long-term care - Legislative Reference Bureau

CONCEPT OF A SINGLE ENTRY POINT
programs designed to respond to their special needs. Identification of such groups -including
people of all ages with physical and developmental disabilities and chronic
mental illness -- is helpful in illustrating the broad scope of the problem. The
coordinated systems of care for the elderly . . . should be equally useful as models
for chronic care services for these other groups as well.
What is less clear is how successful a system can be when dealing with several long-term
care populations within that one system.
Nonetheless, coordination of these tasks would seem to lead to more complete and
appropriate assessments for the provision of appropriate needed care. An integrated process
should also help to ensure a smooth and timely transition from one step in the process to the
next. The chances of a consumer not being referred to the appropriate agency (cabinet or
umbrella models) should be reduced.
Again, coordinating the entry process tasks of screening, assessment, and case
management within a single system does not imply a single physical locus. The key is
operating under a single entry point concept that is based on coordinating or consolidating the
various entry process tasks -- whether among different agencies, under one umbrella agency,
or within one sole-purpose superagency. Whatever the scenario, it would be naive to
predicate an SEP on a single geographical location. That is not to say that an SEP is not
susceptible to bottlenecks. The greater obstacle -- and the greater reward -- lies not in
maximizing the number of geographical entry points but in the challenge of standardizing
multiple criteria for multiple target populations: 17
Regardless of the organizational approaches adopted, the issues which must be
examined across various programs are the same. They include: designing a single
delivery system supported by multiple funding sources; developing eligibility
criteria for individual programs to ensure equitable treatment of persons with
similar needs ·and resources; and examining the mix of community care services
supported by each funding stream. Ultimately, the goal of these efforts is to create
the continuum of care which each individual program rhetorically has embraced but
cannot by itself achieve.
Regardless of the model of state government, a coordinated SEP process should help
reduce service fragmentation at the level of the individual consumer: 18
How programs are organized at the local level is even more important than how
state responsibilities [i.e, which state organization models] are organized. Older people
come in direct contact with local agencies and their differing eligibility criteria,
service packages, and funding sources. If state policies are successful, the elderly
will have access to appropriate care without having to contact multiple agencies to
receive services for which they are eligible. Therefore, most of the study states
[Arkansas, Illinois, Maine, Maryland, Oregon, and Wisconsin] have designated a single
local agency in each part of the state to serve as the client access point for receipt
of all publicly financed community care programs. Centralizing entry helps make
the system less fragmented from the perspective of older people in need of
assistance, while helping states gain better control of total program costs. Client
assessments, pre-admission screening programs, and case management are the key
components of access systems for community based care programs. [Emphasis
added]
Gatekeeper in a Managed Care System: As just noted, an SEP process can also be
seen to serve a gatekeeper function in a managed care system. Even without an SEP,
because "[o]lder people actively seek community based care services, while going to great
lengths to avoid nursing home placement" and because of the accompanying "piecemeal
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