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Illinois Department of Aging Adult Protection and Advocacy Conference

Illinois Department of Aging Adult Protection and Advocacy Conference. August 1 st , 2013 Deborah Merrill, Senior Policy Director, NASUAD Heather Bruemmer , Wisconsin State Long-Term Care Ombudsman. The Long-Term Care, Home Care, & Managed Care Ombudsman.

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Illinois Department of Aging Adult Protection and Advocacy Conference

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  1. Illinois Department of Aging Adult Protection and Advocacy Conference August 1st, 2013 Deborah Merrill, Senior Policy Director, NASUAD Heather Bruemmer, Wisconsin State Long-Term Care Ombudsman

  2. The Long-Term Care, Home Care, & Managed Care Ombudsman

  3. Long Term Care OmbudsmanDefined, mandated, and funded by Federal government in the OAA Home Care OmbudsmanDetermined and funded by each state 12 states currently have some type of Home Care Ombudsman programMedicaid Managed Care OmbudsmanDetermined at the state level but recommended by CMS in the Managed Care process 28 states will have MC by end of 2014

  4. Older Americans Act Work in this field because of the OAA Mission of the OAA is broad: to help older people maintain maximum independent in their homes and communities to promote a continuum of care for the vulnerable elderly

  5. The OAA created the Aging Network: • State Units on Aging – 56 states and territories • Area Agencies on Aging – 655 AAA’s • 233 tribal and Native American Organizations • Services sponsored by the Act include: • Nutrition • Elder Rights Protection • Health promotion • Access to information and assistance • HCBS long-term care

  6. OAA Titles • Title I – Declaration of Objectives • Title II – Administration on Aging established • Title III – Grants to States and Communities • Title IV – Research and Health • Title V – SCSEP • Title VI – Grants to Native Americans • Title VII – Vulnerable Elder Rights Protection • Long-Term Care Ombudsman Program

  7. Long-Term Care Ombudsman Programs • 1972 - Ombudsman program began as a demonstration project in 5 states • 1975 – All but 2 state had LTCO programs • 1978 – Ombudsman services required • 1987 – LTC Ombudsman program received separate authorization of funds • Additional amendments have strengthened the LTC Ombudsman programs

  8. OAA Requirements of the Long-Term Care Ombudsman Program

  9. LTCO ProgramState Long-Term Care Ombudsman is the head of the office. This person, or his/her representatives, shall: • Identify and investigate complaints made by or on behalf of residents • Provide assistance to residents to protect them • Inform residents of services • Represent the interests of residents • Advocate for resident’s interest • Promote citizen advocacy • Provide training • Provide technical support for resident and family councils • Other activities determined by the Assistant Secretary of Administration on Aging, Administrator of Administration for Community Living

  10. State Ombudsman Programs • State structures vary but must follow the OAA requirements • Common to all are: • State Ombudsman position • Voice (advocacy) for elderly residents • Investigation and resolution of complaints • Public education • Training

  11. Home Care Ombudsman

  12. Not a mandate • Not funded by OAA • States make their own decision depending on funding available • 12 states have Home Care Ombudsman • Not all organized the same way: Some respond to complaints Some follow NH discharge Some do Money Follows the Person follow up Pilots in certain areas of state – some statewide

  13. Home Care Ombudsman • State must decide to have a Home Care Ombudsman program and provide the statutes, regulations, and funding to implement • State can structure this how they think is appropriate. • No federal direction

  14. Medicaid Managed CareOmbudsman or Beneficiary Ombudsman

  15. Many states moving to Medicaid Managed Long-Term Services and Supports • Effort to better coordinate physical/acute delivery system and the long-term services and supports delivery system • Money – federal and state funds available, more controlled use of dollars, emphasis on outcomes not outputs • Various models of MC Ombudsman placement – in MCO, within existing LTC Ombudsman office, in a state agency, or in independent agency • A few states have had Managed Care for many years • Some have had Managed Care for a few populations and now are adding more populations and/or geographic areas. • Kentucky, Louisiana, and New Hampshire have had negligible MC in select populations but are now going statewide • New York, Texas and California have had MC in urban areas but are now going state wide

  16. Comparisons

  17. Discussion Points • How does the individual receive the most effective advocacy? • Where should a state locate the Home Care Ombudsman? • Where should a state locate the Managed Care Ombudsman?

  18. Contact information:Deborah MerrillSenior Policy DirectorNASUAD202.898.2578 x 122Dmerrill@nasuad.org

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