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HomeMy WebLinkAboutLong Term Support Planning Committee 11-13-19960 ST. CROIX COUNTY NOTICE OF COMMITTEE MEETING TO: Robert Boche, Chairman St. Croix County Board FROM: Ron Lockwood, SW Su sor Long Term Support71 DATE: November 1, 1996 ----------------------- COMMITTEE TITLE:, Long Term Support Planning Committee MEETING DATE: Wednesday, November 13, 1996 October meeting was cancelled because seven members requested to be excused. MEETING TIME: 2 : 00 p . m. Board Room MEETING LOCATION: St. Croix Co. Health & Human Services Complex ____144_5_N_ 4th Street, New Ri(ZhmpU4,__WL=S4QL7 __________ CALL TO ORDER: ROLL CALL: ADOPTION OF AGENDA: ACTION ON PREVIOUS MINUTES: DATE/LOCATION OF NEXT MEETING: AGENDA: (Agenda not necessarily presented in this order) UNFINISHED BUSINESS: 1997 Budget for Long Term Support Programs in St. Croix County. NEW BUSINESS: 1) Financial Report 2) Variance & Purchase Requests 3) Aging Unit Director's Report --Response to Aging Resource Center Concept Paper with Sandy Gehrman presenting. 4) Wisconsin Department of Health and Family Services 1997-99 Biennial Budget Request. 5) Report on CWAG meetings concerning Long Term Care Redesign. 6) Discussion of policy paper "Will Long Term Care Initiative Keep the Community Promise." ANNOUNCEMENTS & CORRESPONDENCE: POSSIBLE AGENDA ITEMS FOR NEXT MEETING: ADJOURNMENT: Copies to: County Clerk's Office Committee Members /lts-com/notice LONG TERM SUPPORT PLANNING COMMITTEE MEETING MINUTES WEDNESDAY, NOVEMBER 13, 1996 MEMBERS PRESENT. James Craig, Keith Gregerson, Fern Johnson, Lee Kellaher, Ray Mealey, John Mortensen, Robert Palewicz, Marguerite Sumner, Wanda Viellieux MEMBERS EXCUSED: Joan Richie, Glenda Zielski MEMBERS ABSENT. Lorraine Darnauer, Honorine Gedatus, Terri Heinbuch, Larry Weisenburger STAFF PRESENT: Ron Lockwood, SW Supervisor GUEST(S): Robert Boche, St. Croix County Board Chair Sandra Gehrman, Director St. Croix Dept on Aging This meeting was called to order at 2:00pm by Chair Ray Mealey. Roll Call was taken as indicated above with nine present, four absent, two excused. A quorum is present. Motion to adopt agenda as written by John Mortensen, second by Lee Kellaher, carried unanimously. Action needed on previous minutes to correct roll call of September 25th meeting to reflect that John Mortensen was excused from that meeting. That change will be made to LTS records. Motion made by Marguerite sumner to accept minutes of previous meeting as written with above change; second by Fern Johnson; carried unanimously. Date of Next Meeting will be Wednesday, February 19, 1997 at 2:00 pm in the Human Services Board Room, New Richmond WI. UNFINISHED BUSINESS » Ray Mealey reported attending a statewide long term support advisory committee meeting. The main thing Ray brings up was that it is a misconception that the state doesn't want county input. The state DOES want input and recommendations from the county level. Long Term Support Planning Committee Meeting Wednesday, November 13, 1996 page 2 >> FYl the 1997 Long Term Support Program Budget was approved by the County Board as presented. NEW BUSINESS » An attendance record FYI was handed out. One error was noted, will be corrected, and mailed with these minutes. >> Financial Report -- handout -- note that the numbers in the CIP2/COPW waiting list are duplicated between COP & CIP21COPW. These 13 persons are eligible for both programs so are placed on both lists. Regarding waiting list -- this continues to be an issue of not being able to solve completely. Ron Lockwood explained that there is lag time between discharges from hospitals and being able to get approval for funding and getting services started (usually 6-8 weeks). Therefore, persons are admitted to nursing homes directly from hospital and then if it appears community placement or a return home is possible, a referral is made to get the process started. Lockwood noted that as of 1/1/97 LTS will be getting a permanent part time social worker position that will help in the manpower area, but it is still not possible to get discharge, services, and funding approval fast enough to avoid short term nursing home stays in most cases. » Variance and Purchase Requests: NONE » Aging Department Report on LTC Redesign -- Sandy Gerhman reported on and handed out information on services currently provided by Department on Aging. Sandy reported that the Older American Act which funds several of their programs, has not been renewed on the federal level for 1997 as yet. It is expected that it will be in the next few months. Motion was made by Wanda Viel ieux for this committee to write a letter to legislators supporting renewal of the Older Americans Act; second by Marguerite Sumner; carried unanimously. Sandy went on to discuss the handout on Functions of the Aging Resource Center which appears to be one goal of the new redesign. She reports that county agencies are the likely entity for administering LTC Programs. Sandy expressed a need for the Committee on Aging and the LTS Committee working