Exploring Community-Based Long-Term Care

11 Jan 2022
Explore community-based long-term care options for empowering independence and overcoming challenges.

Understanding HCBS

Home- and Community-Based Services (HCBS) represent a significant shift in the provision of long-term care, moving away from institutional care towards community-based settings. This section will delve into the definition, purpose, and eligibility criteria for these services.

Definition and Purpose

HCBS, or Home- and Community-Based Services, aim to address the needs of individuals with functional limitations who require assistance with daily living activities. Their main objective is to allow elderly and disabled individuals to remain in their homes and communities, instead of resorting to institutionalized care like nursing homes [1].

Long term care services under HCBS include medical, social, housekeeping, or rehabilitation services provided to improve or maintain function or health over months or years. These services are not only provided in nursing homes but also in patients' homes or community-based settings [2].

This approach to long-term care, also known as Community Based Long Term Care (CBLTC), encompasses various services such as Nursing Services in the home, Home Health Care, Personal Care Services in the home, Consumer Directed Personal Assistance Services, Adult Day Health Care (ADHC), and Private Duty Nursing.

Eligibility Criteria

Eligibility for enrollment in a Managed Long Term Care (MLTC) plan, which oversees the provision of HCBS, requires consumers to demonstrate the need for these services for more than 120 days. In addition to this duration requirement, individuals must also qualify based on their health status and functional limitations, exhibiting a need for assistance with various daily living activities.

Essentially, the HCBS program serves those who might otherwise require institutional care, offering a range of services designed to support independent living. Whether it's through home health care, personal care services, or adult day health care, these community-based long-term care solutions empower individuals to maintain their independence while receiving the care they need.

Types of HCBS Services

Home- and Community-Based Services (HCBS) offer a variety of options designed to meet the diverse needs of individuals who require assistance with daily activities. These services aim to enable elderly and disabled individuals to continue living in their homes and communities while receiving the care they need [1]. Here, we explore four key types of HCBS services: Nursing Services at Home, Home Health Care, Personal Care Services, and Consumer Directed Personal Assistance Services.

Nursing Services at Home

Nursing Services at Home is a form of community-based long-term care that brings medical services directly to the patient's home. It can include various levels of care, from routine check-ups to more complex services like wound care or administering medication. This service aims to provide patients with the medical care they need without requiring them to leave their home environment.

Home Health Care

Home Health Care covers a broad range of health and social services delivered in the home to treat illness or injury. Services covered under Home Health Care can include doctor services, prescription drugs, therapy services, durable medical equipment, and more. This type of care is ideal for individuals who need medical assistance but prefer to receive it in the comfort of their own home.

Personal Care Services

Personal Care Services focus on assisting individuals with activities of daily living, such as bathing, dressing, and meal preparation. These services can also encompass light housekeeping tasks, helping ensure the individual's living environment remains clean and safe. Personal Care Services can be instrumental in helping individuals maintain independence and quality of life in their homes.

Consumer Directed Personal Assistance Services

Consumer Directed Personal Assistance Services (CDPAS) is a unique model of home care that allows the individual, or their designated representative, to have more control over who provides their care and how it is provided. Under this model, the consumer has the authority to recruit, hire, train, supervise, and if necessary, terminate their personal assistant. This approach offers a higher degree of autonomy and flexibility, allowing consumers to tailor the care to their specific needs and preferences.

All these services play a critical role in supporting the independence and quality of life of individuals who require long-term assistance. By providing care within the comfort of the individual's home or community, HCBS services contribute significantly to the continued independence of these individuals, aligning with the overall objective of community-based long-term care.

Enrollment in Managed Long Term Care

Choosing the right plan for long-term care can be challenging. This section explores the requirements and benefits of enrolling in a Managed Long Term Care (MLTC) plan, a crucial component of community-based long-term care.

Duration Requirement

To qualify for enrollment in a Managed Long Term Care plan, individuals must demonstrate the need for Community Based Long Term Care (CBLTC) Services for more than 120 days. These services include Nursing Services in the home, Home Health Care, Personal Care Services in the home, Consumer Directed Personal Assistance Services, Adult Day Health Care (ADHC), and Private Duty Nursing.

Benefits and Coverage

New York State offers a variety of services and programs as alternatives to nursing home care. These range from simple tasks like light housekeeping to complex services like nursing care or physical therapy, provided at home, in residential settings, or in assisted-living facilities [2].

Medicaid in New York can cover various medical services to help individuals continue to live at home. These include doctor services, prescription drugs, home care, adult day care, transportation to medical care, therapy services, durable medical equipment, and more.

Depending on financial and medical eligibility, and the criteria of the specific service or program desired, individuals may be able to receive long term care services or programs through private health insurance, managed care agencies, Medicaid, Medicare, or by self-payment [2].

In New York, individuals can apply for Medicaid at the county Department of Social Services and can contact the NYS Medicaid Helpline or the Human Resources Administration in New York City for more information on eligibility and covered services [2].

Choosing the right long-term care option involves careful consideration of personal needs and circumstances. Understanding the requirements and benefits of different plans can help individuals make informed decisions about their care. It's always a good idea to consult with a healthcare professional or social worker to determine the best course of action for your specific situation.

Financing HCBS

Funding is a crucial aspect of community-based long-term care. Various sources, including Medicaid, Medicare, and private health insurance, provide financial assistance for Home and Community-Based Services (HCBS).

Medicaid Coverage

Medicaid in New York can cover a variety of HCBS, aiding individuals that wish to continue living at home. Services covered include doctor and clinic services, home care, physical therapy, mental health services, and durable medical equipment among others. Special services are also available to participants in waivers, contributing significantly to their ability to live independently.

