Core Values For a Good Long Term Care System Persons with disabilities and their families are entitled to maximum feasible choice/participation in selecting care settings and providers. Persons with disabilities have the right to expect “quality of life”, personal dignity, maximum feasible independence, health, security and quality of care. Everyone has an opinion about… Bedroom Bathroom What time you get up or go to bed What you watch on TV What you have for breakfast….when you have breakfast

Persons with disabilities have the right to choose and/direct a care plan involving “managed risk”, in exchange for the advantages of personal freedom. The array of public service options and individual client choices may be bonded by reasonable considerations of cost-effectiveness.

Three Tenets of a Balanced LTC System Choice is most important with quality being a close second

No One Service is Most Important Washington provides an array of services– the most important service is the one the client needs . Nursing home Adult family home Boarding home Personal care in-home Assisted Living Supportive services such as adult day health, respite, client training, skilled nursing, home delivered meals, etc. The ARRAY is what is important It is an ARRAY not necessarily a Continuum

A Good Long-Term Care System…… Supports family caregivers as primary resource for long term care Consolidates a full array of options: in-home, community residential, nursing home Controls & coordinates entire LTC budget (nursing home, home & community, AOA/AAA funding) Controls and coordinates residential care QA and regulatory compliance Families should care for loved ones. However, Should not be legislated A system needs to be developed not just individual services. Services need to be accessible to be viable. Quality assurance and enforcement is important. Consumers are very vulnerable Important to regulate and hold people accountable

Core Values for a Good Long-Term Care System Persons with disabilities and their families are entitled to maximum feasible choice/participation in selecting care settings and providers. Persons with disabilities have the right to expect “quality of life” including personal dignity, maximum feasible independence, health and security and quality of care. All component parts in one administrative structure. Assessment and Eligibility issue done timely Quality and Regulation -----Nursing home shut down Rate setting—Get what you can pay for

Who has the front door to the system is important Debate between state employees and AAA. Nether one going away. Divide labor What are the results?

Nursing Home Caseload 1972-2005 One time high of over 17, 000 now around 12,000

Estimate of number of Nursing Facility Clients if Washington Had not done LTC Reform What would have happen if had not done something?

Washington Home and Community LTC Caseload Trend Community side of the system allowed to grow. More preferred, cost less than nursing home services

Give Consumers what they want and it will probably save money. Over the past 12 years, Washington LTC reform policy encouraging development of client-preferred home and community based options has resulted in an annual reduction of 401 clients per year and allowed community placements to increase by an annualized caseload of 1,309 clients. If Washington had not reformed its’ LTC system it is projected that the NF caseload today would be over 24,000 instead it is less than 13,000

An additional 14,000 consumers have been served in HCBS settings. The cost to serve this increased HCBS population has been paid in large part with savings from the nursing home budget. Start summary. Number of consumers by service

What it takes for a good long-term care service system… Summary

What it takes to have a good State Long-Term Care System. A clear State Vision that consumer choice should drive the long-term care system. A belief that quality of life is as important as quality of care. A belief that no one service is more important than another. The most important service is the one the consumer wants and needs. Consumer Choice is critical. Decision about who to share a bedroom. Many lose the opportunity to choose Stanley story with Hospice and bath Quality of life is what most people care about, rather than the size of the windows in the nursing home or weather or not spoons are lined up.

The Ideal State Long-Term Care System A single organizational unit in State Government to plan, develop and operate the long-term care system. A single budget with flexibility and authority to spend on a varied array of long-term care services to meet consumer needs and preferences. A single organizational unit in government most important. Only way to become efficient enough to plan, develop and operate an efficient long-term care system.

Fair rate setting and contracting process for providers. A single point of entry with a fast, timely and standardized automated way to access financial and functional eligibility and collect data. A case management system with capacity to provide assistance and oversight for consumers. Fair rate setting and contracting process for providers. Prompt eligibility critical for potential consumers to have any real choice. Good case management is critical to assist consumers and control cost. Fair rates are necessary for quality, However, not direct correlation between rates paid and quality.

A process for assuring quality oversight throughout the system. A process for resource development that meets consumer demand. A well organized articulate, sophisticated group of consumers/families who advocate for the long-term system. Enforcement must be part of quality assurance. If a provider does something wrong there should be a consequence . Development of resources must be ongoing. Good example is assisted living. No one service is the most important. Consumers are the best advocates. Must be organized and sophisticated. Silver haired legislature does not work.