aging in delaware: the keys to success

Delaware Health and Social Services

Aging in Delaware:The Keys to Success

Delaware Association for Home & Community Care, Nov. 7, 2012Rita Landgraf, Secretary, Department of Health and Social Services


Fast-Growing Older Population

• Today, about 1 in 5 Delawareans is age 60+.

• By 2025, they will make up one-fourth of state’s population.

• And by 2030, the state’s older population is projected to have doubled from what it was in 2000 to 253,646.



• The “oldest old” population – those individuals age 85+, and most in need of critical care services – will nearly double between 2005 and 2020.

• Then double again by 2040.



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50000

100000

150000

200000

250000

300000

350000

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2000 2005 2010 2015 2020 2025 2030 2035 2040

Age 60+

Age 75+

Age 85+

** By 2030, Delaware is projected to have the 9th-highest proportion of people age 65 and older in the U.S.


Where the Growth Comes From

1. Graying of the baby boomers.

2. An in-migration of retirees from other states – New Jersey, Maryland, Pennsylvania and D.C.


• Institutional Bias in Delaware…About 87.5% of long-term care dollars for aging and physical disabilities are spent in facilities.

Costs for institutional care

Community care costs

Institutional Bias in the U.S…About 66% of long-term care dollars are spent in facilities.

Community care costs

Delaware ranks 38th among all states in the percentage of long-term care dollars spent on home and community-based services.

Costs for institutional care


What the Marketplace Wants

89%• That’s the percentage of people surveyed by

AARP Delaware who want to age in place.• They want a high quality of life that allows

them to remain fully engaged in the their community.


Challenge and Opportunity

When the Supreme Court upheld the Affordable Care Act in June, it benefited Delawareans through:

• Increased access to health insurance and quality care.

• Being supported in community-based settings.

• Promoting healthy lifestyles.


ACA’s Effect on Providers• Primary care re-established as

gateway to medical care.• Systems and reimbursements

will focus on patient outcomes and measurable standards.

• Must transition from what Gov. Markell calls a “sick care system” to one that encourages healthy behavior and positive outcomes.


Patient-Centered Medical Homes

• Model transforms organization and delivery of primary care.

• Practice treats the “whole” patient, including physical and mental health needs, coordinating care with specialists, hospitals, and home- and community-based care.

• Secure communication and convenient hours organized around the patient.


Cost Avoidance/Cost Savings

• Right Care, Right Time, Right Place – building access to community.• AARP estimates that for every person we support in a facility, we can support 3 in the community.• Managed LTC.


Cost Avoidance/Cost Savings

• Promotion of self-sufficiency through financial empowerment ($tand By Me).

• Continuum of care contracting in mental health to build a recovery-based, community-robust system of care.

•Increasing the num-ber of Senior Medi-care Patrol volunteer hours.


Aging & Disability Resource Center

Single point for accessing long-term care information and support services:

• Statewide call center: (800) 223-9074

• Website with searchable database of services: www.DelawareADRC.com

• Statewide comprehensive resource, “Guide to Services for Older Delawareans and Persons with Disabilities


Discharge Planning• ADRC support

services: Options counseling, discharge planning & service enrollment support via partners

• Transition/discharge planning with hospitals and LTC facilities

The Care TransitionsTeam from DHSS’ Division of Services to Aging and Adults with Physical Disabilities has a current diversion rate of 92%.


Community-Based Services• State Rental Assistance

Program• PACE Center at

Wilmington Riverfront• Money Follows the

Person• Free legal service hotline

for Delawareans 60+ (NCCo: 478-8850; K&S: (800) 773-0606

SRAP helps individuals who are clients in DHSS’ Emily P. Bissell Hospital, Governor Bacon Health Center or the Delaware Hospital for the Chronically Ill find housing in order to return to the community.


Community-Based Services

• Title II of the Americans with Disabilities Act of 1990 requires accommodations for people with disabilities in all public and workplace settings.

• In its 1999 Olmstead decision, the Supreme Court confirmed the right to individual choice, saying unjustified institutional isolation of a person is a form of discrimination.


Disabilities in Delaware • About 108,000 Delawareans (12.3% of

the population) is estimated to have a disability.

