SB 21 Model Long Term Services & Supports Senate Bill 21/ LTC - - PowerPoint PPT Presentation

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Senate Bill 21/ LTC 3.0 Right Services, Right Time, Right Place

Oregon Department of Human Services

Aging and People with Disabilities

SB 21 Model Long Term Services & Supports

April 2014

Aging & People with Disabilities

Purpose of Straw Model Discussion

Work to date:

• SB 21 Steering Committee Charter
• Formation of four subcommittees
• Recommendations of Assessment Subcommittee
• Preliminary data on causes of entry

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Aging & People with Disabilities

Approaching the Straw Model Discussion

• Straw model as a starting point for discussion on a future

plan for Oregon’s long term services and supports (LTSS).

• The Straw Model is one of many possible futures –
• Consideration of concepts that may take several years to

develop

• Discussion of short, medium and long term barriers
• Does the Straw Model address current gaps in Oregon’s

LTSS system? What are viable alternatives?

• Today’s presentation is intended to start the conversation
• f planning the future of Oregon’s LTSS system

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Aging & People with Disabilities

Findings So Far

• The LTSS system is difficult to navigate for consumers,

caregivers and families

• Two challenges on each end of the LTSS spectrum:
• New and more robust services of prevention and early

intervention for consumers with lower level of care

• Strengthening capacity to serve consumers with higher

needs in their own homes and in the community

• Development of shared accountability between the medical

and LTSS systems

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Aging & People with Disabilities

SB 21 Work To Be Done

• Cost drivers for Medicaid LTSS
• Development of Caregivers Subcommittee

recommendations

• Development of Service Equity Subcommittee

recommendations

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Aging & People with Disabilities

*OPI currently serves SPL 1-18

**Includes State Plan Personal Care (SPPC) Services, which has a separate assessment of need tool.

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Aging & People with Disabilities

Discussion – Prevention and Acuity Scale

• Consumers currently coming into Medicaid LTSS system at a

high level of care

• Preventative services – similar and different services for

seniors and younger adults with disabilities

• Goals of maintaining and improving functioning

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Aging & People with Disabilities

Straw Model – New Federal Regulations

• January 2014: Final Regulations for Home and Community-

Based Settings, including:

• Residents have rights similar to landlord-tenant law
• Residents have rights to privacy, including lockable doors,

decoration of room, and roommate only by choice

• Residents control their own schedule and have 24 hour

access to food

• Residents can have visitors at any time
• Any modification to these criteria tied to a specific, assessed

need in the service plan

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Aging & People with Disabilities

Discussion – New Federal Regulations

• Oregon’s long-developed system and new regulations
• What of the regulations are consistent with Oregon’s current

LTSS system? What is different?

• Resident rights and resident safety and well being
• What may be an Oregon approach to these regulations?

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Aging & People with Disabilities

Takeaways from Composite Consumer Profiles - Values

• Independence
• Choices, including informed choices
• Dignity
• Support for consumer’s:
• Aspirations,
• Life goals
• Purpose
• Consumer-centered and consumer-directed services and

supports – inclusive of culturally and linguistically responsive services

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Aging & People with Disabilities

Takeaways from Composite Consumer Profiles - Resources

• Families, friends, peers
• Local organizations: Area Agency on Aging, Centers for

Independent Living, Aging and Disabilities Resource Connections

• Community organizations: Senior centers, peer support

groups, volunteer opportunities, churches, local colleges, Coordinated Care Organizations

• State agency resources: Aging and People with Disabilities,

Vocational Rehabilitation, Oregon Department of Veterans’ Affairs, Oregon Health Authority

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Aging & People with Disabilities

Takeaways from Composite Consumer Profiles – Services and Supports

• Case management, peer supports, options counseling,

information and referral, transition services

• Technology: home modifications, GPS, telemedicine,

vocational supports, online learning and socialization

• Service and health and mental health assessments and

services

• Money management and financial assessments
• Housing, nutrition, and support services for socialization,

employment and community involvement

• Culturally and linguistically responsive services and supports

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Aging & People with Disabilities

SB21 Straw Model Concepts

• Assessment and Case Management
• Preventative Services
• Central Caregiver Registry
• Congregate Setting Types
• Role of the Nursing Facility
• LTSS and Health System Coordination
• Technology

