Bredesen unveils ‘fundamental restructuring’ of long-term care

By John Rodgers
Nashville City Paper
March 7, 2008

Gov. Phil Bredesen unveiled a “fundamental restructuring” of TennCare’s long-term care package Thursday, which he says would allow more elderly and disabled to stay at home longer rather than move to a nursing home.

The issue is a “very personal thing” for Bredesen because of his elderly mother, who remains in her own home.

“This is about keeping people in their homes as long as they want to remain in their homes,” Bredesen told reporters. “And it’s driven for me by just the experience with my own mother.”

Currently, 98 percent of TennCare’s $1.2 billion long-term care program is spent on nursing homes, leaving just 2 percent for home and community-based care.

Bredesen’s restructuring would take a “fragmented” system and simplify TennCare’s long-term care program, the governor and administration officials said.

The confusing system causes nursing homes to be the “default” option, said state Finance Commissioner Dave Goetz.

“The problem that people have now is it’s very confusing for someone to figure out what they need or what their mother or father or aunt or uncle or neighbor need,” Goetz said. “There are too many places to go.”

The Bredesen administration’s plan, which would require legislative approval, would create a single place - local agencies on aging - for the elderly or their family members to go.

Once there, the aging agency would help facilitate checking the elderly or disabled person’s eligibility for TennCare.

If the person were eligible for TennCare, the Bredesen administration’s proposed system would work with a managed care organization to determine the best fit for that person - whether it’s at home or in a nursing home.

If the person were not eligible for TennCare, he or she could go to a state options only program, which provides services such as Meals on Wheels or transportation.

Another problem the Bredesen administration says it wants to address is the speed in which it currently determines eligibility.

That eligibility determination can sometimes take 90 days or more.

“That’s too long, and that often tends to drive people into nursing facilities because they can get started with services there before they’re determined to be eligible,” Goetz said.

The administration is challenging itself to determine eligibility for TennCare’s long-term care program in three days.

Allowing more people to stay at home under TennCare would also save money, administration officials say.

Darin Gordon, the director of the TennCare Bureau, said it costs $12,000 per person on average to receive home and community-based care compared to $45,000 to $60,000 at a nursing home.

Bredesen releases details on home-based care plan

By Erik Schelzig
Associated Press
March 7, 2008

NASHVILLE, Tenn. - Gov. Phil Bredesen is proposing giving many elderly and disabled Tennesseans the option of staying out of nursing homes by providing them with care givers in their own homes.

The state currently spends about $1.2 billion a year on long-term care services through TennCare, with about 98 percent of it directed at nursing home facilities.

Officials estimate that Bredesen's plan could direct about half of those funds to home-based care over the next decade.

Bredesen, a Democrat, said his proposal would also simplify the process for how elderly or disabled people find out whether they qualify for home-based care.

"At its core this is about keeping people in their homes as long as they want to remain in their homes," Bredesen. "And it's driven for me by just the experience with my own mother."

"It is so clear to me that she would go to any length to remain in her home," he said.

Darin Gordon, TennCare's director, said there's no reliable way to predict how many people will choose home-based care once it becomes more widely available. But based on the experience of other states, Tennessee could move to a 50 percent split between home-based and nursing home services in six to 10 years, he said.

The average cost per person in home and community-based care is about $12,000 per year, while nursing home costs for a year can range between $45,000 and $60,000 per person, Gordon said.

If the Legislature approves Bredesen's plan this year it will start up in July 2009.

"This is a fundamental restructuring," Bredesen said. "It's about quality; it's about offering choices; it's about simplifying the system."

Finance Commissioner Dave Goetz said the state is trying to create a "single entry point" system for people looking for information on long-term care. The state will also work to cut the waiting time. Currently, people interested in long term care have to wait for up to 90 days while the state decides whether they qualify for services.

"That's too long," Goetz said. "And that also tends to drive people into nursing facilities because they can get started with services there before they're determined to be eligible."

Goetz said the state aims to shorten the waiting period to three days.

The administration expects nursing home operators to branch out into home-based care services once more money starts flowing in that direction.

Goetz said officials will work to streamline licensing requirements for nursing home operators that also want to provide home and community services.

Bredesen unveils plan to expand nursing home alternatives.

