In 1980, Florida was recognized as a national leader in innovative care for older people with long-term care needs, thanks to its implementation of the Community Care for the Elderly and Home Care for the Elderly programs. These programs provided supportive services such as personal care, homemaker and home health care, to older persons in their own home that helped them delay moving into a nursing home as long as possible.
By the early 1980s, these programs had already proven to be popular with the public and cost-effective from a public policy perspective. Their success made them models for community-based care across the country, and they inspired the first Medicaid funded, in-home long-term care programs in the early 1980s.
Over the past 30 years, however, Florida has lost its status as a pioneer in long-term care services. In fact, Florida has ranked no higher than 43rd among the states in three national assessments conducted by the AARP over the last seven years. In 2017, Florida fell to 46th, with below-average performance on most of the 26 measures.
What happened? How did Florida slip from its status as an innovator of precisely the kinds of cost-effective long term care services that give older people the freedom to make choices, to exercise as much control as possible over their environments, and to have access to services when they need them?
A key reason is tight, austerity-driven budgets at the federal and state levels, which have diminished the ability of state programs to meet critical public needs including the long-term needs of Florida’s older population, which will double over the next two decades.
The state has also fundamentally changed its long-term care financing and service delivery system by moving from a system of community-based care provided by nonprofit Aging Network organizations to a system administered mostly by for-profit health maintenance organizations associated with large health insurance companies. The Legislature made this shift in 2011 despite evidence of the effectiveness of the nonprofit Aging Network administered community-based service system that had worked well for more than 20 years.
The establishment of a commission assigned to assess the status of Florida’s long-term care system and to recommend interventions is long overdue. The last such commission met in 2000 and produced comprehensive recommendations supported by Gov. Jeb Bush and passed by the 2001 Legislature. Much has changed since then, and we need to prepare the state for the unprecedented increase in the need for care over the next 10 to 20 years. State policy makers cannot pretend that giving HMOs control of the Medicaid long-term care system relieves them of direct responsibility for ensuring that tax dollars are being spent wisely and that older and younger disabled persons who meet eligibility criteria have access to high-quality long-term care services when they need them.
The mandate for a new commission on long-term care in Florida should include the following objectives:
• rigorously assess the costs and the effectiveness of the current long-term care system in meeting the needs of older and younger disabled Floridians;
• compare Florida’s long-term care policies and practices to those of other states with recognized systems of effective and efficient Medicaid long-term care services;
• use this assessment and comparison information and public testimony to develop a comprehensive set of policy recommendations for legislative and executive agency actions.
Floridians deserve no less.
Larry Polivka is executive director of the Claude Pepper Center at Florida State University, which focuses on the health, long term care and income security challenges confronting the nation’s older citizens.