The aging of the American population represents a significant challenge—on both social and economic fronts—that will continue to grow in the coming decades. More of us will need assistance with long-term care as we age, and many of us will want to have choices about how, where and from whom we receive such assistance. As more people want to receive services in a home- or community-based setting, rather than an institutional one, demand for noninstitutional models of service delivery is on the rise. From a strictly economic perspective, long-term-care expenditures represent one of the largest financial risks facing older Americans today: few people have saved adequately (or purchased insurance) for the costs of potential long-term-care needs; state Medicaid budgets are overwhelmed; and Medicare covers little in the way of long-term care.
In the 1980s and 1990s, cognizant of these demographic shifts and changing trends, the Robert Wood Johnson Foundation directed resources toward improving home- and community-based services; testing the integration of health and long-term-care services in a variety of settings; and measuring the implications of several innovative financing demonstrations.
Today, after more than 25 years and an array of programs focused on service delivery and financing in long-term care, the Foundation's projects have advanced the conversation around consumer choice, quality care and financing issues. Programs such as Cash & Counseling, The Green House Project, and the Partnership for Long-Term Care promote consumer choice and innovative financing models in long-term care. Many of the lessons learned from these and other Robert Wood Johnson Foundation programs can help to inform future long-term-care policy reform efforts, possibly serving as templates for models yet to be created.