Full Edition

DIRECTOR’S CORNER

Building for Resiliency: Toward a New System of Long-Term Care

Photo credit: Kristin Chalmers

Ann Hwang, MD
Director, Center for Consumer Engagement in Health Innovation

Rosalynn Carter noted, “There are only four kinds of people in this world: Those who have been caregivers. Those who are currently caregivers. Those who will be caregivers. Those who will need caregivers.”

Despite the ubiquity of caregiving in all of our lives, we – as a country – do a lousy job of supporting caregiving in all of its forms. COVID-19 has made this lack of support vividly apparent, whether it is the loss of childcare and schooling, or the devastating impact of COVID-19 on residents and workers at nursing homes and other long-term care facilities. Across the board, these impacts have fallen most heavily on people of color.

The over 68,000 deaths of residents and workers at long-term care facilities are heartbreaking. The level of loss is staggering and certainly worsened by years of underfunding and neglect exacerbated, as The New York Times has reported, by the role of private equity firms that have been extracting profits from what are largely publicly funded services.

It is long past time for a rethink of how we pay for and deliver long-term care. This rethink should start from what consumers and caregivers need, and also examine how we build a workforce and care delivery system that values resiliency, not just efficiency. We know that many of you are working toward similar goals and we look forward to partnering to ensure a strong consumer and community voice in building the system of long-term services and supports for the future.

In this month’s HIH, we include several resources that examine the intersection of aging, race, and long-term services and supports. Center Research Director Marc Cohen examines the impact of the recession of 2008-2009 on older adults. His research finds a staggering rise in poverty rates, particularly among non-Hispanic Blacks, a worrying sign for what our current economic downturn may hold for older adults – as news reports are already starting to confirm. We also share a collection of articles by researchers at the Gerontology Institute at the University of Massachusetts, Boston on the impact of racism on older adults. I encourage you to read this news article on the impact of COVID-19 on older Black adults and, in case you missed it, our blog about the disproportionate impact of COVID-19 on people dually eligible for Medicare and Medicaid, particularly people of color. Finally, please join us for a discussion on how advocates can work to create the dignified, respectful, resilient system of long-term services and supports that puts people – consumers and caregivers – at the center. As always, please connect with us by email or on Twitter @ccehi with your thoughts and feedback.

FROM THE CENTER & OUR PARTNERS

New Issue Briefs: Economic Hardship from COVID-19 Will Hit Minority Older Adults the Hardest

For Americans 60 and older, COVID-19 has been widespread and deadly. Its economic impact could also be devastating, especially in relation to a deepening recession that leaves little room for recovery for older adults. Center Research Director and Co-Director of the LeadingAge LTSS Center @Umass Boston Marc Cohen co-authored a series of research briefs  which analyze the financial status of Americans 60 and older before and after the Great Recession of 2008-09 and apply it to the economic situation unfolding during the pandemic. The analysis offers a grim picture of the fallout that awaits a wide variety of demographic groups, as outlined in the three briefs that look at data for various demographic groups: non-Hispanic Blacks, Hispanics and non-Hispanic whites; single-person and two-person, married households; retired and non-retired. Marc and co-author Jane Tavares of the LeadingAge LTSS Center offer an overview of the findings in this essay on The Conversation.

Pennsylvania Health Access Network Report on NEMT Work

The Pennsylvania Health Access Network, a Center partner, released a new report last month on their non-emergency medical transportation (NEMT) program that identifies and explores barriers consumers face when accessing transportation to medical appointments. It includes data from over 400 survey responses collected during 2019 and 2020 alongside stories from health care consumers about using the program. Key findings include:

• There is a significant lack of awareness about NEMT among Medicaid recipients.
• Clear communication is needed when arranging appointments and between consumers and providers.
• The lack of specialized vehicles, providers, and rides for evenings and weekends lead to gaps in availability that consumers are forced to cope with and is especially prevalent in rural areas.

Read the rest of report and findings here.

