Long-Term Care Issues for Legal Aid Advocates

[gco...@nsclc.org]

Greetings from Moderator

Thank you for visiting the discussion group on Long-Term Care Issues
for Legal Aid Advocates. This discussion stems from the article
entitled Shaping the Future of Long-Term Care: Aging and Disability
Resource Centers and the Role of Title III.B Attorneys, which I wrote
for the September–October 2008 CLEARINGHOUSE REVIEW.

The article was a product of research that I have been doing on the
“rebalancing” of long-term care; by “rebalancing” I mean shifting the
delivery of long-term care from institutions to the community. As many
of you know, Medicaid is the primary insurer of long-term care in the
nation, and the program historically has relied on nursing facilities
as the primary source of coverage delivery (hence Medicaid’s
“institutional bias”). Change to this system has been very slow paced,
but the combination of the Olmstead decision, persistent consumer
demand for change, and policymaker concerns over how to meet a surge
in need as the boomers age has spurned a number of new initiatives.
(Olmstead v. L.C., 527 U.S. 581 (1999) (Clearinghouse No. 52,203).)

One approach that Congress took was to simply reduce—through drastic
changes it made to the eligibility rules in the Deficit Reduction Act
of 2005—the number of people who might qualify for Medicaid long-term
care coverage. I spent a lot of time analyzing these changes and
educating others about them. But in summarizing the Deficit Reduction
Act’s Medicaid long-term care provisions, I needed to include
information on the Money Follows the Person program, which was not
actually designed to cut people from Medicaid but rather to help
individuals already enrolled and living in nursing homes transition
back to the community.

In educating others about the Money Follows the Person program, I
found it helpful to identify its origins, specifically the state
nursing facility transition grants funded by the federal government in
the late 1990s and the broader federal Real Choice Systems Change
Grants that followed. (An advocate’s guide that I wrote on the Money
Follows the Person program is available in the Files section of this
discussion group.) These grants were designed to help states
experiment in transitioning individuals out of nursing homes and
finding ways to connect individuals to services before they entered
facilities (called “diversion”). The grants included coordination
between the Centers for Medicare & Medicaid Services and the
Administration on Aging. Because many health advocates are more
familiar with Medicaid’s long-term care services than the
Administration on Aging’s, I included an overview of these services in
an advocate’s that guide I wrote on the Administration on Aging s
Nursing Home Diversion Program (available in the Files section of this
discussion group), under which at least a dozen states have been given
grants to divert people from nursing facilities.

Central to the successful operation of these diversion grants will be
the Administration on Aging–supported Aging and Disability Resource
Centers, which are designed to be “one-stop shops” of consumer
information on long-term care from which individuals with a
foreseeable need for long-term care can receive information on the
full range of services available to them. More than forty states have
been granted funds to establish Aging and Disability Resource
Centers.

Because legal aid attorneys have been and will continue to be central
to the effort to rebalance the long-term care system, I thought that
informing them about Aging and Disability Resource Centers and
encouraging possible collaboration would be useful. The driving
philosophies behind the Aging and Disability Resource Centers are that
many individuals default to institutional care because they were never
made aware of their options ahead of time and that a well-known local
entity providing long-term care information will encourage consumers
to seek information before the critical need for care occurs and to
learn about community-based alternatives. So, collaborating with Aging
and Disability Resource Centers could be another method for legal aid
attorneys to pursue that hopefully will help achieve the goal of full
community participation for their clients.

This discussion group is not designed to be limited to Aging and
Disability Resource Centers, however. I have given the background for
this one idea with the hope that a full range of new rebalancing
initiatives will be discussed. Thank you for participating.

Gene Coffey
Staff Attorney
National Senior Citizens Law Center
1444 I St. NW Suite 1100
Washington, DC 20005
202.683.1992
gco...@nsclc.org