Congress' amendments to the Older American Act go a very long way in the struggle to permit persons to receive community-based services in their own homes, instead of in nursing facilities. Allocating $28 million for a "Choices for Independence" demonstration program and also a substantial beefing up the Aging and Disability Resource Centers, Congress threw down the challenge to advocates of Older Americans and disability advocates.
- Choices for Independence has two special features:
First, Choices for Independence "targets services for persons at risk for institutional placement, to permit such individuals to remain in home." Older Americans will not have to enter nursing facilities just to receive long term care services. The Olmstead "unnecessary institutionalization" prohibition is inherent in the statute. The OAA has a "statutory focus on keeping older people independent and living in their own homes and communities for as long as possible." This is very much like "closing the front door."
Second, Choices for Independence is based on the Consumer Model, and it requires the "development and implementation of systems of long-term care in home and community-based settings, in a manner responsive to the needs and preferences of older individuals...." HHS must facilitate "the provision of long-term care in home and community based settings, including the provision of self-directed care models."
"Self-directed care" include "services (including the amount, duration, scope, provider, and location of such services) are planned, budgeted and purchased under the direction and control of such individual." Self-directed care is to respond to the "needs and preferences... [of the Older American] to direct and control the receipt of support services," including "the selecting, budgeting and purchasing of home and community-based LTC and supportive services."
HHS has characterized the "Choices for Independence" as "modernizing the OAA" by "strengthening the Act's role in promoting consumer choice, control, and independence in long-term care."
- Aging and Disability Resource Centers (ADRC) will be the "single point of entry" into the entire long term care system for Older Americans.
The ADRC will provide "coordinated and streamlined access to all publicly supported long-term care options so that consumers can obtain the care they need through a single intake, assessment and eligibility determination process."
The challenges for advocates for older Americans and disabled persons are obvious:
- Will your State apply for a Choices for Independence grant?
- How will States and Area Agencies on Aging respond to Congress' Consumer Model of services?
- Will your Area Agency on Aging step up to be an effective and meaningful ADRC with a single point of entry or will the existing fragmentation continue?
- How will older Americans be informed of the right, if they wish, to avoid "unnecessary institutionalization" in nursing facilities before they go into them?
- Are advocates for older Americans and disabled persons working together in your State, or will the historic dichotomy between AAAs and CILs continue?
Steve Gold, The Disability Odyssey continues
Back issues of other Information Bulletins are available online at http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects. To contact Steve Gold directly, write to stevegoldada@cs.com or call 215-627-7100.
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