CAADS - California Association for Adult Day Services

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Publications -- Reports / Studies

Updated: JULY 27, 2016




Oral Health in California: What About Older Adults?

JUL 27, 2016 | Justice in Aging Health Network Alert

Oral health is a critical aspect of overall health for people of all ages, but especially for older adults. Unfortunately, the oral health needs of older adults, particularly low-income older adults have been neglected.

A new Issue Brief by Justice in Aging, Oral Health in California: What About Older Adults? explores the reasons why the oral health of older adults in the state is suffering and offers recommendations for improvements.

The issue brief launches a new area of advocacy for Justice in Aging in which we seek to improve oral health for low-income older adults in California.

California ranks 30th in dental care for older adults. Older adults with limited income especially face barriers accessing quality dental care through the state’s Denti-Cal program, which provides dental services under the Medi-Cal program. For example, only one in four California dental providers provide services to Denti-Cal enrollees. Five California counties have no Denti-Cal providers and several other counties have Denti-Cal providers, but they are not accepting new patients. As a result of this and other reasons, older adults in California have high rates of dental decay and tooth loss.

Justice in Aging presented a webinar on this topic on Tuesday, July 26. You can access the webinar slides or watch the video here.

This issue brief and its accompanying webinar was funded by a grant from The California Wellness Foundation (Cal Wellness). Created in 1992 as a private independent foundation, Cal Wellness’ mission is to improve the health of the people of California by making grants for health promotion, wellness, education and disease prevention.

 

National Study of Long-Term Care Providers: All ADS Centers Invited to Participate

JUL 17, 2016 | National Adult Day Services Association (NADSA)

CARF International is conducting a 2016 study to highlight the concept of “Financial Ratios as Performance Indicators” to the field of Adult Day Services for 2015 financial results. If your organization is an Adult Day Services provider, you are invited to participate in this unique, exciting annual study that began in 2010.

The goal of this study is to develop financial benchmarks for the adult day services field and to provide you with a complimentary summary of financial benchmarking information. Financial ratios of individual study participants will remain confidential. CARF will share the aggregate data analysis with you as a result of your participation.

To participate in this study, please send the following information by email to as@carf.org or fax to 1-202-587-5009 by Friday, July 29, 2016.

For your adult day service program’s fiscal year ending in 2015:

  • Internal unaudited 2015 fiscal year Financial Statements including Revenue and Expense and Balance Sheet or;
  • Corporate audit Financial Statements for 2015 fiscal year (if available).

    Note: If your financial information is consolidated for a larger organization, please clearly identify the adult day services financials or send a separate report with only the adult day services financial information included.

Mr. Jeff Boland, Partner, Reinsel Kuntz Lesher LLP will be analyzing the financial data submitted. Mr. Boland is a representative from CARF’s Financial Advisory Panel (FAP). He has presented the results of the last 6 studies at the NADSA Annual Conferences in 2010-2015.

Financial Ratios have been used as operational benchmarks for Continuing Care Retirement Communities (CCRCs) since the early-90s. For 20 years, CARF-CCAC has been collecting data from accredited CCRCs for inclusion in an annual publication titled Financial Ratios & Trend Analysis of CARF- Accredited CCRCs. Benchmarking against financial ratios has been a best practice for the CCRC field and CARF sees that the Adult Day Services field also benefits from benchmarking to assess trends and make sound financial decisions in varying economic times. Bankers, accountants, and various payers can rely on these financial ratios to assess organizational financial viability.

CARF, NADSA and RKL view this initiative as a way to add significant value to the ADS field and as a way to share our benchmarking expertise. Please direct questions to Susanne Matthiesen, MBA, Managing Director, CARF Aging Services at either smatthiesen@carf.org or toll-free 866-888-1122, ext. 5006.

 

Drop in Percentage of Physicians Participating in Medi-Cal Raises Red Flags

JUL 8, 2016 | Amy Adams, California Health Care Foundation

New 2015 data now available on ACA 411 show the percentage of physicians participating in Medi-Cal has declined since 2013 — during the same period Medi-Cal enrollment skyrocketed by 39%. This raises serious concerns about whether the supply of physicians participating in Medi-Cal can meet the increased demand.

Self-reported data from a voluntary survey of California physicians show physician participation in Medi-Cal declined from 69% in 2013 to 63% in 2015. (Physicians are identified as participating in Medi-Cal if they report any of their patients are covered by Medi-Cal.) The percentage of specialty care physicians participating in Medi-Cal likewise dropped during this time, from 70% to 64%. MORE

 

Special Report: Meeting the Legal Needs of LGBT Seniors

JUN 22, 2016 | Justice in Aging

Legal services organizations play a crucial role in alleviating the effects of poverty for low-income older Americans. However, not all low-income older adults have the same legal needs, not all will seek out help on their own, and for diverse groups, culturally competent service is key to meeting their needs.

How Can Legal Services Better Meet the Needs of Low-Income LGBT Seniors? is a new Special Report by Justice in Aging, produced in partnership with Services and Advocacy for Gay, Lesbian, Bisexual, & Transgender Elders (SAGE). This report explains why LGBT older adults have higher rates of poverty, outlines how discrimination and other factors lead to unique legal needs, and provides practical tips for outreach, intakes, and providing culturally competent legal services to LGBT older adults.

 

Moving Medi-Cal Forward on the Path to Delivery System Transformation

JUN 21, 2016 | California Health Care Foundation

Today the California Health Care Foundation (CHCF) released Moving Medi-Cal Forward on the Path to Delivery System Transformation. The report, commissioned by CHCF and written by Manatt Health, explores the reforms that are needed to ensure that Medi-Cal consistently delivers excellent access, quality, and patient experience while using resources efficiently.

Manatt conducted a landscape review and in-depth interviews with a diverse array of over 50 Medi-Cal stakeholders and thought leaders. The report assesses key challenges and opportunities in Medi-Cal, establishes a vision for delivery system reform, and articulates a path forward. Topics discussed include capitation rates, behavioral health, workforce shortages, access to providers, and more. See the report.

In the latest CHCF blog, Chris Perrone, director of Improving Access at CHCF, shares his key takeaways from the paper. Read the blog.

CHCF will hold a briefing in Sacramento on Wednesday, July 13 to discuss the report's findings. Register for the briefing.

 

Special Report: Prevent and End Homelessness Among Older Adults

APR 11, 2016 | Source: Justice in Aging Health Network Alert

More older adults are homeless or at risk of homelessness than at any time in recent history. As the population ages, more adults are aging into poverty. The lack of affordable housing and higher costs for health care and other necessities are also leaving greater numbers of older adults at risk of poverty and homelessness, and systemic economic problems are contributing to the problem. A Special Report by Justice in Aging, How to Prevent and End Homelessness Among Older Adults, created in partnership with The National Alliance to End Homelessness, outlines the problem and recommends policy solutions that can be put in place now to ensure that all older adults have a safe place to age in dignity, with affordable health care, and sufficient income to meet their basic needs.

Read the paper and watch the accompanying video about Bill, a 67 year-old Oakland, CA resident who has struggled with homelessness. Please share the report with others.

 

California's Uninsured: Coverage Expands, but Millions Left Behind

MAR 22, 2016 | Source: California Health Care Foundation (CHCF)
View: Report | Infographic

The latest edition of California's Uninsured finds that implementation of the Affordable Care Act (ACA) helped lower the uninsured rate in California from 16% in 2013 to 11% in 2014, but 3.8 million Californians under 65 remained without coverage.

A related infographic shows who gained coverage in California, who remains without it, and why.

Among the key findings from the new report:

  • From 2013 to 2014, the percentage of Californians who had individually purchased insurance or Medi-Cal increased.
  • Californians age 21 to 24 experienced the largest drop of any non-elderly age group in the percentage that was uninsured, from 25% in 2013 to 16% in 2014.
  • Of the state's remaining uninsured, 1 in 4 was between the age of 25 and 34, and more than half (57%) were Latino.
  • Within the employed population, more than 2 million workers, about 1 in 8, were uninsured.

This report is part of the CHCF California Health Care Almanac, an online clearinghouse for key data and analysis examining California's health care marketplace. Find all Almanac reports at www.chcf.org/almanac.

 

Special Report: Strengthening Supports for Low-Income Older Adults and Caregivers

FEB 8, 2016 | Source: Justice in Aging
Report: Advocacy Starts at Home: Strengthening Supports for Low-Income Older Adults and Caregivers | Video
(Download the paper, view the video, read the blog post, and access other materials on family caregivers here.)

Margaret is a mom with two teenagers at home, a husband, and a full time job. Her mother Sadie lives alone on a limited income in an adjacent town. Margaret checks in on her every day, and is always on call for transportation to doctor’s appointments, help with bills, and groceries. Margaret is a family caregiver, one of nearly 35 million Americans providing unpaid care to an older adult.

A new paper by Justice in Aging, Advocacy Starts at Home: Strengthening Supports for Low-Income Older Adults and Caregivers, and accompanying video outline the challenges Margaret faces in helping her mother age safely at home in dignity.

As the population ages and the prevalence of cognitive disorders among older adults increases, policymakers and the media are paying more attention to the challenges of caregiving. These challenges are even more acute for low-income older adults and their families.

That’s why we’ve released this paper now, with the support of the Albert and Elaine Borchard Center on Law and Aging, to make recommendations for policy changes and expanded programs to better serve everyone, but especially low-income older adults and their caregivers.

 

Report Addresses California’s Shortage of Primary-Care Physicians

FEB 8, 2016 | Source: Physicians News Network
CPCA Report: HORIZON 2030: Meeting California’s Primary Care Workforce Needs

The California Primary Care Association (CPCA), which represents community health centers that provide care to one in seven Californians, released a report that provides a sobering analysis of California’s healthcare workforce today while detailing key opportunities to meet the workforce needs of tomorrow.

The CPCA reports: “At current utilization, California will need an estimated 8,243 additional primary-care physicians by 2030, or 32% of its current workforce” (Pettersone, Cai, Moore, & Bazemonre, 2013). The report also notes that California’s ratio of primary-care physicians participating in Medi-Cal is approximately half of the federal recommendation.

One-third of Californians, or 12.7 million, are now covered by Medi-Cal (Karlamangla, 2015). California’s ratio of primary-care physician full-time equivalents (FTEs) participating in Medi-Cal was estimated at 35 to 49 per 100,000 Medi-Cal enrollees, well short of the 60 to 80 that the federal government estimated are needed (Coffman, Hulett, Fix, & Bindman, 2014).

According to the California Academy of Family Physicians, well-qualified new physicians who would like to train in the state instead must leave California due to limited residency opportunities, often not returning to practice in California (CAFP, 2015).

In 2014, for example, the White Memorial Family Medicine Residency Program in Los Angeles received 600 applications for seven slots; Family Health Centers of the San Diego Family Medicine Residency Program received 744 applications for six slots; and the UCSF Fresno Family Medicine Residency Program received 762 applications for 12 slots.

Combined California residency programs train approximately 140 family medicine residents per year. This is an insufficient amount to produce the number of primary-care physicians needed (CAFP, 2015).

