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A Report for the Connecticut General Assembly

Connecticut’s Long-Term Care Needs Assessment Review and Update January 9, 2009. Julie Robison, PhD Noreen Shugrue, JD, MBA, MA UConn Health Center. A Report for the Connecticut General Assembly. What You’ll Hear. Needs Assessment Review and Update

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A Report for the Connecticut General Assembly

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  1. Connecticut’s Long-Term Care Needs Assessment Review and Update January 9, 2009 Julie Robison, PhD Noreen Shugrue, JD, MBA, MA UConn Health Center A Report for the Connecticut General Assembly

  2. What You’ll Hear • Needs Assessment Review and Update - CGA mandated & funded the assessment (PA 06-188) in consultation with the CT Commission on Aging, LTC Advisory Council, & LTC Planning Committee • Going Forward - Rebalancing still key - Workforce issues paramount UConn, Center on Aging

  3. LTC: The Modern Definition • Not Just Nursing Homes • Not Just Insurance The entire range of assistance, services, or devices provided over an extended period of time to meet medical, personal, and social needs in a variety of settings and locations. LTC Encompasses: Rather, a large umbrella definition LTC: Knows no Age or Disability Boundary! UConn, Center on Aging

  4. “Rebalancing” • Connecticut is part of a nationwide initiative to remove barriers to community living for people of all ages with disabilities and long-term illnesses • Central to the state LTC Plan • “Rebalancing” means: Changing the focus and funding priorities to home and community-based supports UConn, Center on Aging

  5. Why Now? ExplodingDemographics • One Million Baby Boomers: Nearly One-Third of CT’s total Population • 600,000 People Age 60 or Older • The Number of People 85 and Older Will Increase Threefold by 2040 UConn, Center on Aging 5

  6. Why Now? ExplodingDemographics Percentages UConn, Center on Aging 6

  7. Why Now?Exploding Costs Soaring LTC Medicaid Expenditures $2.2 Billion (FY2006) • 14% of entire state budget • 56% of Medicaid budget • Nearly 50%of the DSS budget LTC Medicaid expenditures increased to $2.4 Billion in FY 2008 UConn, Center on Aging

  8. Scope of Needs Assessment:Enormous! HIGHLIGHTS OF YEAR ONE: • Survey of CT residents (6,266 responses) • Survey of long-term care providers (500 responses) • 44 key informant interviews with policy makers, providers, advocates, consumers and agency heads • Analysis of LTC “rebalancing” in CT by national experts • Analysis of LTC Ombudsman Program HIGHLIGHTS OF YEAR TWO: • Four detailed issue briefs • Financial planning for LTC • Needs of people with mental illness • Geographic differences • Experiences of people with disabilities • Continuing requests for information & analysis • Ongoing publication of results All reports available athttp://www.cga.ct.gov/coa/ UConn, Center on Aging 8

  9. What Did We Learn? Most Nutmeggers Avoid the Issue • People have done little thinking or planning for their long-term care needs. • People have limited resources set aside for long-term care. • Many erroneously believe long-term care costs will be paid by Medicare or private health insurance. • People don’t know where to go for information & services Lack of LTC Planning & Knowledge UConn, Center on Aging 9

  10. What Did We Learn? Gaps in Services Limit Choice, Independence and Dignity Percentages Percentages UConn, Center on Aging 10

  11. What Did We Learn? Informal Caregivers are the Backbone of the LTC system • 52 million informal caregivers in the U.S. • 560,000 in Connecticut (19% of adult population) • Estimated economic value Nationally = $375 billion In Connecticut = $4.9 billion (Nearly double the public expenditures for formal home health care AND nursing care combined.) Source: AARP 2008 11

  12. What Did We Learn? LTC Workforce Crisis is Here! • Younger people leaving state while aging population and demand for service soars • Negative image of many LTC occupations due to poor wages, benefits, working conditions • Staff turnover often • exceeds 100% • The demand for home health aides is one of the fastest growing occupational needs in the nation UConn, Center on Aging 12

  13. What Did We Learn? CT Lags Behind Other States Percent of Medicaid LTC Dollars for HCBS Oregon & NM top 2 states: > 70% HCBS Source: Thomson Reuters UConn, Center on Aging 13