Medicare Assistance

Medicare offers assistance to eligible individuals by covering hospital care, skilled nursing facilities, some home health care, doctors' services, outpatient hospital care, and other medical services. To check eligibility or coverage, individuals can contact 1-800-MEDICARE or visit www.medicare.gov.

Recent plans by the White House to increase Medicare payments to skilled nursing providers by 3.7%, or $1.2 billion in FY 2024, aim to improve nursing home quality of care and patient safety.

Private Health Insurance Options

Private health insurance is another avenue through which individuals can receive long-term care services or programs. These could be accessed through managed care agencies, Medicaid, Medicare, or by self-payment, depending on the financial and medical eligibility, and the criteria of the specific service or program desired [2].

However, it's important to note that private long-term care insurance policies accounted for only 0.02% of total long-term care spending in 1993. Thus, while private insurance can supplement coverage for long-term care, it may not be the most robust source of funding.

Financing HCBS is a complex task, and understanding the different sources of funding can help individuals and their families navigate the process. It's essential to explore all available options and make informed decisions that best meet the individual's care needs and financial circumstances.

Challenges in Long-Term Care

Despite the many advantages of home and community-based services (HCBS), community based long term care still faces significant challenges. These challenges primarily revolve around workforce issues and funding constraints.

Workforce Issues

One of the key challenges in the long-term care industry is workforce-related issues. High turnover rates, staffing shortages, unmet resident needs, quality problems, worker training and competency, and lack of integration with medical care are some of the persistent issues that have contributed to the broader challenges faced by the industry.

These workforce issues can lead to inconsistent and inadequate care for individuals who require long-term services. The high turnover rates also mean that care providers may not have the long-term relationships with clients that are essential for understanding and meeting their unique needs.

Further, the lack of integration with medical care can result in disjointed care plans that do not adequately address the full range of health needs of individuals requiring long-term care.

Funding Challenges

Another significant challenge facing the long-term care industry is chronic underfunding. Experts have long warned that the system is being stressed to its limits, with serious problems in cost and financing, and in access to and quality of long-term care services.

In response to these challenges, the ‘Build Back Better’ bill that was passed in 2022 included $150 billion in federal funding to help "provide the opportunity for higher wages and increased standard of living for the direct care workforce." This bill aims to "permanently increase by 6 percent the funding the federal government gives each state for in-home and community-based services, as long as the state creates a plan for strengthening and expanding services."

Additionally, the White House announced plans to slightly increase Medicare payments to skilled nursing providers by 3.7%, or $1.2 billion in FY 2024, as part of efforts to improve nursing home quality of care and patient safety.

However, while these funding increases are a step in the right direction, more needs to be done to address the persistent funding challenges in the long-term care industry. This includes finding sustainable sources of funding and developing efficient systems for allocating resources to ensure that all individuals who require long-term care services are able to access them.

The future of community based long term care depends on addressing these challenges. Solutions will require collaborative efforts from policymakers, care providers, and other stakeholders in the long-term care industry. These solutions include developing effective workforce strategies, securing sustainable funding sources, and implementing innovative care delivery models.

Future of HCBS

Home and Community-Based Services (HCBS) play an essential role in community-based long-term care. As the population ages, especially the "oldest old" defined as those 85 and older, and as more people prefer to age at home, the demand for HCBS services is expected to grow. Innovations in care delivery are also rapidly evolving to meet these emerging needs.

Demographic Trends

The population most likely to need community-based long-term care services is growing, particularly as the baby boomer generation ages. According to NCBI Bookshelf, the "oldest old" population (85 years and older) is projected to make up 24% of the elderly population by 2050.

Additionally, more than 10 million Americans of all ages currently need some type of long-term care to remain in their own homes or in other community-based settings. This number is significantly higher compared to the 2 million in institutions such as nursing facilities or chronic care hospitals. The data indicates a clear preference for home and community-based care, which is expected to drive the growth of HCBS.

Innovations in Care Delivery

With the growing demand for community-based long-term care, there have been significant innovations in care delivery. Integrated care and person-centered care have proven more efficient and cost-effective, particularly in the areas of mental health and chronic disease management.

The coordination and integration of health and social services have shown significant benefits in improving the quality of care, access to care, and patient and family caregiver satisfaction. This integrated approach also results in a reduction in the functional decline and levels of incapacity of older people, as well as a reduction in the use of emergency services and medical consultations with a specialist [6].

Implementing appropriate care models for the long-term care needs of older adults contributes to health gains and allows for the development and influence of public health policies based on the best evidence. This allows for international comparability, either at the level of resource allocation or regarding the quality and appropriateness of the health care provided.

In conclusion, the future of HCBS is promising, with demographic trends fueling demand and innovations in care delivery meeting these needs more effectively and efficiently. As the field continues to evolve, it will play a crucial role in empowering the independence of the elderly and people with disabilities, facilitating their ability to lead fulfilling lives within their communities.

References

[1]: https://www.cms.gov/training-education/partner-outreach-resources/american-indian-alaska-native/ltss-ta-center/information/ltss-models

[2]: https://www.health.ny.gov/health_care/medicaid/program/longterm/

[3]: https://www.health.ny.gov/healthcare/medicaid/redesign/mltcpolicy_13-03a.htm

[4]: https://www.careerstaff.com/healthcare-staffing-blog/biggest-challenges-of-long-term-care/

[5]: https://www.ncbi.nlm.nih.gov/books/NBK231110/

[6]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9914432/

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