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State LTC managers: Warm hearts colliding with cold reality

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Officials in most states say their state priorities do include serving older adults and people with disabilities.

But, even though the states make serving older people and people with disabilities a priority, tight budgets, the aging of the population, and a shortage of program staffers and outside care service providers all interfere with efforts to act on those priorities, the officials say. 

The National Association of States United for Aging and Disabilities (NASUAD) is reporting on state officials’ views on the collision between priorities and reality in a summary of results from a recent survey of the directors of the 56 state and territorial aging and disabilities units.

More than 40 of the directors said their states or territories make serving the elderly a priority, and almost 40 said their jurisdictions make serving people with disabilities a priority.

Most identified tight budgets and the aging of the population as key challenges, and more than 40 said they have concerns lack of agency staffers and lack of care providers out in the community.

NASUAD found that the budget, staffing and provider supply constraints are pushing the units to look for new ways to provide and oversee services.

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Most states, for examples, either have or are planning new programs to coordinate care for “dual eligibles” — individuals who are eligible for Medicaid because they are poor or meet long-term care (LTC) eligibility guidelines and also are eligible for Medicare.

In practice, many dual eligibles are elderly people who are in nursing homes or getting LTC services at home.

NASUAD also found that 16 jurisdictions either have or are planning to set up “health homes” for individuals with chronic condition.

A health home is a primary care doctor’s office that agrees to help keep track of a patient’s appointments and, generally, provide the kinds of tracking and coaching services that a private health insurer’s condition management team might provide. Some researchers have argued that coaching will work better if the coaching is done in an office that a patient visits in person rather than by coaches who communicate with a patient through the telephone or via electronic mail.

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