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RE: long-term services and supports (LTSS) |
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| Topic Review |  |
Mercedes
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| 20 Jul 2026 07:21 PM |
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Thank you for the time and effort already devoted to developing this version and for considering additional feedback. The document is solid and with the comments submitted by other reviewers, the next version of the document will be even stronger.
Part of the challenge in the US LTSS system is the patchwork of funders potentially involved (including health services, supportive housing, transportation, food assistance, legal assistance, etc. ) as well as the gaps in available financing. For people in the Medicare system, it is becoming increasingly important for social workers to understand appeal rights (as mentioned by another reviewer). The quagmire of financing LTSS becomes especially complicated when the person needing/seeking services has dementia or another form of cognitive impairment and is without kin and friends.
Here are some specific suggestions for your consideration:
1. Page 7, line 116. Consider re-wording this sentence. Maybe make two sentences—one for the skills already acquired and one for the skills never learned.
2. Page 14 lines 279 and 281 – The first two bullets sound similar. Consider re-wording.
3. Lines 316, 330 and elsewhere. It looks unusual to have section headings whose first letter is not in caps…
4. Line 662—is this referring to the impact of the referral, or some other impact?
5. Line 799 – please consider including an example or two.
I look forward to reading the final version. The document provides guidance that will be useful to practicing social workers, their employers, and social work educators, among others.
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kasstone2002
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| 20 Jul 2026 01:33 PM |
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cherman
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| 20 Jul 2026 01:32 PM |
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Susana Lopez-Sierra
New Member
Posts:1 
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| 12 Jul 2026 08:46 PM |
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I am a Licensed Clinical Social Worker in private practice with nearly 30 years of experience in long-term services and supports across community, hospital, home health, and hospice settings. My current practice focuses on caregivers, individuals with chronic illness, and life transitions, integrating CBT, Brainspotting, coaching, expressive arts, and spiritually integrated care.
Thank you to the NASW Standards Task Force for the thoughtful work reflected in this draft. I appreciate the expansion of LTSS beyond traditional long-term care facilities and the emphasis on person-centered, strengths-based practice. The introduction provides an excellent overview for social workers who may be unfamiliar with the breadth of LTSS practice, and I especially appreciated the recognition of underserved populations and the broad range of settings in which social workers practice.
I respectfully offer the following recommendations for consideration:
• Consider expanding the framework throughout the document to explicitly include a biopsychosocial-spiritual perspective. For many individuals receiving LTSS, spirituality—whether expressed through faith, personal values, meaning, purpose, hope, or connection—is an important source of resilience and coping. Explicit recognition of this dimension would further strengthen the document's holistic, person-centered approach.
• Consider placing greater emphasis on the therapeutic relationship that distinguishes social work practice. Rapport, empathy, active listening, therapeutic presence, and the development of a strong therapeutic alliance are foundational to effective assessment, engagement, and long-term intervention.
• I appreciated the discussion of home- and community-based services and encourage further emphasis on the benefits of remaining in one's home and community whenever appropriate, including preservation of autonomy, meaningful relationships, familiar routines, caregiver involvement, and quality of life.
• I found the Purpose section to be clear and well organized and appreciated the recognition of underserved populations and the realities facing today's LTSS workforce.
Susana Lopez-Sierra, LCSW |
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Jennifer Horn
New Member
Posts:1
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| 12 Jul 2026 01:28 PM |
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Professional background: I am Jennifer Horn, LCSW, a Doctor of Social Work candidate at Tulane University School of Social Work, where my work focuses on health equity, LGBTQIA2S+ aging, and long-term care. I serve as a peer reviewer for The Gerontologist and have published on caregiving and the experiences of older Black same-gender-loving women. I am Board Chair of ZAMI NOBLA (the National Organization of Black Lesbians on Aging) and a member of the National Association of Black Social Workers. My direct practice includes work as a caregiver-support care planner, a clinical supervisor, and a facilitator of social-engagement groups for LGBTQ older adults, and I have conducted cultural-competency research on LGBTQIA+ elders in long-term care. I offer these comments as a practitioner, researcher, and community leader, and as a Black, queer, disabled veteran and
aging practitioner myself.
I want to begin by affirming the draft's strengths. The person-defined support system, the explicit inclusion of "family of choice" (lines 337–338), the naming of racism, ageism, and ableism as systemic drivers of disparity (line 194), and the attention to caregiver burden (lines 815–820) are all meaningful and welcome. My comments are offered to strengthen a document I fundamentally support.
