HD45 - Development and Implementation of a Statewide Comprehensive Case Management System for Long-Term Care
Executive Summary: House Joint Resolution 601, supported by the Joint Commission on Health Care and passed by the 1993 General Assembly, requested the Secretary of Health and Human Resources to develop and implement a statewide comprehensive case management system for long-term care. The resolution also requested the Secretary of Health and Human Resources to require that all public health and human resource agencies use a uniform assessment instrument, common definitions and common criteria for all long-term care programs by July 1, 1994; and to develop and implement a statewide client level database for all publicly funded long-term care services by July 1, 1995. This resolution was introduced as an essential companion to two additional resolutions on long-term care supported by the Joint Commission on Health Care, HJR 602 and HJR 603. House Joint Resolution No. 602 establishes the long-term care policy for the Commonwealth. House Joint Resolution No. 603 requires the Secretary of Health and Human Resources to develop a plan to restructure and consolidate all aging and long-term care programs. The purpose of this report is to provide information on our progress toward the implementation of a statewide comprehensive case management system for long-term care. Case Management for Elderly Virginians Pilot Project In response to problems identified in Virginia's long-term care system, the Joint Commission on Health Care recommended the implementation of the Case Management for Elderly Virginians Pilot Project under the direction of the Virginia Long-Term Care Council. This initiative has funded pilot projects in Fairfax County, Southeast Virginia and Southwest Virginia since July I, 1991. The Project has demonstrated that case management can effectively link elderly Virginians to appropriate long-term care services. The Project has served as a laboratory for the development of policies and procedures critical to the development of a statewide comprehensive case management system. Through the Project, policies which should be uniform across the state have been developed. Those that should be left to local discretion have also been identified. A significant number of elderly Virginians have been served through the Project. Over 16,000 individuals have been screened; 5000 individuals have received a comprehensive, multidimensional assessment and 4200 individuals received case management. One third of all case management clients were Medicaid eligible. The Project is now beyond the pilot stage and all sites have successfully implemented case management systems in their localities. One of the major recommendations of the Project participants is the suggestion that there not be one "cookie cutter" approach to case management replicated across the Commonwealth. Instead, there is the need for some policies and procedures to be standardized across all case management services and others which should be left to local discretion. Virginia Uniform Assessment Instrument (UAI) for Long-Term Care and Aging Services Through the Case Management for Elderly Virginians Pilot Project, a Uniform Assessment Instrument (UAI) has been developed. It is anticipated that the UAI will be adopted by all public health and human resource agencies by October 1994 for long-term care services. The purpose of the UAI is to gather information for the determination of an individual's care needs, and for service eligibility, planning and monitoring client care needs across agencies and services. The major advantage of the UAI for clients is that it ensures easy and equitable access to services; for providers, it provides a comprehensive picture of the clients; and for the taxpayers, it aids in the management, monitoring and evaluation of long-term care and aging services. A short assessment, within the comprehensive assessment, has been designed as a brief review of client needs to determine whether a full assessment is warranted or for use with clients with limited service or information needs. The UAI uses common definitions and establishes the framework for the development of criteria which can target services to those in greatest need. Virginia Client Level Data Base for Long-Term Care and Aging Services Through the Case Management for Elderly Virginians Pilot Project, a client level data base has been developed to capture the information from the UAl on case management clients. The pilot sites are serving as a laboratory for addressing the issues that occur when implementing a standardized statewide data base at the local level. Future plans are to continue development of a statewide client level data base which will capture information to record, measure and assess the quality, necessity and provision of long-term care services in Virginia. In response to House Joint Resolution 601, an interagency committee has been formed to develop and implement a statewide client level data base by July 1, 1995. This committee will develop a plan for a system that complements existing local and state computer systems and determine the resources at the local and state level required to implement such a system. Issues of confidentiality will also be addressed. Levels of Care Homes for Adults Task Force During the 1993 General Assembly, Senate Bill 1064 and House Bill 2280 established the statutory basis for: two-tiered licensing in adult care residences, (previously known as homes for adults); case management for auxiliary grant eligible residents; uniform assessments for all residents; restructure of auxiliary grant payments; and the need for a study of the intensity of service needs of the residents of the homes. A reference to the work of the Levels of Care Homes for Adults Task Force is included because many of the proposed regulations drafted to implement levels of care in adult care residences support or implement some of the requirements set forth in House Joint Resolution 601. Through the development of the regulations, a comparative review of all publicly-funded case management systems in Virginia has been completed. Policies have also been proposed which address the implementation of case management for publicly funded applicants and residents of adult care residents; the use of the UAI for the assessment of all residents; the implementation of standard qualifications for case managers; and authority for case managers to authorize publicly financed admission and continued stay in adult care residences. The intensity of service needs study has also been completed. The UAI served as the survey document for the study. Long-term Care and Aging Task Force A reference to the work of the Long-term Care and Aging Task Force (established in response to HJR 603) is also included in this report because the recommendations of the group are critical to accomplishing the requirements set forth in House Joint Resolution 601. In October 1993, the Long-term Care and Aging Services Task Force, in its report to the Secretary of Health and Human Resources, set 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. Such a system would offer the Commonwealth an opportunity to plan and respond to current and future needs of the citizens of the Commonwealth. This streamlining of the administration of long-term care and aging services at the state level will enhance the implementation of a statewide comprehensive case management system. The Task Force also included in its report its endorsement of the use of the UAI The Task Force recognized that standardization in assessing need for services will facilitate equitable distribution of services. Future Plans for the Statewide Case Management System Future plans for statewide development and implementation of a comprehensive case management system include: • Continue funding of the Case Management for Elderly Virginians Project; • Continue to explore the availability of additional funding for statewide implementation of case management beyond what is currently provided by local and state public health and human resource agencies (Funding sources might include Medicaid, state and local funds, and consumer fees); • Proceed with the implementation of the UAl across all publicly funded health and human resource agencies; and • Proceed with the development and implementation of a statewide client level database for all publicly funded long-term care services. |
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