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Funding of Long-Term Care

Funding of Long-Term Care. Mark Booth Center for Gerontology and Health Care Research Brown University Harkness Fellows Final Reporting Seminar Orlando. June 2007. LTC NZ - Context. Residential homes struggle for survival Tuesday, 9 August 2005, 2:15 pm Speech: ACT New Zealand.

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Funding of Long-Term Care

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  1. Funding of Long-Term Care Mark Booth Center for Gerontology and Health Care Research Brown University Harkness Fellows Final Reporting Seminar Orlando. June 2007

  2. LTC NZ - Context Residential homes struggle for survival Tuesday, 9 August 2005, 2:15 pmSpeech: ACT New Zealand Pay Increase Will Deepen Crisis in Elderly Care Friday, 17 December 2004, 1:34 pmPress Release: Residential Care New Zealand Families appalled by bed shortage for Lakes elderly The Southland Times | Saturday, 5 May 2007 Largest-ever investment in elderly care - Govt NZPA | Tuesday, 1 May 2007

  3. LTC US - Context Looming Crisis of Long-Term Care Highlighted in New StudySenior Journal March 1, 2006 Long Term Care Crisis BuildsHealth Care NewsMarch 1, 2003 State on verge of 'very ugly' elder-care crisisHonolulu Advertiser Sunday, May 13, 2007 Is it any wonder most people dread nursing homes?New York Times May 24 2007

  4. LTC NZ - Context The Government has announced what it says is the largest-ever investment in care and support of the elderly. Health Minister Pete Hodgson made the announcement today, saying the Government recognised the need to raise the level of pay for workers who provided support to senior citizens. "We know that low pay and high staff turnover are a major workforce issue in aged care," he said. "I expect district health boards to satisfy themselves that a sufficient proportion of the funding increase is reflected in improved wage rates," Mr Hodgson said. "Providing quality residential care is a key focus of this budget." NZPA 1 May 2007

  5. New Zealand Funding provided by District Health Boards (21) Nationally consistent contract defining services to be provided Asset testing being removed Income test remains Over reliance upon residential care Poor use of MDS USA Self funded or funding through Medicaid Medicaid funded federally / state but administered at state level Asset and income test used Over reliance upon residential care Strong use of MDS Policy Context

  6. USA & NZ – LTC Issues • Ageing population • Workforce • Quality • Rebalancing • Funding • HIT

  7. Objectives • To determine how NZ may learn from approaches to the provision of long-term care in the US • To compare views and opinions of LTC experts in the US and NZ • To look at practical examples of rebalancing LTC

  8. Methodology - Survey • Initial Survey Design • Expert Panels • Cognitive Testing • Web based survey – US base modified for New Zealand • Sample 3000 in US • Sample 300 in New Zealand

  9. Methodology - Qualitative • Literature • Interviews with LTC experts • Interviews / visits to providers –e.g.: • PACE • Eden Alternative • Cash & Counselling • Pioneer Network • Green House Project

  10. Survey • Rebalancing • Workforce • Quality • Funding • Culture Change • Regulation • Health Information Technology

  11. Recommendations • Rebalancing • Workforce • Quality • Funding

  12. Rebalancing (1) Which of the following strategies would be MOST effective for rebalancing long-term care away from institutions and toward home based support services?  Select your top THREE options.

  13. PACE (USA) Capitated funding Preventive focus Transparency of service provision Services provided in one location PHOs (NZ) Capitated Funding Preventive focus Population health approach Transparency of service provision ‘Virtual’ organisation Rebalancing (2)

  14. Low pay Comparative low pay Low esteem Heavy Caseloads Lack of training Workforce (1) Issues

  15. Workforce (2)Recommendations • Training programmes • Career pathways • Improved salaries • Improved image – building upon positive ageing initiatives

  16. Quality (1) Issues • Loneliness, helplessness and boredom • Staff dissatisfaction • Poor physical layout • Carer stress

  17. Quality (2)Recommendations • Culture Change • Client centered care • Physical change • Staff changes • Information Technology • Comparative information • Minimum dataset (Inter RAI) • Adult Day Care

  18. Funding (1) How much do you oppose or favour each of the following approaches to paying for long-term care needs?  An answer of 1 means that you strongly oppose the approach and an answer of 5 means that you strongly favour the approach.

  19. Funding (2) • Individualised vs. Government • Role of family members • Forward planning for LTC • Linkage with other programmes

  20. Next Steps • Results by end June • NZ analysis by end July • US & comparative analysis in fall • Policy recommendations to NZ Minister of Health and DG in August

  21. Acknowledgements • Commonwealth Fund • Prof. Vince Mor – Brown University • Prof. Eddie Miller – Brown University • Prof. Ngaire Kerse – Auckland University • Dr Karen Poutasi – Ministry of Health • Dr Gillian Durham – Ministry of Health

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