Delaware’s Delivery of Long Term Services and Supports The Need for Change

1. Delaware’s Delivery of Long Term Services and Supports The Need for Change Delaware Health Care Commission January 3, 2013

2. Overview of Services Provided

3. Fast-Growing Older Population ** By 2030, Delaware is projected to have the 9th-highest proportion of people age 65 and older in the U.S.

4. Long Term Services & Supports Scorecard Overall Ranking - 32 • Affordability and access - ranked 27th in the nation • Affordability of long-term care services (nursing home services and home care services) • Access to Medicaid • ADRC/single entry point • Support for family caregivers – ranked 28th in the nation • Percent of caregivers usually or always getting needed support • Legal and system supports for caregivers

5. Choice of setting and provider – ranked 49th in the nation Percent of Medicaid and state funded LTSS spending going to community-based services Percent of new Medicaid LTSS users first receiving services in the community Number of people consumer-directing services Percent of nursing home residents with low care needs Quality of life and quality of care – ranked 7th in the nation Percent of adults with disabilities getting needed supports Nursing home indicators of care (e.g., pressure sores, use of restraints) Adults with disabilities usually or always getting needed supports Long Term Services & Supports Scorecard

6. 2012 Profiles of LTSS Across the States • Ranked 49th among all states in percentage of Medicaid spending for community-based long term services for older adults and adults with physical disabilities • Ranked 13th among all states in Medicaid spending per person for nursing facility services Relative to our sister states, Delaware spends a much higher percentage of its resources on facility-based services

7. Institutional Bias in Delaware… Long-Term Care Expenditure Patterns Community care costs Costs for institutional care About 87.5% of long-term care dollars for aging and physical disabilities are spent in facilities. Institutional Bias in the US… Community care costs Costs for institutional care About 66% of long-term care dollars are spent in facilities. In FY2009, Delaware ranked 49th among all states in the percentage of LTC dollars spent on community based services for older adults and persons with physical disabilities.

8. Critical Concerns • Market demand and choice - the overwhelming majority (86% plus) of Delawareans want services that support them in their own home • Cost - for every person we serve in a long-term care facility, at least three people can be supported in the community (AARP estimate) • The Americans with Disabilities Act mandates that public agencies provide services in the most integrated setting appropriate to individual needs as affirmed by the US Supreme Court’s Olmstead decision.

9. Initiatives Underway • Aging and Disability Resource Center – key to building access to services • 24/7 call center • Dedicated website to search for services (www.DelawareADRC.com) • Options counseling • Service guides (English and Spanish) • Discharge planning support for hospitals

10. Initiatives Underway • Diamond State Health Plan Plus (DSHP Plus) – Medicaid funded long term care services • integrates nursing facility services with community-based services for older Delawareans and those with physical disabilities - implemented April 1, 2012 • incorporated long-term care services into existing managed care delivery system • enhanced benefit package – increases choice of setting and service • improve access to community-based services, improve coordination of care, and supports to improve health status • enables shift of resources from institutional care to community-based services

11. Initiatives Underway • PACE (Program for All-Inclusive Care for the Elderly) – Saint Francis Life located on the Wilmington riverfront • integrated system of care for those 55 and over who have a nursing home level of care • comprehensive long term services for Medicaid and Medicare enrollees (capitated rate) • all inclusive care plan: 24/7, 365 days a year • extensive package of services provided on site – participants return home each night • focus on preventive care and maximum level of physical, social and cognitive function

12. Initiatives Underway • Housing supports (SRAP – housing vouchers; case work supports to find housing) • Money Follows the Person – transition residents of facilities to the community (incorporated into DSHP+) • Care Transitions – providing access to community-based services for those applying for placement in a state facility (diverting over 90% of all referrals – have reduced average admissions from 8+ each month to less than 3 a month) • Partnership with hospitals on discharge planning

13. Initiatives Underway • Expanding access to legal services – critical need for older Delawareans (individual legal support services; statewide assessment of legal needs; legal handbook) • Expanding the capacity of Delaware’s home and community-based services including Adult Protective Services • Expanding community-based mental health services

14. Bill Love, Director, Division of Services for Aging and Adults with Physical Disabilities (302) 255-9351 William.Love@state.de.us