Revamping Long-Term Care in Pennsylvania

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Commentary on The Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey on Views on Long-Term Care by Nora Dowd Eisenhower, secretary of the Pennsylvania Department of Aging

Pennsylvania is undergoing a demographic change that most other states will not see for another 10 to 15 years. Experts accurately refer to Pennsylvania as an aging commonwealth. This shift could be viewed as a looming fiscal disaster and human tragedy, but, in our state, it has been seized on as a unique opportunity for change.

The proportion of Pennsylvanians aged 85 and older—those most likely to need assistance in daily living—is growing at a rate 20 times faster than our overall population. Just as importantly, a significant number (162,000) of adult Pennsylvanians under age 60 are estimated to be in need of some level of daily living assistance. These demographic shifts present challenges but also offer valuable opportunities to promote positive aging and increase our citizens' quality of life by initiating meaningful system reform. With the full support of Governor Edward G. Rendell, we are moving swiftly to revamp our long-term living policies and programs to meet the changing needs of our population.

To launch this effort, the Departments of Aging and Public Welfare have merged related programs under a new Office of Long Term Living. This new office is accountable for the fiscal, policy and program operations of the long term living system for the elderly and adults over age 18 with physical disabilities. Our primary goal is to empower people to remain dynamic and active participants in their communities.

Most people will need long term living services during their lifetime. Meanwhile, a very recent survey of older Pennsylvanians found that the vast majority of people assume that Medicare will pay for their long term living expenses. As any health care provider knows, this is simply inaccurate. Payment for most nursing home service comes from other sources, including personal life savings, with Medicaid a backup once almost all personal assets are depleted.

The current long-term living system in Pennsylvania is too complex and, too often, individuals and families are left with no alternative but a rushed, unexpected placement in a nursing home. This is distressing, because studies consistently show that people want to stay in their homes. To remind people to start thinking about these issues, the governor recently launched the Own Your Future campaign, a federal–state partnership encouraging consumers to consider their future long term living needs and start planning ahead.

When Rendell took office in 2003, 18 percent of our long-term living consumers were served in the community. With our recently passed budget, the ratio will improve to 32 percent in 2009. Roughly four of five taxpayer dollars are spent on nursing home care, while we spend the rest on community-based programs and home care financed under a federal Medicaid waiver.

To address the changing long-term living needs and preferences of Pennsylvania residents, we are working to create a system that is based on the principle of consumer choice and that uses resources efficiently. For instance, in an effort to help nursing home residents to return to their homes and communities when it is safe and appropriate for them to do so, Pennsylvania's nursing home transition program has helped over 3,500 people regain their independence since January 2005.

Nursing facilities will continue to be an important and necessary component of a balanced long term living system. However, we are working with the nursing home industry to reconfigure their facilities according to consumer preference and needs. Our Nursing Facility Partnership Plan is designed to create financially attractive and flexible system incentives that will motivate providers to reconfigure assets according to market realities and consumer preferences. Our Community Services Partnership Plan is designed to reinvest savings from reconfiguring nursing facility beds into home and community-based services and reinvest savings to expand community-based infrastructure.

Meeting our goal will also require us to expand the array of long-term living service options. Assisted living is a less costly alternative to nursing home care for individuals who need access to 24-hour support. New legislation will create housing options for persons who may or may not need nursing home care but prefer an apartment-like setting. Other initiatives that will strengthen the infrastructure of the system include creating accessible one-stop shopping for information, improving training, and strengthening our workforce.

These are just a few examples of our broader long-term living strategy. Each program is designed to shift the balance in the commonwealth's long term living system from reliance on institutional long term living services toward quality home and community-based services. Much of the savings projected from long-term living reform will be used to increase those waiver services and to build the infrastructure necessary to manage and sustain a balanced system.

For more information on the Pennsylvania Department of Aging, visit aging.state.pa.us.

The views presented in this commentary are those of the author and should not be attributed to The Commonwealth Fund or its directors, officers, or staff.