Long-Term Care

This report examines how quality is ensured and measured in home and community-based long-term care services for elderly persons with disabilities. These services range from skilled nursing services to help with activities such as bathing, dressing, shopping, and meal preparation. GAO answers the following questions: How is "quality" defined for home and community-based long-term care services? What measures are now being used to monitor or ensure quality?

GAO found that: (1) the complex financing structure that supports home and community-based care services has resulted in different quality assurance requirements for similar services; (2) program administrators and service providers do not articulate goals for home and community-based long-term care, especially at the individual service level; (3) goals for personal care services are less formal; (4) states are facing challenges in extending access to home and community-based services to all those in need; (5) service providers have emphasized several factors in measuring the quality of home care including coordination of care, appropriateness of treatment, and provider training and experience; (6) state and federal agencies have implemented a variety of quality assurance standards, but these standards are not sufficient to ensure quality long-term care services; (7) Medicare has developed several service requirements to ensure the health and safety of its patients; (8) most states require home care agencies to obtain a license before providing home care services; and (9) on-site inspection and supervision varies due to the lack of specific regulations and funding.