By Dr. JudyAnn Bigby
A recent report released by the AARP Policy Institute, the Commonwealth Fund and the SCAN Foundation ranked Massachusetts 30th in the nation for long-term care. The report highlights areas where Massachusetts can improve upon its ability to provide long-term for some of its most vulnerable residents, The report ranked Massachusetts 40th in its ability to provide home and community-based supports to residents without channeling them to a nursing home first and states that Massachusetts, unlike many of the states that ranked much higher, does not allow registered nurses to delegate some tasks (administering medication, for example) to other home health workers—an issue the co-author of this report said would ease burdens on families who end up having to hire nurses to do these tasks, adding more costs to families and to Medicaid. There is clearly room for improvement and the need to improve is compelling.
This year in the United States, 10,000 people will turn 65 every day. With Baby Boomers coming of age, the Commonwealth’s senior population will increase from 20% today to more than 26% by 2030. Since 2007, the Patrick-Murray Administration has been developing and implementing programs for this growing population based on the principle of “Community First,” which seeks to ensure that elders and people with disabilities have access to community-living opportunities and supports that address each individual's diverse needs, abilities and backgrounds. By promoting a wide range of accessible community-based support services, the Commonwealth can offer elders and people with disabilities the supports they need to live safely, independently and with dignity.
Surveys indicate that most people prefer to remain in their homes or communities receiving medical care and assistance with daily living needs, rather than moving to a long-term care facility. These are some of the supports the Commonwealth provides to accommodate that preference:
- The Massachusetts Home Care Program, overseen by the Executive Office of Elder Affairs (EOEA), currently serves approximately 40,000 elders in need of support services. Slightly more than 5,000 of these consumers have been found to be “nursing facility-eligible” remain in the setting of their choice through the Commonwealth’s Enhanced Community Options Program (ECOP) with expanded support services. Trained caregivers provide personal care, homemaking, transportation, and grocery shopping and are supported by visiting nurses, physical therapists and other healthcare professionals.
- Locally-based community agencies are essential to effective service delivery throughout the Commonwealth. Over the past five years, EOEA has established 11 Aging and Disability Resource Consortia (ADRC) to provide a well-organized, coordinated, seamless information system dedicated to community-based long-term care support. In fact, we employ a ‘No Wrong Door’ policy, meaning that consumers can access comprehensive options information from any point and at any stage in their care. ADRC’s offer Options Counseling is available whenever and wherever a consumer wants information about service choices, even if he/she is in a nursing facility and wishes to return to a community setting. By the end of last year, Options Counselors had served more than 2,300 people.
- In September 2010, Massachusetts was awarded a grant under the Affordable Care Act (ACA) to develop core competency training curricula for personal and home care aides providing long term care services and supports to community-based residents. This program, the Personal and Home Care Aide State Training (PHCAST) program, is a national demonstration project and is expected to set the standard for nationwide training programs. Front-line home-based direct care workers often require intensive training to meet the challenges of geriatric, mentally ill and disabled people who choose home-based care. By the end of the year, the pilot PHCAST program will have trained 20 personal care attendants and 150 home care aides throughout the Commonwealth.
Similarly, under the MassHealth Office of Long-Term Support Services, eligible MassHealth consumers have access to a system of extensive community-based service choices. For example, MassHealth consumers may choose home health services, among them nursing, home health aides, physical therapy, occupational therapy and speech language therapy. A consumer’s physician establishes the care plan for the patient. People requiring continuous nursing services may also receive care under the MassHealth Home Health program. Individuals 55 and older who are clinically eligible for nursing facility admission, may also be eligible for a variety of clinical, day health and social services under the joint Medicare/Medicaid-funded Program for All-Inclusive Care. This program is a critical component to providing essential daily services to individuals who choose to live in the community. Additional supports from MassHealth include:
- Senior Care Options (SCOs) – Last year, 15,891 Medicare/Medicaid consumers 65 and older were enrolled in a SCO, or comprehensive health care provider organization. Consumers in a SCO plan have a primary care provider who coordinates the delivery of acute, behavioral and long-term care services and supports. Studies show that people who are part of a health care plan and have a primary care provider are less likely to require emergency room care, have fewer hospitalizations are able to stay in a community setting for a longer time.
- Adult Foster Care – If a MassHealth consumer prefers caregiver supports in a home setting, the Adult Foster Care program can provide a suitable caregiver who lives with the individual. In the Adult Foster Care program, individuals receive assistance with daily activities (such as dressing, bathing, nutrition); medication management; and health monitoring. Group Adult Foster Care services administered by MassHealth’s Office of Long Term Support Services combines assisted living services with personal care assistance.
- Individuals, 55 and older, who are clinically eligible for nursing facility admission, may also be eligible for all of their clinical, day health and social services under the joint Medicare/Medicaid funded Program for All-Inclusive Care for the Elderly (PACE). For many, PACE is the most critical component in providing essential daily services to individuals who wish to remain living in their communities.
- Massachusetts received the largest Money Follows the Person (MFP) grant award under the federal Affordable Care Act (ACA) to help elders and individuals with disabilities live in their own communities. Massachusetts will receive $110 million in federal funds over five years as part of the MFP program, which supports seniors and individuals with disabilities so they may live in their own homes or in community settings successfully. Massachusetts is one of just 13 states to receive federal Affordable Care Act (ACA) funding for the program and will receive $13.5 million in the first year.
- Support for Dual-Eligible Individuals – Earlier this year, MassHealth was awarded a $1 million design contract with the nation’s Center for Medicare and Medicaid Innovation and the Federal Coordinated Health Care Office (FCHCO) to develop a demonstration proposal to integrate care for dual-eligible individuals (individuals who are eligible for both Medicare and Medicaid). The demonstration will serve dual eligible adults ages 21-64 who currently receive full MassHealth benefits. It will promote an unprecedented level of care integration which will contribute to better health outcomes for the dual-eligible population through the delivery of higher-quality, person-centered care. Dual- eligible adults will experience their coverage through a single, integrated care program that will promote healthy outcomes and offer dual-eligible individuals the opportunity to live with dignity and independence in their communities.
- Consistent with the Patrick-Murray Administration’s commitment to ‘Community First,’ the Commonwealth’s Supportive Housing program offers income-eligible seniors the opportunity to “age in place” in public housing, with access to twenty-four hour on call assistance; housekeeping; daily meals; transportation; grocery shopping; laundry; social activities; and personal care assistance. The Executive Office of Elder Affairs and the state’s Department of Housing and Community Development (DHCD) bring “assisted-living” services to residents of state-aided or federally funded elderly housing. There are 32 public housing buildings with Supportive Housing clients, accommodating approximately 4,630 seniors who might otherwise be in long-term care facilities.
The Patrick-Murray Administration is committed to making significant strides in these areas in the years ahead. Massachusetts now spends 40% of long-term care funding on community-based services, up from 30% since 2007. This funding has helped ensure that seniors and people with disabilities who want to live in their own homes and communities have the support they need to do so successfully. But there is a lot more to do.
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