“Anywhere I choose to live is my home”

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Aging & People with Disabilities

Assessment and Case Management

• Role of Area Agencies on Aging and Local State Offices:
• Assessment and Eligibility Determination
• Service Planning and Authorization
• Conflict-free Case Management
• Fee for Service Case Management
• Coordination with CCOs and Health System

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Aging & People with Disabilities

Preventative Services

• Aging and Disability Resource Connections
• Information, Assistance and Referral
• Options Counseling
• Nutrition
• Family Caregiver Supports
• Money Management
• Education and Interventions (Living Well, Transitions)
• Technology

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Aging & People with Disabilities

Discussion – Assessment, Case Management and Prevention

• Assessment Subcommittee Recommendations
• Case Management – Medicaid, Preventative, Private Pay?
• Preventative Services –
• For older adults
• For younger people with disabilities
• Alternative preventative services
• Service Equity

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Aging & People with Disabilities

Central Registry for Paid LTSS Workers

• A Centralized Registry for All LTSS Workers – Both In-Home and

Congregate:

• Screening
• Training
• Certification
• Career ladders
• Professional development
• Workers Paid per Collective Bargaining Agreement

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Aging & People with Disabilities

Discussion – LTSS Worker Central Registry

• Training needs for the future LTSS paid caregiver workforce
• Career ladders and lattices
• Advantages and disadvantages of central LTSS paid caregiver

registry

• Service equity – provider recruitment for culturally and

linguistically responsive services and supports

• Resources and funding considerations

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Aging & People with Disabilities

Congregate Setting Types

Basic Only Owner/Operator Basic/Brokerage

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Aging & People with Disabilities

Basic Only

• Community-Based Provider Basic Service Package:
• Room and Board
• 24/7 Monitoring and Security, Access to Food
• Medication Safeguarding
• Landlord-Tenant Rights
• Single Room or Roommate by Choice
• Consumer Hires and Manages Worker from the Registry

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Aging & People with Disabilities

Owner/Operator and Basic/Brokerage

• Owner/Operator Community-Based Provider:
• Provides Basic Services Package
• Provides all Additional Services On-Site
• Basic/Brokerage Community-Based Provider:
• Provides Basic Services Package
• Additional Services Provided by Brokerage
• For consumers who cannot or do not want to hire and manage

workers off the registry.

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Aging & People with Disabilities

Discussion: Congregate Setting Types

• All paid caregivers hired from registry (by consumer or

provider)

• Changes to licensing based on congregate type – Regulations

reduced for basic and brokerage types?

• Base rates vs. brokerage rates vs. owner/operator rates
• Performance Based Contracting for number/percentage of

residents who maintain or improve functioning?

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Aging & People with Disabilities

Role of the Nursing Facility

Rehabilitation Respite Hospital Step-Down Hospice Urgent Care In Home Agency

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Aging & People with Disabilities

Discussion: Role of the Nursing Facility

• Use of nursing facility (or other congregate setting) for

family caregiver respite?

• Other uses for short stay
• Capacity in rural areas

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Aging & People with Disabilities

LTSS and Health System Coordination

• Person Centered Principles
• Shared Accountability and Shared Savings
• Coordination with CCOs:
• Medicaid LTSS consumers
• Consumers dually eligible for Medicare and Medicaid
• Private pay consumers (preventative services)?
• Health and service equity

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Aging & People with Disabilities

Technology

• Assistive technology (medications, modifications at home)
• Use of internet
• Technology for social integration and vocational assistive

services

• Technology for providers and paid and unpaid caregivers

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Maslow’s Hierarchy of Needs

Aging & People with Disabilities

“Anywhere I choose to live is my home”

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Aging & People with Disabilities

“Anywhere I choose to live is my home” – In Summary

Person Centered Basic Need Package

Room/Board 24/7 Monitoring Security Single or Roommate Locked Doors / Privacy Landlord Open Visiting Hours 24/7 Food Access Choice of Providers Medication Safeguards Tenant Rights

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Aging & People with Disabilities

Key contacts

• Mike McCormick, Director, APD
• Phone: 503-945-6229
• Email: mike.r.mccormick@state.or.us
• Bob Weir, Advocacy & Development Manager
• Phone: 503-947-2321
• Email: bob.weir@state.or.us

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