By Andy Sher
Chattanooga Times Free Press
March 7, 2008

NASHVILLE - Gov. Phil Bredesen rolled out his long-term care reforms Thursday, saying he wants to simplify a fragmented system, expand choices and make it easier for elderly and disabled Tennesseans to avoid nursing homes and remain at home.

The governor said the Long-Term Community Choices Act of 2008 represents a “fundamental restructuring” of how care is provided through the state’s TennCare program.

“We’re trying to add some real choice in here, to say that we owe an opportunity for people to not simply have a single choice between taking care of themselves at home and then going to a nursing home,” Gov. Bredesen said.

The state spends $1.2 billion on long-term care. Some 98 percent of it now goes toward covering an estimated 23,000 people in nursing homes.

Plans call for a dramatic expansion of the state’s home- and community-based services waiver program, which now covers 2,700 people with “wrap around” services such as house cleaning and Meals-on-Wheels-type programs. Over the next six to 10 years, officials hope as many as 50 percent of people needing long-term can remain in home settings.

“It just looks like, from what we’ve seen, today is a big step forward for Tennessee,” said Steve Witt, director of the Chattanooga-based Southeast Tennessee Agency on Aging and Disability.

Mr. Witt said the reforms would not mean the end of nursing homes, calling them a “very important component in the continuum of care.”

Home- and community-based services should cost about $12,000 annually compared to between $45,000 to $60,000 at a nursing home, said TennCare Director Darin Gordon.

The governor, who worked with Republican and Democratic lawmakers on the legislation, said he hopes the state’s nursing home industry will back him.

If it passes, the reforms would take effect July 1, 2009. The plan must be approved by federal officials.

Nursing home operators in the past have been wary of sharing Medicaid dollars, part of which are raised through a $2,250 per bed nursing home tax, with home- and community-based efforts.

“In the past we’ve been concerned about funding alternative services on the back of nursing home patients,” said Ron Taylor, executive director of the Tennessee Health Care Association, which represents an estimated 330 nursing homes.

But he said the association has been encouraging its members “to get into home- and community-based services and alternative services.”

“This appears to be something that provides us some opportunities to do so,” he said.

The proposal would not encourage current nursing home residents to leave, officials said.

Gov. Bredesen said he is encouraging nursing homes to offer the new services much as hospitals in recent years have provided services on an out-patient basis.

“At its core ... this is about keeping people in their homes as long as they want to remain in their homes, and it’s driven for me by this experience with my own mother,” Gov. Bredesen said during a briefing. “It’s so clear to me that she would go to any lengths to stay at home.”

AARP Tennessee State Director Rebecca Kelly said in a statement that the seniors’ advocacy group hopes that “members of the Tennessee Legislature will listen to their mothers, fathers, grandparents and other loved ones who want to live independently as long as possible.”

LONG TERM CARE

Key components of Gov. Bredesen’s plan to expand home and community-based care for the elderly and disabled include:

* A simplified, faster process for accessing services. The legislation would create a single point of entry for people who are not on TennCare and need access to long-term care services through Medicaid (TennCare) or other available programs. That entry point would be one of the nine area agencies on aging and disability across the state. Officials hope to turn cases around in as few as three to five days.
* Consumer choice and options. Broadens residential care choices in the community beyond nursing homes with new options such as companion care, family care homes and improved access to assisted care living facilities. Creates consumer-directed care options, including the ability to hire nontraditional providers such as family members, friends and neighbors who would be held accountable.
* “Whole person” care coordination. Develops one entity to coordinate all care for TennCare patients including medical, behavioral and long-term care. The administration plans to use TennCare managed-care organizations, which now manage medical and behavioral services.

Bredesen details long-term care overhaul

WPLN-FM
March 6, 2008

Governor Phil Bredesen rolled out a new plan today to create more home-based health care services for people who would otherwise be steered into nursing homes.

Bredesen promised the new look at long-term care in his State of the State message in January.

The proposal calls for “consumer-directed care,” where the recipients decide how to spend funds on non-traditional care providers with the aid of a counselor. Sometimes that paid-provider may even be a relative who would come in to take care of the patient.

State Representative Dennis Ferguson chaired a study committee which worked with the governor’s staff to fine-tune the project.

“There will be some more state funds involved, my understanding, and projection of around twelve million more new dollars that the governor’s going to put in the appropriation.”