According to the CAFP, California’s long-term workforce would grow significantly, as the vast majority of physicians who train in a region stay there to practice. Nearly 70% of medical residents who train in California practice here after graduation.

As reported on ABC 10, California’s population growth, coupled with an increase in insured Californians under the Affordable Care Act, means that the state’s primary-care doctors are in higher demand than ever. The implications are that people could have longer wait times to get into the doctor as well as fewer doctors to coordinate their care.

At a national level, The Robert Graham Center suggests education reform that includes medical-school debt relief, increased primary-care training, and reimbursement reform to attract more physicians to the primary-care field.

 

CMS Releases Guide to Reduce Health Disparities in Hospital Readmissions

FEB 5, 2016 | Source: Justice in Aging

Reducing health disparities for racial and ethnically diverse Medicare beneficiaries is a key part of the Center for Medicare and Medicaid Services (CMS) health equity plan. Medicare hospital readmissions have implications for quality improvement, cost savings, and health equity. Unplanned readmissions cost Medicare $17.4 billion in 2004, and 20 percent of Medicare fee-for-service beneficiaries were readmitted within 30 days of discharge. Research has revealed that minority and other vulnerable populations are more likely to be readmitted within 30 days of discharge for certain chronic conditions, compared to white beneficiaries.

Last week, the Center for Medicare & Medicaid Services (CMS) Office of Minority Health released a guide to preventing readmissions among racially and ethnically diverse Medicare beneficiaries. This guide outlines key issues and offers strategies to prevent readmissions for racially and ethnically diverse patients, high level recommendations for moving the needle on readmissions for diverse populations, and case studies demonstrating how these recommendations work in practice. The guide also contains useful data for advocates that detail health disparities in the top conditions in the CMS hospital readmissions reduction program and health disparities in top chronic conditions.

While the guide focuses on hospital readmissions, the ideas to improve communications and continuity of care for racially and ethnically diverse Medicare beneficiaries can be applied in many settings. For example, the guide highlights the importance of language access – during the hospital stay, at discharge, and when accessing post-hospital care. Advocates can work with providers in their communities to promote these practices to combat health disparities among racial minorities and individuals with limited English proficiency.

At Justice in Aging we work to ensure that low-income seniors have access to the health care they need and that the programs and services they are entitled to by law are delivered without discrimination.

 

Governor’s Budget is a Start But Doesn't Go Far Enough for Poor Seniors

JAN 2016 | Source: Justice in Aging
Governor's Budget is a Start But Doesn't Go Far Enough for Poor Seniors

Rates of senior poverty in California are high and rising, with more than one million seniors in one of country’s wealthiest states struggling to pay rent, buy food, and cover health care costs. California Governor Jerry Brown released a proposed budget for fiscal year 2016-2017 that provided some relief, but more action and bolder policies are needed.

 

New Fact Sheet: Medicare Part D – 2016 Transition Right

JAN 2016 | Source: Justice in Aging
Fact Sheet

The Centers for Medicare and Medicaid Services (CMS) requires that sponsors of Medicare Part D prescription drug plans provide beneficiaries with access to transition supplies of needed medications to protect them from disruption and give adequate time to move over to a drug that is on a plan’s formulary, file a formulary exception request or, particularly for Low Income Subsidy (LIS) recipients, enroll in a different plan.

Transition rules apply to stand-alone Medicare Prescription Drug Plans (PDPs), Medicare Advantage Plans with Prescription Drug Coverage (MA-PDs), and Medicare-Medicaid Managed Care Plans participating in the Dual Eligible Financial Alignment Demonstrations. Transition rules are particularly important for low income beneficiaries who were automatically reassigned to new plans, which may or may not cover their medications. In addition, all plans change their formularies each year, so even people who remain in the same plan may find that their plan no longer covers their medications or has newly imposed utilization management requirements.

To assist advocates with transition issues, this fact sheet sets out the CMS minimum requirements for all plans. For further information, contact Georgia Burke, gburke@justiceinaging.org.

 

New Brief on Integrated Care Models for Dually Eligible Beneficiaries

DEC 17, 2015 | Source: The SCAN Foundation
Brief

A new brief from the Center for Health Care Strategies describes key features and considerations for various integrated care models that states use to serve Medicare-Medicaid enrollees.

 

The Promise of Coordinated Care

DEC 17, 2015 | Source: The SCAN Foundation

Two new success stories from Collaborative Consulting on the value of coordinated care:

 

Wave 2 of Polling Results of California's Medicare-Medicaid Enrollees

DEC 17, 2015 | Source: The SCAN Foundation

Field Research Corporation released its second wave of polling results surveying people enrolling in and opting out of Cal MediConnect (CMC). Findings show that CMC enrollees have continued satisfaction and confidence in their care.

 

Four New Reports Available from the 2014 National Study of Long Term Care Providers

DEC 2015 | Source: NSLTCP

The National Center for Health Statistics (NCHS) has four new reports available based on findings from the 2014 National Study of Long Term Care Providers:

  • Data Brief #224: “Variation in Operating Characteristics of Adult Day Services Centers, by Center Ownership: United States, 2014”
  • Data Brief #227: “Variation in Adult Day Services Center Participant Characteristics, by Center Ownership: United States, 2014”

All data briefs can be found at http://www.cdc.gov/nchs/nsltcp/nsltcp_db.htm.

All data briefs have supplementary state estimate tables which can be found at http://www.cdc.gov/nchs/nsltcp/nsltcp_webtables.htm.

About NSLTCP

The data briefs and state tables use survey data from NCHS’ 2014 NSLTCP. NSLTCP provides reliable, accurate, relevant, and timely statistical information to support and inform long-term care services policy, research, and practice. More information about NSLTCP is available at http://www.cdc.gov/nchs/nsltcp/about_nsltcp.htm.

 

Health Care Costs 101: A Spending Plateau?

DEC 2015 | Source: California HealthCare Foundation (CHF), California Health Care Almanac
Report

In 2013, national health expenditures increased just 3.6%, the lowest growth rate in 50 years and a continuation of the slow growth trend that began in 2009. See the latest Almanac report and updated data visualization.

 

Regulatory Review of Adult Day Services

NOV 20, 2015 | Source: US Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation (ASPE) | View Report

The US Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation (ASPE) recently released a report on Adult Day Services. The Regulatory Review of Adult Day Services, 2014 Edition provides information about each state’s approach to regulating this key community service. Adult day services (ADS)--a non-residential service provided outside an individual’s home for less than a full day--provides direct care to older adults and younger adults with physical disabilities.

The report was authored by RTI International including Janet O'Keeffe, Christine O'Keeffe and Madhu Shresthra.

 

Locally Sourced: The Crucial Role of Counties in the Health of Californians

How California counties provide health services for most vulnerable residents

OCT 14, 2015 | Source: California Healthcare Foundation | View Report

California's 58 counties are core providers of health care services and public health programs. Counties are responsible for health services for low-income people without other coverage, oversee local mental health and substance use disorder programs, operate laboratories, and manage disease prevention and health promotion programs.

To administer this array of health services, counties navigate a complex set of federal, state, and local funding streams and requirements. Over the years, responsibility for program administration, funding, and decisionmaking has been complicated by back-and-forth shifts between the state and counties.

With the unprecedented changes in health care delivery under the Affordable Care Act (ACA), county health programs are in a period of flux as new state and federal policies are implemented, revised, and reframed. The role of counties will continue to evolve as public and private health care markets mature under the ACA's framework of expanded health coverage and delivery system reform.

The latest edition of this report describes:

  • County health services and programs for medical care, behavioral health, and public health as of July 2015
  • Counties' core health responsibilities and the arrangements they use to meet them
  • State and federal policies affecting county programs (including some that are pending)

 

Directory Assistance: Maintaining Reliable Provider Directories for Health Plan Shoppers

SEPT 2015 | Source: California Healthcare Foundation | View Report

With implementation of the Affordable Care Act (ACA), many consumers are making health coverage decisions for the first time. Many turn to provider directories — electronic or printed lists of physicians, hospitals, and other health care providers participating in each health plan. However maintaining accurate and up-to-date directories of participating providers has proved to be challenging.

A new report examines policy, operational, business, and technical obstacles to well-functioning, integrated provider directories and how they have been overcome in four states: Colorado, Maryland, New York, and Washington. It details the perspectives and experiences of consumer advocates, carriers, providers, state-based marketplaces, and state Medicaid agencies in those states. The report examines solutions with the goal of informing California policymakers and stakeholders as they seek to improve consumer access to accurate provider network information.

Key findings include:

  • An environment for shared accountability can be fostered through incentives, policy alignment, and enforcement of regulatory and contractual requirements.
  • Creation of uniform data standards and accompanying guidance ensures that data are usable, especially when they come from disparate sources.
  • Provider directories should engage and inform consumers with diverse language needs and educational levels as they enroll in coverage and seek care.

 

The CMS Equity Plan for Improving Quality in Medicare

SEPT 14, 2015 | Source: Centers for Medicare & Medicaid Services Office of Minority Health | View Full Plan

The Centers for Medicare & Medicaid Services (CMS) Equity Plan for Improving Quality in Medicare (CMS Equipty Plan for Medicare) provides an action-oriented, results-driven approach for advancing health equity by improving the quality of care provided to minority and other underserved Medicare beneficiaries. The plan aims to reduce health disparities in four years, and focuses on six priorities:

  • Priority 1: Expand the Collection, Reporting, and Analysis of Standardized Data
  • Priority 2: Evaluate Disparities Impacts and Integrate Equity Solutions Across CMS Programs
  • Priority 3: Develop and Disseminate Promising Approaches to Reduce Health Disparities
  • Priority 4: Increase the Ability of the Health Care Workforce to Meet the Needs of Vulnerable Populations
  • Priority 5: Improve Communication and Language Access for Individuals with Limited English Proficiency and Persons with Disabilities
  • Priority 6: Increase Physical Accessibility of Health Care Facilities

 

Initial Data from 2014 National Study of Long Term Care Providers

SEPT 11, 2015 | Source: National Adult Day Services Association (NADSA) | View QuickStats

In support of National Adult Day Services Week, the National Center for Health Statistics has released its first data from the 2014 National Study of Long Term Care Providers.

In 2014, cardiovascular disease (44%) was the most common diagnosis among adult day services center participants, while severe mental illness (10%) was the least common diagnosis. About 30% of adult day services center participants had a diagnosis of Alzheimer's disease or other dementias; 30% had diabetes; about 25% had intellectual or developmental disability; and 25% had depression. It is estimated that 282,200 participants were enrolled in adult day services in the United States on any given day in 2014.

View QuickStats: Percentage of Adult Day Services Center Participants,* by Selected Diagnoses† — National Study of Long-Term Care Providers, United States, 2014 in the Morbidity and Mortality Weekly Report (MMWR) from the Centers for Disease Control and Prevention.

 

Los Angeles Healthy Aging Report 2015

SEPT 2015 | Source: USC Edward R. Roybal Institute on Aging | View Report

Health is the most important determinant of successful living at any age. However, not everyone has the same opportunities for a long life free from major afflictions. There are significant differences in the health status of the many communities in Los Angeles. These differences are reflected in higher rates of premature dealth and shorter lifespans for people of certain racial and ethnic bakgrounds who live in certain neighborhoods. The challenge of our time is to implement successful changes in the way we live so that all of us can benefit from longer, more productive, and healthier lives.

