May 4

Written by:
5/4/2011 10:11 AM 

We are hearing some fairly “canned” responses to our messages of budget cut implications:

Help us to help you by getting rid of burdensome regulations.

We need to all work together as a community to get through this difficult time and move forward.

We need to keep the face of the seniors in front of us.

We need to reform how we do things, not spend more money we don’t have.

We have to become more efficient.

Give us your ideas on how we can save money better.

If I had a nickel for every time I have heard one or more of the above statements during the past weeks I would be able to fill those budget deficit holes. There is a piece of these statements we can take to heart, though. Though our discussions with policymakers right now tend to focus on the immediate implications of the current budget-cutting proposals—which is vital to do—it is equally important that we also take a longer, more comprehensive look at the future with respect to services to seniors. We acknowledge that some of the health care savings ideas we put forth early in the session may be too complicated or may take too long for savings to be realized, but it doesn’t mean we should abandon them. Maybe now—during a time of stalemate—is the right time to start the discussions anew to help policymakers stage some of the actions they will need to do before the budget is finalized.

Our profession is known for responding to change—over the past decades providers of older adult services have responded to changing expectations, regulations, and financing by developing alternatives, by promoting the entire spectrum of care, by “right-sizing” the most expensive settings for long term care, and by implementing operational efficiencies. We need to move forward again with even bolder steps and with expanded partnerships:

Supporting Independence. Seniors want to stay at home and in their communities for as long as possible, and it is in the best interest of the state’s budget to encourage this. In many cases there is a family caregiver, neighborhood network or other unpaid assistance in play. Data from the Administration on Aging (AoA)’s national surveys of caregivers of elderly clients shows Older Americans Act services, including those provided through the National Family Caregiver Support Program, are effective in helping caregivers keep their loved ones at home:

• 77 percent of caregivers of program clients report that services definitely enabled them to provide care longer than otherwise would have been possible, and 77 percent reported that the services have “helped a lot”;

• 89 percent of caregivers reported that services helped them to be a better caregiver;

• Nearly half the caregivers of nursing home eligible care recipients indicated that the care recipient would be unable to remain at home without the support services.

Rather than reducing caregiver support grants, these programs should be viewed as budget savers—we want to serve seniors in the right place at the right time.

Care Integration. Because the state’s budgets are developed and implemented by divisions within departments, there is currently no ability to implement practices that save money in one budget “silo” if it costs something in another—even if there is a net savings. Concepts like shared savings from preventative care, medical rounding where medical staff are involved in care transitions, and preventing re-hospitalizations should be fully integrated for health care from birth to end-of-life care. There is a significant body of evidence showing that improving care transitions as patients move across different health care settings can greatly reduce readmission rates. Interventions—such as using a nurse discharge advocate to arrange follow-up appointments and to conduct patient education, or a clinical pharmacist to make follow-up calls—have yielded dramatic reductions in readmission rates. These practices can continue to be expanded in Medicaid, where the average cost of just one hospital admission for an individual with disabilities (excluding dual eligibles) is more than $5,700.

Choice of Provider and Service Type. Currently the Department of Human Services policy and waiver amendment for several of their Medicaid waiver programs includes their preferred model of "no more than four" spaces in any setting for disabled participants in the disability waivers who are under the age of 55. This model is incredibly expensive, and applying this restriction of only four per setting to all settings (including apartment buildings) prevents participants from choosing where they want to live. Now may be a good time to amend the state plan to allow waiver recipients greater freedom of choice in settings—if they want to move into an apartment building where more than three others on the same waiver program live, they should be able to do so. Or if they want to live on a campus that includes other services, they should be able to do so.

Innovation Opportunities. We must expand beyond the current one-size-fits-all system of over-reliance on a few large health plans, and instead foster the development of integrated service delivery models and a variety of demonstrations. While it is true that Minnesota is more advanced than most other states in health care reforms and delivery, we have also moved ourselves to a point where advancements are limited by the health care delivery structure and payment for those residents on public programs. We need to evolve past today’s current limitations of health plan systems monopoly to promote local collaborations such as the Program of All-Inclusive Care for the Elderly or Accountable Care Organizations that include the entire spectrum of care.

Personal Responsibility. Finally, and most importantly, we must provide an array of mechanisms and incentives to encourage everyone to begin saving for their own long-term care needs. The past few sessions (including this one), any small steps made in this direction have not been well received for a variety of reasons, but mainly because there are no immediate savings tied to the proposals. As a recent editorial in the Rochester newspaper noted: “Families who can afford long-term care insurance should be buying it, and the goal of financial planning shouldn't be to protect our parents' assets while letting the government pay for their expensive final months in a nursing home. But this needs to work both ways. As people are told to take more financial responsibility for their final years of life, families that want to do the right thing will need resources to help them be caregivers.”

Copyright ©2011 Patti