During the 2008 session, House Joint Resolution 69 was introduced by Delegate Kenneth R. Plum directing the Joint Commission on Health Care to study alternative solutions to long-term care needs “including identifying and reviewing alternatives to traditional long-term care facilities such as intentional communities of clustered homes." The resolution was left in the House Committee on Rules but the study was agreed to by JCHC upon request by Delegate Phillip Hamilton.

Senate Joint Resolution 102, introduced by Senator Walter A. Stosch during the 2008 General Assembly Session directed the Joint Commission on Health Care (JCHC) “to study support services for family caregivers of the frail elderly and disabled and community-based caregiver support organizations." SJR 102 was agreed to by both houses of the General Assembly. An identical resolution, House Joint Resolution 238, introduced by Delegate Stephen C. Shannon was left in the House Committee on Rules.

The studies for HJR 69 and SJR 102 were combined due to their overlapping subject matter and JCHC meeting time-constraints.

The great majority of individuals prefer to live at home, however the traditional long term care model is not designed to facilitate this preference. Recognizing the need to support greater community-based care, Virginia has created a number of programs such as No Wrong Door, Virginia Easy Access, the Program for All Inclusive Care for the Elderly (PACE), and Money Follows the Person. However, there are still challenges including limited reimbursement for in-home care, fragmented services and funding sources, and strict requirements for Medicaid qualification that prevent individuals from receiving in-home services. Greater support for informal caregivers also is needed. There are several programs in other states that could be used as a model for Virginia to help caregivers. Key elements of these programs include: a single coordinating organization for all services, central point of entry to caregiver resources and information, on-line resource center, standardized call center, family caregiver education and training programs, and caregiver assessments at the point of entry. Two additional innovative approaches to helping elders age at home, the Cash and Counseling Program and Intentional Communities, are addressed in the study.

Aging at home is not always possible or preferable, but many individuals dislike the institutional feel of traditional long-term care facilities. To help nursing homes and assisted living facilities to be as home-like as possible often requires cultural change. The traditional long-term care model is based on the use of large institutional facilities operated according to a medical model that emphasizes efficiency, a hierarchical management structure, rules, routines, and requirements. “Culture change in long-term care is an ongoing transformation in the physical, organizational and psycho-social-spiritual environments that is based on person-centered values…and restores control to elders and those who work closest to them" (Pioneer Network). Initial research has shown that culture change increases the quality of life for residents and the work environment for staff, lowers turnover rates, and that many improvements can be accomplished without substantially increasing operating costs. One of the most innovative models of the culture change movement is The Green House which creates a more home-like environment. Six to ten elders live together in a “house" with a central hearth, kitchen, and dining area where all elders and staff interact in a more familial manner. The work structure is less hierarchical and staff members are empowered to make decisions as a collective, with elder input. The culture change movement has resulted in many changes in nursing and assisted living facilities nationally and in Virginia.

Based on the study’s findings, JCHC voted to continue the study for one additional year to research options for improving “aging at home" services and support for culture change initiatives in Virginia, to restore funding for the Virginia Caregivers Grant when budget allows, and to partner with local Chambers of Commerce in order to educate Virginia business owners about caregiver workforce issues and encourage owners to provide caregiver support programs.

A report will be submitted to the General Assembly and the Governor at a later date for publication as a Senate document.