In years past, 99-percent of state funds for long-term care have gone to nursing homes.

WEB EXTRA

The governor’s changes will be added to Senate Bill 4181 Kyle and other Democrats /House Bill 4144 Ferguson, Odom and other Democrats. This is a “caption bill,” with a title (“caption”) broad enough to be amended to address a lot of issues. Ignore the original verbiage in the title and note that it addresses three different volumes of state law - Tennessee Code Annotated Titles 63, 68 and 71.

Bredesen’s aides released a 16-page draft of the amendment that will be attached to the handy caption bill. It took a five-page summary to outline the effect of 31 sections in the new plan.

That summary includes “guiding principles” for a “restructured long-term care system,” beginning with these two:
Aging is not a disease, but rather a natural process; support services in the home are needed to allow persons to age in place
A “whole person” approach to care delivery

Bredesen’s administration posted on the governor’s website their own press release explaining the program.

Republicans recently outlined their own plans to help Tennesseans “age in place.” There doesn’t appear to be a difference in the aims of the two parties yet on the subject.

Much of the success of the program will lie with how TennCare is able to adopt new procedures. Health care providers will be watching carefully how reimbursement for services is addressed.

Bredesen urges health care reform

By Darren Dunlap
Knoxville News Sentinel
March 11, 2008

Though it's a tight budget year, it's actually a good year to reform long-term health care in Tennessee, Gov. Phil Bredesen said.

Bredesen came to Knoxville to accept the Distinguished Citizen Award from the Great Smoky Mountain Council of Boy Scouts of America on Monday, the first day legislation for a new plan to restructure long-term care was filed.

"The budget is tight, but it's a good year to do some restructuring," said Bredesen. "If we had lots of money, the temptation would be to leave everything in long-term care the way it is and put some money into home- and community-based services."

Having to stick with the discipline of taking the current amount of funding, or a "small amount" of additional money, and restructuring the system means state officials would "do a better job with it than otherwise," said Bredesen.

Long-term care costs $1.2 billion annually and is administered through TennCare.

The proposed "Long-Term Care Community Choices Act of 2008" aims to simplify the system and give people more choices. It calls for more residential care choices in the community beyond nursing homes, like companion care, family-care homes and improved access to assisted-care living facilities

Bredesen said he's not proposing funding be increased substantially, and the restructuring involves taking the amount of money the state has and spending a little smarter.

A bipartisan group of state lawmakers also studied long-term care and submitted ideas, some that were incorporated in the proposed legislation, according to Bredesen.

"I think we've structured something that's going to have good support across party lines and good support in the House and the Senate," he said.

Lydia Lenker, Bredesen's press secretary, said the governor will be making other stops in the state to talk about the new legislation.

The issue has been on the back burner for some time, but Bredesen decided to bring it forward this year.

It was something he talked about in his campaign, and also an issue that has come home personally for Bredesen over the last few years as his 86-year-old mother has aged.

He said it has helped him to learn how important it was for her to remain in her home as she gets older.

He said the choice in Tennessee for long-term care is "pretty much" live independently at home with the help of a family member or go to a nursing home. He said there are a lot of intermediate steps between those, and the aim of the legislation is about making them available.

Bredesen, once a Boy Scout himself, was in Knoxville to take part in the Scouts' Jimmy Williams Distinguished Citizen Dinner Program at the Knoxville Convention Center.

The Scouts took note of the governor's work as a founding member of Nashville's Table, a nonprofit group that collects excess prepared and perishable food from local restaurants and distributes it to the city's homeless population, and the Land Trust for Tennessee, a nonprofit that works statewide to preserve open space and family farms.

Gov. pledges to reform long term, home healthcare

WKRN-TV
March 6, 2008

Long term healthcare is an issue for nearly every Tennessean, especially those with aging or disabled family members.

Thursday, Governor Phil Bredesen cited the wishes of his mother when he pledged to reform long term healthcare benefits for the elderly.

“This is about keeping people in their homes as long as they want to remain in their homes and for me it’s driven by the experience with my own mother,” he said.

The Long Term Care Community Choices Act of 2008 aims to simplify and expand the care options for the elderly and disabled, with a focus on home healthcare.

The governor hopes the proposal simplifies and restructures a complicated system of caring for the elderly and disabled and gives families choices for their loved ones.

