April 11, 2008

Local lawmakers pitch plan to add long-term care options

BY DESSISLAVA YANKOVA/Staff Tennessean.com

Local state lawmakers are proposing changes to Tennessee’s long-term care services that they say could better serve seniors while saving money for both individuals and the state.

“We want the least restrictive, most dignified and the least costly care,” State Sen. Diane Black, R-Gallatin, said in a presentation Monday at the Ruth P. Carter Senior Citizens Center in Gallatin.

Black and State Rep. Debra Maggart, R-Hendersonville, presented several pieces of legislation designed to customize long-term care for seniors in Tennessee, which ranks 49th in dollars spent on home- and community-based care.

Black and Maggart are sponsoring a bill that would allow seniors to select a caregiver to provide services in their home rather than having an agency send a stranger. Called cash counseling or self-directed care, the plan also lets the consumer compensate caregivers, including family or friends, and supplies a third party to manage financial issues.

Seniors may also select the services they need instead of a standard list of recommended procedures.

“We found (that) when we give people the opportunity to choose, they’ll actually choose less services than the agency was choosing for them, so it brings the cost down,” said Black, who is a registered nurse and has worked on long-term care proposals for the past six years.

“As long as we have oversight, I believe absolutely an individual who’s getting the services should have a choice about what they get and who provides them,” she added.

Other states, including Florida, New Jersey and Arkansas, have pioneered this plan, and Black recently visited Oregon to examine long-term care practices there.

“They are probably about 15 years ahead of us,” Black said. “A lot of states have already been doing it. We’re not cutting a new rug.”

Findings show that not everybody selects the self-directed care plan, “but for those who do, it works beautifully,” she said.

Under the plan, people with more specialized needs could continue living in a medically equipped house. When needs require around-the-clock care, seniors can then move into an assisted-living facility, Black explained.

Ultimately, the goal is to keep people in their homes as long as possible, but Black said nursing homes are instrumental when the family no longer is able to provide the necessary care.

State dollars through the Tennessee Commission on Aging and Disability can fund the program, allowing for timely implementation. Black said the commission’s new executive director and many legislators, including Gov. Phil Bredesen, support the idea.

Another bill local Republican lawmakers propose would reward people who buy long-term care insurance by allowing them to keep personal assets equal to the value of the insurance when they apply for state assistance. Ordinarily, people are required to “spend down” their assets before qualifying to receive state aid.

“That would be a very good way to encourage people to plan ahead,” Maggart said.

Bredesen’s comprehensive program to restructure the state’s long-term care system is in committee hearing at the General Assembly. It tries to increase accessibility and make services less complicated and more available, Black said.