delaware health and social services delaware’s delivery of long term services and supports the...
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Delaware Health and Social Services
Delaware’s Delivery of Long Term Services and Supports
The Need for Change
Delaware Health Care CommissionJanuary 3, 2013
Delaware Health and Social Services
Overview of Services Provided
Delaware Health and Social Services
Fast-Growing Older Population
0
50000
100000
150000
200000
250000
300000
350000
400000
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.
Delaware Health and Social Services
Long Term Services & Supports Scorecard Overall Ranking - 32
• Affordability and access - ranked 27th 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 28th 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 49th 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 7th 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 49th among all states in percentage of Medicaid spending for community-based long term services for older adults and adults with physical disabilities
• Ranked 13th among all states in Medicaid spending per 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…
Costs for institutional care
Community care costs
Institutional Bias in the US…
In FY2009, Delaware ranked 49th among all states in the percentage of LTC dollars spent on community based services for older adults and persons with physical disabilities.
In FY2009, Delaware ranked 49th among all states in the percentage of LTC dollars spent on community based services for older adults and persons with physical disabilities.
Costs for institutional care
About 66% of long-term care dollars are spent in facilities.
About 87.5% of long-term care dollars for aging and physical disabilities are spent in facilities.
Community care costs
Delaware Health and Social Services
Critical Concerns• Market demand and 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
24/7 call center Dedicated website to search for services
(www.DelawareADRC.com) Options counseling Service guides (English and Spanish) 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 integrates nursing facility services with community-based
services for older Delawareans and those with physical disabilities - implemented April 1, 2012
incorporated long-term care services into existing managed care delivery system
enhanced benefit package – increases choice of setting and service
improve access to community-based services, improve coordination of care, and supports to improve health status
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 integrated system of care for those 55 and over who have a
nursing home level of care comprehensive long term services for Medicaid and Medicare
enrollees (capitated rate) all inclusive care plan: 24/7, 365 days a year extensive package of services provided on site – participants
return home each night 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 community-
based 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 [email protected]