Dave Goetz, State Finance Committee, said, “It’s very confusing for someone to figure out what they need or mother or father or aunt or uncle, too many places to go.”

Just down the street from Capitol Hill, the Agency for the Aging and Disabled has been directing people to care options for years.

 Under the new proposal, its role will be expanded.

Ernestine Bowers runs the Agency for the Aging and Disabled.

She said, “One of the benefits of being able to work in this field and we advocate that we want people to remain in their homes as long as possible and for my mother to be able to actually do that is one of the great joys of my career.”

Governor Bredesen now hopes thousands of other Tennesseans can do the same.

Tennessee spends more than $1 billion each year on long term health care.  98% of that money goes to nursing home patients.

AARP backs home care plan
Survey finds 88% favor alternatives to institutions

By Richard Locker
Commercial Appeal
March 11, 2008

NASHVILLE -- AARP on Monday endorsed Gov. Phil Bredesen's plan to streamline and expand access to services enabling more elderly people to remain in their homes rather than moving to nursing homes.

The advocacy group for people age 50 and up, which has 713,000 Tennessee members, released the results of a survey it commissioned that found 88 percent of the poll's respondents say it is important to have long-term care services that would enable them or family members to stay at home as long as possible.

Seventy-two percent said they strongly support increasing funds for such services and 57 percent said they are worried about being able to receive long-term care services in the setting of their choice, according to the 811 registered and likely voters 18 and up in Tennessee.

While the results are not likely to surprise anyone, "it shows the momentum for change is continuing to build in Tennessee," said AARP Tennessee Director Rebecca Kelly.

Tennessee ranks last among the states in the percentage of its Medicaid long-term care expenditures that go to pay for home- and community-based services as alternatives to nursing home care. In 2006, the last year for which complete figures are available, 98 percent, or $943 million, of the Medicaid LTC expenditures went to nursing home care while $10.8 million went to alternative care.

Alternative care includes home-delivered meals and health care, homemaker services and assistance with daily living.

Bredesen unveiled legislation Thursday to restructure the state's long-time care programs to expand alternatives to nursing homes for elderly and physically disabled residents through the TennCare program, the largest single payer of long-term care services in the state. The state legislature will consider the bill before it adjourns later this spring.

Bredesen said he hopes nursing homes will evolve and provide the kinds of alternative services he is seeking.

He also would not rule out supporting a controversial proposal that the nursing home industry has pending in the legislature that would cap nursing home liability and require arbitration agreements of residents as a condition of nursing home admittance.

AARP is opposing that measure, saying it "would place nursing home residents at risk by undermining legal remedies when they are harmed or abused."

For more details on the AARP survey, go to aarp.org/research

Governor’s plan offers longterm care options for Tennessee’s seniors

By Mary Perren Russell

NASHVILLE — Gov. Phil Bredesen has finally offered details of his promised overhaul of Tennessee’s outdated system of caring for its elderly and disabled citizens.

Pledges to expand the state’s home and community-based care options are right up there with campaign promises to improve education and public safety and fight off any tax hikes for candidates on both sides of the political aisle.

However, that’s long been easier said than done, given the enormous power of the state’s nursing home industry. Caring for the elderly and disabled is a $1.2 billion business in Tennessee, with 98-percent of that money spent on nursing homes.

Bredesen hopes to change that by streamlining entry into the state’s elder care system and giving people the option to remain in their homes and age with dignity as long as possible.

Rather than tweaking the existing system, Bredesen is proposing an overhaul of the way TennCare handles its elderly and physically disabled enrollees. The state’s Medicaid managed care program is the largest single payer of long-term care services.

For starters, Bredesen’s proposal calls for a single access point to sign up for services. Family members will be able to get the process started by calling a toll-free number to be connected with one of the state’s nine area agencies on aging.

They’re already an entry point into the system, but so is the state Department of Human Services. This can be quite confusing for people who have never dealt with the Medicaid bureaucracy and serves to further compound the stress of coping with an ailing, elderly loved one.

Currently it can take 90 days or more for the state to determine if a person seeking services even qualifies for TennCare. Most people can’t wait that long and wind up in nursing homes as a result, even if their needs could be adequately met at home with a day nurse or meals-on-wheels provider.

Bredesen’s proposal would fast-track that evaluation process and get families an answer within three days.

