Proposal for a Governor's Commission on Long Term Care

Cathy Algood Murphy

Background

The population of Kentucky is aging rapidly. It is estimated that by 2020 there will be over 700,000 Kentuckians over the age of 65. Currently Kentucky ranks 27th in the nation in the proportion of population over the age of 65. By 2025, it is anticipated to move up to 14th. With this increase also comes an increase in demand for support services for the most vulnerable in this population group. We need to have a strategy, a plan of action, for how Kentucky can successfully handle this foreseeable strain: a strain on our limited resources, both economic and human.

New Solutions are Needed

The old ways of providing services for our elderly will not work. We need a reasonable, feasible, coordinated, economically sound plan. One thing is certain: baby boomers are not going to choose to enter nursing homes. In a recent study, 85% of Kentuckians said they would prefer to remain in their own homes. This trend is expected to continue. We cannot afford to institutionalize 700,000 Kentucky seniors!

Currently, 72% of Medicaid funding for long-term care goes to institutional care, and only 28% to community services. We need to plan smart with limited money, develop new business models, and new systems. During the gubernatorial campaign, Governor Beshear expressed his vision to start rebalancing for our baby boomers, providing flexibility for choice in long-term care.

The Cabinet for Health and Family Services has initiated several innovative efforts to shift the ratio of services away from institutional to community-based services and provide greater flexibility. To realize the Governor's vision and to reach the 50:50 balance many states are seeking will take broader policy decisions and larger scaled efforts to support the increase in home and community-based services.

This can be accomplished with an invested group of thinkers who are coming to the table with a single goal: the best interest of Kentucky elders.

Proposal

The best avenue to achieve the desired transformation in Kentucky is to establish a Governor's Long-Term Care Commission to identify the needed reforms of the long-term care system and to explore an array of funding options to help support the provision of long-term care services in the future. The Commission should be made up of members with a broad range of expertise including business, economics, finance, management, and health care policy. To be successful, this group would need strong leadership from the Governor to take the necessary steps to change the system.

Mission and Scope of Work

The Governor's Commission on Long-Term Care will be attached to the Cabinet of Health and Family Services and the Governor's Office for Policy and Budget. Policy and research staffing and other support may also be provided by the University of Kentucky Graduate Center for Gerontology. 

The mission of the Commission is:
  
To deliver to the Governor a plan of action, including recommended executive measures and legislative proposals that would, within current budget constraints, promote a full array of services within the long term care continuum of Kentucky.

The specific charge to the group is to:

• Study and evaluate Kentucky's long-term care system. 
• Develop a six-year plan that addresses any deficiencies identified and prioritizes needed actions and timelines.
• Submit the plan to the Governor no later than October 1, 2009.

Considerations for process:

• Review Kentucky studies and reports that have been published since 2000. Review work undertaken in other states relating to long-term care and transformation.
• Review work related to long-term care transformation undertaken by the Federal Government.
• Conduct public hearings in various locations in the state to obtain citizen and consumer input.
• Conduct a forum for providers to obtain stakeholder input (concerns, ideas, recommendations).
• Use technical assistance as needed to supplement the work of the group.
• Develop a website where up-to-date information can be shared on the activities of the Commission and solicit input on questions that will be coming up in future meetings.

Issues for Consideration: Some Suggestions

1. Are the state goals, principles and priorities for long term care clearly articulated? Do all state agencies and agents of state government work together in implementation of policy, program development and administration of these goals?
   
   
2. Are citizen/patient/client rights and opportunities clearly articulated and reflected in the long-term care plans and programs of the Commonwealth?
   
   
3. Are case management and funding sources coordinated to insure that every person is afforded the opportunity to remain in the least restrictive environment of their choice that addresses their individual needs?
   
   
4. Are services monitoring activities adequately staffed and undertaken in a consistent and timely manner to insure the safety and quality of services and transparency to the public?
   
   
5. Does the state take full advantage of Medicaid matching funds potential to support "nonmedical" services, particularly for personal care homes, family care homes and programs administered by the Area Agencies on Aging and Community Action Agencies?
   
   
6. Are licensure and certification laws, regulations, and standards consistent among services? Or do they provide artificial barriers and categories of services, resulting in unnecessary hardship on clients and cost confusion to providers?
   
   
7. Are the Certificate of Need laws in Kentucky too restrictive to provide services that are needed and will be needed in the future? Do they restrict innovative approaches to service delivery that result in higher costs and unnecessary disruption in the lives of clients?
   
   
8. Are all available housing options being used? Are supplemental support services being used to the maximum benefit to enable persons to age in place with appropriate safety and quality of life concerns? Are there laws relating to licensure of health care professionals that restrict innovative and/or needed approaches to service delivery? Is there a need for more and/or new categories of service providers?