HD64 - A Plan for the State-Level Consolidation of Aging and Long-Term Care Services and the Coordinated Delivery of Such Services at the State and Local Levels


Executive Summary:
House Joint Resolution No. 209 of the 1994 Session of the Virginia General Assembly requested that the Secretary of Health and Human Resources, in cooperation with appropriate state and local agencies and organizations, review the plan for state-level consolidation of certain long-term care and aging services within a single state agency, and develop a plan for the coordinated delivery of such services at both the state and local levels. This report presents the Secretary's response to this request.

To assist the Secretary, the Advisory Committee on Aging, Disability and Long-term Care Services was established by the Secretary. More than two dozen agencies and organizations were represented on the Committee. In May and June, 1995, ten regional forums were hosted statewide to receive input from stakeholders at the community level. The forums were attended by over 800 people. representing consumers, providers, local governments, health and human resources agencies and others interested in the delivery of aging and long-term care services. Hundreds of individuals, agencies and organizations also submitted comments through letters, telephone calls, and attendance at the meetings of the Advisory Committee.

Since the early 1980's, numerous efforts have been made to improve the delivery of aging and long-term care services in the Commonwealth. The need for reform of aging and long-term care services has been extensively documented in the reports on the many efforts to improve the delivery of such services. There are a number of trends which make aging and long-term care services a significant public policy issue and which suggest that changes are needed in the way services are administered and delivered. These include increased longevity and an expanding aging population and the growing need for affordable, quality long-term care services for people of all ages.

The comments and recommendations presented by participants of the statewide forums have been compiled in a report by the Advisory Committee on Aging, Disability and Long-term Care Services. A copy of "Reports from the Statewide Forums on Long-term Care and Aging Services: Identified Issues and Recommendations" is available from the Virginia Department of Medical Assistance Services. Division of Long-term Care Policy and Development; 600 East Broad Street, Suite 1300; Richmond, Virginia 23219.

While many comments and recommendations were received from a large number of individuals, agencies and organizations, the majority of the comments repeatedly focused on the following issues:

• overall guiding principles or philosophies for the Commonwealth's system long-term care services;
• consumer access to aging and long-term care services;
• the availability of information about all available services; and
• the role of the local government in the provision of long-term care services.

The extensive input received by the Secretary from the Advisory Committee and the many interested persons, agencies and organizations has served as the basis for the following recommendations to improve the delivery of services at the local level.

Recommendations to Coordinate and Enhance Local Service Delivery

Recommendation #1: The continued development of the Commonwealth's long-term care system should be guided by principles which reflect the desires, needs, and resources of the people of the Commonwealth.

Recommendation #2: State-level health and human resources agencies should continue to simplify policies and procedures to streamline and improve access to aging and long-term care services that are provided by local health and human resources agencies.

Recommendation #3: Local health and human resources agencies' and local governments' efforts to coordinate' and enhance the provision of services should be recognized and supported.

Recommendation #4: The Department of Social Services.. with the assistance of the Information and Referral Advisory Council, should provide the leadership necessary to strengthen and coordinate information and referral services of health and human resources agencies to increase consumer, community, and provider awareness and utilization of available resources and services in communities across the Commonwealth.

Consolidation and Improved Coordination of State-Level Services

In 1994, the Secretary of Health and Human Resources, with the assistance of the affected state agencies, developed a proposal to consolidate the Department for the Aging and the Department of Medical Assistance Services, and the long-term care functions from the Departments of Health. Social Services, Mental Health, Mental Retardation and Substance Abuse Services, and Rehabilitative Services. Over the past- year, individuals. agencies and organizations have had the opportunity to review the proposal and.to offer comments and recommendations on ways to improve the delivery of aging and long-term care services at both the state and local level.

Several concerns have been raised about the consolidation proposals which have been offered over the last several years. While there are still some people that suggest, "the system isn't broke, so don't fix it," more and more people are saying improvements are needed in the state-level administration and management of aging and long-term care to meet the ever increasing demand for such services. State-level consolidation appears to be a generally recognized appropriate approach to remedy some of the ills in the current system. What is consolidated and how it is done continues to be debated. In addition, Congress is now debating the proposals to reform the Medicare and Medicaid Programs. Consideration is also being given to the expansion of managed care programs including long-term care services.

In light of these developments, and the concerns that have been expressed regarding the proposals for state-level consolidation, it is recommended that the following actions be taken, without delay, to improve the state-level administration and management of aging and long-term care services.

I. Maintain the focal point for long-term care services at the Department of Medical Assistance Services, including the overall planning, development, and funding of long-term care services. Reiterate the Department's responsibility to provide the leadership necessary to facilitate the development of effective long-term care policies and programs and to serve as the focal point for state level activities related to long-term care.

II. Maintain a separate department for the aging and strengthen the existing Department for the Aging's focus on educating the public (including individuals, businesses, employers, policy makers, local governments and elected officials) to increase public awareness of the issues facing an increasingly larger older population, and to encourage personal responsibility and the development of policies, programs, services and products for an aging society.

III. Consolidate the certification and licensing functions of the Department of Health and the licensing of adult care programs of the Department of Social Services. This should be done in either the Department of Health or the Department of Medical Assistance Services.
The report which follows elaborates on each of the points outlined above. The need to improve the state-level administration and local level service delivery of aging and long-term care services has been extensively documented for more than fifteen years. Recommendations to improve such services have been numerous. Immediate action must be taken to guide the needed development of aging and long-term care services in the Commonwealth.