“Stay home.” We all remember hearing these words when the COVID-19 pandemic first took shape in spring 2020. While most complied and were able to minimize their contact with others, many in institutional settings, such as nursing facilities, were still surrounded by people. This environmental challenge resulted in 1 in 10 people living in nursing homes dying from COVID-19 during the pandemic.
This information points to opportunities for growth in long-term services and supports (LTSS). LTSS refers to “the broad range of paid and unpaid medical and personal care assistance that people may need…when they experience difficulty completing self-care tasks as a result of aging, chronic illness, or disability.” LTSS goes hand in hand with Medicaid, as Medicaid pays for more than half of the nation’s spending on these services, according to a recent report by Medicaid Forward.
A National Association of Medicaid Directors (NAMD) report explores how states could help improve the lives of the individuals who use LTSS services—mostly older, low-income adults, and children and adults with complex health needs or disabilities—using what they learned from the COVID-19 pandemic and the more than $9 billion invested by Congress through the American Rescue Plan Act.
The largest movement associated with this population involves a concentrated push to move a majority of LTSS services from institutional settings to Home and Community-based Services (HCBS). HCBS encompasses assisted living facilities and in-home care, which broadly represents the “services and supports that allow people to live more independently and in their community.”
This incentive is fueled by an array of objectives:
The importance of at-home and community care cannot be discounted. In addition to the financial benefits associated with managing LTSS needs within the community, HCBS services are shown to be safer and boost well-being. Self-direction, a key component of person-centered care, allows individuals receiving HCBS services to manage all aspects of their service plan. This adds to their ability to remain independent, thus increasing their satisfaction level and enhancing their relationships with the providers they choose.
While there are many reasons to transition traditional LTSS services to the HCBS environment, states also face significant challenges:
Although the future landscape may seem daunting, states can overcome these obstacles by maintaining a focus on person-centered care and implementing strategies to address these environmental and workforce challenges. For example, access to at-home care can be improved by increasing benefits and incentives for personal care workers and natural supports, both of whom can help provide higher quality care if their monetary and personal needs are met. Targeted improvements such as these will help attract and retain the personnel needed to satisfy growing requirements relative to demand for home and community care.
Present and future
While there is still much work to do, several states have already initiated efforts to bolster this critical workforce.
While these are steps in the right direction, widespread transformation can only occur if other states follow suit. The onslaught of problems brought on by the pandemic coupled with the money invested by Congress through the American Rescue Plan act gives states a huge opportunity to improve the lives of those Medicaid members receiving long-term services and supports. Giving everyone the ability to “stay home” is a cause worth fighting for.
Robert Pittman is Senior Vice President of Government Affairs at Modivcare.