National Association of States United for Aging and Disability
September 11, 2012
Thank you for that kind introduction.
I want to start by thanking everyone here today for your tireless commitment to this country’s seniors and people with disabilities. This administration believes that every American, no matter their age or disability, should have the choice to live an independent, meaningful life in their own community. Thanks to your work, more seniors and people with disabilities have that opportunity today than ever before.
In the years since the Olmstead decision, many Americans have successfully transitioned to community settings. States have begun building the infrastructure to better support people in community based-settings. And we have taken major steps not only to help people leave institutions, but also to ensure they get the right mix of services and supports.
And yet when President Obama came into office, the promise of Olmstead remained unfulfilled for too many Americans.
One reason was that some states have been able to make faster progress than others. As a result, in some places people who could have thrived in their communities were instead allowed to languish in institutions. So the President asked Attorney General Holder and the Department of Justice to step up enforcement. And over the last three years they have joined or initiated litigation in dozens of cases to ensure community-based services across the country.
Another obstacle was a lack of housing for people moving from institutional settings. To address that shortage, the President asked me to work with Secretary of Housing and Urban Development Shaun Donovan to improve access. Today, HUD has already awarded about 1,000 housing vouchers to help people with disabilities move from institutions.
A third obstacle was that many states simply didn’t have the resources or flexibility they needed to move people back into their communities. That’s why we fought to make sure the health care law included a five year extension of Money Follows the Person. This program has already helped more than 19,000 people on Medicaid transition into their own communities. And under the Affordable Care Act, 12 additional states have been able to join the program.
The law also gives States the option of creating a new Medicaid eligibility category for people who receive home and community based services, even if they don’t meet the requirements for institutional care. This gives states the flexibility to design and tailor Medicaid services to meet people’s needs in the community, before they need a nursing-home level of care.
And the law contains the Community First Choice option which provides extra money to state Medicaid programs to improve the quality of the services and supports. Just last week, California became the first state in the country to implement this new opportunity.
What all of these steps represent, in my opinion, is the strongest commitment we’ve ever seen across the federal government to a community-first approach to long-term care. And this kind of progress has put us all on a new path. Now, as more and more Americans see their parents, colleagues, neighbors and children living fully integrated lives with the right support and services, their expectations are changing. Fewer and fewer Americans are willing to accept institutional settings. And that’s a good thing.
But to fulfill that promise, we must recognize that no one works alone. We have to continue building new partnerships. We have to communicate even better across traditional boundaries. And we must improve the way we coordinate our work both at the community level and across the government.
Over the last couple of decades there has been a growing consensus about where we need to move our health care system: toward a focus on prevention and maintaining health, more coordination between providers, greater value for dollars spent, and better use of evidence.
In clinical settings, these principles have led to powerful investments that have begun to transform how we deliver and pay for care. So for example, Accountable Care Organizations are creating incentives for providers to work more closely together. And bundled payments are rewarding doctors and hospitals for keeping their patients healthy not just for the number of procedures they perform.
But we also know that the benefits of coordination and communication don’t stop when we leave the doctor’s office and hospital.
In particular, there’s a need for the same kind of coordination when it comes to community based services. For example, in many communities, long-term services and supports are administered by multiple agencies and have complex, fragmented, and often duplicative intake, assessment, and eligibility processes.
Figuring out how to obtain services can be difficult for anyone – and it can be especially difficult for people with functional impairments.
But we also know that, if there are coordinated systems, consumers and their families have a lot more success finding their way through the maze to choose their best options. This approach also allows state and local governments to better manage their resources, and providers to monitor quality, collect data, and conduct evaluations far more consistently.
That is of course the idea behind Aging and Disability Resource Centers -- an approach our Department has funded for a decade. These one-stop shops are a unique collaboration between Aging, Disability and Medicaid organizations at the state and local level.
And they have become a vital place for older adults, people with disabilities, their caregivers and families to get the right information and services as their long-term needs evolve and change. Since they launched in 2003, Aging and Disability Resource Centers have responded to nearly 17 million requests for guidance and support. And today, 70 percent of American people live within an ADRC service area.
We want to build on that success. That’s why I am proud that the Administration for Community Living is about to award $12.5 million in new grants across 44 states. From these funds nearly $7 million will go to 36 states to continue funding current programs. And another $5.6 million will support 8 states as they implement options-counseling programs.