My central concern is that the draft relies almost entirely on category-level abstractions — "marginalized," "historically underserved," "under-resourced," "cultural identity" — and rarely names the specific older populations whose LTSS vulnerabilities are well documented in the research literature. Naming does advocacy work that "defined by each person served" cannot. When a population is not named, its group-specific risks tend to go unaddressed in practice, assessment, and advocacy. I recommend the task force name populations explicitly where the evidence base supports doing so, without abandoning the flexible, non-exhaustive framing the draft rightly uses.
Older LGBTQIA+ / LGBTQIA2S+ adults. No LGBTQ acronym appears anywhere in the document. Sexual orientation and gender identity appear only within general identity lists (lines 408, 697–698). I recommend the standards name older LGBTQIA2S+ adults explicitly and address their documented LTSS risks: bias or discrimination from staff in residential settings, "re-closeting" in facilities, reliance on chosen-family networks that may be smaller or legally unrecognized, transgender-specific health needs, and HIV and aging. I also urge the task force to adopt "LGBTQIA2S+" rather than "LGBTQIA+." The "2S" (Two-Spirit) is not a stylistic addition; its omission renders Indigenous LGBTQ elders invisible, which connects to the concern I raise below.
Older Black adults and older adults of color. Racism is named once as a systemic driver (line 194), which I applaud, but no racial or ethnic group is ever named. The documented realities of racial disparity in LTSS — inequitable nursing-home quality, unequal access to home- and community-based services, and disproportionate, differently shaped caregiving burden in Black, Latino, and Asian American families — are not surfaced. I recommend the standards name these disparities directly and cite them as targets for the assessment and advocacy activities the draft already describes.
Older Indigenous adults. This is the area of weakest visibility. "Tribal" appears only in jurisdictional and policy phrasing; Indigenous peoples are never named as peoples. I recommend the standards name American Indian, Alaska Native, and Native Hawaiian elders explicitly, reference the Indian Health Service and Older Americans Act Title VI programs for Native elders, acknowledge tribal LTSS structures, and address historical and intergenerational trauma directly. The draft opens the door to this — the trauma definition notes that trauma may be experienced by "a generation, or an entire community or culture" (lines 448–449), and "generational patterns" appears at line 796 — but does not walk through it.
Housing. Housing is well covered structurally (lines 96, 109, 132, 241, 384) and the phrase "unhoused or for whom housing is insecure" (lines 150–151) is inclusive. What is missing is any link between housing access and group-based discrimination — for example, LGBTQIA2S+ elders facing bias in senior housing, or racial disparities in access to affordable and accessible housing. I recommend naming these connections explicitly.
Caregiving. This is the draft's most inclusive domain, and its use of "care partner," "family of choice," and "naturally occurring supports" is excellent. The remaining gap is disparity-naming: the differential caregiving burden carried by families of color and the distinct structure of LGBTQIA2S+ caregiving networks, which more often rely on chosen family and non-biological kin. The assessment items at lines 815–820 would be strengthened by prompting attention to these patterns.
A cross-cutting recommendation. Standard 2 currently addresses cultural and linguistic competence largely by deferring to the separate 2015 NASW cultural-competence standards. Deferral is appropriate, but it should not be the only mechanism by which these populations appear. I recommend that the specific populations named above be surfaced within the Knowledge (Standard 4), Screening and Assessment (Standard 5), and Advocacy and Leadership (Standard 8) standards, so that visibility is built into practice expectations rather than housed entirely in a cross-reference.
Thank you for the opportunity to comment and for the task force's clear commitment to equity. I would welcome the chance to serve as a continued resource as the standards are finalized.
Jennifer Horn, LCSW
Doctor of Social Work Candidate, Tulane University School of Social Work |
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Paige Hector
New Member
Posts:1
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| 12 Jul 2026 11:50 AM |
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Thank you for the opportunity to offer comment and feedback on the revised stands for LTSS. I have compiled my comments in list format below:
• While trauma is mentioned a various points in the document, I would like to see more prominent focus on this critical area including personal trauma, interpersonal trauma, organizational and systemic trauma, community trauma, medical trauma, and generational trauma.
• Name the specific pillars of PCTI care: safety (physical, emotional, social, and moral); trust and transparency; collaboration and mutuality; empowerment, voice, and choice; peer support; attention to cultural, historical, and gender issues.
