Thirty years of home- and community-based services: Getting closer and closer to home

In 1982, the first Medicaid Home and Community-based Services (HCBS) waiver program was initiated in Oregon State. At that time, policy makers and practitioners were eager to develop in-home options as alternatives to nursing home care for older people. In 2012, many advocates aspired that HCBS become the dominant more of long-term care (or long-term supportive services) and nursing home care be the much rarer alternative. This article introduces this topic, describes the major vehicles to reduce reliance on nursing homes, and distinguishes between two major approaches-preventing admissions to nursing homes (sometimes called diversion) or helping nursing home residents return to the community (sometimes called transitions). The article also gives an overview of the content of the Spring 2012 issue of Generations, narrative that takes stock of progress made in HCBS for elders and the challenges that exist now and in the future.