National Policy Reform
In 2003, the National Academy of Social Insurance convened a study panel on the future of the long-term care system. Among the key findings of the panel are:

• Three tenets should guide the long-term-care system of the future:
  • The needs of individuals should determine the kinds of services available.
  • Service delivery should preserve the autonomy of people receiving services.
  • The costs of services should be shared equitably among individuals, families and society, and the services should be similarly available and affordable regardless of the state in which a person lives.
• Transforming long-term care requires fundamental reform of its financing and a substantial commitment of federal resources. Because the need for long-term care is a risk, not a certainty, it should be handled like other unpredictable and potentially catastrophic events—through insurance.
• Private long-term-care insurance, while growing, is affordable for only 10 to 20 percent of the elderly. Some degree of federal involvement is essential to assure access to long-term care without impoverishing families.

The panel produced a final report, Developing a Better Long-Term Care Policy: A Vision and Strategy for America's Future, and two Issue Briefs, one on long-term-care models from abroad and the other on the public's view of long-term care. (See Program Results on ID# 046880.)

State-Level Policy Reform
Medicaid and other state-based programs provide most long-term care and supportive services to disabled and frail elderly populations.

RWJF's State Policy Fellowships in Long-Term Care aimed to reform long-term care policy at the state level by providing fellowships to 36 mid- and senior-level state officials. The fellowship program, which ran between 1997 and 2005, created a forum for learning, networking and peer support to encourage and enable the fellows to undertake policy change in their states around long-term care. (See Program Results on ID# 048829.)

The project supported mentoring of and technical assistance to officials responsible for policy change in state long-term-care systems.

Results
The fellows undertook various efforts in their home states including:

• Developing five pilot programs in assisted living through the Connecticut Department of Social Services.
• Designing and launching expanded home and community-based care options through the New Jersey Department of Health & Senior Services agency.
• Developing a new personal care benefit within the Medicaid state plan in New Mexico, including an option for consumers to choose their own attendants, through the New Mexico Medicaid Planning & Program Office.
• Submitting a number of competitive proposals to public and private funders that resulted in millions of dollars in grant monies to help state agencies reform their long-term-care systems.