Make the Road New York Issues COVID-19 Response Impact Report

Make the Road New York (MRNY) is among the Center's many partners that adjusted their work in response to COVID-19 while still maintaining their core mission and focus. Their work has been featured in prior issues of HIH, but now the totality of their impact to date is available in a new report, Meeting the Moment. It highlights all of the organization’s COVID-19 efforts over the last several months, including rent relief and eviction moratorium work, as well as income support work, both of which were added in response to the pandemic. While MRNY continues to advocate for a just recovery for all, it also has been able to provide direct cash aid, emergency food and intensive case management to thousands of families left out of government relief.

Center Submits Comment Letter on the Administration for Community Living’s Strategic Framework for Action

The Center submitted a comment letter to the Administration for Community Living (ACL) on its Strategic Framework for Action: State Opportunities to Integrate Services and Improve Outcomes for Older Adults and People with Disabilities. Building on the ACL's vision of a holistic health care system that works for low-income older adults and people with disabilities, the Center offered comments that express support for cross-collaboration among states, health care entities and community-based organizations, as well as for addressing the social determinants of health that play a critical role in health outcomes.

Webinar: Engaging Members in Plan Governance During COVID-19

In 2019, Resources for Integrated Care (RIC), in collaboration with the Center, hosted a webinar series on engaging members in plan governance, recruiting and supporting members to participate in consumer advisory councils and other governance structures, and gathering and using member feedback. RIC and the Center subsequently launched the Integrated Care Community of Practice (ICCoP), a learning community of health plans seeking to incorporate meaningful member feedback into their organizational governance structures.

Now, health plans are facing additional challenges to effective member engagement in plan governance due to the COVID-19 pandemic, and its associated physical distancing protocols. However, the current environment also presents opportunities to re-examine meeting structures, implement creative engagement strategies and recruit new members. Over the past five months, ICCoP participants shared challenges and promising practices for engaging members in plan governance.

On Sept. 17 at 12:30 p.m. EST, the Center, in collaboration with RIC, will be facilitating a webinar, “Engaging Members in Plan Governance During COVID-19,” that will feature a panel discussion sharing promising practices for staying connected to member advisors and supporting their continued involvement during the pandemic.

Center Panel Will Examine What the Pandemic is Showing About Change Needed in LTC

COVID-19 has had a devastating impact on the lives of older adults and their family caregivers, especially those that are receiving care in nursing homes and other congregate living communities. The high rates of infection and death can be attributed to inadequate policies and practices. Similarly, low-income older adults living at home who receive long-term services and supports (LTSS) have been disproportionately affected by the virus. Furthermore, COVID-19 has shed light on the inequities within the long-term care system. Older adults of color have been disproportionality impacted by COVID-19 and have been economically devastated.

During our September learning community webinar on Sept. 17 at 2 p.m. EST, we will discuss whether the crisis in front of us could also serve as an opportunity to truly transform the long-term care system. “Making Lemonade: Changing Long-Term Care for the Better,” will present a robust discussion on what it will take to build a long-term care system that puts the consumer at the center and identify the role of the advocacy community. We’ll hear from a national expert at Justice in Aging as well as two state-based advocates about the work they are doing to push for change. Please register for this event and join in this important conversation.

NOTEWORTHY NEWS & RESOURCES

The Root Causes of COVID-19 Health Disparities Among Older Black Adults

Two new resources shine a spotlight on the underlying causes of COVID-19’s disparate impact on older Black adults, who are more likely to die from the virus than any other group in the United States. First, a Kaiser Health News analysis of data from the CDC found that African Americans ages 65-74 died of COVID-19 five times as often as whites. This article, published by CNN, emphasizes the social and economic inequities that play a significant role in these unequal outcomes, including poorer access to health care, fewer financial resources and unstable housing conditions. Furthermore, lifelong experiences of racism in health care settings have made older Black people distrustful of government and health care institutions, complicating efforts to address the pandemic’s disparate impact on this population.

Second, the Gerontology Institute at the University of Massachusetts Boston has released a series of articles highlighting data on how systemic racism creates inequities in health outcomes and economic security for older Black adults. The papers draw attention to the significantly higher rates of chronic diseases, disabilities and behavioral issues among older Black adults in Massachusetts as compared to older white adults. The paper also utilizes the Elder Index, a tool for measuring the income older adults need to live independently, to help illustrate how a lifetime of inequitable experiences and opportunities leads to higher risk of financial insecurity for older Black adults. These racial disparities in health and economic security have manifested themselves clearly in the pandemic’s disproportionate impact on older Black adults.

