Long-term care is a diverse group of services that help meet the medical and non-medical needs of people with a chronic illness or disability, or who are unable to care for themselves for extended periods. Long-term care focuses on individualized, coordinated services that promote independence, improve patients’ quality of life, and meet patients’ needs over a significant period of time. Long-term care commonly provides custodial, unskilled care, such as assistance with normal daily activities such as dressing, feeding, and toileting. Increasingly, long-term care requires a level of medical care that requires the expertise of skilled practitioners to address the multiple chronic conditions associated with older populations. Long-term care can be provided at home, in the community, in assisted living facilities, or in nursing homes. People of any age may need long-term care, although it is most common among older adults. Long-term care can be provided formally or informally. Facilities that provide formal long-term care services provide housing for people who need supervised care around the clock, including professional health services, personal care, and services such as meals, laundry, and housekeeping. These facilities may have different names, such as nursing home, personal care facility, continuing care residential facility, etc., and are operated by different providers. While long-term care organizations have asked the U.S. government not to combine health and personal care services in large facilities, the government instead continues to consider this service as the primary use of taxpayer dollars. Greater success has been seen in areas such as subsidized housing, which may continue to use older apartment complexes or buildings, or may have been part of new federal initiatives in the 2000s. Long-term care provided in the home, also known as home health care, can include a wide range of clinical services ( ). These services are usually ordered by a physician or other professional. Some of the costs of these services may be covered by health insurance or long-term care insurance depending on the country and the nature of the health and social care system. Modern forms of government-reimbursed long-term services and supports include user-directed personal services, family-directed options, independent living services, benefits counseling, mental health facility services, family education, and even self-advocacy and employment, among many others. Home services can be provided by individuals other than nurses and therapists, who do not install elevators, and who belong to long-term support and services systems in the United States. Informal long-term home care is care and support provided by family members, friends, and other volunteers on a voluntary, unpaid basis. It is estimated that 90% of all home care is provided informally by a loved one without compensation. In 2015, some families sought reimbursement from their government for care. “Long-term services and supports” is the modern term for community-based services, which may or may not be funded by Medicare and fall under the traditional hospital-based medical system. The Citizens with Disabilities Alliance, which works with the United States Congress, notes that many non-acute long-term services are provided to help individuals live and participate in the community at the same time that hospitals provide acute care. Examples of this include the group’s international motto, Community Living and Deinstitutionalization, and the variety of supportive services. The term is also commonly used by aging groups, such as the American Association of Retired Persons, which annually provides many services to the elderly in the United States. Long-term services and supports are discussed in depth in the U.S. Department of Community Services' new support force includes direct technical support, largely nonprofit or for-profit, and government, often unionized, in communities across the United States. The core competencies of the Federal-State Interface for "institutional and community-based" helpers in age and physical disabilities, intellectual and developmental disabilities, and behavioral health were identified in 2013. President Barack Obama, Speaker of the U.S. House of Representatives John Boehner, Minority Leader Nancy Pelosi, Majority Leader Harry Reid, and Minority Leader Mitch McConnell received copies of the U.S. Senate Committee on Long-Term Care on "service delivery, workforce, and financing issues that have challenged policymakers for decades." The new commission envisions “a comprehensive financing model that balances private and public funding to underwrite catastrophic expenses, encourage savings and insurance for immediate LTSS costs, and provide a safety net for those without resources.” The direct care workforce envisioned by MDs in America in 2013 was described as: care aides, home health aides, nursing assistants, and independent providers. The United States has diverse and competing health care systems, and hospitals have adopted a model of “community money to the hospital.” In addition, “hospital studies” refer to M-LTSS as billable services. In addition, allied health workers have been largely trained in specialized science and disability centers that theoretically and practically support modern personal assistance services across populations and “manage” behavioral health care as a “subset” of mental health services. Legislation and long-term support services, as well as community-based services and personnel, have been developed to meet the needs of “individuals with disabilities” who have been litigated against state governments and, in many cases, have had to report regularly on the development of a community-based system. These services originally included basic services such as rehabilitation or vocational and residential rehabilitation, family care or foster care, small intermediate care facilities, "group homes," and later employment support, clinics, family support, supportive living, and day services. The original state departments had intellectual and developmental disabilities, mental health offices, major classifications in health departments in brain injury for communities, and later, alcoholism and substance abuse were dedicated state agencies.