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OP-ED | Rebalancing Long-Term Care Offers Budget Bright Spot

by | Apr 24, 2013 8:33pm () Comments | Commenting has expired | Share
Posted to: Opinion

Connecticut continues to face the fiscal strains of a slowly recovering economy and persistent unemployment. That means lawmakers in Hartford face difficult decisions and new challenges to Connecticut’s already strained safety net.

But, good fiscal policy doesn’t always come at the expense of good public policy. In fact, the governor and legislature’s budget proposals offer a path to achieving both when it comes to providing long-term care for our seniors and people with disabilities. It’s time we embrace a balanced long-term care system that provides more consumer choice and better care at a lower cost.

Connecticut has historically supported a long-term care system that is heavily reliant on institutional nursing home care. This restrictive, one-size-fits-all approach is more costly (averaging $74,825 per year) and less desirable to most consumers than receiving care at home. Consider, in 2009, the state spent 65 percent of its Medicaid long-term care dollars on institutional care for older residents and people with disabilities, even though 75 percent of consumers preferred less costly options in the community.

That policy direction is no longer sustainable given the state’s demographic trends. Connecticut anticipates a 25 percent increase in the demand for long-term care services by 2025. Fortunately, bipartisan consensus is building to shift long-term care funding to community based alternatives and family caregiver supports that deliver cost-effective care in the setting consumers prefer. Specifically, Gov. Dannel P. Malloy’s budget proposes a $13 million state investment to expand community based services. This includes $10 million in bonding for nursing home “right-sizing,” which was also included as part of the Finance Committee bonding package last week. Right-sizing begins with the simple premise that our long-term care system should respond to the people it serves. Put in market terms: supply should match demand.

Through “right-sizing,” nursing homes can compete for grants to redesign, update and modernize their business model to match the needs and preferences of local residents.The initiative encourages flexibility and fosters innovation. A nursing home, for example, could apply for funding to convert a portion of their facility into an adult day center or offer temporary respite services for family caregivers. Offering such services allows the nursing facility to expand its customer base beyond traditional clients that need institutional care, and consumers gain new options for home and community based services. 

Taxpayers also benefit. That’s because shifting state resources to cost-effective community based supports is less expense and will result in more people served for each dollar spent. On average, Connecticut can serve someone in the community at about one-third the cost of serving that same individual in an institution. It is no coincidence that one of the most successful programs to expand home and community based care—Money Follows the Person—was first created as part of the Deficit Reduction Act of 2005. Empowering consumers to choose community based services, when those services are appropriate, saves Connecticut money and improves health outcomes. 

CT21 has done studies calling for rebalancing LTC for all the reasons we cite here (see www.CT21.org ). In addition, CBIA’s “Turning the Tide” report on state spending says rebalancing LTC is one of the keys to restore and sustain fiscal health in the Connecticut state budget.

Let’s be clear: right-sizing does not mean we can abandon traditional nursing home care. To the contrary, right-sizing fosters healthy, diversified business models so nursing homes remain financially viable to deliver high quality care for individuals that need or choose institutional care. The policy objective is to strengthen the full continuum of long-term supports consistent with consumer preferences in each community. 

Both fiscal expedience and consumer preferences demand action. Let’s seize this opportunity to empower consumer choice, strengthen our long-term care system and stretch limited state resources.

Nora Duncan, state director, AARP Connecticut and Peter M. Gioia, vice president and economist, Connecticut Business & Industry Association.

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(2) Archived Comments

posted by: BrianO | April 25, 2013  11:36am

“But, good fiscal policy doesn’t always come at the expense of good public policy.”

Absolutely.  In fact, with increasing social service needs and limited resources, good fiscal policy that seeks to deliver better services at less cost IS good public policy.

posted by: Personcenteredcare | April 27, 2013  11:40am

There is no question that the governor’s plan is the right direction.  Life at home, smaller homes, and changes to existing institutions, with “person centered care,” “dignity” and “choice,” are what seniors and their families will want. ...But while the plan discusses the savings and the number of beds that will be needed, other issues are neglected. .  Connecticut’s hospitals were recently penalized for among the 2nd highest readmission rates for elders in the country.  Connecticut’s nursing homes have among the lowest legal requirements for staffing in the country, and as a recent report noted among the highest rates for use of dangerous antipsychotic drugs for dementia patients.  Home Health Services were rated for key quality indicators in the bottom third of all states for 2011.  There is no established metric for surveying the satisfaction of consumers and their families.  Nor is there any assessment of the problem solving ability of the Department of Health or the satisfaction of stakeholders who have filed complaints.    Highly rated nursing homes in Connecticticut (including one that achieved a “best in the country” status from U.S. News and World Reports), have been fined for neglect to patient wounds, lack of supervison, avoidable deaths, and even in one instance a resident who developed maggots.  There is a little public examination of the regulatory process, and any enforcement that facilities are given are subject to a lengthy appeals process which takes place largely outside of the public eye.    On average the care plans lapses including deaths merit fines of less than a thousand dollars while in contrast, the legislature unanimously passed a measure to increase penalties for animal neglect and cruelty to a minimum of 5000. dollars last year.  There are currently only 9 omudsman for a population of 30,000 which is expected to double.    Is keeping elders who will need the same high level of care and supervision in the community going to resolve all of these problems? - Not without examination and effective planning. In others states a shift to the community without the proper resources and oversight have multiplied cases of abuse and neglect, as well as the suffering of preventable conditons. ( See the Michael Berens series:  Seattle Times September 15, 2010 “Seniors for Sale” )  Of course people are going to want to remain in the community, and keeping at vulnerable elders at home and more connected to the community is what everyone wants, but doing this without a comprehensive plan that improves existing facilities, provides clear and effective avenues for advocacy,  and ensures a coordinated approach to health needs, does so at this risk of creating more suffering for our elders.  It can not be accomplished by simply counting beds, loosening regulations, and moving people.

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