Revamping Long-term Care Services and Supports Access

Finding the right long-term services and supports can be overwhelming for an individual or family member who recently experienced a stroke, fall, or, even for someone with an existing disability, who recently relocated to a new city.

Like many other states, Georgia is taking on the challenge of improving access to long-term services and supports through a focus on the needs of the end consumer while improving coordination of the providers and payers within the system. Improving coordination from initial information seeking through assessment and referral aids older adults and those with disabilities, by increasing knowledge and access to information that is responsive to individual needs and supports longer stays in the community.

Long-term services and supports (LTSS) help people when physical or mental disabilities impair their capacity to perform activities of daily living like bathing, eating, or moving around. Unfortunately, these services have traditionally been administered by multiple public agencies—federal, state, and local—or privately, making finding out about available programs and services difficult and confusing.

The risk of needing LTSS rises sharply with age. Almost 70% of people turning age 65 will need LTSS at some point in their lives, according to the U.S. Department of Health and Human Services. Given that one in five Americans will be 65 years of age or older by 2030, the need for LTSS is substantially growing. The Urban Institute predicts the number of older adults with disabilities will more than double from 10 million in 2000 to about 21 million in 2040, requiring home care for more than 5.3 million older adults.

There is a need for unbiased, accurate, and timely information to inform families’ decisions about future LTSS needs. For example, phone inquiries to Georgia’s Aging and Disability Resource Connection (ADRC), which typically provides this type of information, have steadily increased over the last ten years and totaled more than 66,000 in 2016.

Nationally, the U.S. Administration for Community Living, the Centers for Medicare & Medicaid Services, and the Veterans Health Administration have collaborated to build the No Wrong Door (NWD) system, which supports states’ efforts to streamline access to LTSS options for both older adults and persons with disabilities. In 2014, awards were made to 25 states to develop plans to transform systems so that all access points for LTSS are coordinated and serve all populations and all payers. The vision for NWD is to create a new way of providing accurate and consistent information about all care options through a seamless system; assessments for eligibility screening; and tailored assistance through counseling, referrals, and help with planning for the future.

The Georgia Health Policy Center assisted the Georgia Department of Human Services, Division of Aging Services in conducting a statewide assessment to identify community needs, gaps in the system, challenges, and solutions to improve the existing ADRC information system. Key findings included: a need for building and strengthening partner relationships, increasing community outreach, improving program staff training, and seamlessly connecting individuals between agencies.

This assessment was noteworthy because the advisory committee guiding the work sought honest critiques and thoughtful recommendations from a wide variety of perspectives. The assessment included analysis of state administrative data, interviews with key partner organizations, an online survey, four geographically diverse focus groups, and four community meetings.

Based on these findings, the Division of Aging Services, in partnership with the advisory committee, developed a statewide, three-year plan to enhance the provision of information in a way that empowers individual choice and provides easy access for all Georgians, regardless of age, income, or disability. The plan calls for improved coordination and data sharing by partner organizations, extensive outreach, and a streamlined system that drives easy access to information, timely assessments, and personalized counseling.

The stakes are high for improving the delivery of this critical information. The increase in the number of individuals needing support is borne out in rising expenditures. The Congressional Research Service estimates that spending on long-term services and supports totaled $338.8 billion in 2013 and the majority of the spending (71.5%) was paid by public funding sources, like Medicaid. Through this type of planning, Georgia and other states committed to the NWD model will be ready to respond to individuals and their families with a coordinated information and access system and staff prepared to assist with accurate and comprehensive information and support.