System Principles:

The Path to Real Long Term Care Reform

Strategic Principles

Participant-Driven

Choice, Equity, and Quality

Build on High Quality Local Systems

Effective relationship with local acute care system

Integral Long Term Planning

Provider Accountability

Participant-Driven

Consumers and Families are active participants in all stages of design and implementation

Cornerstone is Person-Centered Planning

System honors the preferences of consumers

System supports Self-Determination

Choice, Equity, and Quality

Choice of caregivers, services, supports, and residential options

Quality and Accountability Outcomes

Competent, committed, and valued workforce

Adequate amount of services and supports statewide

High Quality Local Systems

Maximize supports and services resources

Consider impact of all changes on existing community supports

Flexibility of supports; clarity in outcomes

Encourage and support innovation locally

Relationship with Acute Care

Be distinct from the locally available acute care system

Have a clearly articulated method of coordination with the acute care system

Clear and unambiguous financial and functional eligibility criteria

Easy and universal access across settings.

No loss of current supports

Integral Long Term Planning

Independent actuarial evaluation

Savings expand supports

Independent PCP facilitation

Timely Implementation quality

Service limitations are over the whole program, not on individuals

Provider Accountability

Explicit contractual responsibility for quality of services and their deliveryState maintains a system of effective monitoring and measurement of qualitySanctions, including payment refusal, for low qualityUniform, timely appeal systemIndependent investigation of critical incidents, abuse, neglect, and rights violations

Operational Principles

LogisticalSocialCoordinationDecision-MakingWaiting ListsTransition and DiversionConsumer InputWorkforce

Logistical and Coordinative

Rollout in staggered phases to assure effectiveness

Subcontract with existing community organizations with expertise

Pilot untested components

Expand only after thorough evaluation

Social

LTC services must not be medically driven.

Social models using PCP must frame any medical services

Linkage to acute care must be seamless

Access to LTC must not be fragmented (SPE)

Coordination

Service Coordination must be independent

Service Coordinators must be qualified by:Experience with seniors and persons with disabilities

Deep understanding of consumer control

Local program understanding and experience

Knowledge of person-centered planning

Decision-Making

Medical recommednations made by trained providers who know and treat the personAuthorizations made by those who know the personBoth internal and independent conflict resolution systemsTimely process to accommodate emergencies

Waiting Lists

Dynamic plan to reduce waiting lists

No reduced access through utilization monitoring

No reduced access to prescription drugs

Shift savings into reducing waiting lists

Diversion and Transition

Everyone who wants out gets out

Use outcomes as evaluated by the person in the community

Ensure enough community providers

Consumer Input

Free access to all program and provider information

All Committees have at least 50% consumers

Self-Determination in every program option

Workforce

Plan to expand wages and benefits

Free training and skill building programs

Use of registry as work recruitment system

Effective backup system

Consumer can hire, manage, and fire

Resources

LTC Scan http://radio.weblogs.com/0139791/Transition Curriculum http://nfti.prosynerg.com Consumer Consortium http://www.copower.org/mfp/index.php LTC Blog http://fan-the-flame.blogspot.com/