David C. Grabowski, Ph.D., Rebecca Orfaly Cadigan, Sc.M., Edward Alan Miller, Ph.D., M.P.A., David G. Stevenson, S.M., Ph.D., Melissa A. Clark, Ph.D., and Vincent Mor, Ph.D.
D. C. Grabowski, R. O. Cadigan, E. A. Miller et al., "Supporting Home- and Community-Based Care: Views of Long-Term Care Specialists," Medical Care Research and Review, Aug. 2010 67(4 Suppl.):82S–101S.
Over the past 20 years, there has been a substantial rebalancing of the long-term care system away from nursing homes and toward home- and community-based services (HCBS). This article, published in a special supplement to Medical Care Research and Review, reports findings from the Commonwealth Fund Survey of Long-Term Care Specialists, conducted to explore experts' knowledge and attitudes on issues related to support of HCBS.
Survey respondents expressed enthusiasm for rebalancing the long-term care system. The most strongly favored strategies for that rebalancing are establishing programs that offer a comprehensive package of HCBS services (76.8%) and expanding Medicaid eligibility for HCBS (76.5%). Many of those surveyed also support providing a single point of entry through which individuals can access needed services at home or in the community (71.5%) and increasing rates of reimbursement for HCBS providers (67.1%). In addition, just over half of all respondents (53.1%) believe it would be an "effective" or "very effective" strategy to allow public programs to reimburse family members who provide personal assistance.
The long-term care specialists surveyed are most supportive of system-based approaches to rebalancing HCBS, with greater care coordination the single most favored approach. While such approaches "hold considerable promise," the authors say they will be most effective if state policymakers “pursue reforms that engage Medicare, coordinate care delivery with physicians, and are based on rigorous evaluations."