State officials are developing a plan to dramatically reshape the state's long-term care system, just as demand for it is expected to skyrocket.
The effort -- referred to as "right-sizing" the system -- is aimed at allowing more seniors and people with disabilities to live in community settings rather than institutions.
If it goes as officials hope, nearly one in four nursing home beds in the state won't be needed within the next two decades -- at least according to projections being used by state officials. They're planning to award millions of dollars in federal grant money to nursing homes looking to diversify their business models.
Those leading the effort say it's about creating choice, removing the barriers that make it harder to get Medicaid-funded long-term care at home than in an institution.
"We're designing a system that will someday support us," Dawn Lambert told a roomful of people helping to design the effort, including state agency officials, home health care and nursing home industry leaders, long-term care recipients and advocates for seniors, people with disabilities and mental illnesses.
Lambert is project director for Money Follows the Person, a federal-state initiative to help people in institutions move into home- or community-based settings and rebalance the long-term care system.
Doing so requires transforming not just the care system, but the infrastructure of a state sorely lacking affordable, accessible housing and transportation options. There will be a need for community supports to help people avoid being isolated at home, and a major increase in home care workers, who are already in short supply.
The shift will also require a more subtle change in the way care is thought of, those behind the effort say, from a sometimes-paternalistic model that treats people as patients in the care of an institution to one that emphasizes independence, choice and the right to take risks, including getting less care than professionals might advise. While many nursing home residents are seniors, the changes will also affect people with disabilities and mental illnesses, some of whom live in nursing homes.
Many longtime advocates for rebalancing the system say they're cautiously optimistic, saying previous resistance seems to have subsided, and policy changes are starting to reflect a move toward expanding home- and community-based care. Gov. Dannel P. Malloy's administration has already announced plans to expand Money Follows the Person, and Malloy issued a controversial executive order establishing a path for home care workers in state-funded programs to gain collective bargaining rights, citing the expected increase in demand for personal care attendants.
"I don't think we have any choice," AARP Connecticut State Director Brenda Kelley said. "The services that we currently have are not what people want. They're not what people need, and we can't afford it."
The nursing home industry is participating in the planning process, and leaders have acknowledged that a shift toward more home care is inevitable. The industry understands that an overreliance on institutional care, mixed with the looming demographic trends, will lead the state to a long-term care system that's unaffordable, said Matthew V. Barrett, executive vice president of the Connecticut Association of Health Care Facilities, which represents nursing homes.
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