 

RN Role Reimagined

SEPT 2015 | Source: California HealthCare Foundation | View Report

Facing a shortage of primary care physicians and a large increase in patients needing care, safety-net clinics are realizing the full potential of using the nursing workforce to better deliver care.

 

Growing Palliative Care

SEPT 2015 | Source: California HealthCare Foundation | View Report

A new resource center provides strategies for organizations planning, implementing, or enhancing community-based palliative care programs, including payment options.

 

Initial Data from 2014 National Study of Long Term Care Providers

SEPT 11, 2015 | Source: National Adult Day Services Association (NADSA) | View QuickStats

In support of National Adult Day Services Week, the National Center for Health Statistics has released its first data from the 2014 National Study of Long Term Care Providers.

In 2014, cardiovascular disease (44%) was the most common diagnosis among adult day services center participants, while severe mental illness (10%) was the least common diagnosis. About 30% of adult day services center participants had a diagnosis of Alzheimer's disease or other dementias; 30% had diabetes; about 25% had intellectual or developmental disability; and 25% had depression. It is estimated that 282,200 participants were enrolled in adult day services in the United States on any given day in 2014.

View QuickStats: Percentage of Adult Day Services Center Participants,* by Selected Diagnoses† — National Study of Long-Term Care Providers, United States, 2014 in the Morbidity and Mortality Weekly Report (MMWR) from the Centers for Disease Control and Prevention.

 

In or Out: An Examination of Medicaid's Coverage Determination Policies

SEPT 3, 2015 | Source: California Healthcare Foundation | View Report

How do state Medicaid agencies decide what to cover?

Medicaid, the largest US purchaser of health services, plays a big role in whether millions of Americans can get new health care interventions. A new CHCF report reviews how Medicaid and other large public health insurance programs in the US and abroad determine coverage for specific treatments (e.g., procedures, therapies, technologies, and devices), including behavior change interventions and emerging technologies.

The report highlights themes from research and interviews with select state Medicaid agencies and discusses policies and procedures for achieving greater rigor and transparency in this decisionmaking process.

The authors conclude that state Medicaid programs, including California's Medi-Cal, should consider the following core features for their coverage determination policies:

  • A defined process by which third parties may initiate a coverage review
  • A systematic approach to securing and evaluating evidence of the effectiveness and value of a new intervention
  • A systematic evaluation of high-cost, high-utilization services
  • A defined standard by which the state will determine whether to cover the intervention

 

New Report -- Portrait of Promise: The California Statewide Plan to Promote Health and Mental Health Equity

AUG 28, 2015 | Source: California Department of Public Health Office of Health Equity | View Report

In this this document, the California Statewide Plan to Promote Health and Mental Health Equity (“Plan”), we present background and evidence on the root causes and consequences of health inequities in California. We explore and illustrate how a broad range of socioeconomic forces, including income security, education and child development, housing, transportation, health care access, environmental quality, and other factors, shape the health of entire communities — especially vulnerable and underserved communities — resulting in preventable health inequities for specific populations. With a better, data-based understanding of the causes and consequences of health inequities, Californians will be better prepared to take the steps necessary for promoting health across California’s diverse communities and building on the great strengths that our diverse population brings.

The Plan is intended to illuminate the scope of the health equity challenge with compelling data and narrative. It makes the case that health is a basic human right, that health inequity is a moral and financial issue, and that health equity is in everyone’s best interest. It also provides a brief summary of the most pervasive social determinants of health, and it offers examples of programs, policies, and practices that have begun to make a difference in the state’s most vulnerable communities.

 

Fresh Data on ACA 411 Show Impact of Health Reform in California

2014 Numbers Illuminate How Access to Care Is Changing
AUG 26, 2015 | Source: California Healthcare Foundation | View Data

The California HealthCare Foundation (CHCF) has updated its ACA 411 interactive web tool with new survey data to track the impact of the Affordable Care Act on insurance coverage, access to health care services, and affordability in California in 2014. The numbers suggest improvements in access to care, including that the uninsured rate is at a new low and fewer Californians are delaying or skipping necessary medical care. ACA 411 makes it easy to compare data and see trends.

The tool, developed by CHCF and The State Health Access Data Assistance Center at the University of Minnesota, features more than 50 indicators of access, cost, and affordability and now includes the most recent data from the California Health Interview Survey (CHIS), the consumer opinion survey administered by UCLA.

Among the key findings from the 2014 data:

  • The number of Californians under 65 without insurance dropped 12%, falling from 16% of the population in 2013 to 14% in 2014.
  • Uninsured rates declined notably among people living below 138% of FPG and among African Americans.
  • The share of the California population ages 18 to 64 enrolled in Medi-Cal rose 52%.
  • The proportion of uninsured Californians reporting cost as the reason for lacking coverage fell from 53% to 43%, though lack of affordability remains the most common reason cited for going without insurance.

Information from ACA 411 can be readily exported and shared, and CHCF will add new data as they are available to track how health reform is changing health care for Californians. ACA 411 is designed to help policymakers and stakeholders understand the ACA's impact in California, identify areas for further investigation, and inform policy choices.

 

New 50 State Survey of Dementia Training Requirements

AUG 24, 2015 | Source: Justice in Aging | View Survey Findings

With more than 5 million people living with Alzheimer’s and other dementias, there’s a growing need for robust training standards for health care professionals in the special needs of people with cognitive impairment. For example, though 64% of nursing home residents have dementia, only 23 states have laws prescribing training requirements for direct care staff in nursing homes and, of those, only one state requires staff to pass competency examinations. Only ten states require dementia training for law enforcement.

These are among the findings of an in-depth 50-state survey of statutes and regulations that Justice in Aging conducted with the support of the Alzheimer’s Association. We looked at dementia training requirements for professionals in a variety of health care and community settings and found wide variation among states in both the amount and the content of required training. We compiled our findings in a five-paper series, Training to Serve People with Dementia: Is our Health Care System Ready?

So advocates can easily find whether their state has standards in each area, Papers 2 through 4 include detailed tables of state laws and regulations in each category, complete with full citations.

We also presented a webinar outlining the major findings of the study and offering an initial roadmap for advocates working to address training gaps. You can view it on our Vimeo channel.

 

How Consumers Find Information About Prescription Coverage

AUG 19, 2015 | Source: California Healthcare Foundation | View Report

When shopping for health plans, consumers face many challenges in finding information on prescription drug benefits. Publicly posted formularies are often difficult to navigate due to lack of standardization, may be presented in arcane terminology, provide incomplete and inaccurate information, and frequently are not available in languages other than English.

Hidden From View: How Consumers Find Information About Prescription Coverage provides insight into the consumer experience of accessing prescription drug coverage information, pinpoints consumer priorities and preferences for display of relevant benefit information, and identifies opportunities for making benefit information more accessible and easy to comprehend. Consumer input yielded many recommendations for making prescription drug benefit information easier to find and use.

The key findings and recommendations are:

  • The affordability of monthly premiums and other out-of-pocket costs, along with physician selection, trumped questions about drug cost and coverage, even for consumers with significant prescription drug requirements.
  • In general, respondents were not familiar with many of the terms used routinely in prescription benefit information, such as "formulary," "tier," "co-insurance," and "preferred." Consumers want materials written in more common, accessible language.
  • There was little awareness of the exceptions or appeals process for obtaining needed medications not listed on a plan's formulary. Those seeking this information had difficulty finding it.
  • Respondents, including Spanish-speakers who reported being comfortable reading English, said drug information, such as formularies, should be available in Spanish and other languages.
  • All consumers, counselors, and agents reported that an interactive, online tool that provides drug cost and coverage information by plan would improve consumer decisionmaking.

Information from ACA 411 can be readily exported and shared, and CHCF will add new data as they are available to track how health reform is changing health care for Californians. ACA 411 is designed to help policymakers and stakeholders understand the ACA's impact in California, identify areas for further investigation, and inform policy choices.

 

Planning for California's Growing Senior Population

AUG 2015 | Source: Public Policy Institute of California (PPIC) | View Report

California’s senior population is entering a period of rapid growth. By 2030, as the Baby Boom generation reaches retirement age, the over-65 population will grow by four million people. It will also become much more racially and ethnically diverse, with the fastest growth among Latinos and Asians. Many more seniors are likely to be single and/or childless -- suggesting an increased number of people living alone. All of these changes will have a significant impact on senior support services.

 

As California Ages, Will There Be Enough Beds and Services?

New Reports Explore Health Service Capacity
AUG 2015 | Source: California Health Care Almanac from the California Healthcare Foundation (CHCF) | View Reports Beds for Boomers | California Hospitals

With the aging of the baby boomer generation and gains in life expectancy, California's senior population is projected to more than double by 2040. Because seniors use more health care services than other age groups, there are concerns about the capacity of the health care system to accommodate their needs. Two new publications from CHCF's California Health Care Almanac examine supply and demand from different perspectives. Below are highlights from each report.

Beds for Boomers: Will California's Supply of Services Meet Senior Demand? focuses on the projected need for services.

  • Nearly two-thirds of California seniors had two or more chronic conditions in 2012.

  • Californians over age 65 use acute care hospital days at rates up to four times more than younger people. However, since 2008, acute care days used by seniors have declined despite growth in this population.

  • Acute care days are projected to increase by nearly 50% by 2040 if current usage remains steady. Overall, California's 2013 supply of licensed acute care beds is sufficient to meet this projected demand.

California Hospitals: An Evolving Environment focuses on the existing supply of various types of beds in general acute care hospitals.

  • Skilled nursing and acute psychiatric beds declined significantly from 2004 to 2013, while both adult and newborn intensive care beds increased. During that decade, the number of general acute care hospitals fell by 4% while the number of beds remained largely unchanged.

  • The eight largest hospital systems accounted for 40% of hospitals and beds in California.

  • California hospitals performed slightly below the US average on eight patient satisfaction measures.

Note that the statistics between the two reports may differ due to the sets of hospitals covered. These reports are published as part of the CHCF California Health Care Almanac, an online clearinghouse for key data and analysis examining California's health care marketplace. Find all Almanac reports at www.chcf.org/almanac.

 

The Dual Eligible Demonstrations at Five: Justice in Aging Toolkit on Design and Implementation

JUL 28, 2015 | Source: Justice in Aging | View Outreach and Enrollment Materials in States Implementing a Demonstration

On Thursday, we’ll celebrate the 50th anniversary of the day that two of the most successful anti-poverty programs became law: Medicare and Medicaid. Today, over 10 million low-income individuals, known as dual eligibles, receive care and services under both programs. In 2010, under a provision of The Affordable Care Act (Pub. Law 111-148, Section 2602), the Centers for Medicare and Medicaid Services (CMS) created a new office to focus exclusively coordinating the two programs. The new entity, the Medicare-Medicaid Coordination Office, began working with states across the country to better align Medicare and Medicaid benefits through state-run dual eligible demonstrations.

