The subsidisation of informal care has brought with it ongoing debate on both the efficacy and impact for individuals with varying needs of ADL support. In a study conducted by Kim and Lim (2012) findings suggest that institutional care is most cost-effective for individuals partially-dependent on support for several ADL's in that it led to reduction of informal care and medical expenditures whereas cost benefits for home care were higher among individuals that were completely dependent on ADL support through reduced spending on institutional support. Overall a shift from formal care to informal home care seems to be placated here as a financial target for sustainability.

Link: http://www.columbia.edu/~hk2405/ltc_for_publication_v04.pdf

The erosion of medicaid program coverage is what we can see in the horizon under these shifts. Reductions in standards of care, quality assurance and government accountability for public health will inevitable lead to the negligence of service availability for low income and high risk populations. The benefit of these changes will be seen mainly among private interest sectors that have customarily re allocated funds from safety net programs into state budget spending.