February 14, 2008

Bredesen Comes Around to GOP Position on Home-Based Care

Gov. Phil Bredesen addressed the Tennessee Press Association winter convention in Nashville this morning and announced that he would be proposing legislation, the "Long Term Care Community Choices Act," that would begin to shift TennCare nursing home dollars to home-based care for elderly and disabled people on TennCare who would prefer it.

The governor talked about how home-based care is less costly, and more preferable for most elderly people.

"People simply need more choices," Bredesen said. "In the months ahead we're going to fundamentally restructure how our state deals with long-term care in the TennCare program."

Noting that under the current system, 98 percent of state dollars for elderly care go to nursing home care, Bredesen said the lack of home-base care options means "We end up forcing people into nursing homes who would prefer to remain in their own homes."

Bredesen is absolutely correct.

And better late than never.

Advocacy groups have long urged the state put more dollars into home-based care options, and Republican state Sen. Diane Black of Gallatin has been the leading voice in the state legislature for doing just that for the past three years.

Home and Community-Based Services (HCBS) is universally acknowledged to be much less expensive than nursing home care - but under Bredesen's watch less than 2 percent of the more than $1 billion that Tennessee spends (including federal dollars) on long-term care for the poor, elderly and disabled goes to HCBS. That's the lowest rate of any state in the country.

The rest goes to nursing homes - the most expensive form of care. None goes to assisted-living, which is an intermediate step between HCBS care and nursing home, and costs less than nursing home care.

Sen. Black's legislation would significantly increase the use of in-home health care for the state's Medicaid-eligible elderly population - which would both lower health care costs for the state and increased care alternatives to nursing homes for the state's elderly and disabled, but the governor, despite his legendary health care business expertise, has shown no interest in it over the five years he has been in office.

In a press release from the Tennessee Republican Party last year, Sen. Black criticized the governor's inattention to the issue.

The good news: Bredesen has changed his mind and now agrees with Sen. Black and the Republicans on this issue.

Update: Bredesen's promised forthcoming legislation may not be necessary - the state Senate is already moving two bills toward passage that address the same issue. A press release out this morning has the details:

State Senators moved passage of two key health care bills this week aimed at helping elderly or disabled Tennesseans receive more options in their health care, including staying in their homes for as long as possible. The long term care legislation is part of a series of bills aiming to help citizens "age in place."

"We must look at all of our laws to help give citizens more options regarding their health care so that they can age in place in their homes with dignity," said General Welfare Committee Chairman Rusty Crowe (R-Johnson City). "This is one of several bills we hope to pass this year aimed at providing more choices and options to elderly and disabled Tennesseans to help them stay in their homes as long as they can."

One bill, SB 1157, approved by the Senate General Welfare, Health and Human Services Committee, calls for a pilot program for a "self-directed care program" where individual patients get the opportunity to choose services they think they need and who provides them. Consumers would receive a monthly budget based on their needs, and could use this money to hire personal assistant services, make home modifications, and more.

The self-directed care program requires consumers to develop plans that show how they would use the allowance to meet their personal care needs. It would provide counseling and financial assistance to help them plan and manage their responsibilities. Consumers who are unable to manage their care themselves may designate a representative, such as a family member, to help them or do it for them. These features make this program adaptable to consumers of all ages and with all types of impairments. Basically, it gives frail elders and adults with disabilities the option to manage a flexible budget and decide for themselves what mix of goods and services will best meet their personal care needs.

...

"Tennessee has been last in the nation for too long in the number of healthcare choices for elderly and disabled citizens on Medicaid-supported services, a problem that has kept them from being able to stay in their homes and age with dignity," said Senator Diane Black, sponsor of the legislation. "I know from speaking with citizens in my district that this is an issue that concerns many of them, and I can sympathize with their lack of options."

...

Tennessee spent approximately $1.1 billion on long term care last year. Out of the 22,000 seniors on Medicaid in Tennessee, only a few thousand get home- and community-based care services.

The second bill approved this week to help provide more options for elderly and disabled citizens was SB 2614, which was approved by the full Senate on final consideration. The bill, sponsored by Senator Diane Black (R-Gallatin), broadens the definition of assisted living to include hospice services. This bill would make it clear that any assisted-care living facility resident who qualifies for hospice care under Medicare can continue those services and also receive reimbursement for assisted living services.

Update: Tennessee Republican Party press release on the above:

Governor Shifts To Republican Position On Long-Term Care Reform