Bredesen unveils plan to expand nursing home alternatives.

PDF: Press release, fact sheet, bill summary and draft bill language

NASHVILLE — Gov. Phil Bredesen rolled out his long-term care reforms Thursday, saying he wants to simplify a fragmented system, expand choices and make it easier for elderly and disabled Tennesseans to avoid nursing homes and remain at home.

The governor said the Long-Term Community Choices Act of 2008 represents a “fundamental restructuring” of how care is provided through the state’s TennCare program.

“We’re trying to add some real choice in here, to say that we owe an opportunity for people to not simply have a single choice between taking care of themselves at home and then going to a nursing home,” Gov. Bredesen said.

The state spends $1.2 billion on long-term care. Some 98 percent of it now goes toward covering an estimated 23,000 people in nursing homes.

Plans call for a dramatic expansion of the state’s home- and community-based services waiver program, which now covers 2,700 people with “wrap around” services such as house cleaning and Meals-on-Wheels-type programs. Over the next six to 10 years, officials hope as many as 50 percent of people needing long-term can remain in home settings.

“It just looks like, from what we’ve seen, today is a big step forward for Tennessee,” said Steve Hitt, director of the Chattanooga-based Southeast Tennessee Agency on Aging and Disability.

Mr. Hitt said the reforms would not mean the end of nursing homes, calling them a “very important component in the continuum of care.”

Home- and community-based services should cost about $12,000 annually compared to between $45,000 to $60,000 at a nursing home, said TennCare Director Darin Gordon.

The governor, who worked with Republican and Democratic lawmakers on the legislation, said he hopes the state’s nursing home industry will back him.

If it passes, the reforms would take effect July 1, 2009. The plan must be approved by federal officials.

Nursing home operators in the past have been wary of sharing Medicaid dollars, part of which are raised through a $2,250 per bed nursing home tax, with home- and community-based efforts.

“In the past we’ve been concerned about funding alternative services on the back of nursing home patients,” said Ron Taylor, executive director of the Tennessee Health Care Association, which represents an estimated 330 nursing homes.

But he said the association has been encouraging its members “to get into home- and community-based services and alternative services.”

“This appears to be something that provides us some opportunities to do so,” he said.

The proposal would not encourage current nursing home residents to leave, officials said.

Gov. Bredesen said he is encouraging nursing homes to offer the new services much as hospitals in recent years have provided services on an out-patient basis.

“At its core ... this is about keeping people in their homes as long as they want to remain in their homes, and it’s driven for me by this experience with my own mother,” Gov. Bredesen said during a briefing. “It’s so clear to me that she would go to any lengths to stay at home.”

AARP Tennessee State Director Rebecca Kelly said in a statement that the seniors’ advocacy group hopes that “members of the Tennessee Legislature will listen to their mothers, fathers, grandparents and other loved ones who want to live independently as long as possible.”

LONG TERM CARE

Key components of Gov. Bredesen’s plan to expand home and community-based care for the elderly and disabled include:

* A simplified, faster process for accessing services. The legislation would create a single point of entry for people who are not on TennCare and need access to long-term care services through Medicaid (TennCare) or other available programs. That entry point would be one of the nine area agencies on aging and disability across the state. Officials hope to turn cases around in as few as three to five days.

* Consumer choice and options. Broadens residential care choices in the community beyond nursing homes with new options such as companion care, family care homes and improved access to assisted care living facilities. Creates consumer-directed care options, including the ability to hire nontraditional providers such as family members, friends and neighbors who would be held accountable.

* “Whole person” care coordination. Develops one entity to coordinate all care for TennCare patients including medical, behavioral and long-term care. The administration plans to use TennCare managed-care organizations, which now manage medical and behavioral services.