Guest Blog (Donna Rhodes): Long Term Care – The sleeping giant is stirring

Donna Rhodes is the CEO of the Long Term Care Authority, a public trust authority of the city and county of Tulsa leading the Tulsa community and the state in addressing long term care reform.

While the voice of long term care has been mostly silent in the health care reform discussion, it is unlikely to remain that way for much longer.  This sleeping giant has been extensively studied and analyzed, producing a multitude of recommendations both nationally and locally.  Yet without serious effort to strategically plan and implement the necessary infrastructure changes, states will be caught unprepared for the impact of long term care’s growing cost and will miss out on the expected federal incentives for supporting long term care systems change.

Shifting more financing for long term care from institutional care to home and community based services (HCBS) has been a policy goal across the nation since the 1970s.  Oklahoma’s initial investment in “balancing” the state’s long term care financing and service delivery systems changes began in earnest with the creation of a local public trust authority focused exclusively on long term supports and services and, subsequently, the establishment of a statewide comprehensive HCBS system.  The ADvantage HCBS Program, operated and managed by private business located across the state, was intended to become the foundation on which to build a Medicaid managed long term care system for the predicted “tsunami” of long term care needs of an aging population with chronic illnesses and disabilities.

An October OK Policy blog post examining long term care within the new federal health care reform law mentions two significant issues related to priorities for Oklahoma:

  1. state policymakers must “move quickly and purposefully to make sure our state does not miss out on any opportunities that the Affordable Care Act might provide for HCBS”;
  2. the Oklahoma Health Care Authority has indicated that, “with other pressing priorities on their plate, they have not yet looked at the long-term care component of the Affordable Care Act and do not know in which direction they will go”.

State policymakers have the resources available to move “quickly and purposefully”.  In the first place, practical recommendations were provided five years ago by the National Academy for State Health Policy (NASHP)  following a thorough review of Oklahoma’s long term care infrastructure.  Secondly, Oklahoma has the Long Term Care Authority (LTCA) with the sole purpose of furthering the state’s progress in long term care innovations and improvements.  LTCA has been preparing for the long term care component of the Affordable Care Act and for the impact to Medicaid.  And, finally, Oklahoma has a statewide HCBS system of private businesses prepared for the threats and opportunities expected with reform.

As the Long Term Care Authority prepares the state for long term care reform and policymakers move “quickly and purposefully” this session, the following five recommendations must be executed:

  1. Establish a state philosophy to guide financing, policy and program development for long term care and include this philosophy in statute and regulations;
  2. Create balance by shifting more long term care spending from institutional care to home and community based services;
  3. Strengthen the state’s organization of functions to improve accountability and improve efficiency by utilizing the public-private partnership already established in the state’s long term care HCBS;
  4. Fully implement self-direction opportunities in long term care;
  5. Develop an integrated structure for operating and managing Oklahoma’s HCBS waivers and other long term care services.

Oklahomans know the direction in which long term care should go in this state, and implementation of these recommendations is a big step in that direction.  It just happens to be that it is a promising investment for the state as well.

The opinions stated above are not necessarily those of OK Policy, its staff, or its board. This blog is a venue to help promote the discussion of ideas from various points of view and we invite your comments and contributions. To see our guidelines for blog submissions, click here.


Former Executive Director David Blatt joined OK Policy in 2008 and served as its Executive Director from 2010 to 2019. He previously served as Director of Public Policy for Community Action Project of Tulsa County and as a budget analyst for the Oklahoma State Senate. He has a Ph.D. in political science from Cornell University and a B.A. from the University of Alberta. David has been selected as Political Scientist of the Year by the Oklahoma Political Science Association, Local Social Justice Champion by the Dan Allen Center for Social Justice, and Public Citizen of the Year by the National Association of Social Workers.

6 thoughts on “Guest Blog (Donna Rhodes): Long Term Care – The sleeping giant is stirring

  1. With the over 65 population doubling in the next decade and experts releasing information that, as of 1/1/11, 10,000 citizens are turning 65 daily, not to mention the fact that the fastest growing segment of the population are those over age 80, we can no longer ignore this change. Donna Rhodes offers reliable reminders that it is time us to plan, offer a true choice for supports and balance how we serve our aging population who need long term care.

  2. This seems to be an especially timely call to action as Oklahoma’s legislative leaders are preparing to streamline state services. Oklahoma’s partnership with The Long Term Care Authority will create efficient systems that will serve our citizens well while making an effective investment in our future. Thank you Donna Rhodes and the LTCA.

  3. It would really be hard for policymakers to develop programs that can help people bear the heavy burden of the high costs of long term care. Raising funds and maintaining the program and services would be a big challenge. On the other hand, people should also be informed of ways they can save on long term care premiums such as state partnership programs and the discounts available

  4. I believe long term care insurance is important to protect your health and finances. The late 50s, before you turn 60, is the time to buy long-term care insurance. Buying a policy is a good strategy for ensuring that the resources are available to meet your needs of aging.

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