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assisted living: an important option for providing ltss in the community



For many older adults, aging is accompanied by cognitive and/or physical decline that requires caregiving supports for everyday activities like bathing, dressing, meal preparation, and managing medications or finances. These supports, often referred to as long-term services and supports (LTSS), can be provided in the home and community, or alternatively, in an institutional setting. One setting, Assisted Living, connects individuals with more complex needs to services on site, offering a community-based solution in a residential home setting, but this key part of the long-term care continuum often gets left out of policy conversations.


This study is part of a broader effort to quantify and detail the demographics and experiences of older Medicare beneficiaries living across a spectrum of housing options, including Assisted Living. To inform this work, ATI Advisory partnered with the American Seniors Housing Association (ASHA) using the Centers for Medicare and Medicaid Services’ (CMS) 2018 Medicare Current Beneficiary Survey (MCBS). This research found that of the 600,000 older adults living in Assisted Living communities in the U.S. in 2018, most are older than the general Medicare population and have more complex needs. The vast majority (80%) of the costs for Assisted Living are paid for privately, with Medicaid paying a smaller portion (16%). 


Assisted Living is an often-unrecognized part of the home and community-based services (HCBS) infrastructure for frail elders and, depending on an individual’s needs, can often provide a lower cost alternative to nursing facilities. As Congress considers expansion of the Medicaid HCBS programs under the Biden caregiving infrastructure proposals, policymakers should ensure that Assisted Living communities continue to be included as eligible settings for participation.

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