Friday, September 21, 2018
Opinion

Column: What Hurricane Irma taught us about better care for older people in Florida

Irma cut a destructive path through Florida, leaving many people with damaged homes and businesses and communities without essential infrastructure and services. One of the saddest, most heart-wrenching and perhaps avoidable of all the terrible effects from Irma was the death of 10 residents in a Hollywood nursing home and the suffering of more than a hundred other residents. That these individuals suffered as a result of negligence on the part of the facility's operators seems clear and will ultimately be decided by regulators and the courts.

But that should not be the end of the scrutiny. In fact, it should open our eyes to an issue that has not received proper attention for several years — the state of publicly funded long-term care, or LTC, in Florida. We have good reason to fear that the state is not prepared to care properly for the great growth in LTC over the next 20 years. This growth will come with the unprecedented increase in Florida's 75- to 85-and-older population between now and 2040.

Florida does not have the foundation required to meet the future need for care provided through in-home, nursing home and assisted-living programs. AARP released a report in June that provides a well-designed comparative assessment of every state's LTC system using criteria such as ease of access to care and quality of care provided. Florida was ranked 46th in the overall quality of its publicly funded LTC system, far below states such as Washington, Oregon, Minnesota and Wisconsin, which are ranked the highest. Florida ranked 43rd in the 2013 AARP report.

Further illustrating the problems facing older Floridians needing LTC are the long and growing wait lists. The wait list for Medicaid-supported services alone is more than 47,000 people and grows each year by several thousand, a pace likely to increase if more funding is not made available soon. Closer analysis of these trends is needed, with an eye toward policies and funding increases that can address the gaps in care for older Floridians.

Policymakers also need to take a close look at the way Florida delivers publicly funded LTC services. In 2013, the state removed control of community-based LTC programs from the long-standing non-profit Aging Network by contracting for the delivery of these services with for-profit HMOs. This shift was made with very little public debate, in spite of the fact that the Aging Network organizations had built and very effectively administered the publicly supported community-based programs for over 25 years. It is time to take an in-depth, objective look at this arrangement and determine if it is best for the state and its citizens as we prepare for the future.

Florida has a long history of innovation in LTC stretching back to the creation of community care and home care programs for the elderly in the mid 1970s. The state also has a history of using governor- and Legislature-appointed commissions on aging to identify issues and concerns and generate innovative policy options to address them. Three commissions were appointed between 1984 and 2000. The 2000 commission, chaired by Lt. Gov. Frank Brogan, produced a comprehensive set of policy recommendations that were supported by Gov. Jeb Bush and largely passed into law by the 2001 Legislature. Unfortunately, some of the most progressive provisions of this legislation, including increased caregiving staff levels in nursing homes, have been undone since 2005 in order to reduce funding in the Florida Medicaid LTC budgets.

A lot has happened since 2000 as the population needing LTC has grown and programs have changed. It is now time for a new commission to be appointed with a comprehensive mandate to address the future of aging and LTC in Florida. The commission would be expected to inform the public and policymakers about what we are doing well in LTC, where we are failing, and what we must do to ensure the citizens of Florida that our LTC system will be able to provide the quality of care that people needing help deserve in the years ahead.

It does not take a commission, however, to know that the state should begin now to increase funding substantially for its LTC system in order to reduce the number who need care but aren't receiving it and to better prepare for the huge increase in need for LTC that is already under way.

Larry Polivka is director of the Claude Pepper Center at Florida State University.

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