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Long-term Services and Supports: A Rebalancing Act

Monday, October 03, 2011

The ongoing debate over the federal budget and deficit reduction presents a balancing act for policy makers, as many compelling interests compete for scarce dollars. But for 10 million older adults and people with disabilities who need long-term services and supports, there is a “rebalancing act” in progress. The aim is to serve more people at home and in the community, and fewer people in institutions.

States grappling with constrained budgets, at a time when the aging and disability populations are growing rapidly, are actively engaged in this “rebalancing” between institution and home in the hope of delivering high quality long-term services and supports at lower cost.

Are there sufficient home- and community-based programs in all states to address the aging population? To help the growing number of adults with disabilities? How can incentives in the Patient Protection and Affordable Care Act be used to develop new approaches in home- and community-based services? How effective are existing federal initiatives to promote care in home- and community-based settings, such as the “Money Follows the Person” program? What can ongoing state efforts to promote community-based options tell us about the impact on costs, on promoting greater choice of settings and providers, and on adequate support for family caregivers?

To address these and related questions, the Alliance for Health Reform and The Commonwealth Fund sponsored an October 3 luncheon briefing. Panelists were: Bob Hornyak, Administration on Aging; Cynthia Woodcock, Impaq and formerly Hilltop Institute; and Carol Raphael, Visiting Nurse Service of New York. Mary Jane Koren of Commonwealth and Ed Howard of the Alliance were co-moderators.


 Mary Jane Koren, The Commonwealth Fund, Moderator
 Cynthia Woodcock, IMPAQ, Speaker
 Carol Raphael, Visiting Nurse Service of New York, Speaker
 Bob Hornyak, Administration on Aging, Speaker
(Click on the camera icon to see a video of the speaker's presentation.)

Transcript, Event Summary and/or Webcast and Podcast

Transcript: Transcript (Word Document), 10/3/2011
Event Summary: Event Summary (Adobe Acrobat PDF), 10/3/2011
Full Webcast/Podcast: Long-term Services and Supports: A Rebalancing Act

The full webcast and podcast for this briefing, as well as videos of individual speakers' presentations, are provided by Kaiser Family Foundation.

Speaker Presentations

Koren Presentation (PowerPoint), 10/3/2011
Hornyak Presentation (PowerPoint), 10/3/2011
Woodcock Presentation (PowerPoint), 10/3/2011
Raphael Presentation (PowerPoint), 10/3/2011

(If you want to download one or more slides from these presentations, contact us at info@allhealth or click here for instructions.)

Source Materials

Speaker Bios (Adobe Acrobat PDF), Alliance for Health Reform, 10/3/2011
Agenda (Word Document), Alliance for Health Reform, 10/3/2011
Materials List (Adobe Acrobat PDF), Alliance for Health Reform, 10/3/2011
Event Summary (Adobe Acrobat PDF), Alliance for Health Reform, 10/3/2011
Sourcelist (Adobe Acrobat PDF), Alliance for Health Reform, 10/3/2011

Offsite Materials (briefing documents saved on other websites)

Rebalancing Long Term Services and Supports: Progress to Date and a Research Agenda for the Future (Adobe Acrobat PDF),The Hilltop Institute, 6/14/2011
- Woodcock, C., I. Stockwell, A. Tripp & C. Milligan
In Brief: Weathering the Storm: The Impact of the Great Recession on Long-Term Services and Supports (Adobe Acrobat PDF),AARP Public Policy Institute, 1/1/2011
Stakeholder Dialogues Summary Report, U.S. Department of Health and Human Services, 10/3/2011
Implementing the Affordable Care Act: New Options for Medicaid Home and Community Based Services (Adobe Acrobat PDF),National Academy for State Health Policy, 10/1/2011
- Justice, Diane
How The Affordable Care Act Can Help Move States Toward A High-Performing System of Long-Term Services and Supports, Health Affairs, 9/1/2011
- Reinhard, Susan C., Enid Kassner and Ari Houser
PHI Facts 3, Paraprofesssional Healthcare Institute, 2/1/2011
Home and Community-Based Long-Term Services and Supports for Older People (Adobe Acrobat PDF),AARP Public Policy Institute, 5/1/2011
- Kassner, Enid
National Spending for Long-Term Services and Supports (LTSS), National Health Policy Forum, 3/15/2011
Medicaid and Long-Term Care Services and Supports (Adobe Acrobat PDF),Kaiser Family Foundation, 3/1/2011
Money Follows the Person: A 2010 Snapshot, Kaiser Family Foundation, 2/1/2011
Stressed and Strapped: Caregivers in California, UCLA Center for Health Policy Research, 9/1/2011
- Hoffman, Geoffrey J. and Carolyn A. Mendez]Luck
Health Policy Brief: The CLASS Act (Adobe Acrobat PDF),Health Affairs, 5/12/2011
49 Suggestions for Cutting Billions in State’s Medicaid Costs, The New York Times, 2/15/2011
- Hartocollis, Anemona
Medicaid: A Program of Last Resort for People Who Need Long-Term Services and Supports (Adobe Acrobat PDF),AARP Public Policy Institute, 5/1/2011
- Fox-Grage, Wendy and Donald Redfoot
The Growing Contributions and Costs of Family Caregiving (Adobe Acrobat PDF),AARP Public Policy Institute, 1/1/2011
- Feinberg, Lynn, Susan C. Reinhard, Ari Houser and Rita Choula
Medicaid-Funded Long-Term Care: Toward More Home- and Community-Based Options (Adobe Acrobat PDF),Center for Health Care Strategies, Inc., 5/1/2010
- Engquist, Gretchen, Cyndy Johnson, Alice Lind and Lindsay Palmer Barnette
Community Services and Long-term Supports: Balancing, Centers for Medicare & Medicaid Services, 8/29/2011
Community Living Initiative (CLI) – Key Advances During the Year of Community Living, U.S. Department of Health and Human Services, 10/3/2011
Obamacare and the CLASS Act: Creating a Long-Term Care Entitlement Burden, The Heritage Foundation, 1/19/2011
- Blase, Brian
A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers (Adobe Acrobat PDF),AARP, The Commonwealth Fund & The SCAN Foundation, 9/1/2011
- Reinhard, Susan C., Enid Kassner, Ari Houser and Robert Mollica


Mary Jane Koren, MD, vice president for The Commonwealth Fund's Long-Term Care Quality Improvement/Dual Eligibles Program, discussed findings from a   state-by-state scorecard on long-term supports and services at the Oct. 3 briefing cosponsored by the Fund. (7 min.)

Bob Hornyak of the U.S. Administration on Aging explains the interplay of the 20,000 service providers and hundreds of thousands of volunteers involved with the Aging Network. From the Oct. 3 briefing cosponsored by The Commonwealth Fund. (12 min.)

Cynthia Woodcock of IMPAQ International describes how states are boosting home- and community-based services as a way of controlling Medicaid spending. From the Oct. 3 briefing cosponsored by The Commonwealth Fund. (16 min.)

Carol Raphael of the Visiting Nurse Service of New York explains how the nation could make better use of home- and community-based services for those needing long-term care. From the Oct. 3 briefing cosponsored by The Commonwealth Fund. (11 min.)


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