Why assisted living?  Why any long term care living?  My mom wants to stay home.  We know that it's in the future, but we're just not ready right now.  Dad is still doing ok.  It's just too expensive.

Working as the Marketing Director for Sunshine Gardens Senior Living Communities, I hear these phrases daily.  I also understand where people are coming from and can appreciate their concern and apprehension.  I just went through the long term care questions with my own grandfather before he passed on hospice care.  I now am working with his widow, my sweet grandmother, to help address her needs.  Families are faced with so many decisions and it is not easy.  In fact, it can be overwhelming and daunting. 

While I don't claim to be the expert, I have worked at Sunshine Gardens for over five years and have served on the Colorado Assisted Living Association's Board of Directors for five months now.  I see dozens of families on a weekly basis who are looking to help their ailing loved one find the best living solution for them.  When such people come to me and ask these questions, I am eager to hear their story and find the best solution possible.

Why assisted living ? This question comes up quite a bit when people prefer to stay in their homes.  I understand this plight; staying in our homes would be ideal, but most often if people are coming to me, their loved one needs more care.  When a person stays in their home, although their is concern for their safety; it can be very difficult for all involved.  Family members are constantly worried and often carry the heavy load of ensuring their loved one is cared for.  Sometimes home health or custodial care is hired, which can fill an acute need, but when they are not there, the safety issue again comes into play.   Many hospitalizations, rehab stints, and even nursing home placement comes into play when people "wait."  Then there is 24 hour care in the home.  For those who are fortunate enough to afford this care (over three times the cost of assisted living per month on average), the concern over quality of life and socialization comes into play.  So while people often feel the home is the best option, more often than not, there are more advantages to choosing an alternative care facility.

What about nursing homes?  People ask this question trying to understand the different levels of care and what to expect should their loved one's condition decline.  My answer is always the same; yes, nursing homes serve a purpose and offer more care and medical services than assisted living facilities provide.  However, the model is changing to bring those medical services to the resident right in the assisted living facility.  We work closely with the local home health, palliative, and hospice groups to offer a large variety of services should a resident need "more care."  There are also private groups we can work with should the resident's needs become even greater.  A majority of the time, these services are covered under Medicare, which substantially decreases the overall costs for the assisted living resident.  It is an excellent continuum of care approach that we have embraced and has proved successful in both Sunshine Gardens and the County Home facilities. 

There is no one perfect place for a person nor is there one perfect program.  We work hard to uncover all of the individual needs of the resident and tailor a program that is exclusive to them.  If you have any needs or require council on how to help your loved one; please call me.  I love helping people and I look forward to sharing what I have learned over the years.

Have a wonderful April, everyone!  Oh, make sure to take care of those taxes if you haven't done so, yet!

MEDICAID BILL 12-128

Thanks to: Colorado Assisted Living Association Legislative Committee

Please support BILL 12-128!  We are working to provide more options to Medicaid residents who want to live in assisted living facilities vs nursing homes!  Please contact the legislators and let them know what this means to you!  THANK YOU!  

This bill (some revisions) has passed the Senate in three readings, and the first reading in the House.  It will be heard for the second House reading the first week in April.

Second Regular Session
Sixty-eighth General Assembly
STATE OF COLORADO
INTRODUCED
LLS NO. 12-0237.01 Brita Darling x2241 SENATE BILL 12-128
Senate Committees House Committees
Health and Human Services
A BILL FOR AN ACT
101 CONCERNING ACHIEVING EFFICIENCIES IN THE MEDICAID LONG-TERM
102 CARE PROGRAM THROUGH GREATER UTILIZATION OF
103 ALTERNATIVE CARE FACILITIES.
Bill Summary

(Note: This summary applies to this bill as introduced and does
not reflect any amendments that may be subsequently adopted. If this bill
passes third reading in the house of introduction, a bill summary that
applies to the reengrossed version of this bill will be available at
http://www.leg.state.co.us/billsummaries.)

The bill establishes the 3-year alternative care facilities pilot
program (pilot program) designed to increase the utilization of alternative
care facilities in the medicaid program. Alternative care facilities
participating in the pilot program will receive a reimbursement for not 

SENATE SPONSORSHIP
Roberts,
HOUSE SPONSORSHIP
Summers,

Shading denotes HOUSE amendment. Double underlining denotes SENATE amendment.
Capital letters indicate new material to be added to existing statute.
Dashes through the words indicate deletions from existing statute.
more than 1000 clients equal to $3000 per client, per month, after
considering the client portion of the cost, to provide long-term care
services to clients who have been residing in a nursing facility prior to the
referral to an alternative care facility. The single entry point agency shall
assess the client residing in a nursing facility to determine whether the
client will achieve the same or better health outcomes and client
satisfaction in the alternative care facility.

On or before September 1, 2013, September 1, 2014, and
September 1, 2015, the department of health care policy and financing
shall report to the joint budget committee of the general assembly and the
health and human services committee of the senate and the health and
environment committee of the house of representatives concerning the
design, implementation, and outcomes of the pilot program on client
health outcomes, costs, and client satisfaction.
The pilot program repeals on July 1, 2016.

