Presented by Courtney BurkeNelson A. Rockefeller Institute of Government

Health Policy Research Centerfor the

New York State League of Women VotersMarch 20, 2009

Explanation of long-term care (LTC) State role in long-term care How LTC is changing Explanation of ‘aging in the community’ How states provide community care Trends and state comparisons in

community care Conclusions and suggestions for change

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Assistance with essential, routine life tasks

Therapies that improve or maintain functioning

Special equipment

LTC is provided for an undetermined amount of time (i.e., not a one-time intervention)

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Millions of Americans use LTC Even more Americans will need LTC as baby

boomers age Over $207 billion was spent on LTC in 2005 LTC, especially institutional care, is expensive:

U.S. average is $70,900 per year for nursing home and $36,500 a year for four hours/day of a home health aide (Source: Georgetown University)

There is an opportunity to improve quality and continuity of care

Financing care is a burden for states

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Major role in financing state share of Medicaid

State-funded supportive services for individuals in need and caregivers

Regulatory and quality oversight Administrator and coordinator of

services and programs

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Home and Community-Based Services (HCBS) waiver Home health services Hospice care Personal care services Private duty nursing services Program of All-Inclusive Care for the Elderly (PACE) Inpatient hospital, nursing facility and intermediate care

facility services in institutions for mental diseases, age 65 and older

Inpatient psychiatric services, under age 21 Intermediate care facility services for the mentally retarded Nursing facility services, other than in an institution for

mental diseases Religious non-medical health care institution and

practitioner services

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Moving toward more community care: Care at Home & Home and Community-

Based Services waivers (1981) Assistive Technology (1988) Cash and Counseling (1998) Olmstead v L.C. (1999) Federal initiatives – New Freedom, Real

Choice Systems Change, Money Follows the Person, Nursing Transition/Diversion

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Wikipedia – The ability to live in one’s own home — wherever that might be — for as long as confidently and comfortably possible

Journal of Housing for the Elderly – aging in place is not having to move from one’s present residence in order to secure necessary support services in response to changing needs

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Within gerontology, sociology and anthropology, aging-in-place is described as “a complex set of processes that is part of the universal and ongoing emergence of the person-place whole, and the creative social effort to reintegrate the whole in a meaningful way when problems arise, compounded by an older adult’s evolving situation.” (Cutchin, 2003)

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Personal care Adult day care Assisted living Assistive technology Home care Hospice Rehabilitation services Independent living Respite care for caregivers Continuing care retirement communities Naturally occurring retirement communities

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Coordination of care is difficult, i.e., senior centers, AAA, home care providers (licensed & certified), nonprofits, other health care providers, government programs, etc.

Not always a smooth transition between acute care and long-term care

Balance between what consumer wants versus needs makes oversight difficult

Institutional bias in funding system (e.g., Medicaid does not pay for community-based housing)

Administration – Many state agencies involved, e.g., SOFA, OMRDD, OMH, DOH

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New Freedom Initiative Real Choice System Change Nursing Facility Transition Initiative Money Follows the Person Community-Integrated Personal Assistance

Services and Supports Independence Plus Aging & Disability Resource Centers Quality Assurance and Quality Improvement Rebalancing Initiatives Person-Centered Planning Choices for Independence Initiative

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New York Connects – point of entry system

Expanded In-home Services for the Elderly Program (EISEP) – (e.g., case management, ancillary services, in-home services)

Nursing Home Diversion & Modernization Act (NY one of 14 states)

Long-term care restructuring advisory council

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Type of Service

National Medicaid Participants

1999 2004 # change % change

Nursing Homes

1,615,695 1,707,572 +91,877 +6%

HCBS 935,160 1,337,010 +401,850 +43%

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StateOwn Your

Future

Aging and Disability Resources

Center

Cash and Counselin

g

Independence Plus

PACE

National # 16 43 15 10 24

Connecticut X

Massachusetts X X

New Jersey X X X X

New York X X

Pennsylvania X X X

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Provide more recognition, support for informal caregiving

Make HCBS more accessible, fundable Better integrate acute and LTC to

prevent need for nursing home care Provide more state flexibility and

federal financial support for evaluations Examine ways to solve the problem at a

national level

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Policies to allow aging in the community are following disability models

Those policies have been slow to diffuse among state Medicaid programs

Federal initiatives and support are helping states make needed changes

A sizeable proportion of community care is provided outside of government

Changing the system is a slow process

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DOH – Department of Health EISEP – Expanded In-home Services for the Elderly HCBS – Home and Community-Based Services LTC – Long-term care MA – Medicaid NY – New York OMH – Office of Mental Health OMRDD – Office of Mental Retardation and

Developmental Disabilities PACE – Program of All-Inclusive Care for the Elderly SOFA – State Office for the Aging

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Courtney BurkeRockefeller Institute of GovernmentDirector, Health Policy Research Center411 State StreetAlbany, NY 12203(518) 443-5243burkec@rockinst.org

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