Policy and Research Needs to Maximize Independence and Support Community Living Workshop Summary (2016) / Chapter Skim
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3 Home and Community Settings: Services and Supports for Community Living and Participation
3 Home and Community Settings: Services and Supports for Community Living and Participation
Pages 17-32
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From page 17... ...
The speakers gave an overview of the population needing long-term services and supports, discussed the state of Minnesota's efforts to reduce reliance on institutional care among older adults and those with disabilities, described current policies designed to support community living and participation, and provided the perspective of the Centers for Medicare & Medicaid Services (CMS) on community services and supports.
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From page 18... ...
In contrast to the tremendous complexity in the spectrum of disabilities affecting those who need LTSS, the current system used to deliver services narrowly categorizes people by primary disability, which Kaye said is not an effective method for providing services. The Medicaid HCBS waivers for providing intensive services are broken down into hundreds of programs for specific high-need groups based on age, physical disability, mental health, cognitive limitations, and other classifications.
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From page 19... ...
One possible explanation for this may be the finding that the percentage of adults experiencing frequent pain or fatigue follows a similar pattern as overall health status in that the oldest adults report the least pain and fatigue while adults ages 50–64 report the most pain and fatigue. Kaye said that social participation is "shockingly low" among the LTSS population, and not just among the oldest adults.
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From page 20... ...
Colman began by discussing Minnesota's Return to Community initiative.1 The unique feature of this program, he explained, is that it targets private paying individuals living in nursing homes and assisted-living facilities. The program entails contacting these individuals, determining why they continued to live in nursing homes, and then providing them with the appropriate services, such as a community living specialist, and helping them move back into their homes if they would like to do so.
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From page 21... ...
This is somewhat ironic, Colman said, because at the same time that Minnesota is trying to expand Medicaid through the Patient Protection and Affordable Care Act (ACA) provisions, one goal of this and other programs in the state is to help individuals retain their resources and thus keep them from having to enroll in Medicaid.
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From page 22... ...
The goal is to provide a Web-based, Yelp-type review tool that gives people the opportunity to express their opinions about the services they receive. Minnesota has also strengthened its adult protective services by launching the Minnesota Adult Abuse Reporting Center,10 where the public can report suspected maltreatment of vulnerable adults using either a single state-wide toll free number or online reporting.
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From page 23... ...
Some of these provisions could be streamlined and consolidated in order to bring them together under a single state plan authority, and then additional financing incentives could be created, he said. One such provision is Medicaid's Balancing Incentive Program,12 which offers each state the opportunity to build a comprehensive plan for expanding access to HCBS and establish the tools to control how people get into nursing homes and institutional settings.
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From page 24... ...
Workforce Participation Work has become a focus for the intellectual and developmental disabilities community, particularly with regard to helping younger people with disabilities engage in work. Claypool referred to the data Kaye presented on the low level of workforce participation among young adults with disabilities and said there needs to be a concerted effort to remedy that situation through targeted supports that will enable those with disabilities who have work capacity to engage in that capacity.
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From page 25... ...
However, he added, it will be important to go "through a process of really engaging people and learning about what their preferences are for this data sharing." THE CENTERS FOR MEDICARE & MEDICAID SERVICES PERSPECTIVE Shari Ling Deputy Chief Medical Officer, Centers for Medicare & Medicaid Services Delivery system reform is upon us, said Shari Ling of CMS, and although that can be daunting, it can also be a time ripe with opportunities that can lead to actionable next steps, including the opportunity to knit together the care delivery system in a way that is truly personcentered. She added that having a focus on quality will be key because quality has a tremendous impact on value across medical services, health care services, and HCBS.
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From page 26... ...
This focus on quality aligns all measurement efforts across every health care setting and also informs the direction of HCBS quality assessment. The priorities include providing person-centered care across all settings, providing care that is well coordinated, and including individuals in determining their own care and engaging them as full partners in developing their care plans.
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From page 27... ...
Speaking about technical assistance, Ling highlighted the Transforming Clinical Practice Initiative, which will support clinicians in their practice to go beyond the traditional medical model to improve broader health outcomes for beneficiaries and reduce unneeded care and unnecessary hospitalizations. This transformation effort includes helping clinicians work with their patients to better coordinate care, and it facilitates links to community care to achieve outcomes that are important to each individual.
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From page 28... ...
The meeting participants found it challenging that information is often available only at the local or metropolitan area level and not at the state level. Claypool added that statelevel scorecards could help address the fact that there are real disparities in how different states respond to similar needs, meaning that the same person could be served very differently by two state Medicaid programs simply because of where that person lives.
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From page 29... ...
The reports from the table discussions were delivered by the following individuals, listed alphabetically: Margaret Campbell, National Institute on Disability, Independent Living, and Rehabilitation Research; Susan Chapman, University of California, San Francisco; Patricia D'Antonio, The Gerontological Society of America; Teresa Lee, Alliance for Home Health Quality and Innovation; Rasheda Parks, National Institute on Aging; Julianna Rava, National Institutes of Health Office of Autism Research; and Rebecca Sheffield, American Foundation for the Blind. Policy Barriers The facilitated table discussions produced the following list of policy barriers to supporting community living and participation, as noted by the table rapporteurs.
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From page 30... ...
Research and Policy Priorities The facilitated table discussions produced the following list of research and policy priorities to support community living and participation, as noted by the table rapporteurs.
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From page 31... ...
• Conduct research to understand the housing and HCBS needs and goals of an increasingly complex LTSS population, with a particular focus on low-income older adults and people with dis abilities (Campbell) Policy Priorities • Increase federal funding for research on managed care and LTSS (Parks, Rava)
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From page 32... ...
Lee reported that her table discussed the inertia that inhibits policy change and suggested that investing in research that can quantify the value of community programs may help overcome that inertia. She also reported that her table thought that eliminating the silos between the different providers of services might help identify areas of overlap and streamline service delivery.
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