Steps Are Proposed To Re-balance Long Term Care
A little over a week ago I was away from the office for a second time in two months at an Elder Law Conference – this one at the statewide level, the Pennsylvania Association of Elder Law Attorneys (PAELA for short). The conference in January known as the Summit was for the National Academy of Elder Law Attorneys (NAELA). I attend these programs to learn what is on the horizon and what will likely be coming here soon and the programs did not disappoint.
Of special interest at the PAELA Annual Conference was a presentation on the future of Pennsylvania long term care presented by Jen Burnett, Deputy Secretary of Pennsylvania Human Services (previously Department of Public Welfare). The idea known as Long Term Supports and Services (LTSS) which was described includes the movement to “rebalance” long term care so that more money is spent on at home and “community based” care. LTSS is likely to arrive at our doorstep in Southeastern Pennsylvania sometime in the year 2017. It is a national initiative and is in process in several other states now.
LTSS depends on “managed care” instead of the current “fee for service” model. Providers would be paid on a “capitated” (that is per person) rate instead of for each service and providers would be expected to coordinate services.
Rebalancing is a part of the initiative since the idea is to move more funds into home and community based services and likely less into nursing home care. The national goal has been stated as a 50/50 division.
How this would work and whether it would be in the best interest of consumers likely depends on how it is administered since, as with everything, money received at one source must be taken from another. One concern is that nursing homes may be further stretched in trying to provide services for their residents. Also as being considered, nursing homes will likely need to complete more paperwork and be subject to more administrative requirements.
It is a well recognized fact that there is a lack of coordination now among services for the elderly and disabled. One person may need to receive services from several different sources and care plans at home are not easily coordinated to meet the need.
Consider that for one person there may be a need for transportation to meet doctor visits, at-home physical therapy, occupational therapy, assistance with bathing, dressing, readjusting the home environment for safety and to prevent falls, meal preparation and household chores. Family caregivers and friends are the greatest source of support for most now but the strain can become too much even for them.
Kaiser Family Foundation, a recognized source in the health care area, published an on-line report on December 15, 2015, “Medicaid and Long-Term Services and Supports: A Primer” available at http://kff.org/medicaid/report/medicaid-and-long-term-services-and-supports-a-primer/.
It describes long term services and supports as follows:
“Long-term services and supports” encompasses the broad range of paid and unpaid medical and personal care assistance that people may need – for several weeks, months, or years – when they experience difficulty completing self-care tasks as a result of aging, chronic illness, or disability.
Long-term services and supports provide assistance with activities of daily living (such as eating, bathing, and dressing) and instrumental activities of daily living (such as preparing meals, managing medication, and housekeeping). Long-term services and supports include, but are not limited to, nursing facility care, adult daycare programs, home health aide services, personal care services, transportation, and supported employment as well as assistance provided by a family caregiver. Care planning and care coordination services help beneficiaries and families navigate the health system and ensure that the proper providers and services are in place to meet beneficiaries’ needs and preferences; these services can be essential for LTSS beneficiaries who often have substantial acute care needs as well.”
As might be expected there are several other issues and concerns.
One consideration is that many people being served are “dual eligible,” that is they are both on Medicare and Medicaid. There needs to be coordination between the programs and payment sources.
Another issue is that, even if a person needs the services and does not have enough assets and income to pay for extended care privately, if Pennsylvania continues to require a very low income in order to qualify for Medicaid at home (for instance under the at-home Aging Waiver program), individuals who need the care could still be excluded.
About the Author Janet Colliton
Esquire, Colliton Law Associates, P.C. Janet Colliton has practiced law for over 38 years, 37 of them in Chester County, Pennsylvania, a suburb of Philadelphia. Her practice, Colliton Law Associates, PC, is limited to elder law, Medicaid, including advice, applications and appeals, and other benefits planning including Veterans benefits, life care and special needs planning, guardianships, retirement, and estate planning and administration.