Planning for Change in Long Term Care

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Planning for Change in Long Term Care
Dane Rock Counties

• Partnering with
• Community Living Alliance
• Elder Care of Wisconsin

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Definition
Planning for Change in Long Term Care
Long Term Care is..

• Help with everyday activities of living (such as
  bathing, eating, dressing, getting to the
  bathroom, fixing a meal, shopping, cleaning)
• Can be in ones home, in a nursing home or group
  home, at ones school or workplace, or anywhere
  else
• For people of all ages who need help because of
  long-term disability

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Definition
Planning for Change in Long Term Care
Long Term Care is Not

• Acute and primary physical health care (doctor
  visits, hospital stays, prescription drugs)
• Mental health care
• Room and board
• Short-term assistance with activities of daily
  living needed because of temporary illness or
  injury

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History
Planning for Change in Long Term Care
The First Reform

• In 1980, the Community Options Program (COP)
  started
• Covers care in homes and community settings
• Gives people choices
• In 1980s, home and community-based waiver
  programs started (COP-W, CIP 1a, CIP 1b, CIP 2)
  similar to COP, but with federal financial
  participation

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History
Planning for Change in Long Term Care
The Second Redesign

• Beginning 1995, several years of intense study
  and discussion, beginning with focus groups of
  consumers in all settings
• Many, many work groups, all involving consumers
  and family members
• Series of consumer forums
• And lots of other process

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Current
Planning for Change in Long Term Care
Goal of Current Redesign

• The Department of Health and Family Services will
  foster the statewide development of comprehensive
  long term care and support systems that maximize
  independence, recovery and quality of life, while
  recognizing the need for interdependence and
  support.

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Current
Planning for Change in Long Term Care
Goal of Current Redesign (cont)

• The redesigned system will provide individuals
  and families with meaningful choices of supports,
  services, providers, and residential settings, as
  long as such care or support is necessary, meets
  an adequate level of quality, is cost-effective,
  is consistent with the individuals values and
  preferences, and can be provided within available
  resources.

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Future
Planning for Change in Long Term Care
Family Care

• Aging and Disability Resource Centers
•       One-stop shopping for information and
  assistance
•       Eligibility determination
•       Long-term care options counseling
•       Prevention programs
•       Emergency response
• Access to other benefits

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Future
Planning for Change in Long Term Care
Family Care

• Care Management Organization
•       Provides help with managing services
•       Care management team includes at least a
  nurse, a social worker and the member (or
  guardian)
•       Manages the funding
•       Develop and manage a comprehensive network
  of services choices in every category
•       Accountable for quality

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Future
Planning for Change in Long Term Care
Family Care Benefit

• ALL LTC from sidewalk shoveling to nursing home
  care in one flexible benefit
• COP/Waiver services and Medicaid card services
• Home health, personal care, nursing facility,
  ICF-MR, adult day care, home modification, home
  delivered meals, supportive home care, and many
  others)

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Future
Planning for Change in Long Term Care
Family Care Benefit (cont)

• Services individualized based on assessment of
  needs
• Members participate in determining what services
  they get and where they get them with support and
  information from CMO team
• Members live in private homes, in group homes,
  nursing homes
• Members get help coordinating health care and
  achieving employment objectives

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Future
Planning for Change in Long Term Care
Family Care Savings

• Family Care saves money directly by purchasing or
  providing services more economically
• Family Care reduces costs indirectly by helping
  members have better health and abilities to
  function, so they have less need for services.

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Definition
Planning for Change in Long Term Care
Partnership Programs

• Demonstration programs under federal waiver
• Similar to Family Care, except also includes
  funding and management of primary and acute
  health services
• Many members also eligible for Medicare program
  receives separate payment from feds for
  Medicare-covered services
• Many members have multiple and severe health
  issues
• Broader care management team that includes nurse
  practitioner and members physician

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Current
Planning for Change in Long Term Care
Partnership Programs

• Elder Care Dane County age 55
• Community Living Alliance Dane County age
  18-65
• Community Care Milwaukee and Racine Counties
  age 55
• Partnership Health Plan Dunn, Chippewa and Eau
  Claire Counties age 18

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Planning Structure
Planning for Change in Long Term Care

