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Empowering Long-Term Care Reform: Guiding Principles for System Success

This comprehensive guide outlines strategic principles for real long-term care reform. It emphasizes empowering participants, promoting choice, equity, and quality, building strong local systems, fostering effective relationships with acute care systems, integrated long-term planning, and ensuring provider accountability. The principles focus on participant-driven approaches, consumer and family involvement, person-centered planning, support for self-determination, service quality and workforce competency, as well as logistical, social, and coordination strategies. Operational recommendations cover waiting lists, diversion, consumer input, and workforce development. Valuable resources and links for further information are provided for stakeholders in long-term care reform initiatives.

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Empowering Long-Term Care Reform: Guiding Principles for System Success

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  1. System Principles: The Path to Real Long Term Care Reform

  2. Strategic Principles • Participant-Driven • Choice, Equity, and Quality • Build on High Quality Local Systems • Effective relationship with local acute care system • Integral Long Term Planning • Provider Accountability

  3. Participant-Driven • Consumers and Families are active participants in all stages of design and implementation • Cornerstone is Person-Centered Planning • System honors the preferences of consumers • System supports Self-Determination

  4. Choice, Equity, and Quality • Choice of caregivers, services, supports, and residential options • Quality and Accountability Outcomes • Competent, committed, and valued workforce • Adequate amount of services and supports statewide

  5. High Quality Local Systems • Maximize supports and services resources • Consider impact of all changes on existing community supports • Flexibility of supports; clarity in outcomes • Encourage and support innovation locally

  6. Relationship with Acute Care • Be distinct from the locally available acute care system • Have a clearly articulated method of coordination with the acute care system • Clear and unambiguous financial and functional eligibility criteria • Easy and universal access across settings. • No loss of current supports

  7. Integral Long Term Planning • Independent actuarial evaluation • Savings expand supports • Independent PCP facilitation • Timely Implementation quality • Service limitations are over the whole program, not on individuals

  8. Provider Accountability • Explicit contractual responsibility for quality of services and their delivery • State maintains a system of effective monitoring and measurement of quality • Sanctions, including payment refusal, for low quality • Uniform, timely appeal system • Independent investigation of critical incidents, abuse, neglect, and rights violations

  9. Operational Principles • Logistical • Social • Coordination • Decision-Making • Waiting Lists • Transition and Diversion • Consumer Input • Workforce

  10. Logistical and Coordinative • Rollout in staggered phases to assure effectiveness • Subcontract with existing community organizations with expertise • Pilot untested components • Expand only after thorough evaluation

  11. Social • LTC services must not be medically driven. • Social models using PCP must frame any medical services • Linkage to acute care must be seamless • Access to LTC must not be fragmented (SPE)

  12. Coordination • Service Coordination must be independent • Service Coordinators must be qualified by: • Experience with seniors and persons with disabilities • Deep understanding of consumer control • Local program understanding and experience • Knowledge of person-centered planning

  13. Decision-Making • Medical recommednations made by trained providers who know and treat the person • Authorizations made by those who know the person • Both internal and independent conflict resolution systems • Timely process to accommodate emergencies

  14. Waiting Lists • Dynamic plan to reduce waiting lists • No reduced access through utilization monitoring • No reduced access to prescription drugs • Shift savings into reducing waiting lists

  15. Diversion and Transition • Everyone who wants out gets out • Use outcomes as evaluated by the person in the community • Ensure enough community providers

  16. Consumer Input • Free access to all program and provider information • All Committees have at least 50% consumers • Self-Determination in every program option

  17. Workforce • Plan to expand wages and benefits • Free training and skill building programs • Use of registry as work recruitment system • Effective backup system • Consumer can hire, manage, and fire

  18. Resources • LTC Scan http://radio.weblogs.com/0139791/ • Transition Curriculum http://nfti.prosynerg.com • Consumer Consortium http://www.copower.org/mfp/index.php • LTC Blog http://fan-the-flame.blogspot.com/

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