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Long-term care: More than just nursing homes

April 18, 2011 - Mary Ann Heath
In September 1990, a U.S. Bipartisan Commission on Comprehensive Health Care (also known as the Pepper Commission) issued a “Call for Action” blueprint regarding long-term care. In the 20 years since the plan was created, Congress has never acted on the report — until now, of course.

In fact, the Patient Protection and Affordable Care Act touches on this in section 2406 “Sense of the Senate.” It also reveals that despite the commission’s recommendations two decades ago, long-term care for the elderly and disabled has failed to improve, and in many cases has actually grown worse.

For example, in 2007, 69 percent of Medicaid long-term spending for elderly individuals, and individuals and adults with disabilities, paid for institutional services, according to data in the act. It also revealed that only six states spent 50 percent or more of their long-term care dollars on home and community-based services for elderly individuals and adults with disabilities, while half of all states spent less than 25 percent.

The bill also estimates Medicaid dollars can support nearly three elderly individuals and adults with physical disabilities in home and community-based services for every individual in a nursing home. So, why is all the money going only to institutions?

Now, I’m not sure about you, but I know as long as it’s feasible, I would much rather stay in my home, or a home-like setting than in a nursing home. Nursing homes are vital institutions. Many facilities do a wonderful job making their patients feel at home, while also meeting their needs. But, there are also many other options out there for individuals. Thanks to health care reform, residents will be able to take advantage of these other options.

A news release from the Department of Health and Human Services (HHS) said states will see more support for moving Medicaid beneficiaries out of institutions and into their own homes, or community settings. This is because the Patient Protection and Affordable Care Act provides additional funding for two programs that support this goal: The Money Follows the Person (MFP) demonstration program and the Community First Choice Option program.

The MFP demonstration program was originally set to expire in 2011, but was given an additional five years by the Patient Protection and Affordable Care Act. This program offers individuals residing in a nursing home or institution an opportunity to live in the community with the services they need, according to the HHS release. This might include: the elderly, persons with intellectual, developmental or physical disabilities and mental illness. According to HHS, these programs have already helped 12,000 individuals move out of institutions.

The Community First Choice Option available to states shares many of the goals of the MFP program. Nursing homes and other institutions are often the “first choice” when it comes to residents with Medicaid that need long-term care. This new option provides states additional resources in order to make community living a first choice, according to HHS.

Starting in October 2010, states were able to receive a six percent increase in federal matching funds for providing community-based attendant services and supports to people with Medicaid. According to the bill, these services and supports may include assisting individuals with daily living needs, such as bathing and eating, and health-related tasks. States are also permitted to cover costs associated with helping individuals transition from an institution into the community. States must meet requirements to receive increased funding, however. States are required to:

• Develop “person-centered plans,” which allow the individual to determine how services are provided in order to attain independence.

• Establish implementation councils. A majority of the membership of these councils must be persons with disabilities and elderly individuals and their representatives. The councils will help design and implement the Community First Choice Option.

According to Donald Berwick, M.D., administrator of the Centers for Medicare and Medicaid Services, there is increasing evidence that people who need long-term care prefer to live in their own homes and communities, whenever possible.

Thanks to health care reform, they now have that option.

Mary Ann Heath has been reading and blogging about the Patient Protection and Affordable Care Act since January. Her goal is to read all 906 pages of the bill in one year.


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