Contact DHS

Division of Aging and
Adult Services
PO Box 1437
Slot S-530
Little Rock AR 72203

By Herb Sanderson, Director
Division of Aging & Adult Services

This column appears in the November 2001 edition of Aging Arkansas,
a publication of the Arkansas Aging Foundation and the
DHS Division of Aging and Adult Services

United States Department of Health and Human Services Secretary Tommy G. Thompson has announced that Arkansas will receive a $1,025,000 Real Choice Systems Change Grant. The award will help Arkansas make improvements in community-based programs serving the disability and aging communities. These systemic changes will allow children, adults with disabilities, and older Arkansans to live in the most integrated setting suited to their needs.

The Department of Human Services Division of Aging and Adult Services (DAAS) will administer the program in Arkansas. We have come to understand that the greatest thing we can offer anyone we serve is choice. DHS competed with hundreds of other programs across the nation for this grant money and we are excited that we will be able to offer more choices to more families because of this award.

The grants are part of President Bush's New Freedom Initiative to remove barriers to equality for the 54 million Americans living with disabilities. "These grants will allow states to make meaningful changes in the lives of persons with disabilities," Secretary Thompson said. "They will also allow children and adults with a disability to live more independent lives with the freedom to make choices about their services."

The federal grant money will allow Arkansas to pursue four major goals:

• Increase system quality, flexibility and access/availability of services to balance funding between institutions and community.
  
  
• Strengthen recruitment and retention of front-line workers.
  
  
• Improve quality and support of services by strengthening sustainable consumer self-determination.
  
  
• Design and implement a single point-of-entry and information system that will provide consumers with comprehensive, up-to-date, unbiased information for optimal decision-making and choice.

According to the Center for Health Care Strategies (CHCS), nearly 100 million Americans have a chronic illness or disability, yet the current health system is ill suited to provide the care that they need.

CHCS state two fundamental problems hamper current efforts: ineffective ways of paying for care and poor delivery systems for people in need of services.

During the 1990s, care for people with chronic illnesses continued to shift from institutions to community settings where individuals could more easily collaborate with providers to make health care decisions. However, financial, provider, and housing obstacles are still preventing many consumers from getting the care they want and need.

During the past decade, DHCS says it has become increasingly clear that the current health system is not well designed to meet the needs of people with chronic illnesses. The American health care system is largely a medical model with a reimbursement system that favors acute and institutional care rather than preventive and community based care. This delivery system is often unresponsive to those with chronic illness whose needs are not met by episodic care no matter how sophisticated. These problems are likely to worsen over time, particularly as the population ages. Close to 100 million Americans are chronically ill — a number that will increase dramatically over the coming decades as more children and adults with complex chronic illnesses and disabilities live longer.

Brenda Spillman and James Lubitz, writing in the New England Journal of Medicine highlight how the increasing aging population will profoundly effect health care (See Graph).

Health Care Expenditures in the Last Two Years of Life, According to the Type of Health Service and the Age at Death.
Expenditures are in 1996 dollars. Medicare services denotes services covered by Medicare. Other services include home care, prescription drugs, vision and dental care, and durable medical equipment.

But, in a way different than most anticipate: Expenditures in the last two years of life increase with age at death because of steep increases in the costs of nursing home care, not physician or hospital care. Medicare expenditures at the end of life actually decline as the age at death increases-from about $37,000 (1996 dollars) for persons who die at the age of 75 to about $21,000 for those who die at the age of 95.

Conversely, expenditures for nursing home care at the end of life rise. In the last two years of life, expenditures for nursing home care exceed Medicare expenditures for persons who are more than 90 years of age when they die.

Since the Arkansas Medicaid programs pay for about 78% of all nursing home care, these spending trends are a harbinger for the importance of the Real Choice System Change grant.

Not only is institutional care expensive (the State spends over $300,000,000 to care for 14,000 nursing home residents), institutional care is not what most people want.

With the resources of the Real Choice Systems Change grant the State will have an opportunity to offer more choice in how and where long-term care services are delivered.