N.H., Vt. Working to Bolster Care Support Services

Sunday, January 10, 2016
Both New Hampshire and Vermont in recent years have beefed up support systems to guide patients and families in arranging long-term care.

Such help is especially important as the states pursue plans to de-emphasize the role of skilled nursing facilities and give patients and families more choices to receive care at home, in communities or in a range of residential settings.

In 2012, the U.S. Administration for Community Living provided funding to eight states to experiment with a “no wrong door” model that would more easily connect consumers with long-term care and other services.

In New Hampshire, that effort became part of the existing ServiceLink network. Alison Morgan, the director of Grafton County ServiceLink, said that her unit has eight staff members in offices in Lebanon, Littleton and Plymouth, but could use twice as many staff if funding were available.

ServiceLink connects seniors looking for long-term care with resources, referrals and help with applications. “It is a complicated system but (we can) help them get through that,” she said.

The “no wrong door” initiative expanded the range of inquiries to which ServiceLink could respond. “Now, people can call with any issue,” Morgan said. “We will handle referrals for all populations and payers.”

In Vermont, the state’s “no wrong door” hotline number is 1-800-642-5119. The hotline can provide some counseling on care options or give consumers directions on how to get more information from a local agency on aging, the state Center for Independent Living or the Brain Injury Association, said Megan Tierney-Ward, aging and disabilities program manager for the state Department of Disabilities, Aging and Independent Living.

Senior Solutions, which is based in Springfield and provides services in southeastern Vermont, employs the equivalent of 3.5 full-time employees on the hotline as well as eight case managers who meet at least monthly with each Choices for Care participant, said Gary Hilliard, the case management supervisor. The agency also plans to hire two “options counselors” to help guide seniors through the process of finding and applying to programs.

In Vermont, more than one-third of applicants for Medicaid coverage of long-term care wait more than two weeks to learn if they meet health needs criteria, according to state officials. Three in five wait more than two months to complete a financial eligibility review that, Hilliard said, can be “can be daunting and can be lengthy.”

Patients and families can use the Internet to do their homework. The Nursing Home Compare website of the U.S. Centers for Medicare and Medicaid Services, the agency that administers federal participation in both programs, offers a good starting point.

The website, at www.medicare.gov/nursinghomecompare/search.html, includes star ratings for each home that is licensed to care for Medicaid or Medicare recipients. Rating categories assess overall quality, health inspection results, staffing levels and performance on certain physical and clinical measures.

The star ratings employ an easy-to-understand system: One star means “much below average,” two stars are “below average,” three are “average,” four are “above average” and five are “much above average.”

While the ratings offer attractive simplicity, complexity hovers in the background. For example, the overall star rating for a facility is computed by starting with the star rating based on the results of on-site health inspections by state regulators in the last three years.

To get to the overall rating, the health inspection rating is modified to reflect very high or very low scores for staffing levels and the quality and results of care. The staffing and quality ratings are based on reports from the nursing homes.

Critics of the system say those reports, which are not audited or subject to third-party verification, are liable to manipulation. In 2014, a New York Times study of the rating system concluded that some nursing homes had gamed the system to win “a seal of approval that is based on incomplete information and that can seriously mislead consumers, investors and others about conditions at the homes.”

Patients and families should look beyond the star ratings as they judge the quality of a facility, said Craig Labore, administrator of the Grafton County Nursing Home in North Haverhill: “You should still go to a nursing home ... and see how the staff is interacting with the residents.”

Michael Fleming, chief of the New Hampshire Health Facilities Certification Bureau, said that patients or their families should interview staff, administrators and other residents of a facility they are considering. “Go to a facility and do a walk-through” for at least an hour, he said.

Suzanne Leavitt, chief of the survey and certification unit of the Vermont Department of Disabilities, Aging and Independent Living’s licensing and protection division, said that patients or families also should observe activities and meals at a facility they are considering. While families may be under pressure as they try to choose a nursing home, “My hope is that it is never a rush job,” she said. “Plan ahead.”

In Vermont and New Hampshire, patients and their families also can read reports from recent visits by state inspectors. “These inspections take place about once a year, but may be done more often if the nursing home is performing poorly,” according to the CMS website.

Those reports can be found at www.dlp.vermont.gov/nursing-list/nursing-homes for Vermont facilities and at healthfacilitysearch.dhhs.nh.gov for New Hampshire homes.

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