Scan Champions a New Vision of Long-Term Care
Lavery, Joni, Aging Today
Nearly 30 years ago, a group of older citizens, frustrated by lack of access to health services, formed the Southern California-based Senior Care Action Network (SCAN), which eventually led to the creation of the nonprofit SCAN Health Plan, a "Medicare Advantage" HMO serving the needs of approximately 105,000 elders on Medicare in seven Southern Califor- nia and two Ari- zona counties. Those citizens and many others who have worked for decades to en- act long-term care (LTC) reform re- ceived especially welcome news this past April when the SCAN Health Plan announced the new SCAN Foundation. Based in Long Beach, Calif., the Foundation's mission is to advance the development of a sustainable continuum of quality care for elders, and it is an independent phi- lanthropy formed from funds contributed through the SCAN Health Plan.
The SCAN Foundation's primary goals are to find innovative ways to enhance elders' abilities to manage their health and to control where and how they live. The Foundation's board envisions a society where this population receives medical treatment and human services integrated into settings that meet elders' needs and that promote healthy, independent lives. The board recruited Dr. Bruce Chernof, an internist and former director and chief medical officer of me Los Angeles County Department of Health Services, as the Foundation's first president and chief executive officer. The Foundation intends to establish a niche rote - one not filled by any other like entity - that advances development and enactment of LTC policy reform rather than focusing solely on programmatic funding.
THE EXPERTS CONVENE
To get feedback on proposed grantmaking strategies, the Foundation, along with the National Academy of Social Insurance (nasi), convened two groups of LTC experts (see page 2 for access to participant list and experts' findings). Meetings were held in last October in Burbank, Calif., and Washington, D.C. Dr. Chernof and SCAN Foundation leaders asked these experts to identify the primary barriers to providing comprehensive LTC services. Participants agreed that the United States does not have a continuum of care for seniors, is lacking in care coordination - including social services - and uses an outdated model of healthcare financing. They also emphasized me need for new models-for organizing, delivering and financing services.
Nearly all in attendance agreed that mere are no LTC champions presenfly in Congress. One expert mentioned that, due to congressional staff turnover, there is a weak institutional memory on Capitol Hill about past LTC reform efforts. Additionally, mere seems to be lack of political will about addressing LTC issues and including them in general healthcare reform discussions.
Other experts pointed to me caregiving workforce, bom formal and informal, as a barrier to providing comprehensive LTC services. There are not enough trained caregivers in the professional workforce, and most family member caregivers have no special training and need support to help ease the care burden. The number of workers who have expertise working wim older adults needs to increase, along with improved pay and benefits.
The Foundation also sought advice about two of its strategic funding priorities: how to elevate LTC as a state and national priority, and how to develop realistic policy options that would establish and finance a comprehensive continuum of quality LTC Many experts encouraged me Foundation to reframe LTC beyond the definition of institutional care. Policymakers, the press and the public all equate LTC with nursing homes. Whichever way the issue is framed, the proper perspective must include supportive services and include people wim disabilities. "Long-term care isn't just about nursing homes," said Ann Monroe of Community Healtii Foundation of Western and Central New York.
Robyn Stone of the Institute for the Future of Aging Services, at the American Association of Homes and Services for the Aging, Washington, D.C., added, "Continuum of care implies trajectory and decline, but people move in and out of services. A repertoire of care is a better description of what we are after."
Steve Dawson, of the Paraprofessional Healtìi Institute, New York, said, "Reframing long-term care as an economic development issue could push the agenda forward. Given the financial crisis, economic issues are going to come up, including job market issues. Investment in the long-term care workforce could mean less time off work for family caregivers and more jobs created. This framing might get lawmakers' attention."
Some experts advised the Foundation to find a way to translate personal experiences into system change. "Caregivers do not see the connection between what they are doing and public policy. Caregivers need to recognize that the financing and delivery systems can be better man they are now, but improving mem wUl require public as well as private initiatives," observed Joshua Wiener of RTI International, North Carolina.
The groups discussed how to build me political wUl necessary to move LTC policy reform forward. "Consider three arenas: me public, the press and policymakers," advised Diane Rowland of the California-based Kaiser Family Foundation. "The way you move policymakers is to have the press cover your issues, understand your issues well and. keep the public engaged." Her foundation's success with their commission on Medicaid and its comprehensive website, www.k_f.org, was cited as a positive force for change that could serve as a model for The SCAN Foundation. Anotiier tactical suggestion concerned how The SCAN Foundation could fund congressional committee fellows to help raise awareness on Capitol Hill. Funding fellows for longer tiian one year would bring continuity to reform efforts.
Other experts advised that it might be necessary to forgo comprehensive LTC reform at the national level in the near term and instead prepare for the opportunity to include smaller reforms in any healthcare bill that is considered in 2009 or 2010. Meanwhile, there might be some policy options to move at me state level, such as allowing states to tap into the Medicare funding stream or helping states design an efficient and effective reimbursement system for home and community-based care. "California has a lot of characteristics that make it a nice laboratory to try new things that might later be expanded nationally," observed Dr. Jack Rowe from Columbia University's School of Public Health, New York.
Carroll Estes, of the University of California at San Francisco, said, "Social insurance must be included in the poUcy discussion." The idea of long-term care as a social insurance program needs to be a key part of me solution. Social insurance offers a paradigm based on the public interest and the greatest good. A universal risk pool addresses the huge barriers of financing and access. "I'm not saying mere will be no private involvement whatever, but mere's got to be an anchor. As we see from the current financial crisis, government is the ultimate safety net, and social insurance concepts are real and absolutely critical," she added.
Proponents of LTC reform eagerly await news of how the scan Foundation will proceed. The Foundation's Board of Directors approved its 2009-20 1 3 strategic plan, which is posted at www.thescanfoundation.org. They are beginning a first request for proposals and sponsored the distribution of NASI's latest brief, "Long-Term Services and Supports as Part of Healtii Care Reform: Relief for the Invisible Uninsured?" by Lee Goldberg, director of LTC policy care initiatives, Service Employees International Union. The brief was released at the nasi January 2009 conference roundtable and is available online at www.nasi.org.
SCAN FINDINGS AND SESSIONS ONLINE
For information on the October 2008 SCAN meetings, plus participant lists and findings, contact Joni Lavery, firstname.lastname@example.org.
In March 2009, the SCAN Foundation sponsored two policy education presentations: "Long-Term Care: Exploring the Possibilities," held in Washington, D.C., on March 9 with the Alliance for Health Reform; and a March 18 workshop, "Opportunities for Meaningful Change in Long-Term Care Financing and Delivery," with NASI, at Aging in America, the 2009 Annual Conference of the American Society on Aging and the National Council on Aging, held in Las Vegas. These presentations are posted on the NASI website, www.nasi.org.
Joni Lavery is the income security research associate at the National Academy of Social Insurance (NASI) and was a major contributor to their study panel report, Uncharted Waters: Paying Benefits From Individual Accounts in Federal Retirement Policy (January 2005). The report is available at www.nasi.org.…
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Publication information: Article title: Scan Champions a New Vision of Long-Term Care. Contributors: Lavery, Joni - Author. Magazine title: Aging Today. Volume: 30. Issue: 2 Publication date: March/April 2009. Page number: 1+. © American Society on Aging Jan/Feb 2009. Provided by ProQuest LLC. All Rights Reserved.
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