Prevalence of Unmet Service Needs and Associated Person-Reported Outcomes in Long-Term Services and Supports in the United States.

Authors

Romil R Parikh, Jack M Wolf, Nishka U Shetty, Ashwin A Pillai, Benjamin W Langworthy, Chanee D Fabius, Stephanie Giordano, Eric Jutkowitz, Tetyana Shippee

Published in

Journal of the American Geriatrics Society. Jun 19, 2026. Epub Jun 19, 2026.

Abstract

Long-term services and supports (LTSS) serve > 9 million adults in the United States. We examined prevalence and quality of life (QoL)-related outcomes of consumer-reported unmet LTSS needs in publicly-funded LTSS.
We pooled cross-sectional data from the 2016-2017, 2017-2018, 2018-2019, 2021-2022, and 2022-2023 National Core Indicators-Aging and Disability Adult Consumer Surveys. We included 61,829 adults (34% with age < 65 years; 66% female; 27 states). Survey weights generated population-representative estimates. We ascertained unmet LTSS needs by response to: "Do the long-term care services you receive meet your current needs and goals?" (dichotomized- yes vs. no). We estimated weighted prevalence of unmet LTSS needs overall and across subpopulations, and examined associations with two self-reported QoL-related outcomes (dichotomized- yes/no): (1) being active in community; (2) satisfied with how one spends one's day. Prevalence ratios (PRs) were estimated using weighted Poisson regression with robust variance estimators, adjusting for demographics, health and functional status, multimorbidity, funding program, residence setting, state, and survey year.
Among respondents, 18,004 (weighted-estimate, 29%) reported unmet LTSS needs. Prevalence of unmet needs varied across sociodemographic strata, care settings (higher in community-based than in residential-care settings), and funding programs (lower in PACE than in Medicaid programs). Individuals with unmet needs were significantly less likely to report being active in the community (PR, 0.65; 95% CI, 0.62-0.68) and satisfied with how they spend their day (PR, 0.62; 95% CI, 0.60-0.64). Post hoc analyses revealed potential dose-response associations between increasing degree of unmet LTSS needs and outcomes.
Consumer-reported unmet LTSS needs are frequent, vary greatly across care settings and funding programs, and are associated with poorer QoL-related outcomes; highlighting substantial system-level gaps in the fragmented LTSS landscape and the need for coordinated investments and structural reforms to better meet the needs of individuals relying on these services.

PMID:
42319287
Bibliographic data and abstract were imported from PubMed on 19 Jun 2026.

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