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"Applebaum, Robert"
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THE LTSS STATE SCORECARD NATIONAL ADVISORY PANEL
Abstract
Reaching consensus across the field is an important endeavor for a project like the LTSS State Scorecard. Since the Scorecard’s inception in 2008, the AARP Public Policy Institute has engaged a broad range of experts, known as the Scorecard National Advisory Panel (NAP). The NAP is drawn from a broad range of expert stakeholders across private and nonprofit organizations, state agencies, researchers, and the federal government. The NAP has informed virtually all aspects of the Scorecard, including indicator selection, scoring methodology, and the framing and messaging of Scorecard findings. This portion of the symposium will feature remarks and analysis from a long-standing NAP member and expert in the field of long-term services and supports.
Journal Article
WHEN YOU GET TO A FORK IN THE ROAD, TAKE IT: SHOULD STATES FOLLOW YOGI'S ADVICE ON MANAGED LONG-TERM SERVICES?
Abstract
Today's Medicaid challenges, coupled with the baby boom demographics, have every state in the nation recognizing the need to do something different in their Medicaid programs. Although achieving a better balance between institutional and home and community-based services has been an important reform in many states, it does not appear to be enough to create a working system. Medicaid managed long-term care and efforts to integrate Medicare and Medicaid is a growing option. Designed to control the acute and long-term care costs of older people and individuals with disability, the approach also is directed at linking the two disparate systems. A review of the array of studies examining this area shows mixed results, despite the popularity of this option at the state level. This paper introduces the evaluation of Ohio's MyCare integrated care demonstration, raising questions about the important elements of these initiatives for policy makers, providers, and consumers.
Journal Article
What the Paradox of Change Means for the Future of Aging Services
The aging services sector must foster and embrace change, evolving to meet the demands of our modern world, lest it go the way of companies like Kodak and Blockbuster-neither of which anticipated or adapted to changes in the marketplace. But when organizations change, it must be with
the right strategy. If the aging services sector evolves in the wrong way, generations will feel the impact. It must ask the right questions, be clear about where it needs to go and what the issues are, innovate, and lead.
Journal Article
LOCAL FUNDING FOR SOCIAL CARE FOR OLDER COMMUNITY MEMBERS: A BOTTOM-UP STRATEGY THAT IS ALSO GOOD POLITICS
The national response to providing home and community-based services for older people with disability relies almost exclusively on the Medicaid program. Because 90% of older community members are not eligible for Medicaid this means that until a crisis the vast majority of older individuals are not eligible for public support. In 15 states across the nation, communities have raised local funds to support social care services to assist in maintaining community independence. Raising more than$400 million, primarily through property tax levies, the more than 400 communities using this approach fund an array of social care services, such as personal care, home modification, meals, and transportation targeted toward a population above the Medicaid eligibility threshold. This strategy is particularly salient in Ohio, where 74 or the state’s 88 counties have levies totaling more than $ 200 million. This presentation will describe both the programs and politics associated with this funding approach. The presentation will highlight how funds are use and the target population served. Local funding has been successful at the polls, and a review of voting patterns found a more than 95% passage rate in the Ohio communities, with no differences in rates between red and blue counties of the state.
Journal Article
At Almost 60, It's Time for a Life Review of the Older Americans Act as it Approaches Eligibility Age
The Older Americans Act's (OAA) impending age of eligibility is a good time to review accomplishments and opportunities for improvement. The OAA is celebrated for bringing social care for older people to the forefront of U.S. aging policy and programs. But critiques say it has not kept
pace with dramatic demographic, economic, and social changes during the almost 60 years since its passage. Older adults and their caregivers still need supports and services, yet these fall short, contributing to increasing vulnerability and ever-increasing investments in health and long-term
services. This article examines the background of the OAA, its accomplishments, its failures, and aspirations for the future.
Journal Article
WHO CARES? RETENTION STRATEGIES FOR DIRECT CARE WORKERS
Abstract
More than 30 years ago the Gerontological Society sponsored a congressional briefing about a growing problem; concerns about the adequacy and quality of the direct care workforce in long-term care. In 2002 the Robert Wood Johnson Foundation sponsored the Better Jobs, Better Care demonstration, in response to this continued challenge. Today recruiting and retaining high quality workers in the long-term services system has moved beyond a challenge to an all-out crisis. The initial paper of the symposium presents recent retention and work culture data highlighting todays’ hurdles, collected from more than 80% of long-term care facilities across Ohio. The second presentation provides a comprehensive review of state-level initiatives and innovations aimed at improving recruitment and retention for direct care workers (DCWs) in both facility-based long-term care and home and community-based long-term services across the country. A third paper focuses on retention-promoting factors from the perspective of providers and DCWs working in high-performing long-term care facilities in Ohio. In-depth interviews with 37 providers and DCWs revealed an overarching theme of the importance of work culture, highlighting the modifiable, intangible aspects for promoting DCW retention. The final paper introduces a tip sheet with practical strategies for providers who are seeking to retain direct care workers. Symposium findings will include both practical implications for long-term care providers and ideas for future studies. The direct care workforce crisis is the result of an array of challenges, which means that there will not be one solution, but rather many ideas will be needed.
Journal Article
READY, FIRE, AIM: DOES INTEGRATING ACUTE AND LONG-TERM SERVICES WORK?
Abstract
Due to the increasing costs of Medicaid and Medicare and concerns about how these two programs fail to work together to deliver quality care, there has been a growing enthusiasm for integrated care programs. The Financial Alignment Initiatives (FAI), implemented by the Centers for Medicare and Medicaid Services (CMS) in 2011 and tested in 13 states were designed to test the impacts of a program that offers Medicare and Medicaid services under one organization to individuals who are dually eligible for both programs. Previous studies of the expansion of managed long-term services have generated considerable interest over the last two decades however, research results have been mixed. There is also limited information about the implementation of these efforts, as demonstrations have served varying target populations with very different intervention strategies. The lack of conclusive results means that states, now faced with decisions about continued implementation of these initiatives do not have good information to make sound policy decisions. The national evaluation of the FAI states did not include Medicaid costs. Our study is designed to gain a better understanding of Ohio's FAI MyCare Demonstration. This symposium provides data from a comprehensive impact analysis that examined both Medicaid and Medicare claims data using a difference- in- differences treatment and comparison analysis (n= 390,000) and an in-depth process evaluation (using interviews with 487 participants) to gain an understanding of program effects. After reviewing results the symposium will discuss the future of these and other reform efforts to integrate Medicaid and Medicare services.
Journal Article