The Way Forward - Our Strategic Plan 2007
For over 30 years, the Area Agency on Aging has been a leader in the long-term care industry specializing in managed care in a community-based setting. Beginning in July 2006, we expanded our responsibility to Assisted Living. In this context, we have identified a further need to redefine our role in the overall structure of the long-term care system in Ohio to include all care settings: Community-Based Care, Assisted Living and Nursing Facilities.
As we prepare for the unprecedented growth of the older adult population in the United States, it is important to re-examine the strategic underpinnings of Ohio’s system of addressing the corresponding growth in long-term care needs. Clearly, the current system of long-term care is not working well, either in terms of efficient use of public dollars, or in providing older adults the right to choose their own care setting (i.e., where they want to live).
The old adage, “you cannot continue to do the same thing – and expect a different result,” is particularly noteworthy when considering the future of long-term care for Ohio’s older adults. Our current system is costly and ineffective for: 1) older adults on Medicaid who are denied choice of residence in the least restrictive environment and unnecessarily placed in nursing facilities; and 2) older adults of moderate means who do not qualify for government assistance, yet do not have the resources to pay for the care that they need. We cannot afford, either from a human or financial perspective, to continue the policies and practices of long-term care for older adults in the same manner that we have over the last several decades. We must effect change.
In order to accomplish this end, we have focused our strategic initiatives into four clear, concise, overarching goals – The Way Forward: Our Strategic Plan. The four cornerstones of our Way Forward Plan are: 1) Make Consumer Choice a Reality in Long-Term Care; 2) Fight to Win; 3) Work Together; and 4) Invest in the Future.
Our Consumer Plan: Make Consumer Choice a Reality in Long-Term Care
Older adults should have the right to live in the long-term care setting of their choice. This is not currently the case in Ohio.
Medicaid long-term care in Ohio currently operates three separate programs: PASSPORT Home Care, Assisted Living and Nursing Facilities (NF). Each of these programs operates separately; however, only nursing homes have unrestricted access for Medicaid-qualified older adults. PASSPORT Home Care and Assisted Living (the least costly and, in many cases, the most desirable options) have an arbitrarily limited number of openings – regardless of the personal needs or wants of the older adult and his or her family.
These structural and functional barriers result in significant human cost (resulting from restricted consumer choice) and dramatically increased Medicaid costs (since nursing home placement costs four times more than community-based care). We must eliminate these barriers to less restrictive care settings.
Our Advocacy Plan: Fight to Win
We must convince policy makers at all levels of government of the benefits to be derived from new directions in public policy regarding long-term care for older adults. Our comprehensive advocacy plan includes the following:
AT THE NATIONAL LEVEL we must: 1) promote the U.S. Administration on Aging (AOA) CHOICES initiative, which will provide individuals with resources to direct their own care; 2) secure funding for the Aging Disability Resource Network (ADRN) concept, which provides for the initial point of access to long-term care options for consumers and their caregivers; and 3) simplify the Medicare Prescription Drug Program for consumers.
IN OHIO, we must create a unified Medicaid long-term care program to replace the current fragmented system. Our advocacy plan centers on four basic premises:
- The growth of Medicaid expenditures must be controlled.
- A unified Medicaid long-term care program will correct operating inefficiencies resulting from the current fragmented system.
- Care management of Medicaid long-term care helps contain costs.
- Building on 20+ years of experience, Ohio should consolidate its Medicaid long-term care management system through Area Agencies on Aging. In order to demonstrate the feasibility of such a system, we propose that our AAA (PSA 10B) develop and operate a pilot program in our region.
Our Ohio advocacy plan is supported by logic and evidence. Chronically impaired older adults in nursing facilities (who require the most care and are the most costly Medicaid consumers) do not receive any type of comprehensive care management. Properly managed, many Medicaid nursing facility residents could be diverted to less restrictive, less costly and more desirable options.
Evidence of this contention is the AAA’s successful efforts in diverting Medicaid nursing home residents to home care through the “Home First” program, which originated in the State of Ohio 2006-07 biennium budget. “Home First” achieved remarkable success in its first 17 months of operation (July 2005-Nov. 2006). Even with no additional staff, and without assigning care managers to facilities, AAAs statewide have returned more than 1,400 people to their homes from nursing facilities, for a cost savings of nearly $65 million.
IN OUR REGION, it is important to consider a major segment of the older adult population that suffers greatly from inability to obtain needed services. We call this segment “Older Adults of Moderate Means.” These older adults do not qualify for government assistance, yet do not have the resources to pay for the care that they need. They are typically retirees with limited income and minimal assets.
Our plan is to serve this segment of the older adult population through our Care Coordination Program. Funding for such a program would come from local public support through aging services levies. To date, 68 of Ohio’s 88 counties have passed some form of an aging services levy that provide more than $100 million in services to Ohio’s older adults. Perhaps the most successful example in Ohio is the five-county AAA region in Cincinnati. The structure of these levies offers an effective model for such initiatives in our region.
Our People Plan: Work Together
In order to succeed, it is essential that we work toward common goals and objectives. But perhaps more basic, and in the context of the Agency’s overall mission, we must acknowledge a commonly shared vision that is easily understood, universally believed in, and easily articulated by all stakeholders.
