By Piali De
Health Affairs released a Health Policy Brief in September on “Rebalancing Medicaid Long-Term Services and Supports.” The brief announced that instead of focusing on institution-based care, Medicaid is shifting to support community-based care and long-term care options. The driving factor in this shift is the desire to provide “true balance” for beneficiaries through a “comprehensive and flexible community-based long-term services and supports program.” This, the brief argues, will be a more humane and cost-effective approach to our current health care system.
It’s about time. There is a tendency in our country to focus on treating acute episodes, relying on the ER and hospitals to “fix” the problem once it has already reached an exacerbating state. With the new emphasis on long-term care in community-based settings, we can only hope that the current model will soon be something of the past. And it is not only about the money we will be saving from this shift—although that is certainly an important part. But just as important is the quality of life that we provide to these vulnerable populations. The brief notes, “there is national consensus that the vast majority of seniors and people with disabilities would strongly prefer to remain in their homes or in a community-based setting where they can retain their independence and their ability to engage in community life” (3). Enabling seniors to live at home or in assisted-living facilities for as long as possible enhances the feeling of independence, and government incentives for new services and supports in these settings allow for programs that keep them healthy and out of the costly institutional settings.
We have seen the importance of this first hand through our partnership with ElderCare Network of Lincoln County (ECN), an assisted-living organization in Maine that provides residence to elders of mostly low-income status whose families can no longer care for them. ECN strives to be “the next best thing to being home,” and offers a comfortable and familiar atmosphere for the aging Mainers. One of their residents, 80-year-old Colleen, joined the Jefferson Green last year. She struggles with memory loss and requires constant reminders of when to take her medication, exercise, eat, and sleep. Caring for her eventually became too much of a burden for her children—they are working full time and raising their own children—so she moved into ECN, where the residential managers can keep a better eye on her around the clock and help to manage her care.
Our work with ECN is a great example of how the new Medicaid shift will help its beneficiaries. The resident managers at ECN historically kept track of all of their patients’ schedules, health, and well-being on paper, which is overwhelming and doesn’t leave enough time for the personalized care for the residents they wanted to provide. With the Medicaid incentive to implement new solutions for long-term services and support, ECN has been able to implement Ibis to allow them to better keep track of their patient’s data, receive automatic reminders for medication, sleep, and exercise, and have access to a member of the Senscio team to support the residents’ care management. The new program is aimed at identifying exacerbating health issues early for the residents, improving the workflow of the managers, and identifying both population and patient-based behavioral analytics to help determine the best possible care plans.
With the new options and incentives for states to shift to non-institutional service options for people on Medicaid, beneficiaries like Colleen can expect an increase in programs and services aimed to avoid transitions to institution-based care settings, such as the hospital or emergency room. She can feel comfortable in her own space and her managers can help her stay on top of her health through continuous monitoring, online portals, wearable activity trackers, and real-time analytics. This shift in the Medicaid policy will greatly ease the burden on our doctors, nurses, and care managers, lower the cost our country spends on treating chronic conditions, and give our aging and disabled populations a sense of ownership of their own health.