Five years later, states and CMS are in the early stages of evaluating the demonstrations and also looking at mid-course corrections and improvements based on experiences to-date. At the same time, advocates and policymakers are contemplating future health care delivery system reforms, as part of a broader reform effort to pay for value and outcomes, instead of volume.

To contribute to these efforts, Justice in Aging has created a toolkit of design and implementation resources. The toolkit consists of:

  • A new tool for advocates comparing different state outreach and enrollment materials to highlight effective models to use when reaching vulnerable populations. The new tool includes two appendices: Appendix 1, a working chart with links to outreach materials in different states. Appendix 2, accessible from the Outreach and Notices tab on this page, includes examples of notices currently in use in states, and our comments on strengths and areas of improvement.
  • Resources on appeals procedures, designing enrollment notices, care continuity, and ensuring consumer protections in integrated models. These resources were developed earlier by Justice in Aging to influence the demonstration’s design to ensure consumer protections were a focus of new managed care delivery systems. They are assembled together for the toolkit and linked from this page.

 

20 Common Nursing Home Problems and How to Resolve Them

JUL 2015 | Source: Justice in Aging | Request Report (Free)

Can a nursing home deny needed therapy services? Evict a resident for being “difficult”? Limit family members and friends to specified “visiting hours”?

Many common nursing home practices are, in fact, illegal. In order to receive the best possible quality of care, a resident or resident’s family member should be familiar with the protections of the federal Nursing Home Reform Law, and understand how to use the law effectively.

That’s why Justice in Aging wrote a practical and widely-used consumer guide, 20 Common Nursing Home Problems and How to Resolve Them. The new version is completely updated and boasts a reader-friendly new design.

 

Valuing the Invaluable: 2015 Update
Undeniable Progress, but Big Gaps Remain

JUL 2015 | Source: AARP Public Policy Institute | View Report

This report highlights the growing importance of family caregiving on the public policy agenda. It lists key policy developments for family caregivers since the last Valuing the Invaluable report was released in 2011. Finally, the report recommends ways to better recognize and explicitly support caregiving families through public policies, private sector initiatives, and research.

 

Medi-Cal Versus Employer-Based Coverage: Comparing Access to Care

JUL 2015 | Source: The California HealthCare Foundation (CHCF) | View Report

This report takes a close look at access to care under Medi-Cal for nonelderly adults and children on the eve of ACA implementation. Using data from 2012 and 2013 California Health Interview Surveys (CHIS), the research examines a total of 45 measures (41 on realized and potential access and 4 on health status and health behaviors) for nonelderly adults and 31 measures (28 on realized and potential access and 3 on health status and behaviors) for children.

 

Medi-Cal Versus Medicaid in Other States: Comparing Access to Care

JUL 2015 | Source: The California HealthCare Foundation (CHCF) | View Report

This report examines access to care under the Medi-Cal program for children and nonelderly adults, using data from the 2011 and 2012 National Health Interview Study (NHIS). It compares access under Medi-Cal to that under Medicaid programs in other states, where Medi-Cal/Medicaid includes Medicaid, the Children's Health Insurance Program (CHIP), and other state-funded public programs. There are separate analyses for adults age 19 to 64 and for children 0 to 18.

 

Report: Stories from LGBT Older Adults in Long-Term Care Facilities

JUN 29, 2015 | Source: Justice in Aging / LGBT Senior Long Term Care Bill of Rights / San Francisco Board of Supervisors | View Report | Accompanying Video

Imagine being out and proud all of your adult life and then moving into a long-term care facility and having to go back into the closet because you don’t feel safe coming out to staff and other residents. Imagine being dismissed and disrespected when you advocate strongly for the rights of your same-sex companion while she’s being cared for in a nursing home. Imagine feeling like you have to endure homophobic comments from a personal care worker assigned to you because you’re afraid of how he’ll treat you if you speak up.

These anecdotes are not only true; they’re common experiences for LGBT older adults. And they’re all in our ground-breaking report, LGBT Older Adults in Long-Term Care Facilities: Stories from the Field. Published in 2010, the report is still making waves in policy circles. In honor of Pride 2015, we’re re-releasing a fresh version of the report for those who may have missed it, along with its accompanying video.

We’re proud that our report was the impetus for the San Francisco Board of Supervisors recent unanimous approval of an LGBT Senior Long Term Care Bill of Rights – the very first of its kind in the nation. We hope that other cities use San Francisco’s ordinance as a model to ensure LGBT seniors have the right to be safe and treated with dignity in every long-term care facility. That’s why we’re re-releasing the report now.

As we celebrate the Supreme Court ruling on June 26 for marriage equality for same-sex couples across the nation, we recognize what a huge step this is for LGBT older adults. At the same time, we know that we must remain committed to fighting the discriminatory practices that linger in the system.

 

Understanding Medi-Cal High-Cost Populations

JUN 9, 2015 | Source: California Healthcare Foundation (CHCF) | View Documents/Recording High Utilizers of Medi-Cal Services | Infographic Medi-Cal by the Numbers High-Use High Cost

California's government collects vast amounts of clinical and cost data about the care it provides to the 12 million people enrolled in Medi-Cal, the nation's largest Medicaid program.

Aggregating and analyzing this data, which is spread across multiple departments, is a key to understanding the Medi-Cal population, identifying opportunities to improve health care and outcomes, and managing public spending. Document downloads include:

  • Slides – Understanding Medi-Cal High Utilizers (Kizer and Watkins)
  • Slides – Understanding Medi-Cal High-Cost Populations (Watkins)
  • Slides – Improving Service Delivery for High Need Medicaid Clients in Washington State (Mancuso)
  • Slides – Integrated Care Models and Outcomes for Clients with Co-Morbid Conditions (Innes-Gomberg)
  • Slides – Long-Term Services and Supports: Shaping the Delivery System (Schupp)
  • Slides – Using Data to Improve Care: Perspectives on Long-Term Services and Supports (Steenhausen)
  • Slides – Keynote and Demonstration of Washington State’s Predictive Risk Intelligence System (PRISM) (Mancuso)

 

ADA at 25: Aging Advocates Celebrate Partnership And Progress

JUN 2015 | Source: Justice in Aging | View Issue Brief

This paper will provide aging advocates with some background on the ADA and outline four key areas where the ADA continues to shape the environment, care, and services for older adults. As aging and disability advocates continue to partner to advance policy, it’s important to remember how much the ADA accomplished in just twenty-five years.

 

Advocates Guide to California's Coordinated Care Initiative Version 4

JUN 2015 | Source: Justice in Aging | View Advocate's Guide, Version 4

Justice in Aging created an Advocates Guide to California's Coordinated Care Initiative to help advocates understand the extensive changes occurring under the CCI. Today, Justice in Aging released Version Four of the Guide, which:

  • Describes the CCI, including populations affected, changes beneficiaries can expect, and where and when the CCI is being implemented
  • Summarizes CCI policies
  • Provides advocacy tips and additional resources

 

Just Like Home: The Impact of the Federal HCBS Regulations on Older Adults

JUN 2015 | Source: Justice in Aging | View Issue Brief

New federal regulations have established first-time standards for when settings qualify as “community-based” for the purposes of Medicaid-funded Home and Community-Based Services (HCBS). Each state is charged with developing a transition plan to meet these standards. These plans will have a huge impact on older adults receiving Medicaid-funded HCBS in assisted living, adult day services, and other settings.

The transition plans must confront and answer many important questions.

  • What service models are eligible for payment?
  • Should services in assisted living facilities be covered?
  • What about adult day care programs?
  • Does the size of these programs matter?
  • And should programs be allowed to be “secure”, i.e., locked, if they care for persons with dementia?

Consumers and their advocates must be heard in the states’ transition planning processes. Justice in Aging’s new issue brief provides policy recommendations for consideration by states and stakeholders. The recommendations address (among other things) how to assess settings for compliance, judging whether a setting is integrated with the community, protecting consumers from eviction, and applying the regulations when consumers have dementia.

 

Regulatory Review of Adult Day Services: Final Report, 2014 Edition

JUN 2015 (Released) | Source: U.S. Department of Health and Human Services, Assistance Secretary for Planning and Evaluation, Office of Disability, Aging and Long-Term Care Policy | View DEC 2014 Report / PDF version

The 2014 Regulatory Review of Adult Day Services by state has been released by the Assistant Secretary for Planning and Evaluation. This report updates their previous report published in 2005, and is organized into two sections:

  • Section 1 provides a brief overview of states’ approaches to regulating ADS in selected areas -- the state’s general approach to regulation, inspection and monitoring; parameters for who can be served; required and optional services; provisions regarding medication; and staffing and training requirements.
  • Section 2 provides a profile for each state that describes its overall approach to regulating ADS providers, selected regulatory provisions, and Medicaid and other public funder requirements (if any).

 

Preventing Falls: A Guide to Implementing Effective Community-Based Fall Prevention Programs

APR 2015 | Source: Centers for Disease Control and Prevention (CDC) | View Guide

This “how-to” guide is designed for community-based organizations who are interested in implementing their own evidence-based fall prevention programs. This guide is designed to be a practical and useful tool, and it provides guidelines on program planning, development, implementation, and evaluation.

In this document, CDC provides organizations with the building blocks of effective fall prevention programs by providing examples, resources, and tips. It also describes the resources needed to implement and sustain fall prevention programs, and addresses questions that are important when implementing fall prevention programs such as:

  • How do we find a fall prevention program that best meets the needs of our clients?
  • How can we know that this program works and will achieve the desired results?
  • What resources will be needed to support it?
  • What partners should we consider to help us offer the program?
  • How can we support and sustain the program into the future?

This revision of the 2008 publication, Preventing Falls: How to Develop Community-based Fall Prevention Programs for Older Adults, will improve your organization’s ability to reach out to the older members of your community as well as enhance your capacity to implement and maintain effective fall prevention programs.

 

Californians with the Top Chronic Conditions: 11 Million and Counting

APR 2015 | Source: California Healthcare Foundation (CHCF) / UCLA Center for Health Policy Research | View Report | Charts

Chronic conditions are the leading cause of death and disability in the US, and the biggest contributor to health care costs. But there is wide variation in their incidence, with major differences depending on age, income, race and ethnicity, and insurance status. In addition, many Californians with chronic conditions are delaying needed care because of cost.

Californians with the Top Chronic Conditions: 11 Million and Counting looks at five major chronic conditions — asthma, diabetes, heart disease, high blood pressure, and serious psychological distress — and how each of these affects Californians.

 

A Right to Person-Centered Care Planning

APR 2015 | Source: Justice in Aging | View Report | Accompanying Webinar

When people are given the opportunity to choose where, how, and by whom they receive their care; and make their own decisions about their activities of daily living, and generally direct their own lives to the greatest extent possible, they have better health outcomes, more independence, and lead more fulfilling lives. This is at the heart of a concept known as person-centered care planning. With the support of the John A. Hartford Foundation, Justice in Aging released a report on the new Person-Centered Planning rules for Medicaid Recipients in Long Term Care from Centers for Medicare and Medicaid Services (CMS).

The report, A Right to Person-Centered Care Planning, and an accompanying webinar, summarize the rights the new rule gives to beneficiaries as well as identifying for advocates where there are gaps in the rule and where more guidance is needed. Best practices in the states are also included to serve as models for advocates working to ensure true person-centered care planning is a reality for all.

