long-term care - Legislative Reference Bureau

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FOREWORD This study was undertaken in response to Senate Concurrent Resolution No. 33 and Senate Resolution No. 27, adopted during the Regular Session of 1995. This study examines, in general, the concept of a single entry point for long-term care services and its advantages and disadvantages. The operation of coordinated systems, including the use of single entry points in other states is also reviewed. The situation in Hawaii is discussed and a recommendation is made for the implementation of a single entry point for long-term care services for disabled children, non-elderly adults, and the elderly. We extend our sincere appreciation to all who contributed and without whose cooperation this study would not have been possible. December 1995 ii Wendell K. Kimura Acting Director
TABLE OF CONTENTS Page FOREWORD......................................................... ........................................... ii 1. INTRODUCTION ............................................................................................. . 1 Senate Concurrent Resolution No. 33 and Senate Resolution No. 27 .......... 1 Limitations and Focus of Study...................... ........................................... 1 Organization of the Study ......................................................................... 2· 2. CONCEPT OF A SINGLE ENTRY POINT ........................................................... . 4 Concept of Single Entry Point (SEP)....... ........ ............ ..................... .......... 4 Horizontal and Vertical Integration............................................................. 4 System Fragmentation..... ................... ........ ....... ..... ........... .......... ....... ...... 4 SEP as One Component of an Integrated Long-Term Care System ............. 5 A Horizontally Integrated SEP Process...................................................... 7 Obstacles to Service Integration................................................................ 7 A Vertically Integrated SEP Process ..................... ... ... .......... ... ....... ........... 9 Gatekeeper in a Managed Care System..................................................... 10 Preadmission Screening -- Financial Eligibililty Determination ........... .... ...... 11 Medicaid Payments for Home Health Services and Nursing Homes ............ 13 Screening and Functional Eligibility ........................................................... 14 Assessment -- Capacity for Independent Functioning ................................. 15 Sample Assessment TooL......................................................................... 16 Standardized Assessments -- Difficulties........ ............... ............ ................ 19 Numericai Assessments -- Gatekeeper Function ........ .......... ...... ..... ....... .... 21 Case Management................................................................................... 22 Functional and Financial Eligibility Determination ..... ....... .................... ... .... 25 Service Authorization -- Advocacy and Cost Control................................... 26 Endnotes .............................................. ................................................... 27 3. LONG-TERM CARE SERViCES ........................................................................ . 31 Overview ................................................................................................. 31 Single Entry Point and Long-Term Care Services ....................................... 31 Nursing Homes and Community- and Home-Based Long-Term Care ........... 32 Long-Term Care and Long-Term Care Populations ..................................... 32 Long-Term Care Populations..................................................................... 33 Long-Term Care Services as Supports for Functional Limitations ................ 34 Long-Term Care Services -- A Continuum ............. ...... .... ........... ...... ...... .... 35 Inconsistent Terminology .......................................................................... 42 Home Care -- Informal Support by Family Caregivers ................................. 43 Home Care -- Personal Care and Homemaker Services.............. ................ 44 Adult Day Care and Adult Day Health Centers...... ..................................... 44 Adult Day Health Centers........................ ....... .......................................... 46 ADCCs and ADHCs in Hawaii ................................................................... 47 Social/Health Maintenance Organizations for Elders. ......... ............... .......... 47 Hawaii -- ADHCs and PACE...................................................................... 48 Alternative Living Arrangements................................................................ 48 iii
Page 1: LONG-TERM CARE: A SINGLE ENTRY POIN
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SINGLE ENTRY POINT FOR LONG-TERM CA
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LONG-TERM CARE SERVICES • Some pe
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LONG-TERM CARE SERVICES (1) Suffer
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Traditional Developmental Services
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77. Ibid., pp. 18-19. SINGLE ENTRY
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OTHER STATES purchased with state a
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OTHER STATES The main impetus for t
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OTHER STATES long-term care, includ
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34. Ibid., pp. 5-6. 35. Ibid., p. 6
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79. Ibid. SINGLE ENTRY POINT FOR LO
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Chapter 5 HAWAII Organization: Part
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HAWAII (2) Case Management: Continu
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HAWAII (5) A geriatric psychiatry t
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HAWAII As mentioned above, there is
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HAWAII • Home maintenance • Nut
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HAWAII the time of its closing, Pro
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HAWAII (2) Conducting public affair
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50. Ibid., p. 13. 51. Ibid. 52. Ibi
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85. Seely memo, p. 2. SINGLE ENTRY
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SINGLE ENTRY POINT FOR LONG·TERM C
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SINGLE ENTRY POINT FOR LONG·TERM C
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THE SENATE EIGHTEENTH LEGISLATURE,
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Appendix B Model Long Term Care Ass
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ASSESSMENT FACE SHEET The assessmen
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PHYSICAL HEALTH r------------------
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MedicationsfTreatments/Services/Sup
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Physical Health (con't) Note any di
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ACTIVITIES OF DAILY LIVING Completi
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INSTRUMENTAL ACTIVITIES OF DAILY LI
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SOCIAL HISTORYIRESOURCES Please tel
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Social HistorylResources (con't) Wh
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PHYSICAL ENVIRONMENT How long have
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EMOTIONAL FUNCTIONING This section
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COGNITIVE FUNCTIONING This section
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FAMILY SCREEN To what extent has th
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ALCOHOL AND DRUG ASSESSMENT TOOL AL
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GERIATRIC DEPRESSION SCALE 1. Are y
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INSTRUCTIONS FOR HOME SAFETY CHECK-
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