• I highly recommend including more content and references on power. Here are some materials to consider:
• Webinar interview on “A Living Bridges Conversation”, Miki Kashtan on Transcending Scarcity, Separation and Powerlessness | A Living Bridges Conversation - YouTube
• An article, 05-15_Miki_Kashtan_Soft_Qualities_to_Transform_Patriarchy-v2.pdf
• Another article by Miki Kashtan “Making the Invisible Visible: Transforming Functional Patterns for Individual and Collective Liberation”, AHP-winter-2021
• Grappling with Our Own Power. This article emerges from years of… | by Miki Kashtan | Medium
• A Love Letter to My Brothers | The Fearless Heart
• Liberation for All: How We Can Talk Differently about Power and Privilege | The Fearless Heart
• [Learning Packet] Restoring Togetherness in the Context of Power Differences: A Conceptual Framework | The Fearless Heart
• [Learning Packet] Understanding Power, Privilege, and Liberation for All | The Fearless Heart
• I would also like to recommend these resources on Interdependence:
• Needs Choreography and Mutual Influencing: Decoding the Flow of Interdependence | The Fearless Heart
• Interdependence in Action: How to Change Agreements with Care | The Fearless Heart
• Please consider including the crucial function of giving and receiving feedback as a key social work and within organizations. Here’s a resource to consider “Feedback Flow Systems: From Performance to Learning”
o feedback | Search Results | The Fearless Heart
• I also recommend specifically stating Nonviolent Communication as a principle, consciousness, and strategy to uphold PCTI principles for social workers, organizations, and systems. Below are two research articles on NVC:
Non-violent communication as a technology in interpersonal relationships in health work: a scoping review (2024)
• “The global scientific literature indicates that Nonviolent Communication is a significant resource for improving interpersonal relationships in healthcare work.”
• “The use of NVC in health services, according to the studies included, promoted individual skills such as: leadership, communication, teamwork and empathy. It is also presented as strategic for the management of teams and services, as it improves productivity and the climate between teams and, consequently, has led to improvements in organizational culture.”
• Adriani PA, Hino P, Taminato M, Okuno MFP, Santos OV, Fernandes H. Non-violent communication as a technology in interpersonal relationships in health work: a scoping review. BMC Health Serv Res. 2024 Mar 6;24(1):289. doi: 10.1186/s12913-024-10753-2. PMID: 38448956; PMCID: PMC10916228. Non-violent communication as a technology in interpersonal relationships in health work: a scoping review - PMC (nih.gov)
Construction of educational technology on non-violent communication between health professionals: an experience report (2023)
• “Conflicts in health work environments can have different origins, but the proper use of communication can facilitate interaction between people and help in solving problems that affect those involved, witnesses and even the institution(3-4). Thus, NVC is feasible and timely for everyday use by healthcare professionals.”
• Adriani PA, Hino P, Taminato M, Fernandes H. Construction of educational technology on non-violent communication between health professionals: an experience report. Rev Bras Enferm. 2023 Apr 14;76Suppl 4(Suppl 4):e20220414. doi: 10.1590/0034-7167-2022-0414. PMID: 37075361; PMCID: PMC10103637. Construction of educational technology on non-violent communication between health professionals: an experience report - PMC (nih.gov)
• This document about core commitments to Nonviolent Communication (which to me, is the essence of social work) supports the LTSS standards:
o Core Nonviolence Commitments | Miki Kashtan
• Line 81 – reword to remove “not only” and “but also” so that supporting emotional well-being and meaningful social engagement are less important as given the same importance as functional and medical needs.
• Line 83 – consider remove ng reference to the U.S. as a focus on independence is seen across the globe (although it is not a wholly universal experience).
• Line 121 – consider alternate wording than “…are present…” – to me, this implies the role of the social worker as passive
• Consider naming global majority and the impacts in LTSS – refer to this article “Global Majority: Decolonising the Language and Reframing the Conversation about Race” , final-leeds-beckett-1102-global-majority.pdf
• Line 198, add “virtually”
• Line 692 – please create a separate line for advance care planning and another separate line for end of life care and planning
• Consider another line for palliative and hospice care
• Line 699 – I would replace “effect” with “impact”. I would also expand it to include physical, and spiritual impacts of trauma
• Line 725 – add “interagency/organizational” collaboration
• Line 729 – remove the word “professional” before grief
• Line 749 – add “and plan of care or service” after “comprehensive assessment”
• Line 775 – add “and impact(s) on current circumstances” after “substance use history”
• Line 810 – why are disasters singled out as one example of trauma?