 

Medicaid HCBS Settings Regulations and Adult Services

APR 2015 | Source: National Association of State United for Aging and Disabilities (NASUAD) | View Findings

Concerned that the CMS definition for HCBS Settings places restrictive requirements on Adult Day Services settings and may reduce the number of available providers in the Medicaid program nationwide, the National Association of States United for Aging and Disabilities (NASUAD) conducted a survey. Key findings indicate the HCBS regulations may have the unintended consequence of limiting the availability of important health and social services, with the unintended consequence of individuals entering institutional settings.

 

Issues from the State: Advocating for Improved Consumer Protections in Managed Long-Term Services and Supports

APR 24, 2015 | Source: Justice in Aging, with thanks to The Retirement Research Foundation and The Atlantic Philanthropies for their support in producing this paper | View Issue Brief

State Medicaid programs increasingly are moving their long-term services and supports programs to managed care. But the transition is not without its potential pitfalls for Medicaid beneficiaries and their advocates. A new issue brief spotlights the managed LTSS programs from Florida, Kansas, and New Jersey, and discusses how particular program policies may influence availability of services and the ability of consumers to access those services. The information presented will be of use to advocates from any state with a Medicaid managed care program, and will address both individual and systemic advocacy strategies.

 

Survey Says: Californians' Perspectives on Health Care

APR 14, 2015 | Source: California Healthcare Foundation (CHCF) | View Survey Findings | California Health Care Almanac

Are Californians getting the care they need? This survey shows that some groups are having a more difficult time accessing care than others.

While there is recent good news in terms of expanding health coverage, too many Californians struggle to get access to health care. This is particularly true of those with the greatest need: One in two adults who report they are in fair or poor health have delayed care in the past 12 months due to cost.

 

Genworth 2015 Annual Cost of Care Study

APR 9, 2015 | Source: Genworth News Release | View Cost of Care website

At Home Care Costs Increase in California

The results of Genworth's 12th annual Cost of Care Study shows that in California, the cost to receive long term care services at home with a home health aide has increased over the past five years. On a national level, the survey shows a dramatic increase in facility based care, including assisted living and nursing home facilities, while the cost to receive care at home through a home health aide is rising at a more moderate growth rate.

 

Thinking Outside the Box: Creative and Culturally Competent Outreach Strategies in Health Care Transitions

MAR 2015 | Source: Justice in Aging & co-authored by Advocates for African American Elders (AAAE) | View Issue Brief

Changes to health care coverage are happening rapidly and can be confusing for advocates to understand and explain to beneficiaries.

This issue brief discusses, in general, the importance of effective outreach and education during any complex health care transition. As a real world example, it focuses on how AAAE’s culturally competent outreach model communicates changes under California’s Coordinated Care Initiative to dual eligible beneficiaries, who are being moved into managed care plans.

The brief offers insight into and instruction on how to communicate changes in a person-centered and engaging manner. It concludes with practical tips for advocates and stakeholders and should be of use to those who are preparing their own communities for complex health care transitions.

 

New Reports Shine Light on Long-Term Care Problems

FEB 23, 2015 | Source: California Healthline Article

 

California Health Insurers: Brink of Change -- A snapshot in time just ahead of ACA implementation

FEB 2015 | Source: California HealthCare Foundation (CHCF) | View Report | Infographic

This report provides a snapshot of the insurance market in California at the end of 2013, just before the major provisions of the Affordable Care Act (ACA) took effect. It also includes some initial figures from 2014 that point to large shifts in both Medi-Cal and individual coverage levels.

 

The Universal Assessment Tool: Improving Care for Recipients of Home- and Community-Based Services

JAN 22, 2015 | Source: Legislative Analyst's Office (LAO) | View Report

 

A Shattered System: Reforming Long-Term Care in California -- Envisioning and Implementing an IDEAL Long-Term Care System in California

JAN 5, 2015 | Source: California State Senate Select Committee on Aging and Long Term Care | View Report

 


2014 PUBLICATIONS

 

Regulatory Review of Adult Day Services: Final Report, 2014 Edition

DEC 2014 | Source: Office of The Assistant Secretary for Planning and Evaluation (ASPE) | View Full Report | California

Adult day services (ADS)--a non-residential service provided outside an individual's home for less than a full day--provides direct care to older adults and younger adults with physical disabilities. These services also meet caregivers' need for respite in order to work, fulfill other obligations, and recover from the demands of continuous caregiving.

Many caregivers who use ADS are providing care to family members with dementia who need constant supervision to ensure their safety. By providing respite to unpaid caregivers, ADS can potentially delay or prevent nursing home placement.

This report provides information about each state's approach to regulating this key community service.

 

Unfinished Business: Designing Appeals Procedures in the Dual-Eligible Demonstrations

DEC 2014 | Source: Justice in Aging | View: Issue Brief

Under the Affordable Care Act, a number of states are participating in financial alignment demonstrations that combine the delivery of Medicare and Medicaid services for dual eligible beneficiaries. Even though financial alignment demonstrations are already “live” in five states with tens of thousands receiving services through demonstration plans, the appeal systems for the demonstrations in all participating states are still a work in progress, making it difficult for beneficiaries to navigate.

This tool, Unfinished Business, is an update on NSCLC’s September 2013 analysis of appeals processes in demonstrations in six states. Unfinished Business helps stakeholders focus their advocacy about appeals on areas where a consumer voice can have the most potential to affect programs, by highlighting the many areas where appeal rights and procedures have not yet been fully developed.

Ten states are participating (CA, IL, MA, MI, NY, OH, SC, TX, VA and WA), with one more, Minnesota, pursuing a similar but alternate model.

 

Working in Concert: A How-To Guide to Reducing Unwarranted Variations in Care

NOV 25, 2014 | Source: California Improvement Network / California HealthCare Foundation (CHCF) | View: Report

Patients should receive the appropriate level of care — no more and no less. But how is that sweet spot determined? This How-To Guide to Reducing Unwarranted Variations in Care, the result of the CIN's first action group, helps organizations get started.

 

What's In A Notice? How Notices Of Action Protect Consumers in Medicaid Managed Long-Term Services and Supports

NOV 2014 | Source: Justice in Aging | View: Guide

As Managed Long Term Services and Supports (MLTSS) rolls out nationwide, advocates on the ground have seen due process violations in appeals and notices of action. In this tool for advocates and consumers, NSCLC focuses on notice and appeal rights in MLTSS. NSCLC provides background information on notices of action, including an explanation of what type of Managed Care Organization (MCO) behavior constitutes an action that could give rise to due process violations.

This tool also provides advocates with the specific information that must be included in each notice of action to meet due process requirements, and outlines how continuation of services and aid-paid-pending plays out in the managed LTSS context.

 

State Transition Plans for New Medicaid HCBS Regulations: Four Tips for Consumer Advocates

OCT 2014 | Source: Justice in Aging and National Disability Rights Network | View: Four Tips

States now are beginning to release their transition plans to bring their Medicaid HCBS systems into compliance with the new federal regulations on community-based settings. It is essential that consumers and their representatives be prepared to evaluate those plans and advocate for improvements.

 

Adult Day Services: A Model of Person- and Family-Centered Care

OCT 2, 2014 | Source: AARP | View: BLOG by Lynn Friss Feinberg

A recent study found that more than a quarter million participants attend an estimated 4,800 community-based adult day service (ADS) centers in the U.S. Although most participants are older people, more than one-third of ADS participants are younger than 65. Nearly one in three ADS participants has Alzheimer’s disease or another form of dementia.

 

Shared Decisionmaking

OCT 2014 | Source: California Improvement Network / California HealthCare Foundation (CHCF) | View: Report

It is not always easy for providers and patients to make treatment decisions jointly. A new CIN partner report details effective strategies shared by the Gordon and Betty Moore Foundation, Humboldt-Del Norte IPA, and Sharp HealthCare.

 

Up Close: A Field Guide to Community-Based Palliative Care in California

SEPT 2014 | Source: California HealthCare Foundation (CHCF) | View: Field Guide

Health systems across the US are recognizing the importance of palliative care — specialized, interdisciplinary care that attends to the physical, psychological, emotional, and spiritual needs of people with serious illnesses and their family members. While inpatient palliative care programs have proliferated, community-based programs — those that offer services at a clinic, in a patient's residence, or over the phone — are far less prevalent, and those that do exist have developed in relative isolation.

In 2013 the California HealthCare Foundation (CHCF) launched the Palliative Care Action Community to promote collaboration among organizations working to strengthen or expand their community-based palliative care (CBPC) services. Participating provider teams represented diverse types of organizations, provided services in a variety of settings, and came with varying levels of CBPC experience. Despite these differences, the teams shared common approaches and challenges in program planning, operations, and evaluation.

 

Data Briefs Released for 2012 National Study of Long Term Care Providers (NSLTCP)

SEPT 2014 | Source: Centers for Disease Control and Prevention (CDC) | View: National Study of Long Term Care Providers (NSLTCP)

The Long-Term Care Statistics Branch released adult day services-specific state web tables, using data from the first wave of the National Study of Long-Term Care Providers (NSLTCP) conducted in 2012. NSLTCP is a new initiative by the National Center for Health Statistics (NCHS) to provide reliable, accurate, relevant and timely statistical information to support and inform long-term care services policy, research, and practice.

The main goals of NSLTCP are to: (1) estimate the supply and use of paid, regulated long-term care services providers; (2) estimate key policy-relevant characteristics and practices; (3) produce national and state-level estimates, where feasible; (4) compare estimates among sectors; and (5) monitor trends over time.

 

Can Reality Match Rhetoric? Person Centered Service Planning in Managed Long-Term Services and Supports

AUG 2014 | Source: Justice in Aging | View: Policy Issues Brief

Person-centered planning is critical to the well-being of consumers of long-term services and supports. It works by identifying the strengths preferences, needs, and desired outcomes of the individual. In order for person-centeredness to be more than an empty slogan, it must be accompanied by substantive standards set forth in managed care organization (MCO) contract language. Some states have begun to include person-centered planning requirements in their contracts, but more work is needed before all states have a full framework.

This brief begins with a short description of service planning in the Medicaid managed care context. Next, it provides an analysis of what states are doing in their managed care contracts to ensure person-centered planning. Finally, the brief describes how the new federal home and community-based services (HCBS) rule will provide service planning protections for consumers that should be included in and built upon in MCO contracts.

 

Family Caregivers Providing Complex Chronic Care to People with Cognitive and Behavioral Health Conditions

AUG 19, 2014 | Source: News Release from AARP and United Hospital Fund | View: Report

The United Hospital Fund and AARP Public Policy Institute issued a report with compelling new evidence that family caregivers who provide complex chronic care to people who also have cognitive and behavioral health conditions face particularly demanding challenges, including high levels of self-reported depression. As a result, a majority of them (61 percent) reported feeling stress “sometimes to always,” between their caregiving responsibilities and trying to meet other work or family obligations.

 

Physician Participation in Medi-Cal: Ready for the Enrollment Boom?