Options counselors represent what’s best about ADRCs: the personal interaction and support. They conduct individual interviews and they’re there to help during the decision-making process. They support people as they develop a long-term service plan and help them figure out how to finance it -- through personal funds and federal, state and locals benefits. Then they follow up later with the family to make sure their plan is working as designed. If it isn’t, they work together to make it work better.
This approach has shown us how integrating services and supports can dramatically improve people’s quality of life, reduce confusion, and save costs.
But it can go even further. Even as they support and improve people’s experience in the community, we know that the most effective programs have also been shown to help maintain and improve people’s health as well.
We know of course that when seniors and people living with complex disabilities move from an institution to their community, they are especially vulnerable. Changes in settings, providers and medications can lead to complications and errors. Too many people end up in the hospital or back in a nursing home as a result.
That’s why under the Affordable Care Act, we’ve made up to $500 million available through 2015 to test new models of evidence-based care transitions. This investment builds on the success of our Aging Network already making an impact across the country. They confirmed what we always suspected -- that home and community-based services are fundamental to improving care transitions.
There was a time when most people distinguished between what happened at the hospital and what happened at home, as two separate worlds requiring two separate sets of providers. But that separation has not always served people well. Clinical- and community-based settings are different of course. But that doesn’t mean they can’t make their patient’s long-term well-being and independence a shared mission.
When they do, we all benefit.
That was the case for Hattie, a 71-year-old El Paso woman admitted to a local hospital suffering from Chronic Obstructive Pulmonary Disease. During her hospital stay, Hattie’s hospital team noted many complications that would make it difficult for her to safely recover. She’d had several prior readmissions and complicated medication needs.
So the hospital team referred Hattie to El Paso's Care Transitions PATH, a local Community-based Care Transitions Program site funded by the Affordable Care Act. This program improves transitions for Medicare beneficiaries from the inpatient hospital to other care settings and improves quality of care for people at high-risk for hospital readmissions.
After returning home from the hospital, the Care Transition PATH coach noted other concerns from Hattie and her husband, who struggled to maintain her medication routine and nutrition needs. Their home needed maintenance and the rails to Hattie’s hospital bed were broken.
Together they worked with a local medical supply store to obtain a new hospital bed that same day. The coach followed-up with a local home health care agency and the Area Agency on Aging to obtain home services including cooking and cleaning, transportation and home delivered meals.
Hattie’s husband said, quote, “It had been my granddaughter and me lifting my wife up from her wheelchair to the truck and it is difficult. Now we have contacted the transportation department which will pick her up and take her to and from her medical appointments. That is a great help.”
I’ve heard many more stories like this: How a little help here, a little communication there, and the right follow up at the right time can make the difference between independent living and a series of costly and debilitating hospital readmissions. Over the last three years, we’ve made a concerted effort to invest in the people and programs proven to make that difference.
And now we’ve taken the latest step: the one Kathy described earlier this morning.
In creating the new Administration for Community Living, we’re applying the same principles of coordination within our own Department. Our goal is to create a single agency that better supports the needs of the many different groups you serve.
Through this reorganization, we have brought together, under one roof, the Administration on Aging, the Office on Disability, and the Administration on Developmental Disabilities. As you know, not all seniors and people with disabilities share the same needs. A senior with dementia, an adult with a physical disability, and a child with a developmental disability all have unique challenges. And we will continue to support and strengthen the specific initiatives and programs suited to meet their needs.
But seniors and people with disabilities often share a goal of living in their homes and in their community. And by creating the Administration for Community Living, we can use our resources more effectively to help more people achieve that goal.
Together, with the leadership of everyone here today, we’ve already made a big difference. But if we want to continue this progress, we have to protect what we have built from those who want to tear it down. And that means making sure the House Republicans’ Budget plan for Medicaid doesn’t become law.
Over the last two years, the House Republicans have repeatedly passed proposals to turn Medicaid into a block grant program, and would slash its budget by $750 billion. Let’s be clear about what that would mean. The fact is that two-thirds of Medicaid spending goes to two populations: people with disabilities and older Americans. This is the very foundation of long-term care, supports, and services.
To cut Medicaid spending in half would most certainly lead to significant and devastating cuts to benefits for all the seniors and Americans with disabilities who depend on Medicaid.
We can do better. And so many of you here today, have shown us exactly how. Through your tireless efforts and experience, long hours and thoughtful collaboration, you have helped build this country’s vital community living networks. That is an investment that continues to pay off. And it will only make us a stronger and more dynamic nation.
I’m confident that with you at the helm, we will continue to move forward. We will continue moving toward the day when all our citizens have the fundamental freedom to pursue quality lives in homes and communities of their choosing.