July 24, 2003
States Make Progress on Long-term
Care Despite Budget Deficits
DENVER - Amidst a troubled economy, declining tax revenues and expanding Medicaid costs have taken their toll on legislative budgets across the nation. A recently released report from the National Conference of State Legislatures (NCSL) explores how states responded to increasing needs for long-term care services in the face of funding challenges in 2002. The report, State Long Term-Care: Recent Developments and Policy Directions details state strategies focused on assisted living, nursing homes, elder abuse, end of life care, workforce development, and consumer direction.
The findings of the report show a continuing trend in states towards providing home and community-based services to individuals and offering them a greater choice of service providers.
"Even with the fiscal constraints, several states are finding new ways to serve frail elders and people with disabilities in their own homes and communities, " said Wendy Fox-Grage, a co-author of the report. Colorado created a consumer-directed care program to allow frail elders to receive a payment and direct their own in-home care services. Florida designed a similar program.
At least fourteen states passed laws to protect persons with disabilities or frail elders from abuse. New Hampshire's new law, for example, adds financial exploitation and neglect to the list of abusive activities; Maryland's law tightens penalties for abuse.
"States continue to care about the quality of nursing home care," says Donna Folkemer, another of the report's authors. "They are taking action to upgrade the skills of the institutional workforce." Reforms in Missouri include greater authority for regulators and increased background checks for employees. New York created a Quality Improvement Demonstration Program in statute to increase direct care staff in nursing homes.
Other findings of State Long-Term Care include:
- Long-term care planning is underway in most states with the support of federal funds.
- Several states have reorganized state agencies to improve their long-term care systems.
- Cost-containment measures, including payment freezes and enrollment caps, have affected nursing home and community-based services.
State Long-Term Care: Recent Developments and Policy Directions was funded by the Office of the Assistant Secretary for Planning and Evaluation of the U.S. Department of Health and Human Services. It is the second of two reports to provide a thumbnail sketch of long-term care policies in the states. It can be downloaded free of charge from the DHHS web site or the NCSL web site at www.ncsl.org.
NCSL is a bipartisan organization serving the legislators and legislative staff of the states, commonwealths and territories. Its mission is to improve the quality and effectiveness of state legislatures, foster interstate communication and provide the states a strong, cohesive voice in the federal system.
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