| Course | LTC 310 Social and Community Related Programs and Services (LTC/310) |
|---|---|
| Week | 3 |
| Paper type | Home and community-based services paper |
| Length | about 1,126 words, 4 double-spaced pages plus title page and references |
| Format | APA 7 student paper |
| School | University of Phoenix |
| Program | BS in Health Administration |
| Updated | September 2026 |
Free sample paper for LTC 310 Week 3
On the Waiver List for Fourteen Months: How Medicaid Home and Community-Based Services Work, Who Pays and Why a Widow Waited, Seen From a County Agency's Case Management Desk
[Student Name]
University of Phoenix
LTC/310: Social and Community Related Programs and Services
Week 3 Assignment
[Instructor Name]
[Date]
The county, its agency and its clients are composites written for a model paper; program rules, national data and research come from the sources listed.
A 74-year-old widow with Parkinson disease phoned the same composite county agency on aging that anchors this course's earlier papers after falling twice in a month. Her son lived three states away. An assessment found she needed help bathing, dressing and managing medications, enough to qualify for nursing home care. She wanted to stay in her house. Her income and savings met Medicaid limits, but the state's waiver for older adults had a waiting list, and she waited 14 months for a slot. This paper explains home and community-based services and their funding through her case.
What These Services Are
Home and community-based services help people with long-term needs live at home or in the community. They include personal care, homemaker help, adult day services, respite for caregivers, home-delivered meals, home modifications such as grab bars and ramps, personal emergency response systems, assistive technology and case management that coordinates it all.
Medicaid as the Main Payer
Medicare covers little long-term personal care, and few people can pay privately for long. Medicaid is therefore the largest payer. Stepanczuk et al. (2024) reported that in 2022, 7.8 million Medicaid enrollees used home and community-based services and 1.5 million used institutional services, with users and spending for community services rising from the year before.
Waivers
Most community services for older adults are funded through waivers, which let states provide services to people who meet a nursing home level of care, target specific groups such as older adults or people with intellectual disabilities and limit the number of slots. Because states can cap enrollment to control costs, waivers often have waiting lists. KFF (2024) found that in 2024, about 710,000 people were on waiting lists for waiver services in 40 states, with an average wait of 40 months, though waits varied widely by population and many people on lists may receive other services.
State Plan Services
Some community services are part of a state's regular Medicaid plan, such as personal care in states that choose to offer it or home health. Unlike waivers, state plan services must be provided to everyone who is eligible, without waiting lists, which is why some states use them to reduce waits.
The All-Inclusive Program for Older Adults
PACE, the all-inclusive care program open to people aged 55 or over whose needs meet the state's nursing facility standard, offers another route, combining medical care, personal care and adult day services under one organization, with Medicare and Medicaid each paying it a set sum per enrollee every month. The county's PACE program had openings, but the widow chose to wait for the waiver because she wanted to keep her own physician.
The Settings Rule
A 2014 federal rule requires that Medicaid-funded community services be delivered in settings that support integration, choice, privacy and independence (Centers for Medicare & Medicaid Services, 2014). It shapes services such as adult day centers and residential programs, which must offer real community access rather than institutional routines.
What Well-Designed Services Can Do
Szanton et al. (2019) tested a home-based program in which a nurse, an occupational therapist and a handyman worked with low-income older adults on their own goals over five months, fixing hazards, adapting routines and addressing pain and mood. Compared with a control group, participants had a 30% reduction in disability in activities of daily living. Small changes to a person's home and routines, planned with them, can do more for independence than a larger number of generic hours.
The Wait and What Filled It
While she waited, the agency used Older Americans Act funds for five hours a week of homemaker help, home-delivered meals and a personal emergency response button, and a volunteer installed grab bars. Her son paid for an aide on two mornings a week. She fell once more, without serious injury.
After Enrollment
When a slot opened, her waiver plan included 24 hours a week of personal care, adult day services twice a week, a bathroom modification and monthly case management. A year later she had not fallen again and remained at home.
Eligibility: Two Tests
Waiver eligibility has two parts. The functional test asks whether the person needs the level of care a nursing home provides, which the state measures with a standard assessment of daily activities, cognition and health conditions; the widow's need for help with bathing, dressing and medications met it. The financial test applies Medicaid income and asset limits, which in many states allow higher income for waiver participants than for other adults, and a review of transfers of assets in the five years before application. Her modest pension and the house she lived in, which is usually exempt while the owner lives there, kept her within the limits.
Why States Keep Waiting Lists
States cap waiver slots because waivers are optional services and Medicaid is one of the largest items in state budgets. Each slot carries a commitment of state matching funds for as long as the person remains eligible, often years. Legislatures therefore fund a set number of new slots each year, and when applications outrun them, people wait. Some states prioritize by need, moving people in crisis or leaving hospitals ahead of others; the widow's state used a first-come order with an exception for people at imminent risk of institutional placement, which she did not meet until her third fall was reviewed.
Paying the Workforce
Services exist only if workers deliver them. Personal care aides are paid through rates the state sets for waiver providers, and when those rates are low, agencies cannot hire enough aides, so some participants with approved hours receive fewer than planned. The widow's first agency filled only 16 of her 24 weekly hours for two months until a second agency took over part of her schedule.
Costs and Benefits
Community services usually cost Medicaid less per person than nursing home care, but not always, since some people need many hours of care at home, and not every waiver participant would otherwise have entered a nursing home. The main case for these services is that most people prefer to live at home and that, for many, it is safe and less costly.
