long-term care - Legislative Reference Bureau

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CONCEPT OF A SINGLE ENTRY POINT 65. Maryland, Report of the Governor's Commission on Health Care Policy and Financing: Joint Recommendations of the Governor's Commission and the Committee on Long-Term Care, Governor's Commission on Health Care Policy and Financing, vol. V, December 20, 1991, (hereafter "Maryland Report"), p.45. 66. Justice, et aI., p. 95. 67. Koff, p. 176. 68. Indiana 1990, p. 57. 69. Ibid. 70. According to Koff, p. 179: Advocacy on behalf of the client is a inherent part of [case management], as the staff member seeks the appropriate service, the funds to provide the service, and assurance that the person will benefit from the service provided." 71. Ibid., p. 177, citing J. J. Callahan, Jr., ed., Major Options in Long-Term Care (Waltham, Mass.: University Health Policy Consortium, Brandeis University) 1979. 72. Ibid., p. 179. 73. Ibid., pp. 177-178. 74. Justice, et aI., pp. v & 79. 75. Ibid., p. 68. 76. Ibid., p. v. 77. Ibid., p. 79. 78. Ibid. 79. Ibid., p. 80. 80. Ibid., pp. 80-81. 81. Ibid. 82. Ibid., p. 87. 83. Ibid., pp. 75-76. 84. Ibid., p. 87. 85. Ibid., p. 83. 86. Ibid., pp. 83-86. 87. Ibid., p. 86. 30
Chapter 3 LONG-TERM CARE SERVICES OveNiew: This chapter examines the various types of long-term care services in the context of home- and community-based care. The relationship between long-term care and various populations that require long-term care is examined. Rather than purely medical treatment, long-term care is discussed in terms of supports for functional limitations. This leads to a review of the concept of a continuum of services which includes both medical treatment and functional social supports. Various ways of categorizing services are presented and the most common classifications of services are discussed. Examples of service continuums are included. Home care, adult day care, adult day health services, and social/health maintenance organizations are touched upon. In addition, alternative living arrangements, congregate housing, and adult foster homes are also reviewed. How and what long-term care services are selected by a state depends in part on the approach a state takes towards program eligibility. Thus, a discussion and review of the pros and cons of the functional (or generic) approach vs. the categorical (classification by age or diagnosis) is undertaken. The developmentally disabled is reviewed next with this in mind. Finally, various services for the developmentally disabled, including children, are then presented. Single Entry Point and Long-Term Care SeNices: Theoretically, the examination of a single entry point as a method of access to long-term care services can be carried out regardless of the types of services eventually provided. (See discussion in chapter 1.) An SEP is merely the funnel through which clients pass in order to obtain end services. Pragmatically, what services await at the end of the funnel can affect the operation of an SEP. A chief obstacle to a unified SEP is the differing categorical sources of funding for various populations (determined by diagnosis or age) that are available at both federal and state levels. As discussed in the previous chapter, Medicaid has evolved into the largest payer of long-term care expenses. However, Medicaid pays only for care that is medically necessary and related. Unfortunately, the continuing preference for long-term community- and homebased care rather than institutional (but medically-related) nursing home care is not covered under Medicaid. As a result, states have had to obtain individual waivers for programs that provide such community care services. Thus, what services offered by a state's long-term care system and how they are funded affect, to some degree, how well an SEP may operate. One difficulty in integrating a system, including the implementation of a single entry point, is the need to obtain federal waivers. A much larger, possibly insurmountable, problem for many states, is the pooling of differing categorical funding sources that have contributed to the development of historically fragmented systems. A state that has an administrative structure based on the "consolidation" model is best positioned to attempt this. For example, Oregon administers all its long-term care programs through one agency: the Senior Services Division of that state's Department of Human Resources. Such a consolidated structure would be able to reap greater efficiencies from an SEP. However, this is not to say that an SEP requires total consolidation of all programs, services, and funding for all target populations in order to work. Integration can be a matter of degree. Coordination of services, 31
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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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SINGLE ENTRY POINT FOR LONG-TERM CA
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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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