If the person seeking services qualifies for Medicaid benefits, they will be assigned to an individual case manager with their managed care organization who can offer a variety of services tailored to meet their individual needs.

These include the ability to hire a non-traditional caregivers like neighbors and family members, who will be paid by the MCO’s in accordance with federal guidelines, and broadening community residential care choices beyond traditional nursing homes to family care and improved access to assisted living facilities.

Of course, not everyone who needs these services will meet the income guidelines to qualify for federally-subsidized TennCare benefits.

Bredesen also hopes to spend some money to expand the state’s options programs like meals on wheels and respite care services. Unfortunately the waiting lists for these services far exceed the resources available to help the people who need them, and this isn’t the year to dedicate a large sum of recurring state money to that cause.

Lawmakers would do well to remember those needs when the state recovers from the current budget shortfall and make funding those programs on a recurring basis a top priority. Needs for these services aren’t likely to diminish any time soon as the Baby Boom Generation transitions into retirement.

None of the proposals offered by the governor are particularly cutting-edge when it comes to caring for the elderly and disabled. Instead they are tried and true strategies that have worked well in other states to reign in costs and give seniors true choices when it comes to aging.

That’s fine. In this case, it’s not necessary to reinvent the wheel to offer people the dignity and respect they deserve. Lawmakers from both parties should be proud to embrace this comprehensive proposal and provide some long overdue choices when it comes to care for the elderly and disabled.

Mary Perren Russell is the Tennessee correspondent for Metro Source, a division of Westwood One Communications. E-mail her at mary_perren@yahoo.com.

Governor wants more choices for elderly besides nursing homes

By John Pless
NewsChannel9 (Chattanooga)
March 25, 2008

It is a decision most of us will face sooner than later - what will be do with our moms and dads, grandmothers and grandfathers when they can't take care of themselves?

Tennessee Governor Phil Bredesen says it's time to stop think about nursing homes, and focus more on keeping loved ones at home, with help.

Governor Bredesen wants to completely overhaul the long-term care system for the elderly, and replace it with a statewide system that allows people to stay home, and ultimately save taxpayer dollars.

"We're spending a billion-two a year right now, almost all of which is going in nursing home care," Bredesen said.

The governor is in Chattanooga meeting with social workers and providers of long-term care for the elderly at St. Barnabas. In this round table discussion everyone agrees there's a better way to spend the money the state gets from the federal Medicaid program.

Bredesen just introduced a bill that's being considered by the legislature called the Long Term Care Community Choices Act. It's designed to shift millions of dollars into home health care services for the elderly and disabled.

Tennessee is ranked last in the country providing alternatives to nursing homes.

"The evidence is all over the place, including here today that there are a lot of people, they don't need the intensive services of a nursing home. That if you give them a little help they can stay in their home," the governor said.

Medical experts say people who stay at home, versus being in nursing homes, are healthier and happier.

Wanda Dillon, a registered nurse who is a case manager for a home health provider shared just one example.

"She came out of the nursing home and she was 100 years old. And she went to live with her daughter. She's been home now over a year and she's doing wonderful," Dillon said.

Another benefit is the savings in Medicaid dollars. According to TennCare, the average annual cost of staying in a level-1 nursing home is $50,417. But through Medicaid waivers the program pays up to $20,000 a year for home health care, and TennCare says most people use less than that.

The governor wants to put another $12-million into the next budget for people getting waivers for home health care.

Bredesen says he really likes a program right here in Chattanooga that could become a model for a statewide program. It's run by Alexian Brothers and it's called the PACE program.

Sharron Watson, who attended the meeting with the governor, said she uses PACE for her infirm mother who's staying at home with her. PACE provides medical and housekeeping help at home.

"PACE has enabled me to continue to work. It's enabled me to continue keeping my mother at home, which was my objective," Watson said.

Governor Bredesen said "and if somebody can stay out of a nursing home with the help of a couple hours a day to make sure pills get taken, maybe gets a little personal care, that kind of thing, that's a win-win for everyone. Less expensive, they're in their home, it's more suitable with more dignity."

As states and the federal government continue to wrestle with tighter budgets and the skyrocketing cost of health care, the demand is going to skyrocket too.

TennCare is looking at the 65-and-up population to more than double in the coming years, and the 85-and-older population will triple as the baby boomer generation ages... and all of them will have to be taken care of.