Long-term services and supports in the community: toward a research agenda.

Researchers, policy experts, and advocates participating in an invitational conference discussed research needed to address pressing policy issues in long-term services and supports (LTSS). Future research on need for LTSS should focus on projections of need, geographic variations, equity, and unmet needs of consumers and caregivers. Research on access to home- and community-based services (HCBS) should address progress in rebalancing LTSS in favor of HCBS, cost-containment strategies, the shift to managed LTSS, and the performance of managed care organizations. Major gaps in research on LTSS costs and quality center on both comparative costs and cost-effectiveness of HCBS versus institutional programs, cost savings of managed LTSS versus fee-for-service, performance incentives in managed LTSS, and LTSS quality and outcome measurement. Research on workers and caregivers could focus on worker availability, improving job quality, worker training standards, the impact of paying family members to provide LTSS, and the private-pay LTSS workforce.