Long-Term Care

This is a compendium of three discussion papers on the topics of direct service workers in long-term care and strategies for improving the quality of their jobs and services. The authors, each with a background that includes consultation and technical assistance on the topics, share the premises that these workers are fundamental to the future and quality of long-term care and that current and projected workforce shortages need to be addressed.

This report compares strategies of eight states engaged in strengthening consumer participation in long-term care (LTC) policy advocacy. The authors identify several tips for states to encourage consumer advocacy with the goals of increasing the efficacy and accountability of programs. This paper is part of a project funded by CMS to study ways to create a more equitable balance between Medicaid funds for LTC going to institutional services versus community-based supports.

This book and corresponding materials present a strategy for improving the health care workforce serving older adults via expanded education and training, models of care, and public/private programs. The committee proposes a three-prong approach: 1)Enhance the geriatric competence of the entire workforce; 2)Increase the recruitment and retention of geriatric specialists and caregivers; 3)Improve the way care is delivered. The book is available free online or for sale in PDF or hard copy format.

This report outlines an integrated strategy to update the country’s long-term care services infrastructure in preparation for the aging of the population over the next thirty years. Recommendations are focused on the areas of quality, workforce, technology, and financing.

This is the third in a series of reports examining various state systems and processes directed to older adults to realize the goals of the Real Choice Systems Change grants. This report analyzes the results of twenty-four focus groups consisting of 240 participants representing older adults, caregivers to older adults, and HCBS providers. In general, the results indicate Illinois has a plethora of programs and services targeting older adults, but there are disparities between communities.

This study is intended to describe the nursing facility level of care determination processes in use by the states and to draw general conclusions from the data collected. When read in conjunction with the previous work in this area, this study will aid state staffs, CMS, and other parties interested in understanding how to improve post acute care assessment. The Appendix provide a brief description of data the state collects, the name of the assessment form, plus contact information.

Over the last eight years, federal, state, and local governments have re-envisioned how to deliver and pay for an ever-growing caseload of elderly individuals and persons with disabilities who need services at home, in the workplace, or in more costly nursing facilities. This discussion provides a vision and a context for HCBS reform consistent with CMS’ vision for reforming post-acute care that focuses on addressing system barriers and informing and empowering health care consumers.

The Kaiser Commission on Medicaid and the Uninsured supported this focus group project of adults with disabilities in 4 states, who are enrolled in Medicaid Consumer Directed Personal Assistance Services programs. This research was undertaken to learn about Medicaid enrollees’ experiences in the program and their opinions about key features of the program including recruitment issues and degree of responsibility over services. Ways to improve upon the programs were also identified.

Consumer direction of personal assistance services (CD-PAS) is one model of service delivery that gives Medicaid beneficiaries varying degrees of control over hiring, scheduling, training, and paying personal care attendants. Program administrators, experienced with the programmatic features of CD-PAS in their state, were interviewed. Eligibility criteria, participant support services, and method of financial management used by Medicaid beneficiaries to pay direct care workers are discussed.

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