AUG 5, 2014 | Source: California HealthCare Foundation (CHCF) | View: Report and InfoGraphic

By the end of 2015, the Affordable Care Act will add more than two million enrollees to Medi-Cal, the nation's largest state Medicaid program. This estimate has heightened concerns about whether there are enough doctors to care for them all. Californians are likely to have difficulty accessing health care through Medi-Cal unless the number of participating physicians grows or California finds other ways to deliver services. The percentage of physicians treating any Medi-Cal patients increased between 2011 and 2013 from 64% to 69%, according to a new report prepared by researchers at the University of California, San Francisco. Yet their findings suggest that Medi-Cal enrollees face significant challenges due to statewide variations in physician availability.

 

Here's Looking At You: How Personal Health Information is Being Tracked and Used

JUL 15, 2014 | Source: California HealthCare Foundation (CHCF) | View: Report and InfoGraphic

Last month, in a US Supreme Court decision barring the warrantless searches of cellphones, Chief Justice John Roberts declared that a cellphone "contains the sum of an individual's private life" and can reveal more information than the search of an entire house.

Every day, in the course of using cell phones, credit cards, search engines, websites, and an array of medical devices, we leave behind digital footprints. These data flows, which often occur without our knowledge, have the potential to paint an individual health profile, as well as describe whole communities based on location, health conditions, or other factors.

 

Health Care Costs 101: Slow Growth Persists

JUL 8, 2014 | Source: California HealthCare Foundation (CHCF) | View: Report and InfoGraphic and All Almanac Reports

Even with the slow growth in national health spending in recent years, the US continued to spend a greater percentage of its wealth on health care than any other industrialized nation, according to the latest edition of Health Care Costs 101. In 2012, the US spent an average of $8,915 per person on health care, reaching a total of $2.8 trillion. An interactive graphic shows the change in health care spending by payer from 1960 to 2012.

 

ACA 411: An Interactive Tool for Tracking Health Reform in California

JUN 17, 2014 | Source: California HealthCare Foundation (CHCF) | View: ACA 411 Data Tool

The California HealthCare Foundation (CHCF) has created an interactive data tool to keep tabs on the trends that emerge as California continues to implement the Affordable Care Act (ACA) legislation. The tool tracks health care reform's effects in three areas: insurance coverage, access to health care services, and affordability.

 

2014 Scorecard: California's Long-Term Services and Supports for Older Adults, People with Disabilities, and Family Caregivers

JUN 17, 2014 | Source: AARP and SCAN Foundation and The Commonwealth Fund | View: Scorecard and Policy Brief and California's Results

The 2nd State Scorecard on Long-Term Services and Supports shows California ranked 9th overall. While California ranks higher than most states, much work remains to be done to improve affordability, quality, and coordination of services within the state’s system of care to ensure that older adults and people with disabilities can access needed services to support independence and quality of life. The Scorecard is the first step in initiating a conversation about system performance, areas for opportunity, and the importance of continued system transformation in California.

Visitors to the Long-Term Services and Supports website can interact with the data by drilling into performance indicators for a single state, comparing data across states, or using a map to quickly compare overall state rankings.

 

Estate Recovery Under Medi-Cal

MAY 2014 | Source: California HealthCare Foundation (CHCF) | View: Issue Brief

Medi-Cal estate recovery refers to state action to reclaim certain Medi-Cal costs from the estates of beneficiaries after their death. This program, which has been in place for decades, has received renewed attention from policymakers because of reports that some individuals newly eligible for Medi-Cal as expanded under the Affordable Care Act (ACA) may not enroll for fear that their house and assets could later be seized. The purpose of this issue brief is to describe Medi-Cal estate recovery and to clarify who could be subject to it and under what circumstances.

 

2014 Alzheimer's Facts & Figures Report

MAR 19, 2014 | Source: Alzheimer's Association | View: 2014 Alzheimer’s Disease Facts and Figures

2014 Alzheimer’s Disease Facts and Figures is a statistical resource for U.S. data related to Alzheimer’s disease, the most common type of dementia, as well as other dementias. Background and context for interpretation of the data are contained in the Overview. This information includes definitions of the various types of dementia and a summary of current knowledge about Alzheimer’s disease. Additional sections address prevalence, mortality and morbidity, caregiving and use and costs of care and services. The Special Report discusses women and Alzheimer’s disease.

 

California and its Counties Under the ACA: A Leadership Framework

MAY 2014 | Source: California HealthCare Foundation (CHCF) | View: Report

As California moves to carry out the federal Affordable Care Act (ACA), it is implementing major health program, policy, and fiscal changes that will once again transform the state-county partnership. As a prelude to state monitoring and oversight of these sweeping changes, this issue brief offers policymakers and stakeholders:

  • A leadership framework to assess potential impacts of shifting responsibility for health programs and services between the state and local level.
  • Highlights of state policy and ACA implementation activities most likely to affect counties.
  • Application of the leadership framework to state and county roles in 2014.
  • Things to watch for in California counties as ACA implementation unfolds.

 

Long-Term Care in America: Expectations and Reality

MAY 19, 2014 | Source: AP/NORC Center for Public Affairs Research | View: Findings

Findings from the 2nd long-term care poll by AP-NORC have been released. These polls are being conducted in order to produce new and actionable data about the aging population to inform the national dialogue surrounding long-term care issues.

 

Just Like Home: An Advocate's Guide to Consumer Rights in Medicaid HCBS

MAY 2014 | Source: Justice in Aging | View: Guide

New federal Medicaid rules, for the first time, set standards to ensure that Medicaid-funded home and community-based services (HCBS) are provided in settings that are non-institutional in nature. These standards, which took effect in March 2014, apply to residential settings, such as houses, apartments, and residential care facilities like assisted living facilities. The standards also apply to non-residential settings, such as adult day health care programs.

 

Monitoring Access: Measures to Ensure Medi-Cal Enrollees Get the Care They Need

MAY 2014 | Source: California Healthcare Foundation (CHCF) | View: Report

This report offers a framework and a targeted set of measures for monitoring access to ambulatory care for individuals enrolled in the Medi-Cal program. It is intended as an actionable starting point for elected leaders, state and federal program officials, and other stakeholders, to help them monitor changes in access to care over time, to identify disparities in access to care across subgroups or geographic regions, and to compare access between Medi-Cal enrollees and other insured populations in California and nationally.

 

In Transition: Seniors and Persons with Disabilities Reflect on Their Move to Medi-Cal Managed Care

APR 23, 2014 | Source: California HealthCare Foundation (CHCF) | View: Report

Researchers from the University of California, Berkeley, present findings from a survey of more than 1,500 SPD Medi-Cal enrollees who made the transition to Medi-Cal Managed Care. The report offers suggestions for improving transitions to managed care involving populations with complex needs, including those dually eligible for Medicare and Medicaid, and examples of actions taken by DHCS in response to the study's findings.

 

America's Long-Term Care Crisis: Challenges in Financing and Delivery

APR 2014 | Source: Bipartisan Policy Center (BPC) | View: Report

America's Long-Term Care Crisis: BPC Launches Initiative to Find a Politically and Fiscally Viable Path Forward to Improve the Financing and Delivery of Long-Term Care

This report sets the stage for BPC’s recommendations by identifying the major challenges and key questions in the financing and delivery of LTSS for both seniors and individuals under age 65.

 

Genworth 2014 Cost of Care Study

MAR 25, 2014 | Source: Genworth | View: Executive Summary and Full Report

Over the past 11 years, Genworth has been able to recognize and identify trends across the long term care services landscape. The 2014 Genworth Cost of Care study looked at Homemaker Services, Home Health Aide Services, Adult Day Health Care (ADC), Assisted Living Facility (ALF) and Nursing Home Care.

Among the key findings for Adult Day Health Care (ADC): National Median Daily Rate: $65 | Increase Over 2013: 0% | Five Year Annual Growth: 3.4%*.

*Percentage increase represents the compound annual growth rate for surveys conducted from 2009 to 2014.

 

Daily Stressors and Adult Day Service Use by Family Caregivers: Effects on Depressive Symptoms, Positive Mood, and Dehydroepiandrosterone-Sulfate

FEB 3, 2014 | Source: The American Journal of Geriatric Psychiatry | View: Abstract by Steven H. Zarit, PhD, et al

This study examines effects of daily use of adult day service (ADS) programs by caregivers of individuals with dementia (IWD) on a salivary biomarker of stress reactivity, dehydroepiandrosterone-sulfate (DHEA-S), and whether these effects on DHEA-S are associated with daily variability in positive mood and depressive symptoms.

 

Long-Term Care: What Are The Issues?

FEB 2014 | Source: Robert Wood Johnson Foundation | View: Issue Brief

The demand for long-term care services will explode as the population ages and more people live longer with chronic conditions. Who will pay for these services and how will they be delivered?

 


2013 PUBLICATIONS

 

California's Uninsured: By the Numbers

DEC 19, 2013 | Source: California HealthCare Foundation (CHCF) | View: Report

California's Uninsured: By the Numbers provides a look at California's uninsured population before full implementation of the ACA.

 

Monitoring Performance: A Dashboard of Medi-Cal Managed Care

DEC 18, 2013 | Source: California HealthCare Foundation (CHCF) | View: Report

This first public performance dashboard of Medi-Cal managed care shows areas of strength and opportunities for improvement.

 

Long-Term Care Services in the United States: 2013 Overview

DEC 12, 2013 | Source: National Center for Health Statistics (NCHS) | View: Report

The National Center for Health Statistics released a 93-page report based on findings from the National Study of Long-Term Care Providers (NSLTCP). The study considered long-term care services provided by adult day services centers, home health agencies, hospices, nursing homes, and assisted living and similar residential care communities. The key goals of the periodic study are to:

  • Estimate the supply of paid, regulated long-term care services providers
  • Estimate key policy-relevant characteristics of these providers
  • Estimate the number of long-term care services users
  • Estimate key policy-relevant characteristics of these users
  • Compare provider sectors
  • Produce national and state estimates, where feasible
  • Monitor trends over time

 

Medicaid Expansion in California: Opportunities and Challenges for Older Adults and People with Disabilities

NOV 2013 | Source: Justice in Aging | View: Issue Brief

A new NSCLC issue brief provides an overview of new coverage options and how they impact low-income older adults and people with disabilities. The brief also explores how people receiving coverage under Medicaid expansion and exchanges will transition into Medicare coverage when they turn 65 or otherwise become eligible. While the issue brief focuses on how these issues play out in California, much of the information is relevant to advocates and policymakers in other states as well.

 

Health Information Technology in California: Milestones and Miles to Go

NOV 2013 | Source: California HealthCare Foundation (CHCF) | View: Report

This report shows interest continues to grow among Californians in using technology to support their health care needs, with 60% saying they would like online access to their health information. Similar percentages want the ability to schedule appointments online, receive appointment reminders, and email their medical professionals.

 

Quality of Care: Steps in the Right Direction

OCT 2013 | Source: California HealthCare Foundation (CHCF) | View: Report

This report looks at the quality of care in California on a variety of measures, including childbirth, children's health, and management of patients with common chronic conditions. It also provides data on patient safety, nursing homes, home health, and end-of-life care.

