Long-Term Care History

1965  Great Society Programs: Medicare, Medicaid, Older American's Act, Community Mental Health
Themes: expansion of Nursing Homes (NH); quality problems and cost concerns in NH's; demonstration of alternatives to NH's; VA becomes the model for the development of LTC; case management a widespread proposed solution to controlling costs in HCBS. The new National Institute on Aging becomes a focal point for aging and Alzheimer's research.
1974 National Institute on Aging is founded in the National Institute of Health
1974-77 Medicare 222 demonstrations of home care and day care as alternatives to NH's
1970's 13 Medicaid LTC experiments or quasi-experiments
1970's VA develops Geriatric Research, Education and Clinical Centers
Themes: Continued implementation of OBRA 1987 with emphasis on refining MDS, public quality reporting, quality indicator development, and public reporting of NH quality. Early in the decade, LTC in the community had a prominent place in the ultimately failed Clinton Health Care Reform Taskforce, Pioneeer Network founded with an emphasis on person-centered individualized services. State Aging Departments began merging with disability programs. ADA enacted and, at the end of the decade, used to affirm community care in Supreme Court Olmstead decision. Rebalancing LTC resources toward HCBS became a common effort in this decade. 
1991 ADA
1993 Clinton Taskforce proposed HCBS expansion
1995 Pioneer Network in LTC founded
1998 Nursing Home Compare Website launched
1999 Supreme Court Olmstead Decision. NH MDS developed to point that all data submitted electronically to states and Centers for Medicare and Medicaid Services MDS-derived quality indicators developed
Themes: HCBS waivers begin without waiting for various demonstration results; hospital DRGs start, placing emphasis on reducing stays and on NH postacute care; NH quality concerns continue, culminating in 1987 reforms called OBRA 1987; implementation of OBRA, including developing NH MDS starts; effort to make HCBS services more flexible and responsive to family caregiver needs; Cash and Counseling demonstration begins, and attention to "consumer-directed' LTC starts; AOA pays more attention to LTC with LTC Gerontology Centers and, later, National LTC Resource Centers; attention to capitated models under Medicare and Medicaid and to "Dual eligible" in this decade
1980-1985 Long-Term Care Channeling demonstration
1982 1st Medicaid waiver for HCBS in Oregon. Prospective hospital payment under Medicare (DRGs) began
1983 Cash and Counseling demonstration began—included cashing out Medicaid benefits & payment to family caregivers
1985 Social HMO Demonstration. TEFRA implemented with full-risk TEFRA HMOs under Medicare
1986 PACE (On Lok replication demonstrations began). 3-year Medicare Alzheimer's Demonstration began.
1987 Nursing Home Reform Act (OBRA 87)
1989 AOA funded National LTC Resource Centers
Themes: Common agenda for disability and aging continued, the administration on Aging began emphasizing family caregiving programs, and Aging and Disability Resource Systems, new forms of neighborhood and Green House NH's developing. Decade concluded with Affordable Care At, which included nursing home and community care initiatives. VA, always a harbinger for change, renamed its NH's as Community Living centers and emphasized QOL and new building standards. Thrust for NH quality adds a quality improvement component.

2000  National Family Caregiver Support Program under AOA


2001  Real Choice System Change Grants to develop HCBS Infrastructure began. These included NH transition grants, grants to develop personal assistant models of care, and grants to start Aging & Disability Resource Centers, now in all states. 


2004  First Green House NH launched in Tupelo, Mississippi


2006  Advancing Excellence in LTC starts


2007  Money Follows the Person Demonstration began

2008  NH Five Star Rating Program launched VAs renamed its nursing home care units as Community Living Centers and promulgated new building standards

2009  AARP launches livable communities initiative

2010 Affordable Care Act

@2016 LTC Rethink Tank

Mailing address:


Tel: 952-215-7052