Long-term Care 2000: Overview

Department of Human Services

Bureau of Elder and Adult Services


	Overview: Maine’s Long-term Care System

Goal:

Reduce reliance on institutional care and offer consumers and families a wide range of affordable choices.

1993:	Budget crisis begins process of LTC reform.
1994:	Maine implements more stringent nursing home admission standards.
1995:	Legislature enacts universal pre-admission screening for anyone considering nursing home placement.
1996:	Governor’s Long-term Care Initiative makes significant investment in expanding home care and residential resources. Nursing home eligibility amended to address needs of persons with dementia.
1997:	For the first time, more people receive care at home than in nursing facilities.
1998:	Maine implements MECARE system to determine medical eligibility, and inform consumers about LTC options.

More people are receiving home and community care: In SFY ‘99 18,000+ disabled and older adults received services at home or in residential care facilities, an increase of more than 8,000 since 1995.
Spending on home and community care grows: Maine spent $78 million on home and residential care services in 1998, up from $45 million in 1995. Maine allocated 30% of its LTC budget to home and community care, compared to the national average of 14%.
Total State and Medicaid LTC spending declined 2% between 1995 and 1999.
Closing the gap in residential resources: Maine has more, and more kinds of residential alternatives than ever before. They range from private assisted living complexes to small adult family care homes, where most residents are Medicaid eligible:

Creation of 1830 new residential beds including 456 beds to serve populations with special needs;
204 additional residential care beds in development;
Nine assisted living developments to serve lower and middle income elders

Conversion of nursing home beds to other uses: Maine has been creative in using the Certificate of Need process to assist nursing home owners to convert excess capacity.

More than 1300 nursing home beds have been “banked” or de-licensed since 1994.
43 Nursing homes now offer multiple levels of care, up from 9 in 1995.
Long-term Care Assessments: Goold Health Systems, the Department’s contractor, completed 19,340 assessments last year.

Home Care Coordination: The Department contracts with two agencies, Alpha One and Elder Independence of Maine, to arrange and pay for home care services statewide. Alpha manages consumer-directed programs and Elder Independence manages home care services purchased through agencies. Consolidating the administration of home care services has saved approximately $800,000 annually since 1996.
Managing long-term care and other health services: Maine is developing its own model of “managed” care for Medicaid eligible older and disabled adults. The model is based on contracting directly with physician practices to manage care in partnership with Elder Independence.
Equity and Cost-containment:

After a period of rapid growth in the early 1990s fueled by increases in nursing home costs, total long-term care spending has declined since 1995.
The Department is attempting to base eligibility, spending, regulatory requirements, and reimbursement on the consumer’s acuity.

Long-term Care: Where are People Receiving Services?
Total Persons Served: 26,822	Total Persons Served: 19,803
Long-term Care: State and Medicaid Spending
Total Expenditures: $277,997,634	Total Expenditures: $284,715,157

Maine’s LTC system has experienced rapid growth and change beginning in 1994. We face a number of challenges going forward:

Labor Shortage: The shortage of professional and paraprofessional staff is at a crisis level across the system.
Home Care Waiting Lists: Consumers and families seek services at the point they are needed, not before, so it is essential to eliminate this barrier to access.
Quality of Care: When asked, the vast majority of home care consumers express satisfaction with their services. However, as more consumers receive care at home we must develop models of quality assurance that best fit this setting.
Support for Family Caregivers: Families are the underpinning of the system. Most would report that getting into the LTC system can be daunting.
Affordable Assisted Living: There is an adequate supply of market-rate assisted living (private apartments with services offered based on level of need). Assisted living that serves low and middle income elders is less available.
Special populations: Maine has not developed a coordinated approach to serving the needs of older adults with mental illness.
Financing, Financing, Financing: What, how much, and how to pay for long-term care in an environment of growing demand for publicly funded services.