Forward

This report arrays evidence and analysis to assist decision makers in the private and public sectors to address three important and perplexing questions about long-term care for the increasing number of Americans who are elderly and frail. These questions are who should pay for long-term care services through what mechanisms; how to design and deliver these services; and how to recruit, train, and retain a workforce to deliver long-term care services.

The Milbank Memorial Fund commissioned Robyn I. Stone to write this report as a result of meetings of leading trustees and executives of both nonprofit and investor-owned organizations in long-term care. The Fund and the American Association of Homes and Services for the Aging (AAHSA) convened these meetings between 1997 and 1999. AAHSA represents 5,600 nonprofit organizations that provide health care, housing, and services to more than one million of the nation’s elderly. The Fund is an endowed national foundation that works with decision makers in the public and private sectors to study and communicate about significant issues in health policy.

The leaders convened by AAHSA and the Fund deplored the absence of a synthesis of information and analysis pertinent to developing public and institutional policy for the future. They welcomed an invitation to Stone to write such a synthesis because of her achievements as a researcher and senior public official in long-term care.

Many people reviewed Stone’s report in draft. Reviewers included managers and trustees of organizations that provide long-term care services, executives of associations and advocacy groups, researchers, and senior officials in the legislative and executive branches of both state and federal government as well as those in international organizations. Stone made many changes in response to questions and suggestions from this diverse set of reviewers.

Daniel M. Fox
President

Samuel L. Milbank
Chairman