 

Health Care in the Two Americas: Findings from the Scorecard on State Health System Performance for Low-Income Populations, 2013

SEPT 2013 | Source: The Commonwealth Fund | View: Scorecard

Of all the challenges we face in health care, variation in system performance and disparities in health outcomes are among the most persistent and troubling. The Commonwealth Fund's new Scorecard on State Health System Performance for Low-Income Populations, 2013 sheds light on these problems and identifies opportunities for states to improve their health systems for economically disadvantaged populations.

 

New HIPAA Privacy Policies and Procedures Manual

SEPT 2013 | Source: CAADS | View: Regulatory Alert and Order Form

On September 23, ALL Adult Day Health Care / CBAS facilities that are subject to the HIPAA privacy and security rules must come into compliance with the “HIPAA Omnibus Rule” which implements changes required by the HITECH Act of 2009. Any facility engaging in electronic transmission of protected health information is included. Failure to have internal guidelines in place that comply with the new Rule can lead to fines and other sanctions after September 23, 2013.

A fully updated Privacy Policies and Procedures Manual, designed to be easily customizable to your center, is available from CAADS. This manual replaces the previous CAADS HIPAA Policy and Procedures Manual in its entirety.

 

Long Term Care in California: Ready for Tomorrow's Seniors?

AUG 2013 | Source: California HealthCare Foundation (CHCF) | View Report and Long Term Care Facts and Figures (NOV 2009)

The leading edge of the baby-boom generation is beginning to flood California's long term care system. And the population of residents 65 and older is projected to triple by 2060. This report describes the state's supply and use of long term care services, including Medicare and Medicaid spending on services, and quality of care. The oversight and regulation of long term care services varies by provider, resulting in limited information — especially quality data — about assisted living facilities, personal care providers, and other home- and community-based services.

*Correction: The graphic on page 49 of  Long Term Care in California: Ready for Tomorrow's Seniors? mischaracterized the frequency of reviews for assisted living facilities. These facilities are subject to annual compliance reviews and investigations of serious complaints, but are not subject to annual site inspections.

 

Pathways to Progress in Planning for Long-Term Care

AUG 13, 2013 | Source: AP/NORC Center for Public Affairs Research, with funding by The SCAN Foundation | View: Survey Results

Langer Research Associates launched an in-depth analysis of the April 2013 AP/NORC Center for Public Affairs Research poll. Findings show that people who know where to get information on long-term care are more apt to prepare for those needs.

 

State-by-State Profiles on Direct-Care Workforce

AUG 2013 | Source: PHI Data Center | View: Web Tool and California's profile

This unique state-by-state web tool now includes standards for home health, personal care, and nursing aides. View California's profile of Workforce Size, Employment Projections, Wages, Health Coverage, Public Assistance, Training, Legislation/Regulation, Best Practices and Resources.

 

A State-by-State Snapshot of Poverty Among Seniors: Findings From Analysis of the Supplemental Poverty Measure

MAY 20, 2013 | Source: Kaiser Family Foundation | View: Issue Brief

Key Findings:

  • The share of seniors living in poverty is higher in every state under the supplemental measure than under the official measure, and at least twice as high in 12 states, including California.
  • The share of seniors living in poverty under the supplemental measure is especially high in some areas. Based on the supplemental measure, about one in four seniors (26%) are living in poverty in DC and roughly one in five seniors are living in poverty in six states, including California (20%).
  • Nationally, nearly half of all seniors (48%) live with incomes below 200 percent of the poverty threshold under the supplemental measure, compared to 34 percent under the official measure.
  • At least half of seniors have incomes below 200 percent of poverty in 10 states and DC based on the supplemental measure, including California (56%).

 

The Effects of Adult Day Services on Family Caregivers' Daily Stress, Affect, and Health: Outcomes From the Daily Stress and Health (DaSH) Study

MAY 20, 2013 | Source: The Gerontologist | View: Study

In this study, we examine the effects of use of adult day service (ADS) by caregivers of individuals with dementia (IWD) on daily stressors, affect, and health symptoms. Participants were interviewed for 8 consecutive days. On some days, the IWD attended an ADS program and on the other days caregivers provide most or all of the care at home.

 

Long-Term Care: Perceptions, and Attitudes among Americans 40 or Older

APR 2013 | Source: Associated Press-NORC Center for Public Affairs Research | View: Poll Findings

According to this new poll, Americans underestimate their chances of needing long-term care as they get older - and are taking few steps to get ready. Conducted by the Associated Press-NORC Center for Public Affairs Research, funded by The SCAN Foundation, the poll examined how people 40 and over are preparing for this difficult and often pricey reality of aging.

Related article:
Americans Seriously Unprepared for Long-Term Care, Survey Finds (PBS NEWSHOUR, 4/24/2013)

 

Cal MediConnect Program

APR 2013 | Source: The SCAN Foundation | View: Fact Sheet

Cal MediConnect: A Summary of the Memorandum of Understanding Between California and the Centers for Medicare and Medicaid Services is a 13 page fact sheet issued by the SCAN Foundation. The fact sheet provides background information and summarizes key points of the MOU that formalized a federal-state partnership to implement the Dual Eligibles Integration Demonstration known as "Cal MediConnect."

 

California's Health Care Safety Net: A Complex Web

APR 17, 2013 | Source: California HealthCare Foundation (CHCF) | View: Report

The health care safety net is a complicated web of programs and providers that serve low-income Californians without private health insurance. Changes in the economy, government budgets, and health care policy can influence how the safety-net population obtains medical care. An updated report by the California HealthCare Foundation, California's Health Care Safety Net: A Complex Web, provides a snapshot of California's safety net at a critical juncture ahead of the full implementation of the federal Affordable Care Act (ACA) in 2014. Stakeholders are preparing for important ACA deadlines, such as the expansion of Medi-Cal, the state's largest safety-net program, while legal and political battles wage on over the future of health care reform.

 

Long Term Services and Supports Program Compendium

APR 17, 2013 | Source: The SCAN Foundation | View: Compendium

The Long Term Services and Support Program Compendium, issued by The SCAN Foundation, is a compendium of federal and state agencies and departments supporting Long-Term Services and Supports Systems (LTSS).

 

LTC Commission Should Right Imbalance in How Medicaid Pays for LTSS

MAR 2013 | Source: Justice in Aging | View: Brief

The HCBS Opportunity: Recommendations for the Commission on Long-Term Care

President Obama recently appointed the final members of the Commission on Long Term Care. Over the next six months the Commission must accomplish one objective: develop a plan for the establishment, implementation and financing of a comprehensive, coordinated, and high-quality system that ensures the availability of long-term services and supports (LTSS) for individuals who need LTSS.

 

Transitioning the SPD Population to Medi-Cal Managed Care: Examining the Experiences of Beneficiaries

MAR 28, 2013 | Source: California HealthCare Foundation (CHCF) | View: Video

The video and slides from the March 28, 2013 California HealthCare Foundation briefing, Transitioning the SPD Population to Medi-Cal Managed Care: Examining the Experiences of Beneficiaries, may be viewed on the CHCF website.

 

Limited English Proficient HMO Enrollees Remain Vulnerable to Communication Barriers Despite Language Assistance Regulations

FEB 20, 2013 | Source: UCLA Center for Health Policy Research | View: Health Policy Brief

The policy brief, Limited English Proficient HMO Enrollees Remain Vulnerable to Communication Barriers Despite Language Assistance Regulations, reveals that HMO enrollees with limited English proficiency, and particularly those in fair to poor health, face communication barriers despite language assistance regulations. More than 1.3 million California HMO enrollees ages 18 to 64 do not speak English well enough to communicate with medical providers and may experience reduced access to high-quality health care if they do not receive appropriate language assistance services.

 

California’s Proposed 2013-14 Budget: Impact on California’s Seniors and People with Disabilities

JAN 2013 | Source: The SCAN Foundation | View: Fact Sheet

On January 10, 2013, California Edmund G. Brown, Jr. released his proposed budget, outlining his spending plan for fiscal year beginning on July 1, 2013 and ending June 30, 2014. This fact, California's Proposed 2013-14 Budget: Impact on California's Seniors and People with Disabilties, looks at the initiatives and program adjustments that would impact California's seniors and people with disabilities.

 


2012 PUBLICATIONS

 

2012 MetLife Mature Market Study of Long Term Care Costs

NOV 13, 2012 | Source: MetLife Mature Market Institute® | View: Study Findings

The MetLife Mature Market Institute® has released the 2012 MetLife Mature Market Study of Long Term Care Costs, its annual national survey of charges for adult day services, home care, nursing homes and assisted living. The study found that the national average daily rate for adult day services is $70, unchanged from 2011 after being $67 in 2009 and 2010. The median daily rate for adult day services rate nationally remained at $65.

 

Across the States 2012: Profiles of Long-Term Services and Supports

OCT 12, 2012 | Source: AARP Public Policy Institute | View: In-Brief and Executive Summary and CA and Full Report (370 pgs)

From the AARP Public Policy Institute, Across the States 2012: Profiles of Long-Term Services and Supports presents comparable state-level and national data for more than 140 indicators, drawn together from a wide variety of sources into a single reference. The full report provides a comprehensive picture of long-term services and supports in each state.

 

Moving “Dual Eligibles” Into Mandatory Managed Care and Capping Their Federal Funding Would Risk Significant Harm to Poor Seniors and People With Disabilities

OCT 10, 2012 | Source: Center on Budget and Policy Priorities | View: Report

As policymakers seek to reduce federal budget deficits, they may face proposals to reduce spending on low-income Medicare beneficiaries who also are eligible for Medicaid (the “dual eligibles”) by 1) requiring them to receive both their Medicare- and Medicaid-covered services through a single managed care plan that would operate under a contract with their state, and 2) imposing a cap on the funding their state would receive for that purpose. Such proposals would be ill-advised at this time.

Experts agree that we should try to find ways to better coordinate care for these beneficiaries that would improve quality of care while producing savings. But, as the report Moving "Dual Eligibiles" Into Mandatory Managed Care and Capping Their Federal Funding Would Risk Significant Harm to Poor Seniors and People with Disabilities shows, we do not yet know how to do this.

 

Medicaid Rate-Setting Strategies to Promote Home- and Community-Based Services

MAY 2012 | Source: Center for Health Care Strategies (CHCS) | View: Policy Brief

In creating managed long-term services and supports approaches that foster home- and community-based services, states need to explore rate-setting strategies that reward health plans for promoting the use of such services. The brief, Medicaid Rate-Setting Strategies to Promote Home- and Community-Based Services, discusses strategies for structuring rates for managed long-term services and supports programs to encourage the use of home- and community-based services and details state experiences in setting rates for these programs.

