Bredesen pushes long-term care plan

Gov. Phil Bredesen said that his own mother, last year, was in a position where she was too sick to be home alone and yet not disabled enough to be in a nursing home.

Fortunately, she had "a son who knows a little bit about the system," in the governor's words, and he was able to arrange for her needs to be met.

That's exactly the kind of situation that led Bredesen, who was a health care executive before entering politics, to propose a plan to expand home care and community-based care and to better inform seniors and their caregivers about the options.

"This is really a very personal kind of thing," said Bredesen.

In a conference call with Tennessee reporters on Thursday, Bredesen and deputy commissioner of TennCare Darin Gordon discussed the plan.

Bredesen said the proposal is "beginning to move" in the General Assembly and should provoke discussion in the coming weeks. He said it has three goals: to simplify the process of arranging for long-term care, to add more choices and to promote cost-effective options that are less expensive than nursing home care.

"Health care is hard enough to manage when you're young and healthy," said Bredesen.

Currently, it can take 45 days to process applications for coverage of community-based long-term care. In the meantime,t he patient is often sent to a nursing home. Bredesen said some patients are referred to nursing homes almost by default when there are other options that would be better in those particular situations.

Gordon said the plan would promote options like assisted living, non-traditional care providers like friends or fellow church members, adult day care or adult foster care.

Reimbursing friends or family members for care of a loved one must be managed carefully to avoid abuse, said Bredesen, but he believes that can be done.

Gordon said that 42 states have some form of community-based care program.

"For the people that need it, this can be a lifesaver," he said.

According to the initial announcement earlier this month, key components of the "Long-Term Care Community Choices Act of 2008" include:

* Create consumer-directed care options, including the ability to hire non-traditional providers like family members, friends and neighbors with accountability for taxpayer funds;

* Broaden residential care choices in the community beyond nursing facilities with new options such as companion care, family care homes and improved access to assisted care living facilities;

* Streamline the member's eligibility process for faster service delivery and the enrollment process for new providers;

* Maintain a single point of entry for people who are not on TennCare today and need access to long-term care services through Medicaid or other available programs;

* Use existing Medicaid funds to serve more people in cost-effective home and community settings;

* Designate one entity to coordinate all of the care a TennCare member needs including medical, behavioral and long-term care;

* Implement active transition and diversion programs for people who can be safely and effectively cared for at home or in another community setting outside the nursing home; and

* Install an electronic visit verification system to monitor home care quality.