LTSS Choices: Home and Community-Based Services for Older Adults – AARP

Experts answer your questions Thursday at a tele-town hall about finding purpose as we move beyond COVID. Join us at 1 p.m. ET.
AARP Public Policy Institute
AARP Public Policy Institute

Getty Images
LTSS Choices: Home and Community-Based Services for Older Adults (PDF)
Demand for home and community-based services (HCBS) is expected to continue to increase over time as the 65+ population grows larger and older and has a greater need for long-term services and supports. More than 80 percent of adults have expressed a desire to remain in their homes and communities as they age and prefer a home setting over a nursing home or other institutional setting.  
HCBS includes a wide range of services and supports provided at home (e.g. personal/home care, home health services, home modifications) and in the community (e.g. transportation, meal services, and adult day services).
The $12.7 billion investment in state Medicaid HCBS programs from the American Rescue Plan Act has the capacity to transform state HCBS systems in the coming years. This fact sheet serves as a primer on the current state of home and community-based long-term services and supports for older adults and highlights successful models for expanding these services.
HCBS Recipients and Providers
Most people who receive HCBS are older adults and people of all ages with disabilities. In 2018, for example, about 12.6 million American adults living in the community needed LTSS, and more than half (6.7 million) were over age 65. 
Much of the work of HCBS is performed by more than one million direct care workers, including personal care aides and home health aides, more than half of whom are Black or Hispanic/Latino and 87 percent of whom are women. HCBS settings also serve more diverse populations than nursing homes and other institutional settings.
Family support underpins the entire LTSS system, and unpaid family caregivers furnish the majority of activities of daily living (ADL) supports to older adults and people with disabilities. As of 2020, more than 40 million adults served as family caregivers (which includes friends and neighbors) and many incur out-of-pocket costs.
HCBS Financing
People receive HCBS by paying for services and supports a) privately, b) through enrollment in public coverage, or c) through private long-term care insurance. And despite the common misperception, Medicare does not cover most LTSS costs, with only a subset of HCBS services (e.g., home health services) covered for a limited duration of time.
Medicaid is the primary source of public HCBS funding, with more than $50 billion going to HCBS for older adults and people with physical disabilities in recent years. Under federal Medicaid law, most HCBS are included as an optional benefit, while nursing home services are categorized as mandatory. The optional nature of these services gives states discretion and results in significant variation across states, as reviewed in detail in the fact sheet.
Other sources of HCBS funding are:
Expanding HCBS
Some of the service delivery models and policy solutions that have helped expand HCBS access and improve services in recent years could be further expanded to accommodate older adults’ and people with disabilities’ overwhelming preference to age in their own homes and communities.
Suggested citation:
Hado, Edem, and Brendan Flinn. LTSS Choices: Home and Community-Based Services for Older Adults. Washington, DC: AARP Public Policy Institute, November 2021.
Find the Public Policy Institute content you are looking for by entering in search terms below.
News Alerts
Sign up for alerts on the latest research, events and videos on policy issues.
A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers
Aging Demographics

By 2030, one out of every five people in the United State will be 65-plus. Will your community be ready?
AARP is a nonprofit, nonpartisan organization that empowers people to choose how they live as they age.
You are leaving and going to the website of our trusted provider. The provider’s terms, conditions and policies apply. Please return to to learn more about other benefits.
You are leaving and going to the website of our trusted provider. The provider’s terms, conditions and policies apply. Please return to to learn more about other benefits.
Your email address is now confirmed.
You’ll start receiving the latest news, benefits, events, and programs related to AARP’s mission to empower people to choose how they live as they age.
You can also manage your communication preferences by updating your account at anytime. You will be asked to register or log in.

In the next 24 hours, you will receive an email to confirm your subscription to receive emails related to AARP volunteering. Once you confirm that subscription, you will regularly receive communications related to AARP volunteering. In the meantime, please feel free to search for ways to make a difference in your community at
Javascript must be enabled to use this site. Please enable Javascript in your browser and try again.



Never miss any important news. Subscribe to our newsletter.

Leave a Reply

Your email address will not be published.