Recent policy initiatives promote home- and community-based services (HCBS) to reduce the need for institutional care because most older adults prefer to remain in their home and community. The desire to live at home may be an elusive dream, given resistance to bolstering options in Medicaid community-based care, and nonpartnered adults who have the most limited options. Future policy should expand HCBS options for nonpartnered older people. Options include extending Family and Medical Leave Act coverage to smaller employers and expanding self-directed Medicaid services, including budget and employer authority, to facilitate the provision of longterm care by family and friends.
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