The Quality of Health Care
In-Brief: Home Care Quality: Emerging State Strategies to Deliver Person-Centered Services
Research Report
Enid Kassner, AARP Public Policy Institute
March 2006
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Table of Contents: Introduction and Purpose | Key Findings | Conclusion
Introduction and Purpose
This In Brief summarizes the findings of the AARP Public Policy Institute (PPI) issue paper, Home Care Quality: Emerging State Strategies to Deliver Person-Centered Services.1 The growth of publicly funded home care services and supports for persons with disabilities has led federal and state governments to devote increased attention to the quality of care being provided. Traditional methods for assessing quality, such as standards for home care agencies and workers, have been found inadequate in addressing whether consumers are satisfied with the care they receive, whether they receive the type and duration of care they believe they need, and whether their quality of life has been maintained or improved. The purpose of this paper was to illustrate several states’ attempts to craft a more person-centered approach to quality assurance. After a review of all state quality systems, three states (Wisconsin, Washington, and South Carolina) were selected for analysis.
Key Findings
States are now taking incremental steps to change the paradigm that has dominated quality assurance systems for home care – a pattern that has almost forgotten the consumer in the process of documenting structure and process standards for providers. These traditional quality standards have been weak in helping care managers assess the outcomes of services to the consumer and the quality of life that the consumer is experiencing. The states that are highlighted in this report are using a more person-centered approach to quality assurance in home care through improved communication with consumers, greater responsiveness in care management, and more effective information technology.
Top of PageWisconsin:
- As part of its Family Care Program, Wisconsin has developed 14 “member outcomes” to assess how well care providers address the needs and goals of program participants.
- A participant feedback system is used to assess consumer outcomes. State officials have intensified interactions with care managers to determine how well participant responses help care managers improve their performance.
Washington:
- Washington has developed an intensive monitoring system of the assessment and care plan processes to ensure that consumer needs are being correctly addressed by care managers.
- This system has become a more consistent and reliable measure of consumer needs. A fast-track financial eligibility determination process is speeding up consumer access to services. Careful monitoring of care manager performance is helping to ensure the development of appropriate care plans for the consumer, effective delivery of services, and improved training for care managers.
South Carolina:
- South Carolina is using information technology to help care managers assist consumers more quickly and to monitor consumer needs in both everyday situations and emergencies.
- The state has also developed an electronic monitoring system to verify that a worker is present when he or she should be and to ensure backup if a worker fails to report to work.
The federal government is guiding states toward improved person-centered quality assurance systems for home- and community-based services programs, and has imposed more stringent program requirements to ensure quality standards are met by the states. These actions include the following:
- Establishing a quality framework to guide state quality system redesign.
- Requiring concrete evidence from states that they are systematically monitoring activities and correcting problems.
- Crafting a new Medicaid waiver program application that requires more detailed information from states on their quality management systems.
- Providing substantial grant support for quality redesign initiatives.
Conclusion
With the encouragement of the federal government, a more person-centered approach to quality management is taking hold in states. This approach is designed to improve the daily lives of consumers by ensuring that authorized services are actually delivered, eligibility is determined in a timely manner, and the voices of consumers are listened to by care managers and home care workers. The quality assurance initiatives in the three states featured in this report point to the significant ongoing efforts that states are using to meet the challenge of ensuring quality care and support in the home. The challenge for state officials continues to be the creation of quality assurance systems that place consumer needs and goals for quality of life first.
Footnote
1 Folkemer, Donna, and Barbara Coleman. PPI Issue Paper #2006-07. February 2006.
Written by Enid Kassner, AARP Public Policy Institute
February 2006
©2006 AARP
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Pub ID: INB119