• Dane and Rock Counties receive planning grants
  from the State
• Dane and Rock partner with Elder Care and
  Community Living Alliance
• Initiative is known as Planning for Change in
  Long Term Care
• Steering Committee formed which includes
  representation from stakeholders

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Actions Taken
Planning for Change in Long Term Care
Goal Statement Developed

• Goal 1 Develop a managed care model for
  provision of long-term care services for frail
  elderly and people with physical disabilities who
  meet financial and functional eligibility for
  Family Care. The model will
• provide a seamless continuum of managed care
  service options for people with physical
  disabilities and elders.
• reflect a commitment to high quality, cost
  effective service for frail elderly and people
  with physical disabilities
• be consistent with/complement non-managed care
  services that will remain a county responsibility

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Actions Taken
Planning for Change in Long Term Care
Goal Statement Developed (Goal 1 cont)

• include a plan for serving eligible persons on
  the waiting lists for long-term care services
  building toward an eventual entitlement model
• be fiscally sound and sustainable in terms of
  capitation rate, risk reserve, shared risk, and
  federal, state, county and CMO contributions  
• build on the core competencies, knowledge of the
  populations and service strengths of both the
  private and county partners and
• allow opportunities for self-direction of services

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Actions Taken
Planning for Change in Long Term Care
Goal Statement Developed (cont)
Goal 2 Plan for an Aging and Disability
Resource Center (ADRC) that will serve older
adults and people with physical disabilities in
Dane County and support the implementation of
managed long-term care. The ADRC model will
include or allow expansion to serve persons with
developmental disabilities and mental
health/substance abuse needs
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Actions Taken
Planning for Change in Long Term Care
Goal Statement Developed (cont)
Goal 3 Develop a communication plan to make
certain the broad Dane County community,
including consumers, community agencies,
families, guardians and other interested parties,
can learn about and follow the planning process
and are aware of the opportunities to participate
and/or voice ideas and concerns.
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Actions Taken
Planning for Change in Long Term Care
Goal Statement Developed (cont)

• Goal 4 The Dane County Long-Term Care Reform
  planning process will
• develop a clearly defined set of Action Steps
  describing Dane County's readiness to implement a
  managed care program for financially and
  functionally eligible frail elderly and people
  with physical disabilities
• identify statutory/regulatory issues that need to
  be addressed to successfully implement the
  managed care program

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Actions Taken
Planning for Change in Long Term Care
Goal Statement Developed (Goal 4 - cont)

• study ways to a create seamless, continuum of
  care for eligible consumers by maximizing the
  potential integration of funding streams and
  services of both the Medicare and all Medicaid
  funded services
• incorporate the guiding principles of
  consumer-centered and self-directed care
• define a governance structure
• take into account the proposed reimbursement
  rates for long-term care services for Dane
  County and

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Actions Taken
Planning for Change in Long Term Care
Goal Statement Developed (Goal 4 - cont)

• will include an active and appropriate role for
  consumers and stakeholders, particularly in the
  development of a Quality Assurance/Improvement
  program. Existing structures for consumer input
  will be utilized where possible. The plan will
  address development of a LTC Council or other
  structure for ongoing, post-implementation
  consumer input.

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Key Tasks
Planning for Change in Long Term Care
Identifying a Governing Structure

• Define relationship with state and between
  partners, including oversight, financial
  management, etc.

Define Which Benefits Will Be Available

• Family Care Model
• CMO/Acute Care

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Key Tasks
Planning for Change in Long Term Care
Subcommittees Formed to Address Key Needs

• Aging Disability Resource Center (ADRC)
  Development
• Communications/Public Involvement
• IT/Fiscal
• CMO Development

Stakeholders will be involved in subcommittee
work as appropriate for example to help determine
a grievance system, development of quality
assurance process and system access issues.
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Future Meetings and Activities
Planning for Change in Long Term Care

• Town Hall Meetings
• Dane County - November 13th, February 7th and
  May 21st at 200 p.m. and 630 p.m. at Alliant
  Energy Center
• Rock County - October 5th, January 8th and April
  9th at the Rock County Job Center in Janesville

• Focus Groups
• Invited participants help give feedback on
  specific issues and tasks related to Long Term
  Care planning process.

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For More Information
Planning for Change in Long Term Care
FOR MORE INFO...
Visit our Planning for Change in Long Term Care
website at   http//www.danecountyhumanservices.o
rg/longterm.htm