Value-Based Health Care Must Value Black Lives

A Health Affairs blog post articulates the need to ground value-based health care in an anti-racist framework in order to reduce inequities in health outcomes for Black patients, which have not been significantly reduced since the push toward value-based care began. Traditional approaches to improving health care quality have often left certain populations further behind, necessitating an explicit focus on racial justice in value-based payment models and quality measures. The blog outlines three steps for making progress – include equity in pay-for-perfrmance, invest in evidence-based community health models and increase accountability for community impact investments.

Direct Care Work is Real Work

Direct care workers are often severely limited by insufficient training, underappreciation and few career advancement opportunities. A report by the Paraprofessionals Healthcare Institute examines the current training landscape for direct care workers and the aspects of direct care work that tend to be unseen or underestimated, including physical demands, social and emotional complexity, and their growing contributions to consumers’ health management. The report proposes ways to maximize the role of direct care workers in care delivery through upskilling and integration into care teams and advanced roles.

Medicare-Medicaid Integration: Progress to Date and Charting the Path Forward

Health Management Associates has released the second issue brief in a series examining Medicare-Medicaid integrated programs. The brief summarizes the elements for success, and barriers encountered, by integrated programs. It asks essential questions and proposes next steps to move forward with federal and state public policies and care delivery options centered around, informed by and available to more dually-eligible individuals.

Training and Supporting Community Health Workers and Promotores

Despite increasing recognition of the value of community health workers and promotores (CHW/Ps) for reaching underserved populations and the need to support this workforce with professional development opportunities, there is no single nationally recognized standard for CHW/P training. The Center for Health Care Strategies has released a report outlining a set of training and professional recognition considerations for sustaining a robust CHW/P workforce. The report shares specific considerations for California, but the lessons are applicable to other states as well.

STATE HIGHLIGHTS

Massachusetts

The Medicare-Medicaid Coordination Office extended the three-way contract for the One Care Duals Demonstration program by one year. A summary of key changes can be found here.

New York

The state of New York recently announced two requests for proposals for homeless housing and support services. The state’s Homeless Housing and Assistance Program is providing up to $128 million in capital funding which would support building supportive housing or emergency shelters. Furthermore, the Empire State Supportive Housing Initiative is providing up to $30 million for supportive housing for individuals with special needs and other conditions experiencing homelessness.

Pennsylvania

Last month, the COVID-19 Response Task Force for Health Disparity released a report that includes six recommendations focused on: housing, criminal justice, food insecurity, health disparity, education and economic opportunities. Among the key recommendations included are:

• Seal evictions for individuals who applied for unemployment during COVID-19.
• Ensure that state-based grant/loan programs do not impose broad disqualifications for prospective applicants who are justice-involved.
• Increase funding to food-and-meal-delivery services to serve senior citizens, people with disabilities and people who cannot afford the cost of transportation, and require those services to provide access in more languages.
• Increase funding and service programs for business technical assistance to immigrant-owned businesses.

South Carolina

The Medicare-Medicaid Coordination Office re-executed the three-way contract for the South Carolina duals demonstration program, extending the program until 2023. A summary of key changes can be found here.

KEY DATES

Thursday, Sept. 17 (12:30-1:45 pm Eastern) - Webinar: Engaging Members in Plan Governance During COVID-19: A Panel Discussion, presented by The Lewin Group in collaboration with the Center for Consumer Engagement in Health Innovation. Please register for the webinar.

Thursday, Sept. 17 (2-3 pm Eastern) - Webinar: Making Lemonade: Changing Long-Term Care for the Better, presented by the Center for Consumer Engagement in Health Innovation. Please register for the webinar.  

Thursday, Sept. 24 (2-3:30 pm Eastern) - Webinar: Integrated Care Programs for Dually Eligible Individuals in the Era of COVID-19: Response Efforts and Policy Recommendations, presented by Center for Health Care Strategies, Inc. Please register for the webinar.