Oregon Department of Human Services Aging and People with Disabilities SB 21 Model Long Term Services & Supports Senate Bill 21/ LTC 3.0 Right Services, Right Time, Right Place April 2014 1
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 2
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 of planning the future of Oregon’s LTSS system 3
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 4
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 5
Aging & People with Disabilities 6 * OPI currently serves SPL 1-18 **Includes State Plan Personal Care (SPPC) Services, which has a separate assessment of need tool .
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 7
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 8
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? 9
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 10
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 11
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 12
Aging & People with Disabilities SB21 Straw Model Concepts “Anywhere I choose to live is my home” • Assessment and Case Management • Preventative Services • Central Caregiver Registry • Congregate Setting Types • Role of the Nursing Facility • LTSS and Health System Coordination • Technology 13
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 14
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 15
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 16
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 17
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 18
Aging & People with Disabilities Congregate Setting Types Basic Only Owner/Operator Basic/Brokerage 19
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 20
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. 21
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? 22
Aging & People with Disabilities Role of the Nursing Facility Hospital Rehabilitation Respite Hospice Step-Down In Home Urgent Care Agency 23
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 24
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 25
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 26
Aging & People with Disabilities “Anywhere I choose to live is my home” Maslow’s Hierarchy of Needs 27
Aging & People with Disabilities “Anywhere I choose to live is my home” – In Summary Room/Board 24/7 Tenant Monitoring Rights Security Medication Single or Safeguards Roommate Person Centered Basic Need Package Locked Choice of Doors / Providers Privacy 24/7 Food Landlord Access Open Visiting Hours 28
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