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This report describes efforts in one state to reduce reliance on nursing homes for care that seniors could receive, and that most would prefer to receive, in their own homes or in homelike settings. The authors assess the experience of “rebalancing long-term care” in New Jersey since 1996, when that state consolidated all services for seniors in one department.

This is a story of steady progress, not dramatic reform. “A few states,” the authors write, “have led the way for decades. Other states, like New Jersey, demonstrate that it is possible to change the direction of long-term care—step by step, year by year.” The authors derive lessons from New Jersey’s experience for policymakers in other states.

This report began, as most projects of the Milbank Memorial Fund do, with a question from a policymaker. Christine Grant, then Commissioner of Health and Senior Services of New Jersey, asked in mid-2001 if the Fund would convene persons experienced in making and implementing policy for long-term care from New Jersey and other states to assess the results of the first six years of the consolidation of health and senior services in that state. The meeting occurred in January 2002; participants in that meeting as well as persons who reviewed the report in draft are listed in the Acknowledgments.

The report goes considerably beyond the discussion at the meeting because of the expertise of its authors. Susan Reinhard served as the first Deputy Commissioner for Senior Services after the reorganization in 1996. She is now co-director of the Rutgers Center for State Health Policy. Charles Fahey, currently a Program Officer of the Fund, has held many distinguished positions in the fields of aging and long-term care at local, state, national, and international levels. More information about each of the authors is available at the end of the report.

Daniel M. Fox
President

Samuel L. Milbank
Chairman