• Seniors are far more likely to have a disability: 31% of individuals 65+ report one or more disabilities, compared with 11% of those age 18-64 and 4% of those younger than 18.


How the State Can Help

Seniors or individuals with disabilities may need support services or modifications to their home:

• Personal care service• Housekeeping services• Emergency Response System• Home-delivered meals• Personal attendant services• Access to transportation


Support for Caregivers• The number of Delawareans age 65+ with

Alzheimer’s is expected to increase to 16,000 by 2025, a 33 percent increase over the 2000 total.

• The demand for medical care, physical therapy, respite and caregiving services will skyrocket for this and other chronic diseases, and for people with disabilities.

• In a public/private/nonprofit collaboration, we must increase capacity for these services.


What is a Model? Definition of model (any initiative, strategy, tactic or policy

oriented toward the Governor’s Commission on Health Promotion and Disease Prevention): • Current model’s Sussex Outdoors • Sussex County Health Promotion Coalition • DSU Student Health • Healthy Weight Collaborative • DelaWELL • DE HEAL (Healthy Eating and Active Living) • UD Healthy Campus • Small Employer Initiative • United Way of Delaware Youth Health Program • Delaware Small Communities Initiative


DHSS’ Partnership with UD• Alignment of

opportunities between College of Health Sciences and DHSS:Health coaching

curriculumWorkforce developmentResearch to practice

and practice to research


Health Benefit Exchange• Delaware’s HBE must be live by

Jan. 1, 2014; accepting clients by October 2013.

• Pursuing a federal exchange partnership option rather than create a state exchange.

• Partnership option permits Delaware to maintain control of plan management and consumer assistance functions.


ACA: Medicaid Expansion

• In January 2014, Delaware will widen eligibility up to 133% of the federal poverty level ($14,856 for an individual; $30,657 for a family of four).

• State expects to cover an additional 20,000 to 30,000 Delawareans.

Federal government will pay 100% of the cost for newly eligible clients from 2014-2017; phased down to 90% of costs by 2020.


Delaware’s Workforce Needs

• Delaware’s aging population, health care reform, and additional insured clients under Medicaid expansion and health benefit exchange will increase demands on health professionals.

• To deal with shortage: Encourage nurse practitioners to practice to top of licenses, using prescriptive authority.

• Electronic medical records: As of July, 95% of providers enrolled in the DHIN.


Delaware’s Workforce Needs

• Delaware experiencing shortages among mental health providers, especially in Kent and Sussex.

• Use State Loan Repayment Program to attract professionals.

• Telehealth will help extend resources, especially for specialty care.


How Telehealth Started Here

Dennis Leebel of Lewes:• His wife, Betty, was diagnosed

with Parkinson’s disease 10 years ago. In, 2008, they retired from College Park, Md., to their second home in Lewes.

• In 2009, he founded the now 150-member Sussex County Parkinson’s Education & Support Group. To serve members, he advocates for telehealth.


Expansion of Telehealth• The Delaware Telehealth Coalition formed

in 2011. It now has 50+ members, including hospitals.

• Delaware Medicaid began reimbursing for telemedicine-delivered services on July 1, 2012.

• A Delaware hospital and DHSS are using telepsychiatry for crisis evaluation.


Why Delaware Needs Telehealth

• Many Parkinson’s support group members see specialists in Washington, Baltimore or Philadelphia – a difficult round-trip.

• Dennis Leebel is working with La Red on a teleconferencing setup for Dr. Ray Dorsey, a Johns Hopkins neurologist who treats patients with Parkinson’s.

• Betty Leebel will be Dr. Dorsey’s first telehealth patient.


What’s Next in Telehealth

• Bringing more hospitals and primary care doctors into the coalition.

• Looking at applications, including at-home uses, for Delaware’s aging population and the state’s underserved rural areas.

• Creating a website for the coalition.

• Using it to manage chronic conditions as supported by the Affordable Care Act.


“Grow old along with me!The best is yet to be.”~ Robert Browning


Rita Landgraf, Secretary, Delaware Department of Health and Social Services: [email protected] or (302) 255-9045

aging in delaware: the keys to success

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