Why Transform Long Term Supports and Services?

The Administration on Aging funds the Technical Assistance Exchange to support states’ efforts in developing and sustaining a person-centered, self-directed national long term care system. This system should effectively assist consumers with identifying and accessing a range of home and community based resources which maintain independence of older citizens and persons with disabilities and slow the rate of growth and expenditures in the states' Medicaid programs.

Why make this transformation now?

1. The national long term care system has already begun to evolve with programs such as CMS’s Real Choice Systems Change Grants, Cash and Counseling, and other consumer-centered and consumer-directed programs.
2. There is an opportunity to build upon this recent innovation and creatively resolve inefficiencies in the nation’s long term care system using identified best practices and programmatic strategies developed by the Aging Network and its partners.
3. State budgets will not be able to support the current system of Medicaid long-term care and spend-down without creating a plan to slow the rate of its growth and expenditures.
4. The “Silver Wave” is coming and states are not prepared.
5. States’ fiscal crises must be resolved to effectively build service capacity and infrastructure for the growing numbers of elderly people and individuals with disabilities.

From the Point of View of Decision Makers

From the Point of View of Consumers and Community Advocates

From the Point of View of Grantees and Program Staff

---

Decision Makers

• Why should we work to transform the long-term care system?
  • State budgets will not be able to support the current system of Medicaid long-term care and spend-down without creating a plan to slow the rate of its growth and expenditures.
    • Change in per capita rate of Medicaid long term care spending, less than or equal to 5.2% annual increase from 1995 – 2005. Source: The Lewin Group
  • An inefficient and overburdened system is not a good use of resources and it results in consumer dissatisfaction with a state’s publicly funded services.
  • Consumers would like a person-centered, self-directed system that assists them with identifying and accessing a range of home and community based resources which support and maintain their independence.

• What are we doing that is different from what’s been done before?
  • AoA is re-framing long term care policy to nationally focus on consistent data outcomes which assist states with transforming their long-term care systems.
  • Targeting services to non-Medicaid consumers who are at risk for spending down their assets will enable states to slow the rate of growth and expenditures in their Medicaid programs. This flexibility is part of the guidance of the Older Americans Act.
  • AoA and its national, state, and local level partners are bringing best practices to scale and enhancing services for consumers.
    • Creating ease of access to home and community based long term care services (Aging and Disability Resource Centers)
    • Managing taxpayer resources more effectively (Cash & Counseling and the Community Living Program)
    • Using data to inform program innovations and improvements (Evidence-Based Disease Prevention Programs)

• What is the value of how we are transforming long-term care?
  • Slowing down the rate of growth and expenditures in the states' Medicaid programs saves money because home and community based services cost less than nursing facility services.
  • Saving money allows states to more efficiently leverage public dollars and build a transparent case of cost savings to citizens and legislatures.
  • Slowing the rate of growth and expenditures in the states’ Medicaid programs will help states prepare for future fiscal and capacity demands and build a more efficient and effective long-term care system.
  • Citizens want a system which maximizes their home and community based support options.

Consumers and Community Advocates

• Why should we work to transform the long-term care system?
  • Citizens have a right, via the Olmstead Decision, to have broad access to home and community based supports and to be free of publicly funded systems that have an institutional bias.
  • Citizens thrive in a community that supports person-centered, self-directed choices for staying at home and in the community.
  • It is in our best interest to support a system that maximizes quality of life as well as taxpayer resources.

• What are we doing that is different from what’s been done before?
  • AoA and its national, state, and local level partners are bringing best practices to scale and enhancing services for consumers.
    • Creating ease of access to home and community based long term care services (Aging and Disability Resource Centers)
    • Managing taxpayer resources more effectively (Cash & Counseling and Nursing Home Diversion)
    • Using data to inform program innovations and improvements (Evidence-Based Disease Prevention Programs).
  • We are specifically investing in community based, person-centered resources which assist states and local level publicly funded service providers to empower citizens to make informed choices while they access a range of supports which will help them maintain independence in their communities.

• What is the benefit of how we are transforming long-term care?
  • Managing tax payers’ dollars more efficiently, to create a system that reduces confusion, builds trust, and empowers citizens to make educated decisions about their long term care needs.
  • Creating an infrastructure which provides a person-centered, self-directed long term care system, i.e. helping the consumer to take control over their own long term care decisions while maximizing their choices to remain in the community.
  • No consumer wants to spend down their hard-earned assets in order to access public resources.

Grantees and Program Staff

• Why should we work to transform the long-term care system?
  • The Aging Network has been directed, via congressional intent and authority, to address systemic long term care inefficiencies.
  • The Olmstead decision supports and upholds citizens’ rights to have the broadest access to home and community based supports and be free of publicly funded systems that have an institutional bias.
    • Many current nursing facility residents could potentially be served in the community.
  • Consumers would like a person-centered, self-directed system that assists them with identifying and accessing a range of home and community based resources which support and maintain their independence.

• What are we doing that is different from what’s been done before?
  • AoA is re-framing long term care policy to nationally focus on consistent data outcomes which assist states with transforming their long-term care systems.
  • Targeting services to non-Medicaid consumers who are at risk for spending down their assets will enable states to slow the rate of growth and expenditures in their Medicaid programs. This flexibility is part of the guidance of the Older Americans Act.
  • AoA and its national, state, and local level partners are bringing best practices to scale and enhancing services for consumers.
    • Creating ease of access to home and community based long term care services (Aging and Disability Resource Centers)
    • Managing taxpayer resources more effectively (Cash & Counseling and Nursing Home Diversion),
    • Using data to inform program innovations and improvements (Evidence-Based Disease Prevention Programs)

• What is the value of how we are transforming long-term care?
  • Creating a local environment in which citizens have easy access to a range of publicly funded home and community based resources which help to maintain their independence in the community and that builds trust and credibility with state and local level service providers.

---