What the Affordable Care Act Means for Long Term Care

I recall seeing one of my mentors, medical sociologist and long-term advocate for nursing home reform, Charlene Harrington speak in Washington, DC.  She said she had been advocating for nursing home reform for more than 20 years and that in those 20 years she had seen little positive change.  The Affordable Care Act (ACA 2010) may well be the turning point that Dr. Harrington was looking for.  From what I have learned of the ACA, this piece of legislation offers a first step towards real transformation of how we care for and support our parents and loved ones as they age.  What the ACA does is facilitate the use of state and federal funding streams for home and community-based services and basic health care for all, both of which should have an important impact on how we age.

LTC ACA

 

Here is what the Affordable Care Act has to offer:  First, there is a much greater emphasis and facilitation for states to support home care and community-based living for people as they age.  The Community Living Assistance Services and Supports (CLASS) Program establishes a new public long-term care insurance program geared towards funding home- and community-based supports.  Once someone has paid into the program for a minimum of five years, they will be eligible to receive an average of $50-75 per day to help them pay for home or community based care.  Section 2401, the Community First Choice Option, allows states more freedom to provide attendant care and increases the Federal coverage for these services.  Section 2402 offers a number of ways to reduce barriers and facilitate access to a wide array of home- and community-based services through the existing Medicaid HCBS waiver programs.  Section 2403 extends until 2016 what has been a successful demonstration project started under President Bush, Money Follows The Person. These grants allows states to develop projects that allow people to choose where they want to live, giving people with care needs the option to live at home or in the community as opposed to in a nursing home.  Section 10202, the Balancing Incentives Program, also helps states have better flexibility to spend their money on non-institutional services.

Second, there appears to be some steps for reforming institutional care.  Section 2701 includes the development of adult health quality measures and Section 2703, Health Homes for Individuals with Chronic Conditions, appears to be a measure to reformulate how institutional care is delivered for persons with a focus on “person-centered” care.

Successful long term care is so much more than the latest medical breakthroughs and treatments.  It is about providing families with the supports they need to care for their loved ones and when family are not able to do that it is about stepping in to serve that function in the most humane and life-affirming way possible.  Universal access to health and social supports is critical for transforming long term care in the U.S..  American families are carrying too much of the burden and while gaps are sometimes filled locally by community- and faith-based organizations and in part by national programs of Medicare and Medicaid, this is not enough. 

Fixing this system does not necessarily mean spending more money on increasingly costly medical technologies, pharmaceuticals, or the latest medical advancements.  It means spending wisely on home care, nursing and personal care, respite for families, and coordination of care, such as case management.  It means doing further research on innovative and cost-effective solutions at the end of life, shifting the focus of federal dollars from nursing home to home- and community-based care where relationships can continue to keep people connected to life.  It means looking into new ways to deliver nursing home and hospital care for those who do need that level of care.  It means tapping into local resources (community- and faith-based initiatives) that have come to find cost effective and humane, care-based programs for persons who are elderly, disabled or dying.   I believe the Affordable Care Act (2010) is that step in the right direction that we have all been waiting for.

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4 thoughts on “What the Affordable Care Act Means for Long Term Care

  1. Robert

    Are you familiar with the current state of Community Based Long-term Care services in California and the Governor’s proposals related to the budget? Apparently, Adult Day Health Care and Multi-purpose Senior Services programs are to be eliminated — under the guise of a budget play to save money. The problem is that the programs already save the state money, so eliminating them actually creates great pressure to spend in nursinghomes. However, it makes implementing Affordable Care Act easier, more convenient–so one must argue that the ACA is actually contributing to the dismantling of community based systems of care in California. Are you aware of provisions of the act that could be triggered to help preserve the existing network and framework of community based assets and innovations in states like California?

  2. Helen Kwan

    Having taken a look at the early results o f the MFP demonstration projects, it appears that the cost of moving individuals back to the community is daunting;there are a numerous obstacles and I question this being a wise use of resources. While I appreciate its intention,my professional experience leads me to be skeptical. I believe we should concentrate our resources on families currently struggling to provide care,identify them and help to keep their loved one at home through savvy case management and respite . Respite for families providing care should be a national priority and an integral component of ltc reform.

  3. Your post is very informative and encouraging as well. People come to nursing home with the belief that they are cared properly and if they get proper care, then this would be the only thing that can make them happy.

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