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 Michelle Putnam, PhD Simmons College School of Social Work, Boston, MA, USA Growing Older with a Disability, FICCDAT Toronto, Canada June 8, 2011.

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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:

1  Michelle Putnam, PhD Simmons College School of Social Work, Boston, MA, USA Growing Older with a Disability, FICCDAT Toronto, Canada June 8, 2011

2  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.

3 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)

4  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.

5  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.

6  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. (

7  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.

8  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.

9  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.

10  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

11  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?

12  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.

13  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.

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