LTSS Roadmap Step 2: Goals and Objectives

Guidance for the LTSS roadmap planning model specific to step 2: goals and objectives.

Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: August 03, 2016

Establishing goals for LTSS in your community will provide direction, mission, and purpose to your community’s efforts. Objectives provide measurable steps along the path to meeting the goals.

Questions to Ask

What goals do you want to achieve by providing LTSS?
- Example: "Provide reservation-based home health care services for elders and persons with disabilities."
What are some intermediate objectives that must be met to achieve the larger goals?
- Example: "Learn about state accreditation for home health care services."

Defining Your Goals and Objectives

Goals set your purpose. They state what you want to address.
- Example: "Improve the quality of life of elders and people with disabilities in the community."
Objectives are targets that can be measured and that work together to help achieve your goal.
- Example: "Achieve 100% Medicaid enrollment among eligible elders and persons with disabilities by June 30, 2014."

"Performance Metrics" - What to Measure

Performance metrics (measurements) are the means by which you measure change. It's good to choose your performance metrics at the beginning, so you can take measurements before and after, to accurately measure change.
- Examples: Medicaid enrollment rate, mental health screenings, hospital re-admittances, accidental personal injuries, etc.

Performance Metric Examples

In a 2012 report, a federal agency defined six major themes, with many specific measurements, that can help describe well-being for older adults. Reviewing these indicators can help you decide what your program should measure.

See the full report, Older Americans 2012: Key Indicators of Well-Being (June 2012), to learn more about any of the indicators listed below.

Population

Number of elderly
Racial and ethnic composition
Marital status

Educational attainment
Living arrangements
Older veterans

Economics

Poverty
Income
Sources of income

Participation in labor force
Total expenditures
Housing problems

Health Status

Life expectancy
Mortality
Chronic health conditions
Sensory impairment and oral health

Respondent-assessed health status
Depressive symptoms
Functional limitations

Health Risks and Behaviors

Vaccinations
Mammography
Diet quality
Physical activity
Obesity

Cigarette smoking
Air quality
Use of time

Health Care

Use of health care services
Health care expenditures
Prescription drugs
Sources of health insurance
Out-of-pocket health care expenditures

Sources of payment for health care services
Veteran's health care
Residential services
Personal assistance and equipment

End of Life

Use of hospice or intensive care unit/coronary unit services in last 30 days of life

Place of death (hospital inpatient, LTC facility, residence, other)

When your community has identified its goals and objectives for LTSS, it is time to examine and compare LTSS models to see which models meet the needs of your Tribe and community.

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