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Goals for LTC Redesign
Formally adopted goal of the DHS for LTC Redesign
The Department of Health Services will foster the statewide
development of comprehensive long term care and support systems that maximize
independence, recovery and quality of life, while recognizing the need for
interdependence and support. The redesigned system will provide individuals and
families with meaningful choices of supports, services, providers, and
residential settings, as long as such care or support is necessary, meets an
adequate level of quality, is cost-effective, is consistent with the individual’s
values and preferences, and can be provided within available resources.
DHS LTC & Support System Redesign: Guiding Principles
The new long term care and support system will:
DESIGN
 | Maximize flexibility, effectiveness, innovation, practicality and
creativity in funding sources, services and resources. |
| Be consumer centered and family focused, as appropriate, especially for
families with young children in need of ongoing support. |
| Involve a care managed system with the following characteristics:
 | Resources and funding follows the person. |
| Provider has shared responsibility with consumer for positive clinical
and personal consumer outcomes. |
| Services are managed to provide continuity and quality care. |
| Supports families in their care giving roles. |
| Includes an array of available service and support choices. |
| Whenever possible, individuals are supported to live in the community. |
| Have the capacity to respond to urgent needs in a timely fashion in a
variety of settings, not just in institutional placements. |
| Supports preventative efforts and planning. |
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| Be understandable, culturally competent, efficient, responsive, reliable
and easy to access. |
| Not be limited to existing systems, programs, and resources. |
| Encourage collaboration among federal, state, county, tribal, private
agencies, and consumers in the design and provision of long term care and
support. |
| Maximize support to and from friends, family, neighbors and the community,
recognizing the importance of informal support. |
| Make decisions ethically and consciously when situations arise involving
conflicting principles and/or ethical choices. |
| Have coordinated funding and service policies that support the long term
care and support goal. |
| Provide useful data, including client satisfaction data, that can be used
for long term planning purposes and for quality assurance and regulatory
functions. |
| Provide a timely and affordable appeals process. |
| Address labor force issues such as availability, salaries, benefits, and
training needed. |
RELATIONSHIP TO CONSUMER
| Provide opportunities and support for people to sustain or create
important relationships and social roles, which may include education and
employment; to be included in the life of the community; to contribute to
society; and to achieve the greatest fulfillment possible. |
| Promote and treat people with respect, dignity, and trust. |
| Make available to the general public understandable information on long
term care and support. |
| Provide supports that facilitate, promote, encourage, and reward personal
responsibility. |
| Ensure individual access to a range of flexible services and supports. |
| Support transitions throughout a person’s life. |
| Promote hope and recovery--rather than disability and hopelessness. |
ASSESSMENT AND PLANNING
| Have the capacity to obtain ongoing and comprehensive knowledge of each
person’s condition, resources, abilities, disabilities, support needs, and
preferences with the involvement of the consumer and her/his family or
guardian as appropriate. |
| Utilize the information from the assessment in conjunction with the
consumer’s preferences to design service plan. |
| Authorize public support based on information gathered in the individual’s
assessment. |
| Ensure that funding and service decisions are made in conjunction with the
consumer, and if appropriate, the family or other person(s) who is (are)
closest to and most knowledgeable about the consumer’s needs and
preferences. |
| Treat individuals equitably with respect to access to public support,
regardless of the individual’s location in the state or method of entering
the long term care and support system. |
| Monitor services so that they are provided according to care plan and
according to the quality and outcomes desired. |
| Include a process to resolve differences in care planning and assessment
including: dispute resolution, grievance procedures and mediation. |
FUNDING
| Take into consideration publicly-funded, privately-funded, and voluntary
informal supports, services, and resources. |
| Seek to provide maximum service and/or support and quality for dollars
spent. |
| Have the ability to differentiate individuals’ functional and fiscal
needs and prioritize public resources equitably. |
| When available use a consumer’s own financial resources including
private insurance coverage to the extent it doesn’t impoverish other
family members or provide a disincentive to employment or further
independence, and remove barriers to family financial contributions. |
| Encourage and support family caregiving as much as possible, including
supporting changes in tax, estate and other state laws that would facilitate
such caregiving. |
| Authorize publicly-funded services, within the limits of state, county,
and federal funding. |
Family Care Summary of Goals
Family Care is a common sense approach to reforming Wisconsin’s long term
care system. The goals of this reform are to make our system…
Responsive—give people better choices:
| Give people better choices about where they live and what kinds of
services and supports they get to meet their needs. Let them manage their
own services to the degree that they are willing and able. |
| Organize services and money around individuals, not around service types.
Case managers help each enrollee develop a personalized plan of supports
that fits his or her needs, circumstances and preferences. |
| Let people who want to work do so, getting the support they need while
paying what they can for health and long term care. |
| Keep the fee-for-service system as an option for those who choose not to
enroll. |
| Make sure people know about their choices when they are making critical
long term care decisions—particularly when they are seeking admission to a
nursing home or other residential facility. |
| Give people some help before they become impoverished, but require
everybody to contribute what they can to the cost of their care. |
Reliable—and fair:
| Guarantee access to those with the highest needs and those already
receiving nursing home or county-managed community services. |
| Create Care Management Organizations that receive funding for every
eligible person who chooses to enroll. Provide funding up front, in a per
person per month payment, rather than in a fixed block grant. |
| Design the payment to cover a flexible benefit covering everything from
sidewalk shoveling to nursing home care, and everything in between. Make
Community Options, Residential Options and Nursing Home Options available to
everyone who enrolls. |
| Let funding follow each person across service setting, county lines and
time. |
| Protect safety and rights. |
| Assure that access, choice and quality are consistent from county to
county. |
Understandable—keep it simple:
| Develop "one-stop shopping" through Aging and Disability
Resource Centers, where everybody can learn about community resources and
government programs and get unbiased, professional advice about their
options. |
| Have fewer rules and fewer cracks to fall through. For those who choose to
participate, collapse multiple programs and fragmented delivery systems—including
Medicaid fee-for-service funds—into one funding stream. |
Accountable:
| Manage for quality. Measure performance based on how well elderly people
and people with disabilities do, not on how many units of service were
provided. |
| Instead of county mandates, let counties choose whether or not they want
to participate in managing the new system. |
| Transfer management tools to local care management organizations and hold
them accountable for management of all long term care resources for their
enrollees. |
| Involve people with disabilities and elderly people at state and local
levels of system design and direction. |
Affordable—now and into the future:
| By 2040, Wisconsin’s over 65 population will double and the over 85
group will triple. We currently spend $1.5 billion on long term care—about
8% of the total state budget. |
| Use existing resources more efficiently and effectively. On average,
Wisconsin spends 50% more than the national average for each
Medicaid-eligible elderly person. Eliminate the institutional bias and allow
public funding to support the most effective setting for each person. |
| Help people stay as independent as possible. Incorporate prevention
efforts to avoid or postpone the need for long term care. Be ready with
advice that can help people make their own resources last longer. |
| Help individuals and families identify community resources. Provide just
the right amount and kind of paid services and supports in the right place,
at the right time. |
| Reduce our reliance on services that are more medical, professional and/or
restrictive than people want or need. Given real choices, people usually
choose less formal and less expensive supports to meet their needs. |
Content E-mail Contact: Wendy
Fearnside
Last Modified: Wednesday, March 09, 2011
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