System Principles:

1
System Principles

• The Path to Real Long Term Care Reform

2
Strategic Principles

• Participant-Driven
• Choice, Equity, and Quality
• Build on High Quality Local Systems
• Effective relationship with local acute care
  system
• Integral Long Term Planning
• Provider Accountability

3
Participant-Driven

• Consumers and Families are active participants in
  all stages of design and implementation
• Cornerstone is Person-Centered Planning
• System honors the preferences of consumers
• System supports Self-Determination

4
Choice, Equity, and Quality

• Choice of caregivers, services, supports, and
  residential options
• Quality and Accountability Outcomes
• Competent, committed, and valued workforce
• Adequate amount of services and supports statewide

5
High Quality Local Systems

• Maximize supports and services resources
• Consider impact of all changes on existing
  community supports
• Flexibility of supports clarity in outcomes
• Encourage and support innovation locally

6
Relationship with Acute Care

• Be distinct from the locally available acute care
  system
• Have a clearly articulated method of coordination
  with the acute care system
• Clear and unambiguous financial and functional
  eligibility criteria
• Easy and universal access across settings.
• No loss of current supports

7
Integral Long Term Planning

• Independent actuarial evaluation
• Savings expand supports
• Independent PCP facilitation
• Timely Implementation quality
• Service limitations are over the whole program,
  not on individuals

8
Provider Accountability

• Explicit contractual responsibility for quality
  of services and their delivery
• State maintains a system of effective monitoring
  and measurement of quality
• Sanctions, including payment refusal, for low
  quality
• Uniform, timely appeal system
• Independent investigation of critical incidents,
  abuse, neglect, and rights violations

9
Operational Principles

• Logistical
• Social
• Coordination
• Decision-Making
• Waiting Lists
• Transition and Diversion
• Consumer Input
• Workforce

10
Logistical and Coordinative

• Rollout in staggered phases to assure
  effectiveness
• Subcontract with existing community organizations
  with expertise
• Pilot untested components
• Expand only after thorough evaluation

11
Social

• LTC services must not be medically driven.
• Social models using PCP must frame any medical
  services
• Linkage to acute care must be seamless
• Access to LTC must not be fragmented (SPE)

12
Coordination

• Service Coordination must be independent
• Service Coordinators must be qualified by
• Experience with seniors and persons with
  disabilities
• Deep understanding of consumer control
• Local program understanding and experience
• Knowledge of person-centered planning

13
Decision-Making

• Medical recommednations made by trained providers
  who know and treat the person
• Authorizations made by those who know the person
• Both internal and independent conflict resolution
  systems
• Timely process to accommodate emergencies

14
Waiting Lists

• Dynamic plan to reduce waiting lists
• No reduced access through utilization monitoring
• No reduced access to prescription drugs
• Shift savings into reducing waiting lists

15
Diversion and Transition

• Everyone who wants out gets out
• Use outcomes as evaluated by the person in the
  community
• Ensure enough community providers

16
Consumer Input

• Free access to all program and provider
  information
• All Committees have at least 50 consumers
• Self-Determination in every program option

17
Workforce

• Plan to expand wages and benefits
• Free training and skill building programs
• Use of registry as work recruitment system
• Effective backup system
• Consumer can hire, manage, and fire

18
Resources

• LTC Scan http//radio.weblogs.com/0139791/
• Transition Curriculum http//nfti.prosynerg.com
• Consumer Consortium http//www.copower.org/mfp/ind
  ex.php
• LTC Blog http//fan-the-flame.blogspot.com/