It suggests that the state has more nursing-home beds than is needed.
By Ginnie Graham, Staff Writer, Tulsa World, November 27, 2005
Long-term Care Recommendations
- Develop a state philosophy to guide financing, policy and program development.
- Budgets for nursing homes and the Advantage waiver independent living program should be linked. Establish a single Medicaid long-term care budget line in one state agency.
- Through the public-private partnership established for the Advantage program, streamline access to long-term care using comprehensive entry points. These points would include counseling on housing options and pre-admission screening for nursing-home placement.
- Build home- and community-based services to prevent unnecessary and premature nursing home placements, giving consumers more choices.
- Promote programs allowing consumers to control service delivery.
- Develop an integrated structure for conducting quality oversight.
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TULSA - - Charles Henry Nail got depressed after spending more than two years in a nursing home.
The 52-year-old can do everything an able-bodied person can do, except bathe. A gunshot wound to the face paralyzed Nail in 1994. Police never found his attacker.
Nail adjusted to life in a wheelchair while living with his wife until her death from a brain aneurysm in 2001. Then, the options were limited, and he went into a nursing home.
"At the time, I didn't have any other choice," Nail said. "It was pretty rough, but I just dealt with it day by day. I was pretty well depressed, but I wouldn't let them know it."
A nursing home resident told Nail about the nonprofit Ability Resources and the Advantage Medicaid waiver program, which helps people live independently by providing personal care services.
In early November, Nail moved into Tulsa Housing Authority's Murdock Villa and receives help with personal grooming from the waiver program.
The nursing home cost all but about $50 from his disability income each month. Now he has about $400 left.
"It was a beautiful day when I moved in," Nail said. "I was more excited to get out of the nursing home than anything else. Here I have freedom to go where I want and do what I want. In the nursing home, I saw a lot of people who didn't need to be there."
A recent report conducted by a team of four national long-term care experts reinforces Nail's experience. The National Academy for State Health Policy reviewed Oklahoma's system for delivering long-term care and made recommendations for improvement.
Deborah Karns, chief executive officer of the Long-Term Care Authority, said the report brings a national perspective.
The authority was founded in 1987 in Tulsa as the first long-term care public trust authority in the nation. It is charged with researching, planning and developing a coordinated system of long-term care.
"There's credibility attached to it," Karns said. "It says 'Yes, it's a problem here and in other states.' It's not us saying it. It's a third party coming in and saying it."
A second phase of the report is expected in about two months and will focus on the costs of implementing the recommendations and projected future savings. A third phase will include an implementation plan.
The report is funded by a grant from the Centers for Medicare and Medicaid Services received by the Aging Services Division of the state Department of Human Services.
A conference is being planned for January in Tulsa to give an overview of long-term care issues.
"The biggest obstacle is being able to effectively educate various stakeholders as to the benefits to implement these recommendations," Karns said.
Oklahoma has more nursing-home beds than needed, according to the report. The supply of nursing-home beds per thousand people older than 65 in Oklahoma is 69.3, while the national average is 46.3 beds.
The need for nursing-home care is often linked to the number of activities for which a resident requires assistance.
In Oklahoma, more than 35 percent of nursing home residents need assistance for up to three activities. Some of those residents require no help. The national average ranges from 25 percent to 30 percent.
The percent of residents needing help with four to five daily activities is lower than the national average, according to the Nursing Home Statistical Yearbook.
Karns said the report does not diminish the need for nursing-home care. With the baby boomer generation aging, the demand for nursing care will increase.
"Long-term care is a continuum," Karns said. "Nursing home care is vital and has to be in place for people to be safe and healthy. But this is a good time to diversify the settings."
The report recommendations include expanding home- and community-based services, streamlining access to long-term care and developing an integrated system for oversight.
The cost is a significant factor in long-term care. Oklahoma increased expenditures for nursing home services from $40 million in 1994 to $434 million in 2004. The Advantage waiver services rose from $400,000 to $94 million during that same time, the report said.
About 85 percent of Oklahoma's Medicaid is spent on nursing-home care, and 15 percent on home- and community-based services. Per day, the Advantage program costs about $38, and nursing homes cost about $85.
Karns said the state will face spending more than $1 billion by 2020 if changes are not made by the time baby boomers start using long-term care services.
"The legislators there now will be there when the bubble bursts," Karns said. "Medicaid is not a simple subject, and attached to Medicaid comes with misperceptions and myths."
A person entering a nursing home using private pay usually qualifies for Medicaid within eight weeks, Karns said.
The patchwork of long-term care services across state agencies is a result of how the federal system has dealt with the issue since the 1960s, Karns said.
Services now include nursing care, adult day services, assisted living, community group-care living and personal home services.
With a rising national debt and an aging population, Karns said, it is a good time to re-evaluate the long-term care system.
"Usually when we have a budget crisis or problem, it creates an impetus, momentum and creativity," Karns said. "We can use this time to come up with a better way to serve long-term care."
Source: Long-Term Care Authority, Home and Community Based Services: A Systems Review Report
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