Long-Term Care

In 2004 the Veterans Affairs' Vocational Rehabilitation and Employment (VR&E) program was reviewed by a VR&E Task Force. It recommended numerous changes, in particular focusing on employment through a new Five-Track service delivery model and increasing program capacity. Since then, VR&E has worked to implement these recommendations. This report includes VR&E's progress in implementing the 2004 recommendations and includes additional recommendations moving forward from the Accountability Office.

In addition to recommendations for reforming long-term care, this report goes over why it should be reformed and suggests the first steps for accomplishing change in the public and legislative arenas. Finance, service delivery, workforce, and quality are all identified as focus areas for improvement, and options are provided for each. Special attention is paid to low-cost options as a place to start with bipartisan cooperation. The report is accompanied by presentation slides.

Minnesota’s Legislative Auditor investigates the state of the personal care workforce and the regulation of these services and presents recommendations for improvement. Information is provided on eligibility and access as well as the demographics of people that are assessed for or receiving personal care services. Program traits examined include regulation, expenditure trends, fiscal integrity, and quality. Family caregivers are looked at in the final section.

To answer the question posed in the title, the authors studied HCBS spending and the availability of family members. Higher HCBS expenditures are found to be associated with lower risk of nursing home admission, but this association is statistically insignificant for older adults with living children. Doubling state HCBS expenditures would reduce the risk of nursing home admission among childless seniors by 35%.

New York spends more than most states on Medicaid and long-term care. To understand why this is, the following traits are evaluated: demographics of residents over 65; poverty level; long-term care spending, budgets, and services; and quality of nursing home care. The findings identify a number of demographic and program factors likely contributing to the high rate of spending.

Money Follows the Person (MFP) programs only target 0.9% of the people that could be eligible for transitioning out of institutions each year. However, there is a potential to increase rates to 15-40% annually depending on quality of program implementation, who is targeted, and how successful states are in overcoming barriers to transitioning high-needs people. The report looks at grantee states’ potential for accomplishing this rate increase.

Finding and enrolling older adults and adults with disabilities into benefit programs for which they may be eligible represents an enormous challenge to the agencies that serve them. This website provides tools and resources to these local, state and national agencies to assist them in helping their clients access benefit programs, along with information on best practices and cost-effective strategies for outreach and enrollment.

Twelve states received Cash & Counseling Replication grants in October 2004. Here, the Replication States’ experiences in developing and implementing their new programs are documented in three stages: planning; design/development; and implementation/enrollment. The appendix includes summaries of the states' grant initiatives.

The three-year study examined relevant policy, program design, and cultural implications that may have an impact on enabling self-directed Medicaid beneficiaries to save money without losing benefits. Using extensive stakeholder engagement, six elements were studied: savings models; costs and benefits of self-direction; Federal tax policy; state policy context; participant needs; and an implementation plan.

Program history, outcomes and recommendation of areas for future study are summarized. The study was commissioned to compare participant demographics to another IL program; measure cost of services and administration and see what participants purchased; gauge satisfaction and unmet needs; and understand disenrollment rates and reasons.