This white paper was partially supported by The SCAN Foundation and prepared by Joshua M. Wiener, Ph.D., Senior Fellow and Program Director, Aging, Disability and Long-Term Care, RTI International, under a project with the Alliance for Health Reform. The goal of this paper is to frame the main issues of long-term care reform and to lay out the principal reform options available to policymakers. While long-term care is unlikely to be at the center of the upcoming debate on health care reform, much can and should be done to improve the system in the near term. The paper begins with a brief background section that sets the stage for a discussion of financing, service delivery, and quality assurance. In most cases, the options presented are not mutually exclusive in principle, but limited resources will require choices among them.