The Texas Department of Health and Human Services, formerly the Department of Aging and Disability Services (DADS), administers multiple long-term services and supports programs for the aging, for people with intellectual and developmental disabilities (IDD), and for people with physical disabilities. Staff in HHSC/DADS have conducted a large-scale biennial survey to assess consumer satisfaction and needs since 2005. The Long-Term Services and Supports Quality Review (LTSS) is a statewide survey of people receiving services and supports through home and community-based and institutional programs, excluding nursing facilities, formerly offered by DADS. The purpose of the LTSS survey is to describe the consumer perceived quality and adequacy of long-term services and supports administered by HHSC/DADS, consumer quality of life, and trends in long-term services and supports over time.

The quality review process has been in effect since 2005 as a continued activity of a Real Choice Systems Change Grant awarded by the Centers for Medicare and Medicaid Services (CMS). The review process is not regulatory in nature, but rather a discovery method to identify areas of need and for improvement. People receiving services and supports, or their family members and guardians, provide valuable feedback through face-to-face and mailed interviews. These surveys obtain the individual’s perspective about their lives, services and supports. The LTSS survey provides baseline information for continuous quality improvement, monitoring and intervention, helping the agency build a quality management strategy, identify trends, develop innovations, and provide information to stakeholders and CMS. Increasingly CMS is requiring quality information directly from consumers, and the LTSS survey meets these requirements.

The LTSS survey uses three nationally recognized survey instruments designed for measuring specific consumer indicators – National Core Indicators Adult Consumer (NCI) and National Core Indicators Child and Family Survey (CF) for the I/DD population, and the Participant Experience Survey Elderly/Disabled (PES) version for the elderly disabled. Data is collected on the following broad domains: Services Satisfaction, Systems Performance, Health and Welfare, Individual Choice and Respect, and Work and Community Inclusion.

The sample selected is a representative sample of individuals receiving services across programs around the state. The entire population of individuals served is stratified by program and geographic location of residence and then randomly sampled to select individuals to be surveyed. Providers are not identified until after an individual has been selected, therefore, the number and identity of providers changes each survey period. Once an individual has been selected as a potential survey subject and their provider identified, we contact the provider to provide health and demographic information on the selected person. Background information is collected from the provider rather than the interview subject in order to receive more accurate information to describe the population and to try to minimize survey fatigue among the people interviewed. We do not discuss or evaluate providers in the reports.

Geocoding services provided in partnership with Texas A&M GeoServices.




  • Survey Research


  • Alicia Novoa (Principal Investigator)

  • Andrea Sesock

  • Anthony Jackson

  • Kristina Waller

  • Marina Brandman