ANN ARBOR, Mich.--(EON: Enhanced Online News)--The current system for providing long-term services and supports (LTSS) is dysfunctional and needs substantial reform, concludes the final report of the 15-member Long Term Care Commission on Sept. 18th. Although the Commission lacked sufficient time and resources to develop legislation, members put forward a broad array of recommendations that may spur action and interest in the future.
“to enable providers to utilize a standardized care plan document as consumers with LTSS move among settings of acute care and LTSS”
Among the key service delivery reform recommendations made by the panel are directives to:
- Broaden the focus on Accountable Care Organizations, in conjunction with physician payment reform, to “focus on the whole range of LTSS needs of individuals and explore ways in the next round of experiments to expand the scope…to include coordination with LTSS providers,”
- Incorporate LTSS care plans in Electronic Health Records “to enable providers to utilize a standardized care plan document as consumers with LTSS move among settings of acute care and LTSS,”
- Develop and implement “a standardized assessment tool that can produce a single care plan across care settings for an individual with cognitive or functional limitations. The standardized tool would inform consumers of LTSS choices and be responsive to the needs of older adults and all categories of individuals with disabilities in need of LTSS,” and
- Expand Options counseling programs provided by Aging Disability Resource Centers in order to “ensure best practices are disseminated to other states...[which should] receive support to expand their option counseling programs.”
The Commission also made a series of recommendations for building out the workforce, specifically direct care workers, and it urged inclusion and close involvement of family caregivers. They also called for a White House Conference on Aging to take place in 2015. To date, neither Congress nor the Obama Administration have shown marked interest in hosting or participating in efforts for such a conference, which began during the Kennedy Administration.
“It is good news that the Commission is spurring providers and policymakers to take action right now,” said Joanne Lynn, Director, Altarum’s Center for Elder Care and Advanced Illness. “We are working hard to advance the pace of change and to build momentum for a thorough revision of how our current programs coordinate to provide LTSS. It is not enough to tinker at the margins and keep trying to make incremental improvements that improve services on a piecemeal basis, while doing nothing to rethink the larger system of care for older adults with disabilities.”
Lynn also congratulated the Department of Labor for finalizing a long-awaited rule for personal and home care aides, who have been denied basic minimum wage and overtime pay protections under federal labor law for decades.
“It’s an important move to build out the workforce of hands-on direct care that we need to accomplish the goal we must achieve -- a doubling of the capacity of our system to serve the tens of millions of frail elders who will need a mix of health and LTSS services during the 'age wave,'” Lynn said. “At Altarum, we are also working with like-minded organizations to develop a volunteer-focused ‘Caregiver Corps’ in communities across the country that can supplement, but not replace, the invaluable services that our direct care workforce provides.”
Judith Brachman, Jewish Federations of North America, pointed to the need for a Caregiver Corps during brief remarks made yesterday at the Commission’s final public meeting. Brachman is among the nine Commissioners who voted in favor of the final report. As a former urban planner, Brachman said the panel’s final recommendations are “a roadmap for improving existing programs” and can be expanded on to create “livable communities” that focus on “the nexus between housing and care.”
The six Commissioners who did not vote in favor of the final report expressed deep concern that the recommendations skirt the issue of financing reform. “We can’t keep taking a pass on this issue,” Henry Claypool, executive vice president of the American Association of People with Disabilities (AAPD), stated, adding that doing so “leaves the impression families can magically cobble together the resources” to pay for catastrophically high LTSS costs. AAPD posted its own recommendations on its website.
Claypool’s recommendations include streamlining the structure of the Medicaid program in order to boost state efforts to expand home and community-based services systems, and designing a national “buy-in” options for individuals with significant disabilities who want to work but are currently frustrated and penalized by statutory barriers, notably Medicaid’s provision requiring those qualifying for services to have no more than $2,000 in assets.
Altarum Institute (www.altarum.org) integrates objective research and client-centered consulting skills to deliver comprehensive, systems-based solutions that improve health and health care. Altarum employs more than 400 individuals and is headquartered in Ann Arbor, Mich., with additional offices in the Washington, D.C., area; Portland, Maine; and San Antonio, Texas.