  14. Create parity among age groups, across disabilities, and among programs. Allocate funds equitably based on level of need… not simply age or type of disability Break down silos that exist within and among state agencies and programs. Our Findings Led Us to the Following Guiding Principles: UConn, Center on Aging 14

  15. Needs Assessment Recommendations … Some Progress over Past Year But lots still to do • Money Follows the Person cuts across many of the recommendations… • Statewide single-point-of-entry or “No Wrong Door” • Address scope and quality of institutional care • Provide true consumer choice and self-direction 15 UConn, Center on Aging

  16. Needs Assessment Recommendations … Some Progress over Past Year But lots still to do • Address long-term care needs of persons with mental health disabilities • Expand and improve vocational rehabilitation for persons with disabilities • Build data capacity and system integration to provide better client service • Access & reimbursement for key Medicaid services UConn, Center on Aging

  17. Needs Assessment Recommendations … Some Progress over Past Year But lots still to do • Greater integration of state-level functions through a consolidated, efficient all-ages & disabilities approach • Public education and information needs • Accessible, affordable transportation • Simplified state Medicaid structure …striving for universal coverage across all ages and disabilities UConn, Center on Aging 17

  18. Needs Assessment Recommendations … Lots Still To Do! • Rebalancing Progress is Lagging • Policy & financing reforms to provide a broader range of community-based choices for LTC supports • Foster flexibility in home care delivery • Workforce Issue is Paramount • (Both formal and informal workers) • Address the long-term care workforce shortage • Support informal caregivers UConn, Center on Aging 18

  19. Major Roadblocks 1. CT is Institutionally Biased Percent of Medicaid LTC Dollars for HCBS This serves 51% of the people This serves 49% of the people UConn, Center on Aging 19

  20. LTC in Connecticut Today UConn, Center on Aging

  21. Inaction vs. Relief from Rebalancing Hypothetical FY06 Medicaid LTC Savings UConn, Center on Aging

  22. Major Roadblocks 2. CT has a Fragmented HCBS System Multiple Medicaid waivers (built on good intentions) further fragment the system. National experts say “CT has too many waivers.” Graphic: CT Commisison on Aging 22

  23. Recommended CT Waiver Structure of the Future One (Universal) Waiver or include HCBS Services in the State Plan with consistent requirements across ages and disabilities Leading to: Consistency, Equality, Continuity, Efficiency, Flexibility and Choice UConn, Center on Aging 23

  24. Major Roadblocks3. CT has a Workforce Crisis • Workforce infrastructure not currently in place to support substantial increases in HCBS • Support for family caregivers lacking • As we’ve seen,workforce crisis already exists • “Money Follows the Person” facing the issue first-hand UConn, Center on Aging

  25. BLS Employment Projections 2006-16:30 Fastest-growing Occupations Healthcare growing twice as fast as all occupations UConn, Center on Aging

  26. Example of Provider Concerns:CT Assoc. for Home Care & Hospice 2006 Cost vs. MedicaidReimbursement Rate Source: CAHCH UConn, Center on Aging

  27. Institute of Medicine Report • Committee on the Future Health Care Workforce for Older Americans • “Retooling for an Aging America: Building the Healthcare Workforce” (300 pgs - 2008) • Looked at entire spectrum of healthcare; not just LTC • Primarily aging-focused, but concepts equally applicable to people with disabilities UConn, Center on Aging

  28. IOM: Sample Workforce Issues • 7,100 geriatric physicians (2007) • Projected need for 36,000 (by 2030) • Older adults are 1/3 of visits to PAs • Only 1% of PAs certified in geriatrics • Recommendations include training, licensing, enhanced reimbursements • Includes training in home settings UConn, Center on Aging

  29. Legislative Responses to IOM Report • National response:Two major bills in Congress concern education & training, loan forgiveness, including both direct care & family caregivers. • State response:Bills in South Carolina, Oklahoma & California include loan forgiveness, voluntary license fees. UConn, Center on Aging

  30. Conclusions • Connecticut is losing ground on rebalancing • Small, pilot-oriented programs only at present • Major issue is workforce • Money Follows the Person is addressing many of these issues systematically • Great opportunity/lots of excitement! • In order for MFP to succeed  workforce Progress can SIGNIFICANTLY SLOW GROWTH of LTC spending UConn, Center on Aging

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