Over the past few decades in the United States, much of the innovation in the long-term services and supports (LTSS) system has originated at the state or local levels, only to be elevated to the national level after much experience and testing of new concepts. Such evolution--and subsequent expansion--has involved federal government and foundation support, along with changes in federal Medicare, Medicaid, and housing policies. Most innovations take a long time to diffuse or fail to do so. For example, in health care, the average time it takes for an evidence-based practice to make its way into general practice is 17 years, and half of all new practices never become widespread. to Implementation. However, five promising innovations currently in the LTSS system are becoming more commonplace. This paper discusses these innovative programs and the diffusion of innovation, or scaling-up process, underlying them. We also make observations about the factors affecting their expansion to date.
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