An Attempt to Right Size Connecticut Long-Term CareMay 03, 2012
George W. Thomas, CPA
With the 2012 regular legislative session completed, a key element of last year’s session continues to be analyzed. Section 17b-369 of the State of Connecticut General Statutes was revised last year, and requires the Commissioner of Social Services to develop a strategic plan to rebalance long-term care supports and services between those provided in institutions (nursing facilities) and those provided in home and community based settings.
The state hired Mercer Consulting to evaluate the current landscape, and a draft report evaluating the State’s home and community based waiver program was issued in December 2011.
Mercer’s report noted the following key points:
Connecticut spent 13% of the state budget for long-term care in fiscal year 2009.
Currently, Connecticut spends 78% of the long-term care Medicaid dollars on nursing homes.
The state ranks third in the country with 5.8 residents per hundred people over age 65 being in a nursing home compared to a national average of 3.8.
The state has an average Activity of Daily Living score of 3.7 which is the third lowest in the country. The national average is 4.0.
- The cost of home and community care at face value could be lower, but acuity levels of patients and expansion of services could result in little or no savings to the state.
The underlying reasons and drivers for some of these statistics can be debated, but the fact is that they are now documented in a state-sponsored report. Regulators and politicians will likely refer to this report as evidence to support future initiatives and positions.
The report also suggested looking at six targeted initiatives that the State should analyze with the goal of successful rebalancing:
Home and Community Based Services- This initiative would target the creation of an infrastructure in the state to allow more individuals to live with family, in their own home or in other community based organizations as an alternative to nursing homes.
Workforce- This initiative would focus on gaining an understanding of the workforce needs under a rebalanced system scenario, including an understanding of necessary retraining of providers.
Housing and Transportation- This initiative would involve an analysis to determine if:
- Affordable, safe and accessible housing is currently available for a successful community based program.
- The transportation for caregivers to provide services at these locations is available.
The transportation for patients to attend medical appointments is accessible.
Hospital Discharges- This initiative would work towards a goal of more hospital discharges directly to the community instead of to a nursing home.
Nursing Home Diversification and Modernization- This initiative would determine where changes are needed in current nursing homes. One line of thought is that while some nursing homes, as presently configured, will be needed in a rebalanced system, some facilities will need to close or diversify the services that they provide, including taking care of more medically complex patients.
- “Money Follows the Person Grant”- This initiative would determine how grant money received from CMS should be used to advance planning and implementation of community based services to transition at least 5,200 residents from nursing homes by 2016.
Late in 2011, a group of more than 60 individuals, including representatives from Mercer Consulting, the state and the long-term care provider community, met on how best to advance these initiatives. Significant discussion on these initiatives occurred, and follow-up commentary was provided back to Mercer Consulting. A draft of the right size strategic plan was issued January 15, 2012. This draft emphasizes the importance of the six targeted areas above and provided some additional tangible elements which are still needed to begin the rebalancing process. The final report was issued on April 16, 2012. The main objectives of the report were not significantly different than what was included in the draft.
Certain elements of the report which the state hopes to implement in the short term were included in the Governor’s 2013 fiscal year budget. The Governor’s budget addresses rebalancing through funding for nursing home workforce retraining, nursing home diversification, downsizing or modernization and a hospital discharge information system. The Governor’s budget also contains initiatives to expedite the “Money Follows the Person Program” funds to bring residents back to the community through home modernization and expansion of the assisted living pilot program.
Many of these initiatives were included in the final bonding bill passed by the House and Senate including $10 million for nursing home diversification, $1 million for home modernization in the community and $12 million for congregate housing development. Additionally, $11 million has been budgeted for “Money Follows the Person Programs”, and a special session could result in additional budget initiatives being funded.
The next step identified in the final Mercer Consulting report is to take the information obtained to date and determine how it will affect the supply and demand for nursing facilities services on a local level in the future. This step will help to shape the state’s policy approach for the industry in future years.
It is important that you begin to prepare for these changes. Make sure you understand your source of patients, how this might change under a rebalancing scenario and what, if any, role you might play in implementing rebalancing. Changes to the way the state’s elderly population are cared for is coming.