State government spends more than $500 million dollars annually on long-term care services, primarily on nursing home care financed by the Medicaid program. Approximately 77 percent of the state's long-term care related Medicaid expenditures are for nursing home care, and the Medicaid program finances approximately 70 percent of the nursing home care in the Commonwealth. The Medicaid program also finances an array of home and community based services, including adult day care, respite care, and assisted living care. In addition to the Medicaid program, the state provides long-term care related services through five other Health and Human Resources agencies including the Department for the Aging; the Department of Mental Health, Mental Retardation, and Substance Abuse Services; the Department of Health, the Department of Rehabilitative Services, and the Department of Social Services.

In addition to long-term care, which affects a number of populations including but not limited to the elderly, aging issues will be an increasingly important area of concern for state government. Virginians over age 85 are the fastest growing segment of the state population. Aging issues potentially impact many if not most of the areas of state government, including education, public safety, transportation, and economic development, in addition to health and human resources.

Past studies of long-term care and aging issues have tended to treat the two issues as synonymous. While there are important areas of overlap between these two issues; the two issues are distinct. Long-term care effects populations other than the elderly (such as the mentally disabled), and most of the elderly do not require long-term at any given time. At the same time, aging issues include a variety of issues such as programs for older drivers and employment opportunities that are not long-term care related.

Senate Joint Resolution 316, House Joint Resolution 655, and Item 12 of the 1997 Appropriation Act directed the Joint Commission on Health Care to examine long-term care and aging issues. The Commission formed a subcommittee to examine these issues. The subcommittee's work included site visits to a nursing home, assisted living facilities, a continuing care retirement community, a local Department of Social Services, and an Area Agency on Aging. The subcommittee also held four meetings during the fall of 1997.

This study examines financing and coordination issues related to long-term care. The study also examines aging and elder rights issues. The study resulted in a number of statutory changes, resolutions, and budget amendments to be introduced during the 1998 General Assembly. These legislative actions were adopted by the Joint Commission on Health Care during its January 6, 1998 meeting. These include:

• a bill establishing a Deputy Secretary of Health and Human Resources for Long-Term Care and charging the secretary of Health and Human Resources with (1) coordinating the implementation of the state's long-term care policy as established by the General Assembly, and (2) developing a long-range plan for financing long-term care for the elderly and frail elderly (companion budget amendments for $100,000 to fund the position and $350,000 for small demonstration projects were also approved);

• a bill eliminating the Department for the Aging's statutory responsibilities for coordinating long-term care (these responsibilities would now be assigned to the Secretary of Health and Human Resources);

• a bill strengthening the Governor's Advisory Board on Aging by clarifying the powers, duties, and membership of the Board;

• a bill strengthening the statutory foundation of the adult protective services program;

• a bill improving enforcement of health and safety standards in adult care residences by empowering the Commissioner of the Department of Social Services to more quickly impose intermediate sanctions;

• a resolution continuing the joint Commission on Health Care's long-term care subcommittee and a companion budget amendment funding staff for the subcommittee;

• a resolution directing the Joint Legislative Audit and Review Commission to study the mission and operation of the Department for the Aging;

• resolutions directing the Department of Health and the Department of Social Services to report on past studies of their long-term care licensure programs and the staffing and training needs of these programs;

• a resolution directing the Virginia Retirement System to study the feasibility of offering a long-term care insurance program for state and local government employees and retirees;

• a budget amendment directing the Department for the Aging to privatize the elder rights program and providing $130,000 (GF) in each year of the biennium to fund an elder rights hotline program;

• a budget amendment providing $180,000 (GF) in each year of the biennium for the expansion of the long-term care ombudsman program statewide;

• a budget amendment providing $2.79 million (GF) in each year of the biennium for the expansion of the case management program through Area Agencies on Aging statewide.

Our review process for this study included an initial public briefing followed by a public comment period during which interested parties forwarded us written comments on the report. In many cases, the public comments, which are provided at the end of the report, provide additional insight into the various topics covered in this study.