HD30 - Report of the Joint Subcommittee Studying Long-Term Care
Executive Summary: BACKGROUND AND AUTHORITY FOR THE STUDY Long-Term Care can be defined as a system of health and social services required by the frail and handicapped of all ages to assist them in activities of daily living. These services may be required either continuously or intermittently but are required over an extended period of time. The services may be provided by a formal organization or by informal resources such as family. The population in need of long-term care services includes the frail elderly, the developmentally disabled, the physically handicapped and the chronically mentally ill. The Joint Subcommittee Monitoring Long-Term Care was created in 1983 by House Joint Resolution No. 37. Its charge was to oversee the implementation of an integrated approach to long-term care by facilitating cooperation and exchange of information. It was to accomplish this by receiving regular reports of cooperative action and proposals for joint effort from agencies involved in the provision of long-term care. The Joint Subcommittee was continued in 1984 for two years by House Joint Resolution No. 52 and again in 1986 by House Joint Resolution No. Ill. (Appendix A) Activities of the Joint Subcommittee During 1983, the Joint Subcommittee heard reports on activities from agencies and groups active in long-term care service provision. The Department of Mental Health and Mental Retardation reported on the rationale for and community responses to deinstitutionalization of geriatric patients from the state hospitals in 1983 and 1984. The Department also discussed the needs of mentally ill children and the growing problem of serving chronically mentally ill young adults. The Long-Term Care Council presented its state plan to the Joint Subcommittee. The Council also discussed its development of alternative services to prevent unnecessary institutionalization of the elderly. These efforts include a study of costs of public and private community services for this population and a discussion of problems in cost-sharing between federal, state and local governments in service provision. The Department of Health reported on the status of relevant Medicaid waivers, including those related to case management and home and community-based services, and on the accomplishments of the Nursing Home Preadmission Screening Program. The Department of Social Services discussed fire safety standards in homes for adults. The Joint Legislative Audit and Review Commission discussed its recommendations regarding amount of auxiliary grants from its report on Local Mandates and Financial Resources. These grants are the major resource used by residents of homes for adults to pay their room and board. Finally, the American Health Care Association and its Virginia counterpart presented an overview of the system of life-care communities. The Joint Subcommittee received a report on the deinstitutionalization pilot project in the City of Richmond and received the Department of Mental Health and Mental Retardation's report on census reduction at the state hospitals, prepared as requested in the 1984 Appropriations Act. At the beginning of 1984, the Joint Subcommittee identified and initiated the study of several issues through the use of expert task forces organized by the Joint Subcommittee. These issues, discussed in detail in the Joint Subcommittee's interim report of January, 1985, (House Document No. 33) include regulation of life-care communities in Virginia, a revised method of Medicaid nursing home reimbursement, housing for persons with special needs, and post-education transition of the handicapped. The Joint Subcommittee continued to monitor the Long-Term Care Council's study, undertaken pursuant to Senate Joint Resolution No. 30, of the cost-effectiveness of maintaining the frail and impaired elderly in community settings, to be determined through documentation of public and private costs associated with community placement. The Joint Subcommittee held two public hearings to provide an opportunity for public comment on available effective services and services which are needed to serve all populations in need of long-term care. Finally, the Joint Subcommittee attended the conference of the American Health Planning Association on "The Complex Cube of Long-Term Care." During 1985, the Joint Subcommittee continued its study of regulation of life-care communities by focusing specifically on the need for maintenance of reserve funds. The Joint Subcommittee also completed its study of post-educational long-term care services required by the handicapped. These issues are discussed in detail in this report. The Committee on Housing for the Disabled reported its findings to the Joint Subcommittee, which encouraged the passage of the Committee's legislative proposals by the 1986 Session of the General Assembly. The Joint Subcommittee continued to monitor the study of the Medicaid nursing home reimbursement system. The study, completed late in 1985, was conducted by the Virginia Center on Aging by contract with the Virginia Department of Medical Assistance Services, pursuant to the 1984 recommendation of the Joint Subcommittee. In October, 1985, the Long-Term Care Council reported to the Joint Subcommittee the results of its study, conducted as directed by SJR 30 (1984), on the public and private costs of institutional as compared to community-based long-term care. The study specified a need to provide financial assistance and other support to families and friends of those in need so that this informal support system can continue to meet the needs of impaired individuals. Finally, the Joint Subcommittee held a symposium on the projected need for nursing home beds in Virginia through 1990. Representatives of public and private agencies and of advocacy groups concerned with long-term care planning participated to identify need and actions necessary to meet the need. The 1986 General Assembly asked the Joint Subcommittee for recommendations regarding alternative methods of payment on behalf of residents of homes for adults which consider the amount of care provided to residents; feasibility, availability and affordability of private insurance coverage for long-term care services; and feasibility and efficacy of requiring continuing care retirement communities to maintain reserve funds. Task forces studying the issues affecting homes for adults and continuing care retirement communities completed their work during 1986. Their findings and recommendations are reported in detail in this report. The Joint Subcommittee monitored the progress of the study conducted in 1986 by the Bureau of Insurance and the Department of Medical Assistance Services, as authorized by House Joint Resolution No. 87 (1986), on action needed to encourage private insurance coverage of long-term care services. That study is in progress and due to be completed in time to report its recommendations to the 1987 Session of the General Assembly. |
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