Presentation on theme: " Michelle Putnam, PhD Simmons College School of Social Work, Boston, MA, USA Growing Older with a Disability, FICCDAT Toronto, Canada June 8, 2011."— Presentation transcript:
Michelle Putnam, PhD Simmons College School of Social Work, Boston, MA, USA Growing Older with a Disability, FICCDAT Toronto, Canada June 8, 2011
Brief history of Bridging by way of “Systems Change” policies. Operationalization of Systems Change in the U.S. through policy examples. Evaluation of effectiveness. Progress and challenges. Recommendations.
Americans with Disabilities Act (1990) ↓ Supreme Court’s Olmstead Decision (2001) ↓ Executive Order: New Freedom Initiative (2001 ) SYSTEMS CHANGE AS A POLICY MANDATE TIMELINE (VS. CIVIC CULTURAL CHANGE) Real Choice Systems Change Grants for Community Living (2001) Aging & Disability Resource Centers (2003) Affordable Care Act / CLASS ACT (2010) Money Follows the Person (2005) Community Living Initiative (2010) Person Centered Planning (2007) Community Living Program(2007)/ Veteran’s Administration (2008)
Operationalized - Defined: o Legal definition from Olmstead decision: New Freedom Initiative – Executive Branch interpretation. Open to legal interpretation. o Policy concept: Goal = achieving compliance with Olmstead decision & NFI. LTCSS - Centers for Medicaid & Medicare Services statements & directives about HCBS, community integration. o Cultural concepts: Disability Scholarship: Theoretical and Ideological. Irving Zola. Disability activism: Integration and participation. Disability Rights Movement (also ICF, WHO, UN Disability resolutions). Aging scholarship and activism: Aging in place, successful aging.
Main approach is incentivized policy/program re-design: o Federal level: Grants to incentivize state action & facilitate Systems Change. o State level: Matching funds or budgetary reallocations → dedicated funding. o Local level: Possibly stretching of funds, efficiencies? Key implementation issues: o Stakeholder buy-in. o Incentivizing state and local levels. o Absorption of cultural change to accompany structural change. Examples of slow movement in U.S. Policy using this legal/federal model.
Aging & Disability Resource Centers (ADRCs) Community based information and referral for long-term care/independent living. (http://www.aoa.gov/AoAroot/AoA_Programs/HCLTC/ADRC/index.aspx ) Money Follows the Person Funds for LTC track person regardless of where services are provided (institution or home). (https://www.cms.gov/CommunityServices/20_MFP.asp) Community Living Initiative Coordination of care across service facilities – hospitals, skilled nursing facilities, home & community based (includes Veteran’s initiatives). (http://www.aoa.gov/AoARoot/AoA_Programs/HCLTC/NHD/index.aspx) Systems Change Grants Funds to support infrastructure development in support of consumer/client integration and self-determination: administration, regulation, program, funding. (
2010: 325 ADRC sites in 45 states and territories (S/T). o First awarded to 12 states in o 1/3 of ADRCs are state-wide. Total federal funding approximately $111 million dollars. Implementation progress measured through 5 criteria: o Information & Referral o Options Counseling & Assistance o Streamlined eligibility determination o Consumer populations, partnerships, & stakeholder involvement o Person-centered transition support o Quality assurance & continuous improvement. 80% S&T’s achieved more than 50% outcomes; 50% more than 75% outcomes; None are “fully functional” state-wide yet.
ADRCs are required to have aging and disability partners. o Partner roles determined by S/T and specific ADRCs. o Aging entities (State Aging agency & Area Agency on Aging) are funded entity – disability subcontracts. Equity and equality of relationships vary. Vast majority of disability partners are CILs (Centers for Independent Living). Infrastructure usually connects partners: o Single-entry point, no wrong door. For example: technologically linked, shared data bases, co-located professional staff. Person-to-person, organization to organization links tougher to solidify. o Cultural distinctions and assumptions about aging and disability matter.
What to evaluate? o Depends on how you define the policy problem. Measurement evolution: o Customer service, satisfaction. o Program reach and coverage – i.e. number of users (i.e. availability of services). o Added value of ADRCs– “prevention” of over-use, poor quality of life outcomes. o LTC institutional balance – MDS 9, new codes in Medicare/Medicaid institutional data set. o Cost effectiveness? o What about cultural change → participation/integration outcomes? Not clearly measured.
Predecessors: Federally financed cost-neutral HCBS: o Medicare Channeling Demonstration (1980s). o Medicaid’s Cash & Counseling Home & Community-Based Care Option (2000 onward). Olmstead initiated bridging efforts – what’s different?: o Public and private paying consumers/clients. o Compliance with civil rights law vs. federal policy. Significant push for cultural change. Not readily reversible. Not easily achievable. DNA change or seeking particle diffusion
Progress: o Structural modifications encouraged though Systems Change incentives. o Implementation & Evaluation activities are demonstrating viable pathways and testing bridge’s structural integrity. o Federal advocacy added to grassroots advocacy for professional cultural change. Challenges: o Determining collective and distinct positive effects, benefits and/or gains for aging, disability, aging with disability populations? o Systems change vs. cultural change. o Sustainability and ongoing advancement in this federally-incentivized policy model. Does policy change generate cultural change?
Production of additional, in-depth evidence paying attention to: o Sample. o Measures. o Data points. o Methods. o Research models and inclusion of stakeholders in research. Widen policy analysis lens. o Fit LTC Bridging efforts within larger policy frameworks to evaluate initiatives across policy domains. Long-term care, health care, workforce, housing/transportation, poverty.
Identify what else is going on – where other Bridging efforts are and what works. o In the U.S. and internationally. Add players to bridging endeavors. o Assess stakeholders. o Add Ambassadors. Design international portals for Bridging: o Knowledge gathering and transfer. o Discussion space. o Promotion of innovation.