ABSTRACT
The United States has no comprehensive and coherent national long-term-care policy focusing on affordable, community-based assistance for people with disabilities (Litvak et al., 1987). The financing of community-based assistance is scattered across several federal programs: (1) home health, homemaker, and chore services financed under Titles XIX (Medicaid) and XX (Social Services Block Grants) of the Social Security Act; (2) services provided under Title XVIII (Medicare) when home-based assistance is associated with a recent hospital stay; (3) services provided under Title III of the Older Americans Act; and (4) the Veterans Administration’s Home Care program and its Aide and Attendant Allowance program, which apply only to eligible disabled veterans. While some of these programs have been liberalized over the years, many remain fraught with assumptions and features that render them unresponsive to needs of various groups within the population.
