Question

Identify and explain the direct correlation between the Affordable Care Act and the Continuum of Long Term care.

List and explain the key factors that have been introduced by the Affordable Care Act enabling Medicare and Medicaid to provide longevity for long term care services.

Answer 1

a) Affordable Care Act is acomprehensive health care reform law enacted in March 2010 (sometimes known as ACA, PPACA, or “Obamacare”).

The law has 3 primary goals:

• Make affordable health insurance available to more people. The law provides consumers with subsidies (“premium tax credits”) that lower costs for households with incomes between 100% and 400% of the federal poverty level.
• Expand the Medicaid program to cover all adults with income below 138% of the federal poverty level. (Not all states have expanded their Medicaid programs.)
• Support innovative medical care delivery methods designed to lower the costs of health care generally.

The Patient Protection and Affordable Care Act (ACA) includes several provisions that aim to improve prevailing deficiencies in the nation's long-term care system.The most prominent long-term care provision is the now-suspended Community Living Assistance Services and Supports Act. Others include incentives and options for expanding home- and community-based care, a number of research and demonstration projects in the areas of chronic care coordination and the dually eligible, and nursing home quality reforms.

The ACA led to a number of changes for nursing homes and long-term care in general. For example, the ACA gave the Centers for Medicare & Medicaid Services (CMS) the authority to collect data from nursing homes on an expanded list of quality measures. The ACA also made it easier for states to use federal Medicaid dollars for long-term care support systems and services, including expanding options for home- and-community-based services for people who are eligible for a nursing home but can alternatively reside at home with the appropriate support systems in place. Until more details emerge, we will not know how these changes will be affected by the prospective repeal and replacement for the ACA, or how CMS will enforce the executive order.

b) he Affordable Care Act includes a series of provisions designed to reduce spending while improving the quality of care in the health care system. Reducing excessive payments to Medicare Advantage plans, strengthening antifraud efforts, and initiating reforms to Medicare provider payment systems, among other policies, are expected to extend the life of the Medicare Trust Fund by an additional eight years. These reforms complement numerous other provisions that improve health care quality while lowering costs.

Long-Term Care Services and Supports

One of five Americans—56 million people—report having a disability that limit

s routine activities of daily living. Among this population, about 10.3 million people require long-term care, which includes a variety of medical and social services to help meet health or personal needs. Most long-term care is to assist people with basic tasks, such as eating or bathing, or activities necessary for independence, such as preparing meals or managing money. And most people who need long-term care services and supports (85%) receive them at home or in community-based settings, such as a daytime activity center. However, a significant number of people who require long-term care—1.5 million—reside in nursing homes or other facilities that attend to their long-term care needs

Most long-term care is provided as unpaid help from family and friends: four of five people who receive long-term care in the community rely exclusively on unpaid assistance (National Clearinghouse for LTC). When unpaid assistance is not enough or not available, then people with disabilities rely on paid individuals or companies to provide services. These services are expensive and can quickly exhaust lifetime savings. When that happens, the Medicaid and Medicare programs provide assistance.

Expanding Home- and Community-Based Services

Over the past three decades, states have been expandirecipients of long-term care. Overall, Medicaid beneficiaries who receive long-term care services accounted for 42 percent of total Medicaid spending in 2009 ng Medicaid home- and community-based services (HCBS) in response to consumer preferences for alternatives to facility-based long-term care and, since 1999, in response to court-ordered mandates to serve people with disabilities in the least restrictive setting, taking into account the resources of the state.

Changing the Culture of Residential Care

"States need to be careful not to focus too narrowly on just HCBS options," says Bonnie Kantor, executive director of the Pioneer Network. "Instead of focusing on the setting of care," she says, "the real goal is to create a culture of patient-centered care that creates a sense of home and community in every setting, including facility-based care."

This is particularly important for older adults, who are more likely than younger adults to receive facility-based long-term care: 22 percent of people age 65 and older who need long-term care reside in a facility,