Centering Equity in Long-Term Services and Supports: Case Studies & Lessons from the U.S.
As the U.S. population ages and people with disabilities live longer, demand for long-term services and supports (LTSS) is rising. But our LTSS system exacerbates existing inequities in our society, particularly among people of color, women, and people with disabilities.
LTSS workers, who are primarily women of color, earn poverty-level wages and have limited room for advancement. LTSS consumers must often impoverish themselves to access the services they need through Medicaid. By forcing individuals to get rid of a vast majority of their assets, Medicaid limits the opportunity for generational wealth, which is the primary contributor to overall wealth. And family caregivers, who are often women, can be forced to limit their own earnings and spend their own savings in order to care for loved ones. The U.S. must take action to create a more equitable, accessible, and affordable LTSS system.
This report, the second in a series of three, delves into four U.S. case studies. Each case study in this report provides valuable insight into how different LTSS financing program structures impact equity, accessibility, and affordability. The report concludes with lessons for state and federal policymakers as they consider establishing new LTSS financing programs.