 

A Tough Time for Physicians: 2012 Medical Practice & Attitude Report

MAY 24, 2012 | Source: Jackson Healthcare | View: Survey Findings

In A Tough Time for Physicians: 2012 Medical Practice & Attitude Report, Jackson's findings from a series of surveys conducted between May and June 2012 are summarized. Topics surveyed and included in this report:

  • Current practice environment (p 5)
  • Current retirement plans (p 7)
  • Current access for Medicaid and Medicare patients (p 10)
  • Current use of physician assistants and nurse practitioners (p 13)
  • Current participation in Accountable Care Organizations or Medical Homes (p 15)
  • Current attitudes on the Affordable Care Act (p 17)

 

The 2012-13 Budget: Integrating Care for Seniors and Persons With Disabilities

FEB 17, 2012 | Source: Legislative Analyst's Office (LAO) | View: Report

In a February 17, 2012 LAO report, The 2012-13 Budget: Integrating Care for Seniors and Persons With Disabilities, the Legislative Analyst found that it is premature to expand the Care Coordination Initiative demonstration statewide and make LTSS managed care benefits, since the demonstration has not yet been implemented—much less evaluated—and many key implementation details remain to be determined. The report recommends the Legislature reject the Governor’s proposal to expand the demonstration statewide before the results from the demonstration have been properly evaluated, but proceed instead with the four-county demonstration. Additional recommendations are made with the intent to help the state move toward a more integrated system of care delivery for SPDs.

 


2011 PUBLICATIONS

 

Independence at Risk: Older Californians with Disabilities Struggle to Remain at Home as Public Supports Shrink

DEC 2011 | Source: UCLA Center for Health Policy Research | View: Health Policy Brief

Researchers spent a year following and documenting the lives of a typical group of seniors with disabilities who are enrolled in Medicare and Medi-Cal and receive in-home and community care in Los Angeles, San Diego, San Francisco and Santa Clara counties. The seniors depend on fragile networks of paid public programs and unpaid help to live safely and independently at home. In spite of these challenges, most display resilience and fortitude, and all share a common determination to maintain their independence at almost any cost. Read: Independence at Risk: Older Californians with Disabilities Struggle to Remain at Home as Public Supports Shrink.

 

National Study of Long Term Care Providers

OCT 2011 | Source: Centers for Disease Control and Prevention National Center for Health Statistics (CDC NCHS) | View: Study

The National Study of Long-Term Care Providers (NSLTCP) is a new integrated initiative sponsored by the Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS). The NSLTCP will replace the NCHS’ National Nursing Home Survey, National Home and Hospice Care Survey, and National Survey of Residential Care Facilities.

NCHS plans to field the residential care and adult day care components of NSLTCP in late 2012. Participants will be selected randomly from among all residential care communities and adult day services centers in the United States. The main goals of NSLTCP are to:

  1. Estimate the U.S. national supply of paid, regulated LTC providers (i.e., nursing home, home health care, residential care, adult day care, and hospice).
  2. Estimate key policy-relevant characteristics and practices of these providers.
  3. Estimate the use of these providers.
  4. Estimate key policy-relevant characteristics of these users.
  5. Monitor national trends in these estimates of LTC supply and use, overall and by provider type.

 

Medi-Cal Provider Payment Reductions in SPAs Approved by CMS

OCT 27, 2011 | Source: CA Department of Health Care Services (DHCS) | View: Chart -- Medi-Cal Provider Payment Reductions

On October 27, 2011 the Centers for Medicare and Medicaid Services approved California’s request to reduce Medi-Cal reimbursement rates for providers of health care services. To view documents related to approval of the State Plan Amendment (SPA), visit: www.dhcs.ca.gov.

Additional details about implementation of the retroactive 5% and 10% rate reductions for ADHC providers in urban areas of the state are not yet available from the state. The 5% rate reduction is currently enjoined by federal court order, but the new 10% rate reduction was approved by the California Legislature in March 2011 to be retroactive to June 1, 2011 and, therefore, is not currently part of any litigation proceedings. Also see: OCT 27, 2011 | CAADS Industry Alert.

 

A Study of Patient Discharge Outcomes Resulting from California's Elimination of Adult Day Health Care on December 1, 2011CAADS Report on ADHC Patient Discharge Outcomes

OCT 2011 | Source: CAADS | View: Study Findings

CAADS surveyed ADHC providers for the purpose of analyzing overall services needed and services available for typical ADHC patients attending 4 or 5 days per week who will be involuntarily discharged from ADHC when Medi-Cal funding for the program ends December 1. The findings from A Study of Patient Discharge Outcomes Resulting from California's Elimination of Adult Day Health Care on December 1, 2011 - CAADS Report on ADHC Patient Discharge Outcomes, focus on:

  • Post-ADHC Discharge Prognosis
  • Multi-Disciplinary Team Recommendation for Discharge
  • Patient Needs
  • Services Needed / Available
  • Significant Risk Factors

In compliance with HIPAA, the ADHC Involuntary Discharge Form was developed as an e-form which transmitted the data without patient identifying information.

 

Stressed and Strapped: Caregivers in California

SEPT 21, 2011 | Source: UCLA Center for Health Policy Research | View: Policy Brief

Family members or friends caring for aging or disabled individuals in California are under both financial and emotional strain and are likely to face even greater burdens, given recent cuts in state support for programs and services that support in-home care, according to the authors of a new policy brief, Stressed and strapped: Caregivers in California, by the UCLA Center for Health Policy Research.

 

Elimination of ADHC as a Medi-Cal Optional Benefit

JUN 2011 | Source: CAADS | View: Survey Findings

CAADS surveyed California's ADHC providers on the impact the elimination of ADHC as a Medi-Cal optional benefit would have on their center, patients and community. The survey findings focus on:

  • Adult Day Health Care Providers Ability To Stay Open Without Medi-Cal Reimbursement
  • Nursing Facility Placements and Access to Medi-Cal Nursing Home Beds
  • Psychiatric Facility Placements and Access to Medi-Cal Psychiatric Beds
  • Consequences For Patients With Developmental Disabilities
  • Cost Shift to Emergency Rooms and Emergency Room Visits Over One Year
  • Consequences for IHSS Caregivers and Consequences for Working Caregivers
  • Availability of Alternative Services

 

Keeping Adults Free from Institutions (KAFI): Medicaid Options to Guide Program Design

MAY 10, 2011 | Source: Health Management Associates (HMA) | View: Report

The 2010-2011 California Legislature enacted AB 97 eliminating Adult Day Health Care as a Medi-Cal covered service. The legislature is instead proposing to transition individuals no longer eligible for ADHC services to other service options including California’s In-Home Supportive Services program, (which provides personal care and related services) or to existing home and community-based services (HCBS) waivers.

 

The Health of Aging Lesbian, Gay and Bisexual Adults in California

MAR 2011 | Source: UCLA Center for Health Policy Research | View: Policy Brief

Members of California's aging lesbian, gay and bisexual population are more likely to suffer from certain chronic conditions, even as they wrestle with the challenges of living alone in far higher numbers than the heterosexual population, according to a new policy brief from the UCLA Center for Health Policy Research.

 

Getting Serious About Delirium: Hospitalists amp up screening, treatment and prevention

JAN 2011 | Source: Today's Hospitalist | View: Article by Bonnie Darves

It is important for Adult Day Services providers to be able to distinguish delirium from Alzheimer's and related dementia. This article, Getting serious about delirium, covers how to prevent and treat delirium without meds and offers insights to those working in the community setting with high risk consumers.

 


2010 PUBLICATIONS

 

Evaluation of the Parma D.A.Y. (Designed Around You) Program

JAN 2010 | Source: Case Western Reserve University | View: Report

Facilitating the safe transition of persons from the acute care hospital to home is a priority issue, given the frequency with which individuals are readmitted and/or visit the emergency department within 30 days of discharge. Many of these individuals require rehabilitation services, but reimbursement policy currently limits available options for continuing care. Furthermore, families may need more comprehensive education about health care needs of their family member, and home environments may need to be modified to ensure safety once the person returns home. One strategy for meeting these needs of patients and family members is an expanded adult day services program.

 

A New Nursing Home Population: The Young

DEC 9, 2010 | Source: National Public Radio (NPR) | View: Investigative Report

There's one age group that's going into nursing homes at a higher rate. And it's not the elderly. Young people ages 31 to 64 now make up 14 percent of the nursing home population, an analysis of federal data from the Department of Health and Human Services by NPR's Investigative Unit found. That's up from 10 percent just 10 years ago.

 

Projected Economic Impact of Eliminating California's Medi-Cal Adult Day Health Care Program

MAY 18, 2010 | Source: The Lewin Group | View: Report

Our analysis indicates that the savings associated with eliminating this program would be more than offset by cost-shifting to other services and reductions to State revenue resulting from the program elimination. In total, we estimate the State would lose $51 million in 2010-11 over and above the estimated savings that would come from eliminating the program (excluding the loss of federal matching funds). Annual losses to the State are projected to increase to $72 million in 2020-21, $198 million in 2030-31 and over $412 million in 2040-41.

 

Budget Proposals Turn Back Clock 30 Years in Long-Term Care Services for California Seniors

FEB 2010 | Source: UCLA Center for Health Policy Research | View: Policy Note

The 2010-2011 California budget proposal released in January by Governor Arnold Schwarzenegger’s office proposes deep cuts in community-based services available to low-income seniors and low-income Californians of all ages with disabilities. The cuts will make it much more difficult for many older adults to continue to live safely in their own homes, create hardships for their families, lead to a loss of jobs and health insurance by direct service providers, and close many adult day care centers. Increased use of emergency rooms, hospital in-patient care and nursing facilities by affected older adults are likely to erode the financial savings of the reductions.

 


2009 PUBLICATIONS

 

California Budget Cuts Fray the Long-Term Care Safety Net

OCT 2009 | Source: UCLA Center for Health Policy Research | View: Policy Brief

The deep budget cuts enacted by California’s legislature in the summer of 2009 will be felt especially among the elderly and infirm. Disabled older adults with low incomes will find it harder to access services and, ultimately, harder to live safely at home.

 


2006 PUBLICATIONS

 

Adult Day Services: A Key Community Service for Older Adults

JUL 2006 | Source: U.S. Department of Health and Human Services (HHS) | View: Report

Adult day health services are part of the continuum of both health and long-term care services. In the states we visited, ADS providers are furnishing preventive care, health monitoring, and skilled nursing services to individuals with chronic illnesses and physical and cognitive impairments. Some providers are also serving adults under age 65, depending on regulatory requirements and the funding streams for this population.

 


2003 PUBLICATIONS

 

Health of Older Californians: County Data Book

OCT 2003 | Source: UCLA Center for Health Policy Research | View: County Data Book

Data from the 2001 California Health Interview Survey and 2000 U.S. Census

This data book provides important information about the health behaviors, health status, and the use of health services by Older Californians. The first section contains a narrative summary about the health of the older people in California. The second section has maps that show the distribution of the older population along several of the basic demographic characteristics used in this report, including race/ethnicity, low-income, and limited-English proficiency. The third section provides a series of two-page tables with the rates of selected health behaviors, the health status, and the use of health services of older Californians. Each geographic area has columns with information for elders of different races and ethnicities, older women, older people with low-incomes, older people with limited-English abilities, and for Medi-Cal recipients age 65 and over. This section ends with a summry table that makes comparisons between counties easier for the total county populations of older adults. The fourth section has demographic data for the state, substate regions, and each of the 58 counties. The fifth section contains technical appendices and acknowledgments.

 

 

California Association for Adult Day Services
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EMAIL: caads@caads.org

 
 
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