closely together in light of the possible redesign changes. LTS Planning Committee Meeting Wednesday, November 13, 1996 page 3 » WI DHFS 1997-1999 Budget Request -- Handout from Ron Lockwood and discussed main highlights. Some changes in daily rates for waiver programs, change in mandatory COP Program. » Policy Paper: "Will Long Term Care Initiative Keep the Community Promise". Ron Lockwood made note that one main issue%oncern throughout is that consumers may lose control of options/choices witoin a private entity. Another concern is quality control and rights issues. Keith Gregerson suggested that possibly individual letters should be written with regard to the Older Americans Act renewal. Ron and Ray will draft their letter as a sample for individuals to use and mail out personally. Motion to adjourn this meeting at 3:OOpm by Keith Gregerson; second by Lee Kellaher; carried unanimously. Submitted by Michele Johnson, LTS Unit Clerk 111 10/8/96 WILL THE "LONG-TERM CARE INITIATIVE" KEEP THE "COMMUNITY PROMISE"? Aging & Disability Groups* respond to the apparent direction of the DHFS Long Term Care redesign Process Background In January, 1995, aging and disability groups released "Keeping the Community Promise", a proposal for long term care (LTC) reform which features three themes: 1. Reduce the state's disproportionately high reliance on institutional care. 2. Provide adequate funding for home and community care. 3. Integrate CBRF's (community -based residential facility) into a comprehensive, coordinated long-term care system in Wisconsin. Since that time, over 50 state and local organizations have formally endorsed this proposal. In December, 1995, DHFS Secretary Joe Leean announced the beginning of the Long Term Care Initiative process. Some of the goals of this initiative paralleled aspects of our "Keeping the Community Promise" proposal. Consequently, we were (cautiously) optimistic that this process would lead to some positive changes in the system. We are still optimistic about that, although there are certain aspects of the LTC Initiative process which concern us. What we like in the LTC Initiative so far The LTC Initiative process is not completed yet; however a number of likely directions of the initiative are beginning to become apparent. The purpose of this paper is to present an interim response from advocacy groups at this stage. Listed below are several features of the initiative which we view as positive. *This is a joint position statement of the Coalition of Wisconsin Aging Groups, the Wisconsin Coalition for Advocacy, ARC -Wisconsin, the Wisconsin Council for Developmental Disabilities, the Board on Aging and Tong Term Care, and the Wisconsin Coalition oflndependent Living Centers. Poolina LTC resources. Pooling institution and community resources does not guarantee anything, but it would create more opportunities to reduce the reliance. on institutional care. Under this scenario, the system could finally fulfill the objective that "money follows the person" to the appropriate and consumer - preferred setting, without being obstructed by the current firewall between institution and community resources in Wisconsin. 2. Increased funding for home and community care. It's not clear what overall LTC funding levels DHFS envisions in the future. However, even if future spending growth is limited the new system could enable Wisconsin to reduce nursing home and other institutional utilization to levels more in line with national trends. This would make funding available for other uses. If these resources are kept within the LTC System this could increase the pot of funds available for community services. 3. Intearati_na all residential facilities into the System. The comprehensive system envisioned in the LTC Initiative would (presumably) include nursing homes, state Q.D. Centers, CBRF's, Adult Family Homes, Assisted Living, and all other residential settings (as well as a variety of other non-residential services). It also appears that the new system would ensure that individuals could only move into these settings if they had first gone through a thorough assessment (which would address the question of whether such a setting is appropriate). Residential facilities could also be held more accountable for cost and quality in the new system. 4. Single point of entrk. Consumers and families have long raised concerns regarding the difficulty of entering the system. Clarifying the entry points would be a positive change, if there is sufficient expertise regarding each population available at the entry point for that population, and if the system ensures that eveUone (including private pay consumers) enters the system through these points. We also believe that the entry point organization should have information and referral responsibility. 