HD44 - Long-Term Care and Aging Services
Executive Summary: In 1993 the General Assembly passed House Joint Resolution No. 603 requiring the Secretary of Health and Human Resources to develop a plan to restructure and consolidate all aging and long-term care programs. To ensure that the plan has the input and guidance of major stakeholders, the Secretary appointed the Long-Term Care and Aging Task Force. The Task Force is composed of individuals and persons representing organizations with an interest in aging and long-term care services. The report which follows reflects the deliberations of the Task Force itself and the work of its three subcommittees -- State, Local, Services/Linkages/Public-Private. The Task Force also gave consideration to comments received at its public forums for input before the deliberations began and at public hearings on the draft plan. Information received from state agencies and other sources was also considered. The report sets forth a plan to consolidate long-term care and aging functions from four state agencies into a restructured agency which would be responsible for the planning, administration, management, development, regulation, and funding of long-term care and aging services. These functions are currently carried out across four agencies, and the consolidation would offer the opportunity to provide for the efficient and effective development and management of a system of long-term care and aging services. Such a system would offer the Commonwealth an opportunity to plan and respond to current and future needs of the citizens of the Commonwealth. The report also discusses local level systems development and recommends the creation of an advisory group to assist in the further development of local level systems. Such an advisory group would be made up of representatives of local government, providers of services, and consumers. Included also are sections on issues to be considered in the development of local level long-term care systems and in the implementation of the state level consolidation. The Task Force also suggested that the Commonwealth's long-term care and aging services be focused on the client with the goal of providing maximum independence for the longest possible time. Individual choice in the selection and provision of long-term care services should be stressed. A broad array of services is encouraged with communities selecting services needed in their specific areas from three categories: home-based services, community-based services, and residential services. State Level Responsibilities Recommendation One: A consolidated and restructured state-level long-term care and aging agency should be established and operational by January 1, 1995. The following programs, services, and functions were identified by the Task Force to be included in the consolidated agency: From the Department for the Aging: All programs, services, and functions, including: • the Long-Term Care Ombudsman Program • in-home and adult day care services • home delivered and congregate meals • respite care • elder rights, including guardianship • transportation From the Department of Medical Assistance Services: Nursing home and home health provider rate setting, audit, and cost settlement (including provider appeals) Long-term care information management support Quality care assurance including: • home and community-based care waiver administration • home health utilization review • hospice program administration • nursing home patient class validation and utilization review • long-term care service pre-authorization • nursing home pre-admission screening From the Department of Social Services: Adult Services Adult Protective Services, including guardianship Auxiliary Grant payments Central/regional office administration of Adult Services, Medicaid and the Auxiliary Grants Program Licensing of homes for adults (adult care residences) and adult day care providers From the Department of Health: Licensing and certification of nursing homes and home health providers Nursing home pre-admission screening Recommendation Two: The consolidated agency should be served by a policy board comprised or citizens, consumers, providers and other persons with expertise or interest in long-term care and aging services. The Task Force was concerned that the board which governs the agency be a policy-making board with authority to influence the administering agency, and that it be composed of citizens and consumers who were knowledgeable about long-term care. The Task Force urged that statutory language ensure consumer representation. The board should be comprised of persons from various geographic areas, and should clearly represent rural, as well as urban and suburban areas. The policy board should be appointed on July 1, 1994, along with the new director of the agency, so planning for full implementation at the state and local level can begin. Recommendation Three: The long-term care system should serve individuals or all ages needing long-term care services. Long-term care services are needed by persons of all ages. However, the Long-Term Care and Aging Task Force's primary focus has been on older persons, as mandated by HJR 603. Younger persons receiving long-term care services in nursing homes, homes for adults, and through the Medicaid-funded home- and community-based waiver programs for the elderly and disabled have also been included in the Task Force's discussion. Programs at the Department of Medical Assistance Services which serve the younger disabled and adult programs and at the Department of Social Services which serve all adults are included in the consolidation. The Task Force recognized that younger persons need long-term care services and views the consideration of the inclusion of persons who are younger and disabled as critical to the effective and efficient delivery of long-term care services. The Task Force recognized that these needs for long-term care were beyond its charge and urges that the General Assembly give consideration to the long-term care needs of all Virginians. Recommendation Four: The Task Force endorses the use of the Uniform Assessment Instrument (UAI) and recommends the development of a "short form" of the UAI for use when appropriate. Standardization in assessing need for services will facilitate equitable distribution of resources. The Uniform Assessment Instrument (DAI) provides an opportunity for standardization of assessment. The UAI was developed as a component of the Case Management for Elderly Virginians Pilot Project and currently is being revised for application to all publicly funded long-term care services. The UAl provides a mechanism to complete a comprehensive review of an individual's needs and resources. The UAI does not need to be completed for all individuals seeking long-term care services. Therefore, the Task Force supports the development of a "short form" for those situations when a comprehensive assessment is not needed, but urges that criteria also be developed to ensure appropriate use of the "short form." Local Level Responsibilities Recommendation Five: The state entity should establish a local implementation planning group in July 1994 to begin to consider the issues related to local service delivery. The local long-term care and aging services delivery system should be established and operational as soon as possible and no later than January 1, 1998. The Task Force recognized the need to acknowledge the diversity across Virginia in delivering long-term care and aging services. There was consensus that local flexibility in administration and delivery of services was required at the local level but that guidance about expectations for statewide service delivery needed to be given. The Task Force agreed on principles for local level responsibilities and a: list of such responsibilities. The Task Force also identified issues for consideration as the local level delivery system is further developed. The Task Force indicated that additional time was needed to allow a full discussion of issues and to offer detailed recommendations for improving the local delivery system. |
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