Bridging the gaps: building a labor force to meet long-term care needs.

The long-term services and supports (LTSS) system is intended to grant Americans, requiring care that extends beyond what can be provided in a hospital and/or primary care settings alone, access to the appropriate caretakers and facilities. Federal policy has struggled to ensure sustainable access to LTSS and the workforce that provides it. In particular, Medicaid beneficiaries are required to have access to these services but still face difficulties in obtaining them. Long term care provision has traditionally been institutionally based due to funding mandated through Medicaid, but the formalized workforce cannot keep pace with an aging population. Many rely instead on informal caregivers (ie, family, friends, etc.) for their care. While populations requiring long term care prefer to receive care from the comfort of their own communities, informal caregivers are rarely compensated and often forced to juggle employment and caregiving duties. This commentary explores how mandated funding for home and community-based services (HCBS) may improve access to LTSS by mobilizing an existing informal workforce.