Homepage
-- Programs and Services -- Contact Information Elder Services Executive Director
Equal Choice in long-term care and reauthorization of the Older Americans Act
By Robert P. Dean
Every 10 years a White House Conference on Aging is held in Washington D.C. The fifth such conference was convened in December 2005, and was attended by delegates from around the country. During the conference, the delegates selected 50 recommendations related to aging services, which will be sent to the President and to Congress. The top two recommendations were to “Reauthorize the Older Americans Act Within the First Six Months Following the 2005 White House Conference on Aging,” and to “Develop a Coordinated, Comprehensive, Long-Term Care Strategy by Supporting Public and Private Sector Initiatives that Address Financing, Choice, Quality, Service Delivery, and the Paid and Unpaid Workforce.”
In regards to recommendation number one, and reauthorization of the Older Americans Act - the Act was originally authorized in 1965 as part of the Johnson administration’s “Great Society,” and is the basis for numerous programs and services that help seniors to live with dignity and independence. Some Elder Services programs, which receive funding through the Older Americans Act, include Nutrition/Meals on Wheels, Family Caregiver, Long Term Care Ombudsman, and Senior Aide. While the Act itself is reviewed and revised by Congress every few years, Congress passes the appropriations or dollars to fund programs authorized under the act on a year to year basis. Unfortunately, these programs - with few exceptions - have been basically level funded for years even though the cost of providing the services has increased. This is why programs such as Nutrition/Meals on Wheels remain under-funded and face a deficit each year.
Regarding recommendation number two and the development of a comprehensive long-term care strategy and the issue of choice – a basic foundation of any coordinated long range strategy must be to allow seniors the choice of where they will receive their long-term care services. Such a strategy would further advance the U.S. Supreme Court’s 1999 decision in Olmstead v. L.C., which states that individuals with disabilities are entitled to receive the most appropriate services in the least restrictive environment. In 2001, the President reinforced Olmstead through an Executive Order which stated that the federal government “is committed to community-based alternatives for individuals with disabilities... [and] must assist states and localities to implement swiftly the Olmstead decision, so as to ensure that all Americans have the opportunity to live close to their families and friends, to live more independently... and to participate in community life.”
In 2002, as a partial response to Olmstead, Massachusetts created the Community Choices Program to provide a greater level of in-home services to disabled Medicaid eligible elders who are at imminent risk of nursing home placement, but would prefer to live in their own homes. Currently, the Massachusetts legislature’s Joint Conference Committee on Health Care is reviewing a measure entitled, “An Act Regarding Choice of Long Term Care Setting,” which was reported favorably by the legislature’s Joint Committee on Elder Affairs this past November. This measure would establish clinical eligibility for a long-term care benefit. Any person determined clinically eligible for this benefit would be given the choice of care setting that is the least restrictive and most appropriate to meet his or her needs. The dollars that would be provided for this long-term care benefit would be “setting neutral,” which means that the care would not be contingent upon the care setting. As a result, the dollars would follow the individual if or when his or her care setting changes. Prior to its favorable reporting of this measure, the Committee on Elder Affairs met with experts from Vermont and Oregon, two states that have successfully implemented similar programs to serve seniors in less costly, less restrictive settings. The Chair of the Committee on Elder Affairs has drafted a letter to the Chair of the Committee on Health Care urging support for “equal choice” and stating in part that “it is important that we listen to our elders’ wishes and respect their desire to choose the setting that is most appropriate for them to be cared for, whenever possible.” At press time, 89 representatives have signed on in support of this letter.
Stay tuned...