Our Board of Directors: Improving Care Through Strategic Partnerships – With the leadership and cooperation of our Board of Directors, we have been a leader in the development of strategic partnerships between the medical service system and the aging services network that provides support to the chronically impaired. As a result, the overall effectiveness of patient care is enhanced through comprehensive care management. Examples include:SUMMA-Area Agency Geriatric Evaluation (SAGE) – With the leadership of Dr. Kyle Allen, Chief Medical Officer of our Board of Directors, we have developed a nationally recognized program that links geriatric evaluation through SUMMA Hospitals and supportive care management through the Area Agency on Aging.
Hospital Assessor Program – Because half of all nursing home admissions originate from an acute care setting, efforts to prevent unnecessary permanent NF placements must focus on older adults being discharged from the hospital. With the cooperation of hospital and physician leaders on our Board, we have deployed Assessors directly into six area hospitals (Akron City Hospital, Akron General Medical Center, Barberton Community Hospital, Robinson Memorial Hospital, St. Thomas Hospital, and Wooster Community Hospital). Our PASSPORT Registered Nurse Assessors work directly with hospital discharge planners and the older adult to ensure that necessary supportive services are in place upon the patient’s return to his or her home. Our plan is to be in every area hospital by the end of the decade.
Managed Care and Aging Initiative – This innovative program is the result of a federal grant from the federal AOA which integrates community-based long-term care with a Managed Care Organization (MCO). Partnering with SummaCare, we are able to develop comprehensive supportive treatment plans. The program features shared software that allows both organizations to share care plans in “real time.” A vital component of this program is a geriatrician-led interdisciplinary team that reviews difficult cases, thereby improving coordination of care, reducing emergency room visits, hospital admissions and permanent NF placements.
Our Staff: Promoting Learning and Growth – As the breadth and complexity of our business evolves, it is essential that we attract and retain the requisite talent and expertise to meet new or expanded stakeholder demands. Therefore, we have committed to providing the specific education and enhanced procedures needed to enable our clinical staff to better serve our members. Examples of such initiatives include the development of emergency preparedness and response protocols to enable our Care Managers to quickly and effectively respond to the needs of our members in the event of local or widespread disasters; and, screening and intervention protocols designed to identify and develop more effective care plans for members at “high risk” for permanent nursing home placement.
In addition, as we broaden our responsibility to care for clients in different care settings (from community-based care, to assisted living, to nursing facilities), we have identified the need to enhance the skill set and clinical nursing expertise on our staff. To accomplish this, we will add management expertise in Medicaid Managed Care and Medicaid Waiver management, as well as a Clinical Nurse Specialist (CNS) to oversee the special needs of our high-risk members in all care settings. Further, we have acknowledged the need to groom our next generation of leaders at the AAA. In recognition of the eventual need for current organizational leadership to “pass the baton” to the next generation, we have developed a Leadership Academy. Our Leadership Academy, now in its fourth year, provides training in planning skills, decision making, group dynamics, and interpersonal leadership skills needed to assume responsibility for the achievement of the AAA’s mission in the future.
Our Volunteers: Providing a Meaningful Experience– Our organization relies heavily on a large network of committed volunteers. This volunteer network numbers in the hundreds and, without its contribution, we would be unable to provide the level of service that we do. Our volunteers include: Advisory Councils in each of our four counties, who provide legislative advocacy and advice on planning issues; Ombudsman volunteers, who help protect the rights of older adults in nursing homes; and student interns, who perform numerous important tasks in support of AAA Divisions.
Our Financial Plan: Invest in the Future
In order to accomplish our Mission, we must build:
Improved Care Management Models for Each Long-Term Care Setting –
- Community-Based – focus on early detection of high-risk older adults and tailored interventions that mitigate the impact of their risk factors.
- Assisted Living – develop evidence-based criteria to identify the most appropriate placements in this setting.
- Nursing Home – identify residents willing and able to move to less restrictive care settings with emphasis on returning home; and develop a palliative care model for “permanent” residents that emphasizes comfort and reduces ER and hospital admissions.
A Financial Model That Will Position Us to Accept Risk Contracts – These contracts must ensure adequate provider reimbursement rates that enable us to attract and retain a responsive service network that accommodates the long- term care needs of the burgeoning older adult population.
Consumer Education Programs – We must evolve our consumer education programs that enable older adults and their caregivers to select from available health insurance options including Medicare Prescription Plans, Medicare Advantage Plans, and Special Needs Plans.
A New Office Complex – As a direct result of the extraordinary growth in the PASSPORT Program, the AAA has outgrown its current facility. Over the last 15 years, the number of PASSPORT enrollees increased from 640 in 1990 to 1,837 in 2000 to more than 3,000 in 2005 (+369%). At the same time, the number of Area Agency on Aging staff has grown from 55 in 1990 to 110 in 2000, and is currently approximately 150 (+173%).
We will be examining the relative merits of several options to address this critical need. We have developed a proposal to build a new facility in the City of Green utilizing a financial partnership comprised of the AAA, federal, state and local funding components. The AAA will assume more than half of the total cost of this project. Significantly, the City of Green has committed to contributing the land and sewer to the project, as well as provided valuable assistance in facilitating support for the project.
The Way Forward Plan presented here is intended to encapsulate our thinking for the future in order that all stakeholders may proceed with a common purpose. While our goals are bold, they are all realistically achievable. We are firm in our belief that the accomplishment of our plan will benefit all stakeholders who are concerned about the long-term care of older adults in Ohio. We must effect epic change in the system of long-term care for Ohio’s older adults – and we must begin now.
Stephen Colecchi Chairman
Joseph L. Ruby President & CEO
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