Key Informants’ Visions and Solutions to Improve Home- and Community-Based Services for Older Adults and Persons With Dementia

Abstract

Recent decades have seen state successes in rebalancing Medicaid long-term care from institutional care (e.g., nursing homes) into home and community settings. However, significant barriers can prevent access to home and community-based services (HCBS) among older adults and persons with dementia. Qualitative research on potential innovations and solutions in the contemporary context with attention to a wider range of state-level policy contexts is limited. Drawing on interviews with 49 key informants including state Medicaid officials, HCBS providers, and advocates for persons with dementia across 11 states, we examined perceived solutions to barriers. Key informants articulated a range of potential solutions and innovations, ranging from tangible or realized policy changes to ‘magic wand’ solutions. Policy research has typically focused on the former; excluding the latter may miss opportunities to envision and design a more effective long-term care system for persons living with dementia and older adults.