Rural Long-Term Services and Supports: A Primer provides policymakers and other interested stakeholders a primer on rural long-term services and supports (LTSS): (1) the fundamentals of the rural LTSS system, (2) rural access to and use of LTSS, and (3) discussion of the opportunities within and limitations of current Federal and State LTSS policy for advancing rural health system transformation toward a high-performing rural health delivery system.1 The paper focuses principally on the population of older (i.e., aged 65+ years) LTSS users.
In an ideal health system, primary care, acute care, post-acute care, and LTSS form a continuum of coordinated services designed to meet individuals’ needs based on their level of clinical, social, behavioral, or other chronic care needs and preferences. In reality, these services tend to be fragmented, with only weak coordinating connections. This fragmentation is the result of multiple funding sources, each with their own legislatively and policy-defined boundaries regarding eligibility, scope of services, and payment rules. The issues that arise as a result of fragmentation are exacerbated in rural areas, where the availability of, and access to, LTSS services is more limited.