Lessons Learned

1
Lessons Learned

• Oregons Long Term Care System August 2005
• Cindy Hannum, Administrator
• Office of Licensing Quality of Care
• Seniors People with Disabilities
• Department of Human Services
• [phone]
• cindy.hannum_at_state.or.us

2
Initial Vision - 1981

• Person Centered Values
• Choice, Independence, and Dignity
• Serve more people and lower cost per case
• Home/Community Care Focus
• Statewide Availability
• Single Entry Access

3
State Statute on Aging and Disability

• Created a single state agency to administer
  Medicaid long-term care, Older Americans Act, and
  OPI programs
• Partnership with local government
• Emphasize the development of community based care
  programs

4
Oregon Statutory Specifications

• Coordinate community services
• Assure health and social services to allow
  persons to live as independently as possible
• Foster preventative and primary health care
• Prevent inappropriate or premature
  institutionalization

5
Legislative Mandate(ORS 410)

• a growing elderly population demands services
  be provided in a coordinated manner that the
  elderly and disabled citizens of Oregon will
  receive the necessary care and services at the
  least cost and in the least confining situation
  it is appropriate that savings in nursing home
  allocations be reallocated to alternative care
  services

6
Critical Elements of Success

• Development of Services
• Use of informal care
• Home Care
• Relative Foster Care
• Residential model development
• Adult Foster Homes
• Residential Care
• Assisted Living Facilities
• Enhanced Care Special Populations

7
Critical Elements of Success

• Community Based Care Nursing
• Refocus Nursing Facility Care
• Skilled Rehab
• PACE
• Develop for private pay not just for Medicaid

8
Critical Elements of Success

• Delivery System
• Statewide Accessibility
• AAA Partnership
• Single Point of Entry coordination of services
• Common assessment planning tool and assessment
  process
• Purchase of services from publically available
  services

9
Critical Elements of Success

• Long Term Care Regulations
• Value driven beyond health and safety
• Person centered approach
• Incorporate nurse teaching and delegation
• Partnership with Board of Nursing
• Collaboration with advocates
• and providers

10
Oregon Assisted Living 1990s

• Environment
• Occupancy Individual / Couple
• Private Apartments / Private Bath
• Philosophy Social Model
• Independence, Consumer Direction, Dignity, Choice
• Aging in Place
• Functional Limitations
• Lay Caregivers

11
Oregon Assisted Living Year 2005

• Informed Choice / Disclosure
• Admission
• Service Agreement
• Health Oversight
• Chronic Care Management
• Assessment / Service Plan
• Change of Condition
• Nurse Delegation
• Capacity to Provide Care Services
• Capacity to Provide Care Services
• Adequate Staffing / Qualifications
• Training
• State / Provider Collaboration
• Standards / Training
• Special Projects

12
Future Challenges

• Quality Accountability Cost Containment
• Population Growth
• Boundaries of Client Choice
• Refinement of service eligibility and level of
  care
• Control over provider rates
• Escalation of home care workers costs
• Collective Bargaining
• Adequate supply of trained caregivers
• Focus on chronic care management
• Maximizing FFP strategies