.

GAO found that: (1) state agencies generally agree on the key components of well-designed long-term care programs; (2) although state agencies agree that elderly persons' ability to perform daily functions is the best indicator of their need for services, the agencies do not agree on the definitions of daily living activities; (3) the three most useful methods for determining service needs for the elderly are case or care management, a standard assessment instrument, and the elderly person's involvement in the decision process; (4) most severely disabled elderly persons need nonmedical services such as personal care; (5) there is less consensus on which is the best method for controlling costs; (6) state agencies believe that a greater private-sector role in long-term care could reduce government long-term care spending for the elderly; (7) private-sector approaches to long-term care include family caregiving, private long-term care insurance, private residential care alternatives, employer-sponsored elder care, and other private-sector financing mechanisms; and (8) nonfinancial government interventions such as consumer education, technical assistance, and national standards could increase private-sector participation in long-term care.

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