Delawares Delivery of Long Term Services and Supports

Delaware’s Delivery of Long Term Services and Supports The Need for Change Delaware Health Care Commission January 3, 2013 Delaware Health and Social Services

Overview of Services Provided Assistance for Caregivers • Adult Day Services • Alzheimer’s Day Treatment • CARE Delaware • Respite Care Home and Community Based Services • Attendant Services • Home Delivered Meals • Personal Care • Home Modification Information and Support • Case Management • Delaware Aging and Disability Resource Center (Information and Assistance, Options Counseling, Service Enrollment Support, Diversion and Transition Services) • Money Management Program Rights and Protections • Adult Protective Services • Legal Services • Long Term Care Ombudsman • Medicare Patrol Program Delaware Health and Social Services

Fast-Growing Older Population ** By 2030, Delaware is projected to have the 9 th -highest proportion of people age 65 and older in the U. S. Delaware Health and Social Services

Long Term Services & Supports Scorecard Overall Ranking - 32 • Affordability and access - ranked 27 th in the nation a) Affordability of long-term care services (nursing home services and home care services) b) Access to Medicaid c) ADRC/single entry point • Support for family caregivers – ranked 28 th in the nation a) Percent of caregivers usually or always getting needed support b) Legal and system supports for caregivers Delaware Health and Social Services

Long Term Services & Supports Scorecard • Choice of setting and provider – ranked 49 th in the nation a) Percent of Medicaid and state funded LTSS spending going to community-based services b) Percent of new Medicaid LTSS users first receiving services in the community c) Number of people consumer-directing services d) Percent of nursing home residents with low care needs • Quality of life and quality of care – ranked 7 th in the nation a) Percent of adults with disabilities getting needed supports b) Nursing home indicators of care (e. g. , pressure sores, use of restraints) c) Adults with disabilities usually or always getting needed supports Delaware Health and Social Services

2012 Profiles of LTSS Across the States • Ranked 49 th among all states in percentage of Medicaid spending for community-based long term services for older adults and adults with physical disabilities • Ranked 13 th among all states in Medicaid spending person for nursing facility services Relative to our sister states, Delaware spends a much higher percentage of its resources on facility-based services Delaware Health and Social Services

Long-Term Care Expenditure Patterns Institutional Bias in Delaware… Community care costs Costs for institutional care About 87. 5% of long-term care dollars for aging and physical disabilities are spent in facilities. Institutional Bias in the US… Community care costs Costs for institutional care About 66% of long-term care dollars are spent in facilities. In FY 2009, Delaware ranked 49 th among all states in the percentage of LTC dollars spent on community based services for older adults and persons with physical disabilities. Delaware Health and Social Services

Critical Concerns • Market demand choice - the overwhelming majority (86% plus) of Delawareans want services that support them in their own home • Cost - for every person we serve in a long-term care facility, at least three people can be supported in the community (AARP estimate) • The Americans with Disabilities Act mandates that public agencies provide services in the most integrated setting appropriate to individual needs as affirmed by the US Supreme Court’s Olmstead decision. Delaware Health and Social Services

Initiatives Underway • Aging and Disability Resource Center – key to building access to services ü 24/7 call center ü Dedicated website to search for services (www. Delaware. ADRC. com) ü Options counseling ü Service guides (English and Spanish) ü Discharge planning support for hospitals Delaware Health and Social Services

Initiatives Underway • Diamond State Health Plan Plus (DSHP Plus) – Medicaid funded long term care services ü integrates nursing facility services with community-based services for older Delawareans and those with physical disabilities - implemented April 1, 2012 ü incorporated long-term care services into existing managed care delivery system ü enhanced benefit package – increases choice of setting and service ü improve access to community-based services, improve coordination of care, and supports to improve health status ü enables shift of resources from institutional care to community-based services Delaware Health and Social Services

Initiatives Underway • PACE (Program for All-Inclusive Care for the Elderly) – Saint Francis Life located on the Wilmington riverfront ü integrated system of care for those 55 and over who have a nursing home level of care ü comprehensive long term services for Medicaid and Medicare enrollees (capitated rate) ü all inclusive care plan: 24/7, 365 days a year ü extensive package of services provided on site – participants return home each night ü focus on preventive care and maximum level of physical, social and cognitive function Delaware Health and Social Services

Initiatives Underway • Housing supports (SRAP – housing vouchers; case work supports to find housing) • Money Follows the Person – transition residents of facilities to the community (incorporated into DSHP+) • Care Transitions – providing access to communitybased services for those applying for placement in a state facility (diverting over 90% of all referrals – have reduced average admissions from 8+ each month to less than 3 a month) • Partnership with hospitals on discharge planning Delaware Health and Social Services

Initiatives Underway • Expanding access to legal services – critical need for older Delawareans (individual legal support services; statewide assessment of legal needs; legal handbook) • Expanding the capacity of Delaware’s home and community-based services including Adult Protective Services • Expanding community-based mental health services Delaware Health and Social Services

Bill Love, Director, Division of Services for Aging and Adults with Physical Disabilities (302) 255 -9351 William. Love@state. de. us Delaware Health and Social Services