Long-term care for seniors due for revamp

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Written by Linda Baker   
Thursday, November 29, 2012

11.29.12 Thumbnail SeniorsAs health care reform efforts get under way nationally, Oregon's Department of Human Services embarks on effort to modernize long-term care for seniors and people with disabilities.


oregon senior care revampOne of the most commented on stories in the Oregon Business archive is an article I wrote a couple of years ago about Romanian adult foster care providers. The comments tend to fall under one of three categories.

The good: "We found a great home in Beaverton ran by a great family and they took wonderful care of my father until he passed away in their home."

The bad: "I don't recommend (these homes) for people who are not ambulatory on their own due to the night time confinement.”

And the challenge of finding care for a loved one: “I have been blown away by the lack of national policy for the care of our elderly. It is mind boggling what is going to happen when all the baby boomers need care.”

One never knows exactly why one article generates more comments than another story, but my guess is that the latter comment gets to the core issue — that the story tapped into a deep-seated  anxieties about the way Americans take care of and fund services for the elderly.

In Oregon, a national leader in developing successful innovations in long-term care and support for seniors, these anxieties continue to attract the attention of policy makers. This past fall, the Department of Human Services launched an ambitious long-term care initiative—“LTC 3.0” — to rethink and modernize the state’s long-term care services for seniors and people with disabilities.

The project is driven by demographics. By 2020 there will be about 800,000 people 65 and older in Oregon; by 2040, people in that age group will represent about 20% of the state population. Individuals over age 85 will be the fastest growing segment of the population.  Meeting the needs of an aging population and maintaining the leadership earned over the past 20 years will require reviewing and enhancing the existing system.

Bob Weir, Advocacy & Development Manager for the DHS Aging and People with Disabilities Services Division (APD), frames the LTC 3.0 project this way:   “If the Olympics of long-term care were on the podium, don’t Oregonians deserve the gold?”

LTC 3.0 is very much a work in progress. This fall, DHS project leaders have held over 20 community meetings around the state to get feedback from the public; a meeting summarizing the community tour for stakeholders takes place on Monday. At this point, says Weir, there is no defined vision or plan, although some key themes have emerged.
For example, Weir said the existing long term-care system does a good job for people who need Medicaid assistance, “but that’s only 3.7 percent of all Oregonians.” One question going forward is whether the current system encourages a “pathway to poverty”: that is, whether the current system encourages people to spend down their assets to qualify for Medicaid instead of helping seniors use lower cost services.   

Another objective is coordinating long-term care with medical care, an effort that is beginning to happen as part of Oregon’s health care transformation. According to Weir, local APD offices now have to enter into a memorandum of understanding with their district Coordinating Care Organization, the new entities created last year as a way to improve efficiencies for Oregon Medicaid recipients. That MOU will focus on information sharing and information and working as a team.  

“It sounds simple, rudimentary,” says Weir. But under the old system — LTC 2.0 — doctors don’t know if a given patient is receiving home-care services, leading to obvious inefficiencies.

Expanding the state’s robust home and community care program is yet another goal. The state’s leadership in home-based care was a big part of my story about how the Romanians cornered the market on adult foster homes. Fleeing dictatorship in their native country, Romanians came to the right state at the right time, helping pioneer and grow a whole new industry in the United States — while saving the state millions of dollars a year in long-term nursing home expenses.

But according to Weir, there is still plenty of room for improvement, including ensuring everyone has a right to community-based care and ensuring the system doesn’t just treat people after they are in crisis. “We need to be preventative with folks,” he said.  Federal guidelines for community based care settings are also moving toward a “person centered care” philosophy, ensuring that care services meet the personal preferences and needs of the individual.

A quick aside.  Prevention, innovation and coordination dominate the LTC 3.0 rhetoric.  If those themes sound familiar, it’s because they gird most of the big policy reforms under way in Oregon, be it in health care, education, corrections, and now, long-term care. In all these areas, the goals are improved services and reduced costs to individuals, businesses and the state.

What’s next on the  LTC 3.0 agenda? The goal is to roll out the concept during the 2013 legislative session, then work on an implementation plan over the next year, with specific legislative proposals to come in 2014.

Today the number of senior citizens is growing and the number of seniors are facing financial hardships, increasing the burden on families and the state.  In that context, the LTC 3.0 may be one Olympian step toward alleviating the anxieties that we continue to read about in the Oregon Business comments section appended to a niche article about how Romanians cornered the market on adult foster care in Oregon.

"I'm pretty sure," writes one of those commentators, "that America is at the top of the list for our spot-on reputation of being one of the world's worst perpetrators when it comes to taking care of our elderly."

Linda Baker is managing editor of Oregon Business.


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