A significant portion of elderly and disabled Americans receive some type of formal long-term care. More than 1.7 million Americans lived in nursing homes in 2000 and more than 1.3 million Americans received some sort of home health care.

This Topic Summary synthesizes Program Results and Robert Wood Johnson Anthology chapters on the following work the Robert Wood Johnson Foundation (RWJF) supported on formal long-term care provided in homes, the community and nursing homes:

• Home health care and community-based services—Home and community-based services are vital to many people with chronic illness or disabilities. RWJF work covered by Program Results and summarized below includes service improvement experiments, home health care financing research related to formal care, quality improvement indicators related to formal care. In the area of community-based services, work included programs to educate nonprofit adult day centers, which provide respite care for caregivers of demented and disabled adults, about marketing, financial management and program design so they could achieve financial self-sufficiency.
• Nursing home care—RWJF has had a long interest in improving the quality of nursing home care. Within this report are summaries of projects that assessed the effects of federal nursing home reform, experiments with nursing home staffing arrangements, quality improvement efforts and the “swing bed program”—which supported rural hospitals to use empty hospital beds for patients needing long-term skilled nursing care.
• Frontline Workforce in Long-Term Care—In 2000, approximately 1.9 million direct-care workers, such as nurses and nurse aides, provided long-term care to 15 million Americans. The U.S. Department of Health and Human Services estimates that by 2050 more than 6 million workers will be needed to care for 27 million people. This increase in demand will come at a time when the supply of workers who traditionally fill these jobs likely will increase only slightly.
  
  RWJF supported two expert panels that examined the demographics of America’s aging population and the effects on the long-term care workforce. RWJF has continued to make grants to improve the long-term care workforce and increase its numbers. In 2006, the team of program officers working in this area is developing new programs to build and strengthen the frontline health and health care workforce—the network of people such as social workers, home health aides, addiction counselors and nursing assistants, who provide regular care and services to patients. This effort builds on Better Jobs, Better Care: Building a Strong Long-Term Care Workforce, a program that is intended to foster changes in policy and practice that will help to attract and retain high-quality home health care workers.
• Integrating Long-Term and Acute Care—Individuals with chronic illness often find themselves negotiating a bureaucratic maze of fragmented and unresponsive services. Two programs tested models of formal care that integrated medical, social and long-term care services for the chronically ill.

Home and community-based services are vital to many people with chronic illness or disability. More than 1.3 million Americans received home health care in 2000. A review of state spending by the Visiting Nurse Service of New York found that by 1997, Medicaid spending on home and community-based services was growing faster than spending on nursing home care (see Program Results on ID# 030172).

In 1995, RWJF began the $4.8 million Home Care Research Initiative, on home health care policy and practice. (See Program Results.)

According to the National Program Director, the Home Care Research Initiative substantially contributed to the knowledge base about spending on home and community-based services and options for expanding managed long-term care and assisted living.

Several research projects funded under the program, and other home care projects are described in this report.