Long-Term Care - Illinois General Assembly

Maybe two-thirds of nursing homes converted to residential alternatives. For the facilities who
have done that, they are doing much better than those who haven't. They can offer people
alternatives as their needs change, whether it’s community placements or nursing home care.
Financially those homes are doing much better than the ones who said: “No way. We've
always been a nursing facility. That's all we'll ever be.” Those homes are struggling.
The rate of the long-term care cost increase also slowed. Maine's average increase in total
long-term care spending has averaged about 2.5% over the last ten years, and that compares
with the national average that is probably more like 8 percent. The state has shifted the care
setting from nursing home to either other residential facilities or home care. It has reduced per
capita spending.
How did this happen? The budget deficit was definitely a factor. That disaster had a silver
lining. It was very difficult in the beginning. Legislators don't like making decisions that are
going to upset constituents, whether they are nursing home owners or families who suddenly
found out that mom couldn't go into the nursing home under Medicaid anymore, because the
admission threshold had changed. If the money had been there, the legislature would have
said: “Okay, this was a lovely little experiment, but let's go back to the way life was.” The deficit
in Maine continued for several more years. Even if people wanted to go back, the money wasn't
there. That had the benefit of giving the state time to allow the reforms to work.
This doesn't happen overnight. Even in Oregon, the masters of this type of reform, it took five
years before they saw significant change. It can be discouraging when there is chaos in the
process of reform.
There was very strong support from some key legislators. There was strong support from the
Governor. Like Minnesota, in the midst of this process Maine had an independent governor
who had run and won essentially financing his own campaign. He didn't owe anything to
anybody, and he could really come to this process much more unfettered. Other elected
officials are (probably) unable to do that, but it clearly helped.
There was also strong support from older adults and disabled consumers, who probably knew
better than state authorities that nothing comes without some hard work and pain. They were
willing to put up with the bumps at the beginning.
Having a single agency do pre-admission assessments definitely has been an important
element.
Restructuring home care programs is another. It was done in a way that allowed us to reduce
overhead and administrative expenses in those programs by about 20%. Those savings were
invested in home care programs and in direct services.
Having Medicaid as a payment source for residential alternatives to nursing homes was
absolutely crucial. When the process started, the nursing home were the all-purpose solution
for whatever problem was out there. The answer was: “Put that person in a nursing home.”
The data showed that a lot of people were in the nursing home essentially for shelter and
supervision. They didn't (really) need any nursing care. They didn't need assistance with
activities of daily living. They just couldn't live alone.
Having Medicaid pay for residential alternatives to nursing homes has been critical. You can't
go into a nursing home and say to somebody; “Well, you're better now; you don't need to be
here;” and then not be able to offer them (an alternative) place to go.
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