• Line 854 – insert “capacity determination” in front of guardianship support”
• Line 858 – add “and prevention”
• Line 859 – alternate wording “Mediation to support conflict engagement, conflict reduction, and conflict resolution”
• Line 861 – please include person-centered and trauma-informed care
• Line 868 – recommend placing “in collaboration” in front of “on behalf”
• Consider a brief section addressing AI
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Michelle Castile
New Member
Posts:16
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| 08 Jul 2026 09:39 AM |
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Professional background: I am a Community Health Worker and advocate with lived experience navigating disability, Medicaid, managed care, HCBS, LTSS, caregiving/support systems, rural access barriers, and service coordination for disabled people and families.
I strongly support NASW updating the LTSS standards so they apply across the lifespan and across both facility-based and home- and community-based settings. I especially appreciate the draft’s recognition that LTSS should support independence, quality of life, emotional well-being, meaningful social engagement, and the goals of the person served.
I recommend strengthening the standards in several areas:
First, the standards should more clearly address managed care accountability, service denials, appeals, grievances, and documentation accuracy. In HCBS and managed care systems, inaccurate assessments, incomplete records, unclear service-plan language, or undocumented statements can directly affect whether a person receives necessary supports. Social workers should have a clear responsibility to ensure that assessments and service plans accurately reflect the person’s needs, risks, preferences, barriers, and goals, and that people served have meaningful access to corrections, records, appeal information, and advocacy support.
Second, the standards should explicitly state that natural supports or support systems should not be used as a substitute for necessary LTSS unless the person served freely chooses that arrangement and the support is actually available, reliable, safe, and sustainable. Support systems should be respected, but they should not be assumed, overburdened, or used to justify denying services.
Third, the standards should more strongly address rural access, transportation barriers, disability-related access barriers, caregiver responsibilities, and home safety needs, including home modifications, adaptive equipment, assistive equipment, assistive technology, meal access, personal care, communication access, and accessible housing. Many people cannot access services in the community if the system does not account for geography, disability, poverty, transportation limitations, and lack of available providers.
Fourth, the standards should emphasize that person-centered planning must be more than a form or a meeting. It should require meaningful participation, accessible communication, plain-language explanations, trauma-informed practice, timely follow-up, and service planning that reflects the person’s actual life circumstances.
Finally, I recommend stronger language requiring LTSS social workers to advocate at the micro, mezzo, and macro levels when systems create barriers to safe, dignified, community-based living. LTSS standards should make clear that social work practice includes challenging service fragmentation, inaccessible processes, inaccurate documentation, and policies that prevent people from receiving appropriate supports in the least restrictive setting.
These standards are important because LTSS decisions affect whether disabled people, older adults, children, families, and caregivers can live safely, participate in their communities, and maintain dignity and self-determination. |
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Gilberto Cintron
New Member
Posts:1
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| 29 Jun 2026 02:13 PM |
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I would first like to commend the Long-Term Services and Supports Standards Task Force for developing a comprehensive and thoughtful revision of these standards. The draft reflects the core values of social work through its emphasis on person-centered practice, strengths-based approaches, trauma-informed care, interdisciplinary collaboration, and advocacy across the continuum of long-term services and supports.
As I reviewed the draft, however, I was struck by the absence of one emerging area of social work practice that I believe merits explicit recognition within the standards: Aging in Recovery.
Over the past several decades, advances in addiction treatment, recovery support services, and mutual-help communities have enabled unprecedented numbers of people to age while living in recovery. As these individuals increasingly access home- and community-based services, assisted living, skilled nursing, hospice, and other long-term services and supports, social workers will encounter a growing population whose recovery is not simply part of their history, but an ongoing source of identity, resilience, social connection, daily structure, and recovery capital.
In my recent work, I have described this emerging population as "The Invisible Cohort" because, despite its growth, it remains largely absent from discussions of aging services, workforce development, long-term care planning, and LTSS policy.
The draft standards appropriately recognize substance use disorders, behavioral health, strengths, resilience, person-centered care, and care transitions. I respectfully suggest that they could be strengthened further by recognizing Aging in Recovery as an emerging area of practice and by encouraging social workers, when relevant and consistent with the wishes of the individual, to consider recovery history, recovery capital, recovery-supportive relationships, and the preservation of recovery-supportive routines during care transitions and long-term service planning.
I believe that this addition would strengthen an already excellent document while preparing the profession for an emerging area of practice that will continue to grow in importance in the decades ahead. |
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Dave A Abebe
New Member
Posts:57
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| 10 Jun 2026 01:55 PM |
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Please submit your comment on the draft standards by clicking either on the blue "Add Reply" button above this comment or on the "Reply" button and back arrow icon to the right of this comment.
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Thank you for participating in this public comment process. Your feedback is valuable and will be considered carefully by the NASW LTSS Standards Task Force. |
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