Late last month, a draft of the State of Connecticut’s Long-Term Care Right-Sizing Strategic Plan came across the desk of every long-term care provider in our state. Facilitated by the consulting firm Mercer, this much anticipated report outlines what has to happen to meet the long-term care needs of our state’s aging population while controlling costs and providing more patient-centered, community-based solutions
The report came about with input from seniors, families, advocates and health care professionals as well as state officials. As past chair of LeadingAge Connecticut, I was privileged to be one of four individuals to represent our state association for input in this exercise. Other groups asked to participate were people with disabilities and participants in the “Money Follows the Person” (MFP) initiative. (MFP is a federal-state pilot program to move people currently in nursing homes back into the community. It has met with modest success, as certainly, not every nursing home resident is a candidate to go back into the community.)
The backdrop to all of this is the reality that Medicaid is the largest single item in the state budget. 46% of that Medicaid number goes to long-term care facilities such as Masonicare Health Center and Masonicare at Newtown.. The remaining 54% is delivered in home and community-based settings (HCBS) that include agencies such as Masonicare Home Health & Hospice. Not only is there currently a moratorium on adding any new nursing home beds in Connecticut, the Mercer plan seeks to take 7,000-9,000 of Connecticut’s 28,000 nursing home beds out of the Medicaid system and effectively “re-balance” or shift care so that, by the year 2025, 83% of long-term care would be delivered outside of institutional settings, up from the current 54%.
Some say that the plan aims to create choice and make it easier to get Medicaid funding for at-home care. Others say it is about saving the state money. I think they are both right. But I also think that making it happen – getting to the 83% – won’t be easy. An increase in the
workforce of home care workers will be required, as will better transportation, an expansion of adult daycare programs, and housing that’s more accessible.
Those of us with a front-row seat to this right-sizing effort know there will always be a need for nursing homes, regardless of the reduction in overall numbers. The nursing home patient of tomorrow is projected to have a higher acuity, require more hands-on care, and have a shorter length of stay with multiple readmissions from their community setting.
One in four Connecticut residents currently provides some form of assistance to a homebound person. For this transition to occur, the ratio will need to increase. HCBS caregivers do not generally provide 24-hour care such as that currently provided in our nursing facilities. This will result in a changing role – with funding, of course – for nursing homes to serve as transition “hubs” for an array of long-term care services. While all of this is a long way from becoming a reality, with our comprehensive continuum of care, Masonicare will be better positioned than most for what lies ahead.