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Researcher: Set up ACOs that include long-term care

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Policymakers could set up a volunteer “Caregiver Corps” that would show people how to provide care for their loved ones at home.

Policymakers also could try encouraging communities to set up accountable care organizations (ACOs) that would coordinate long-term care (LTC) services and social support services as well as medical care.

Joanne Lynn, director of the Altarum Center for Elder Care and Advanced Illness, gave those ideas for improving LTC service delivery Wednesday at the second meeting of the Federal Commission on Long-Term Care.

Congress created the 15-member commission in 2012, with a provision in the same bill that officially eliminated the Community Living Assistance Services and Supports (CLASS) Act program, a component of the Patient Protection and Affordable Care Act (PPACA) that was supposed to set up a voluntary, employee-paid LTC benefits program.

The commission is supposed to try to come up with ideas for improving the LTC finance and delivery systems by September.

The commission got off to a slow start and held its first meeting only in June. 

The commission got its website up and running this week.

Much of the discussion at the second meeting focused on statistics, and lack of statistics.

Robin Stone, executive director of the LeadingAge Center for Applied Research, noted, for example, that the rise of assisted living facilities, and other “residential care” facilities other than nursing homes, contributed to the percentage of people ages 85 and older living in nursing homes falling to about 14 percent in 2004, from about 21 percent 20 years earlier.

One lesson is that many older people, especially older people who are not enrolled in Medicaid, are living in facilities other than nursing homes, Stone said. 

Policymakers will need to work on ways to make that non-nursing home residential care affordable, Stone said.

Another lesson is that getting information on what is going on with older people and long-term care today can be complicated, because many important surveys were last updated years ago, speakers said.

Lynn said getting providers of various types of care, such as rehab care, home care and nursing home care, to agree to use standardized, easy-to-compare quality assessment tools is difficult.

Today, “everyone’s making money on the chaos in the current system,” Lynn said. “We simply do not establish databases that make sense.” 

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