5. Universal screening and assessment. We agree that there is a need for screening, functional assessment, and a case plan for all individuals (including private pay consumers) wishing to receive LTC services, and that there must be some statewide consistency. Our Concerns about the LTC Initiative at this point DHFS officials have already identified certain directions they plan to take in the LTC Initiative which concern us. There are also some important questions regarding the future of the LTC System where DHFS has as yet given no indication of its intentions. Both types of concerns are summarized below: 1. Entry_points and eligibility determination must be publicly -controlled. In our view, deciding who can receive publicly -funding LTC services in Wisconsin is a 2 responsibility of government -- it should never be delegated to a private organization. We encourage the state to explicitly affirm that entry points to the system will be governmental units and/or'otherentities which are governed by elected or appointed public officials: 2. Preserving quality and promoting public control in the management of the publicly - funded LTC System. tem. Thus far, it appears that DHFS plans to put the management of the current county -administered LTC System up for grabs, creating a wide open competition among HMOs, in -state and out-of-state profit and non-profit corporations, county government, and other contenders. Advocacy groups are well aware that some counties do a better job than others in running their LTC System, and we strongly support setting threshold requirements for any prospective entity (including counties) which proposes to manage the system in their area. We also recognize the reality that some counties may not want to take on this role. However, we believe that counties which have demonstrated commitment and competency in providing quality long term care should have the first crack at managing the redesigned system. This is not only matter of conserving and respecting proven performance; it also relates to the important policy issue of "Who should manage a system which is fueled with taxpayer dollars -- a local government body headed by elected and appointed officials or a private business which may have its' headquarters far from where services are provided?" We believe strongly that county governments should be the preferred option., and only if a county a) chooses not to take on this role, b) cannot meet the threshold requirement to qualify for this role at the outset, or c) cannot competently perform the role over time, should the state consider an alternative configuration. 3. A statutory foundation of clear values and explicit outcomes to base the future system on. Generally we support the LTC Initiative Guiding Principles developed by DHFS. However, if the state is really going to base its future operations on those principles, they must be reflected in Wisconsin Statutes. This has been a crucial element of successful LTC reform efforts in other states, and it will be essential here as well. 4. Ensuring that hat public funds saved are re -invested in addressing unmet need for services. At present, many Wisconsin consumers are not receiving the LTC services they need. Correcting that situation should be a priority goal for the future of the system. If the state allows profit-taking by the agency which manages the system or the provider agencies with which it contracts, then public funds will be siphoned off the LTC System. Neither Wisconsin taxpayers or LTC recipients can allow that to happen. The new system should prohibit profit -making, and ensure that any savings the system can achieve will be available to serve people who need LTC services. This is the only position that is consistent with the DHFS Mission Statement, which includes a commitment to "manage public resources responsibly". I Remaining questions to be resolved in the coming months. We respect the LTC Initiative process, and the timeline that goes with it. It takes time and energy to think through all the issues associated with LTC reform, especially if the state includes consumers, families, advocates, providers, and counties in the process (which they have -- to their credit). There are many questions which are yet to be answered, and advocates will be watching closely to see what answers emerge. For example, it will be important to us to see: 1. whether there will be safeguards to ensure that consumers and families serve in governance roles in the system (a major theme from DHFS consumer focus groups around the LTC Initiative); 2. whether the new system will include a full array of formal and informal due process protections for consumers; 3. how the system will ensure that consumers have increased (not fewer) choices in the new system; 4. how the new system will ensure that consumers will experience high quality long term care, and primary and acute health care; 5. whether there will be an explicit rejection of caps in favor of more flexible and individualized cost control approaches; 6. whether DHFS accepts the premise that there must be some "risk -sharing" between the state and the entities which manage the system locally (and whether this risk - sharing will be time -limited or permanent); and 7. how DHFS will ensure that county funds invested in the LTC system s� in the system. 4