Briefing
On Friday July 11th, 2008, I attended the Briefing on Long-Term Care Reform
hosted by the Engelberg Center for Health Care Reform at Brookings in
collaboration with The New School and the Center for Health
Transformation.
This event provided an opportunity to identify some of the big challenges in
long-term care quality and financing and also to highlight innovative ideas
and solutions moving forward. Bob Kerrey and Newt Gingrich were featured speakers.
Susan Reinhard, PhD, FAAN (Senior Vice President, AARP Public Policy Institute)
was also featured.
During her talk she focused on the recently released AARP Public Policy Report
summarized below. I think Susan was the best of all the speakers. She
focused on how nurses must be care coordinators and disease managers.
Barriers must be removed to allow nurses to practice in their full scope
of practice. Do take time to review Susan's concrete recommendations on
how to improve our long term care system.
A Webcast of the event is now available online. The Engelberg Center will
welcome any feedback you may have.
Forums on Health Care Reform
Lately I have been attending several Forums on Health Care Reform. Long
term care (LTC) is an important part of discussions on health care
reform. Currently, most LTC dollars are spent on the most expensive
type of care in nursing homes. In the future, states will need to use
their LTC dollars much more efficiently.
The AARP report is a good illustration of the work the AARP Public Policy
Institute is doing in the area of long term care reform. Findings of this survey
across all the states indicated that states are doing much better in
using home and community based services for people with developmental
disabilities and mental retardation than they are for older adults.
Public policy will need to change at the state level to decrease use of
the most expensive types of institutionalization (nursing homes) to that
of making home and community based choices available to older adults.
States that have made the most progress have used case management across
all settings so that patient and caregiver see a nurse to consider all
the available options of care.
The nurse works closely with the patient and family to coordinate care and
makes home and community based care choices available before nursing home
is considered. States that have made the most progress in LTC reform allow
Advanced Practice Nurses to practice at their fullest scope of practice. Incentives such as
monetary rewards will need to be provided to those states that make changes in using their
LTC dollars more wisely. See the press release below for more information about LTC reform.
Press Release
New AARP Report Finds Older Americans Have Limited Access
to Home and Community-Based Services under Medicaid
July 11, 2008
A new report by AARP's Public Policy Institute finds promising signs and
mixed results among state government efforts to balance long-term care
(LTC) options under Medicaid. Unfortunately, according to the report,
only four states spent more than 50 percent of their Medicaid LTC
dollars for older people providing home and community based services
(HCBS). The remainder of the states continues to spend the majority of
their Medicaid LTC dollars for older people on institutional care, such
as nursing homes.
The report, A Balancing Act: State Long-Term Care Reform, is the first
to examine Medicaid spending on long-term care for older people and
adults with physical disabilities, separate from other LTC users such as
people with mental retardation/developmental disabilities (MR/DD).
Nationally, 75 percent of Medicaid LTC spending for older people and
adults with physical disabilities pays for institutional care in nursing
homes. In contrast, states have done a much better job balancing
Medicaid LTC for people with MR/DD, spending just 39 percent on
institutional care. The majority of funds now supports people in home
and community-based settings.
"What states have accomplished for people with mental
retardation/developmental disabilities is remarkable," said Susan
Reinhard, Senior Vice President AARP Public Policy Institute. "It proves
that balancing long-term care is achievable and should be used as a
model to help states provide home and community based services for older
adults."
Medicaid's bias remains a major barrier to leveling the playing field
between options for institutional care and HCBS for older adults,
according to the report. Medicaid is required to provide nursing home
care for older adults who are impoverished and require care, but is not
required to provide HCBS.
"This is backwards. People are entitled to costly nursing home care, but
not to often more cost- effective services in their homes. Clearly home
and community-based services are preferred by older residents," said
Reinhard. "Our research shows that older people want to remain in their
homes as they age. They want independence, choice and control over every
day decisions. However, public funds continue to steer older people into
institutions."
Also highlighted in the report are best practices from states that are
making progress balancing LTC options. Alaska, Oregon, Washington and
New Mexico spent more than 50 percent of their Medicaid LTC budget for
older people and adults with physical disabilities in 2006 on HCBS.
These states embraced a philosophy of delivering services in a way that
allowed older people the greatest independence. The ability of some
states to accomplish substantial reforms for older people and adults
with physical disabilities - as well as increased HCBS options for MR/DD
- demonstrates that obstacles to balancing LTC options can be overcome.
The report examines Medicaid LTC funding because it is the primary payer
for LTC in the country. It found that balancing Medicaid LTC options
will require a commitment from state officials and cooperation from
federal authorities. HCBS can be both cost-effective and responsive to
the preferences of older people and adults with disabilities.
"This underscores the need for better government and private sector
financing options for long-term care. Americans have few options to plan
and pay for their long-term care. Medicare provides only modest funding
for a limited number of services and Medicaid's stringent financial
eligibility criteria require most people to become impoverished to
qualify. It is clear that we must eliminate Medicaid's persistent bias
towards costly and undesired institutional care, and we need to advocate
for more affordable long-term care financing options. Government,
individuals and the private sector all have a role to play," said
Reinhard.
Click here for the new report.
