Perspective: Improving Home and Community-Based Services Infrastructure

October 21, 2019

Anne Montgomery

What it would take to harness the energies of states to take big leaps forward in key areas – housing supports, transportation supports, workforce supports, family caregiver supports, and employment supports for individuals with disabilities?

The answer is, policy that motivates Members of Congress to organize funding and a framework to help make infrastructure investment a reality! And in that regard, it’s good news that an issue brief, Improving Home and Community-Based Infrastructure: A Policy Proposal, has just been published by the Community Living Policy Center at the University of California, San Francisco (UCSF).

The thesis of the issue brief – and of evolving policy that is now being discussed in both the House and the Senate — is that what we most need to do in order to get ready for 2030 — when more than a fifth of all Americans will be 65 and older – is to make a one-time serious investment in state capacity in order to get ready. This investment needs to be in the form of a great deal more accessible housing; much more extensive networks of accessible and affordable transportation for those who move around in wheelchairs; and a far more robust workforce of personal care assistants and other types of direct care workers – who will only stay in these jobs if there are meaningful career ladders and positions with benefits. We need to also make much more possible for family caregivers to provide voluntary assistance – which means regular respite and various kinds of ancillary support that is ongoing. And we need to make it possible for those with disabilities to work and to support themselves.

There’s yet another reason we need to build out this capacity – and that is, the health care system won’t work very well without it. It’s a bit like roads and bridges and sidewalks and curb cuts – infrastructure is what allows everything else to work.

We think that these are exactly the kinds of investments that Members of Congress from both parties and across the spectrum can readily understand the need for and get behind.

Stay tuned for more on this front!

Altarum is a nonprofit organization that works with federal and state agencies and foundations to design and implement solutions to improve the health of individuals with fewer financial resources and populations disenfranchised by the health care system. We achieve measurable results by combining our expertise in public health and health care delivery with technology, workforce training and continuing education, applied research, and technical assistance. Our innovative solutions lead to better health for beneficiaries and better value for payers.
Improving Home and Community-Based Services Infrastructure


Anne Montgomery

Anne Montgomery  - MS

Program Director, Delivery System Transformation

Areas of Expertise
  • Long-Term Services and Supports
  • Medicare, Medicaid, the Older Americans Act, and other programs
  • Social Determinants of Health in Older Adults

Anne Montgomery develops policy and research initiatives that improve long-term services and supports and medical care for older adults receiving services from Medicare, Medicaid, the Older Americans Act, and other programs. She is co-leading efforts to implement and evaluate comprehensive culture change and quality improvement in nursing homes and is working with colleagues to develop a new volunteer-based Community Care Corps program at the national level. Anne conducts workforce policy analysis for home and community-based services (HCBS) and advises on how to expand models of community-based care for older adults requiring complex services.