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:
- 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”;
- 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:
- Establish a state philosophy to guide financing, policy and program development for long term care and include this philosophy in statute and regulations;
- Create balance by shifting more long term care spending from institutional care to home and community based services;
- 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;
- Fully implement self-direction opportunities in long term care;
- 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.
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