Conclusion
Home and community-based services let people like the widow live at home with the help they need, and Medicaid, mainly through waivers, pays for most of them. Waivers' enrollment caps create long waits, national data show a steady shift of spending toward community care and research on programs like the nurse, therapist and handyman model shows what services can achieve. Her 14-month wait is where the system's reach and its limits met.
References
Centers for Medicare & Medicaid Services. (2014). Medicaid program; State plan home and community-based services, 5-year period for waivers, provider payment reassignment, and home and community-based setting requirements for community first choice and home and community-based services waivers. Federal Register, 79, 2948. https://www.federalregister.gov/d/2014-00487
KFF. (2024). A look at waiting lists for Medicaid home- and community-based services from 2016 to 2024. https://www.kff.org/medicaid/a-look-at-waiting-lists-for-medicaid-home-and-community-based-services-from-2016-to-2024/
Stepanczuk, C., Carpenter, A., Murray, C., & Wysocki, A. (2024). Medicaid long-term services and supports users and expenditures by service category, 2022. Mathematica. https://www.mathematica.org/publications/medicaid-long-term-services-and-supports-users-and-expenditures-by-service-category-2022
Szanton, S. L., Xue, Q.-L., Leff, B., Guralnik, J., Wolff, J. L., Tanner, E. K., Boyd, C., Thorpe, R. J., Jr., Bishai, D., & Gitlin, L. N. (2019). Effect of a biobehavioral environmental approach on disability among low-income older adults: A randomized clinical trial. JAMA Internal Medicine, 179(2), 204-211. https://doi.org/10.1001/jamainternmed.2018.6026
What the LTC 310 Week 3 instructions ask
LTC 310 Week 3 usually asks students to explain home and community-based services for long-term care populations and how they are funded. Students may be asked to describe the services included, such as personal care, adult day, respite, home modifications and case management, explain Medicaid funding authorities such as waivers and state plan options, discuss eligibility, waiting lists and quality requirements and assess the shift from institutional to community care. Some versions ask students to evaluate a program or a state's approach. Strong papers explain funding mechanisms accurately, use current national data on use, spending and waiting lists, include evidence on outcomes and show the effect on a real or composite person.
How this LTC 310 Week 3 example is built
The paper begins with a 74-year-old widow with Parkinson disease calling the agency after two falls. She qualified for nursing home level care but wanted to stay home, and the state's waiver had a waiting list. It explains Medicaid's role as the main payer of long-term services, the difference between waivers, which can cap enrollment, and state plan services, which cannot. The all-inclusive program for older adults is described as an alternative. National data show 7.8 million home and community-based services users in 2022 and about 710,000 people on waiting lists in 2024. A trial of a nurse, occupational therapist and handyman program shows reduced disability. Her services and outcome close the paper.
LTC 310 Week 3 grading rubric: where the points go
The home and community-based services week is generally graded on how accurately students explain funding and how well they connect it to people's experience. Instructors look for a clear description of services, correct explanation of Medicaid authorities such as waivers and state plan options, eligibility rules including functional and financial criteria, the reasons for waiting lists and the federal settings requirements. Current national data on use, spending and waiting lists add strength, and research on outcomes earns credit. Following one person through the system shows understanding. Sources should be government data and research. The remaining points reflect structure and APA style. Papers that treat home care as always cheaper or always available, or skip funding, usually fall short.
LTC 310 Week 3 help: mistakes to avoid
A frequent confusion in LTC 310 Week 3 is treating all Medicaid home care as one program. Waivers let states offer services to people who would otherwise need institutional care and can cap enrollment, which creates waiting lists; state plan services must be offered to everyone eligible. Explain both. Include the functional test, usually needing a nursing home level of care, and the financial test. Use current national data and date them. Mention the settings rule, which requires community services to support independence and integration. Add evidence that services work. Follow one person, including any wait. Finally, weigh costs and benefits honestly rather than assuming home care always saves money.
Related LTC 310 sample papers
Other LTC 310 week samples
- LTC 310 Week 1: Long-Term Care Populations
- LTC 310 Week 2: Community Programs and Services
- LTC 310 Week 4: Caregiver Support Programs
- LTC 310 Week 5: Future Trends in Long-Term Care
More BS in Health Administration sample papers
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- LSM 404 Week 3: Financial Management
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- LSM 417 Week 3: Survey, Certification and Citations
LTC 310 Week 3 questions, answered
What does LTC/310 Week 3 usually ask for?
Many sections ask students to explain home and community-based services, including the services offered, Medicaid funding through waivers and state plan options, eligibility, waiting lists and outcomes.
Where can I find a free LTC 310 Week 3 sample paper?
The waiver case paper is published above with margin comments, and reading it costs nothing. For a paper built on your own state's programs, the first one is free.
What is a Medicaid 1915(c) waiver?
A Medicaid authority that lets states provide home and community-based services to people who would otherwise qualify for institutional care, with the option to limit enrollment and target specific groups.
How many people are on Medicaid home care waiting lists?
A 2024 survey found about 710,000 people on waiting lists for waiver services in 40 states, waiting an average of 40 months, though many may already receive other services.
Does Medicaid spend more on home care or nursing homes?
Most Medicaid long-term services spending now goes to home and community-based services, and in 2022 about 7.8 million people used them compared with 1.5 million institutional users.
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