Managing Demand for Long Term Care Services During Times of Economic Crisis

1. Managing Demand for Long Term Care Services During Times of Economic Crisis Charles A Reed Former Deputy Secretary Washington Department of Social and Health Services Reed

2. Fiscal and Social Environment • Demographic/population in need rapidly increasing • Nursing home budget grows • Rates and caseload • Very powerful nursing home lobby • Difficult to get Federal money to community programs • Limited State money for community programs and things are getting tighter Reed

3. Core Values for a Long Term Care System • Persons with disabilities and their families are entitled to maximum feasible choice/participation in selecting care settings and providers • Person with disabilities have the right to expect “quality of life,” including personal dignity, maximum feasible independence, health and security and quality of care • Persons with disabilities have the right to choose and/or direct a care plan involving “managed risk,” in exchange for the advantages of personal freedom Reed

4. Philosophy of choice • Everyone has an opinion of how they want their long term care service • Bedrooms, bathrooms, breakfast and TV • No one service is the most important --all are equally important Reed

5. Choice... • Options must be viable to be a valid choice • All options must meet quality standards • Case management is critical for customers and families to understand choices and have access Reed

6. Organizational Structure • Location, Location and Location. • Placement in state government hierarchy is important • Not too high, not too low Reed

7. Office of the Secretary Dennis Braddock Secretary Liz Begert Dunbar Deputy Secretary Office of the Secretary Dennis Braddock Secretary Liz Begert Dunbar Deputy Secretary Aging & Adult Services Administration Medical Assistance Administration Health & Rehabilitative Services Administration Economic Services Administration Juvenile Rehabilitation Administration Children’s Administration Reed

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9. Organizational Structure • Must control • Medicaid dollars • Placement and case management in nursing homes and community settings • Licensing and quality assurance • Rate setting Reed

10. Gaining Control • Where does the money go? Reed

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12. Gaining Control • Controlling the number of nursing home beds • Controlling the nursing home rate • Paying for empty beds • Good licensing and quality assurance Reed

13. Gaining control • Getting articulate, knowledgeable consumer groups and advocates on your side • Dealing with the nursing home lobby • “To be nice, or not?” • Convincing decision makers that you have a plan that can save money and give consumers what they need and want Reed

14. Gaining Control • Convincing the decision makers that “Choice” is the key element in a good Long Term Care System. Reed

15. Setting Up The System • Deciding on who has the “Front Door” • Is there more than one “Door?” Reed

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17. Setting Up The System • Who does case management? • Types of services to be funded? Reed

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23. Setting up the system • Develop a “philosophy of regulation” and stick to it • Working with the Federal agencies • How data is collected and used • Data must be used for making decisions Reed

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28. Maintaining the System • Training • Staffing issues • Low wages and turnover a critical problem. • Quality assurance • Liability issues Reed

29. Maintaining the system • Helping people (consumers, families, taxpayers, decisions makers, etc.) understand the “system” • “Getting” to consumers and their families when the “decision” needs to be made. • Developing a consistent funding steam. • “Who’s got the Money” Reed