1 Be it enacted by the General Assembly of the State of Colorado:
2 SECTION 1. In Colorado Revised Statutes, add 25.5-6-113 as
3 follows:
4 25.5-6-113. Alternative care facilities pilot program -
5 legislative declaration - rules - report - repeal. (1) (a) THE GENERAL
6 ASSEMBLY HEREBY FINDS AND DECLARES THAT:
7 (I) THE NUMBER OF COLORADANS NEEDING LONG-TERM CARE IS
8 INCREASING;
9 (II) STATE GENERAL FUND EXPENDITURES FOR LONG-TERM CARE
10 ALREADY REPRESENT A SIGNIFICANT PORTION OF THE STATE'S MEDICAL
11 ASSISTANCE BUDGET;
12 (III) MANY PERSONS IN NEED OF LONG-TERM CARE ARE UNAWARE
13 THAT THEY MAY BE ABLE TO RECEIVE LONG-TERM CARE SERVICES IN A
14 HOME-LIKE ENVIRONMENT, RATHER THAN A NURSING HOME, AND AT A
15 LOWER COST TO THE MEDICAID PROGRAM;
16 (IV) ALTERNATIVES TO NURSING HOME CARE FOR PERSONS WHO
17 DO NOT NEED OR WANT THAT TYPE OR LEVEL OF CARE SHOULD BE
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1 DEVELOPED AND IMPLEMENTED;
2 (V) WHILE BEDS IN PRIVATE ALTERNATIVE CARE FACILITIES ARE
3 AVAILABLE, MANY OF THESE FACILITIES CANNOT ACCEPT MEDICAID
4 CLIENTS BECAUSE THE REIMBURSEMENT RATE FOR THESE FACILITIES
5 UNDER THE MEDICAID PROGRAM IS NOT SUFFICIENT TO INCENTIVIZE THESE
6 OFTEN SMALLER FACILITIES TO ACCEPT MEDICAID CLIENTS; AND
7 (VI) UNLESS COLORADO IMPLEMENTS NEW METHODS FOR
8 FINANCING LONG-TERM CARE, THE COST TO THE STATE FOR LONG-TERM
9 CARE SERVICES WILL CONTINUE TO RISE PRECIPITOUSLY, AND MANY
10 CLIENTS WILL CONTINUE TO BE SERVED IN NURSING HOMES PROVIDING A
11 LEVEL OF CARE THAT THE CLIENT NEITHER NEEDS NOR WANTS.
12 (b) THEREFORE, THE GENERAL ASSEMBLY FINDS THAT IT IS
13 APPROPRIATE TO ESTABLISH A PILOT PROGRAM TO PROVIDE GREATER
14 FINANCIAL INCENTIVES TO ALTERNATIVE CARE FACILITIES THAT ARE ABLE
15 TO MEET THE NEEDS OF MEDICAID CLIENTS AT A LOWER COST TO THE
16 MEDICAID PROGRAM.
17 (2) (a) ON OR BEFORE SEPTEMBER 1, 2012, THE STATE
18 DEPARTMENT SHALL ESTABLISH THE ALTERNATIVE CARE FACILITIES PILOT
19 PROGRAM THAT MAXIMIZES UTILIZATION OF ALTERNATIVE CARE FACILITY
20 PLACEMENTS FOR MEDICAID CLIENTS RECEIVING LONG-TERM CARE
21 SERVICES, REFERRED TO IN THIS SECTION AS THE "PILOT PROGRAM".
22 (b) UNDER THE PILOT PROGRAM, AN ALTERNATIVE CARE FACILITY
23 SHALL BE REIMBURSED AT THE RATE SET FORTH IN PARAGRAPH (c) OF THIS
24 SUBSECTION (2) FOR A MEDICAID-ELIGIBLE CLIENT REFERRED TO AN
25 ALTERNATIVE CARE FACILITY WHO WAS RESIDING IN A NURSING FACILITY
26 IMMEDIATELY PRIOR TO THE REFERRAL. FOR PURPOSES OF THE PILOT
27 PROGRAM:
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(I) A CLIENT 1 SHALL BE ELIGIBLE TO RECEIVE LONG-TERM CARE
2 SERVICES UNDER THE MEDICAID PROGRAM AND SHALL BE REASONABLY
3 EXPECTED TO CONTINUE TO NEED LONG-TERM CARE SERVICES FOR THE
4 FORESEEABLE FUTURE; AND
5 (II) AS PART OF THE REGULAR ASSESSMENT PROCESS, A SINGLE
6 ENTRY POINT AGENCY SHALL HAVE REFERRED THE CLIENT TO AN
7 ALTERNATIVE CARE FACILITY AFTER DETERMINING THAT THE CLIENT WILL
8 ACHIEVE THE SAME OR BETTER HEALTH OUTCOMES AND CLIENT
9 SATISFACTION IN THE ALTERNATIVE CARE FACILITY AS IN HIS OR HER
10 CURRENT NURSING FACILITY PLACEMENT.
11 (c) THE STATE DEPARTMENT SHALL REIMBURSE ALTERNATIVE
12 CARE FACILITIES PARTICIPATING IN THE PILOT PROGRAM AT A PER DIEM
13 RATE THAT EQUALS THREE THOUSAND DOLLARS PER MONTH, PER CLIENT,
14 REDUCED BY THE CLIENT PORTION OF THE COST. STATE DEPARTMENT
15 REIMBURSEMENTS TO ALTERNATIVE CARE FACILITIES PURSUANT TO THIS
16 PARAGRAPH (c) SHALL NOT EXCEED ONE THOUSAND CLIENTS.
17 (3) BASED SOLELY ON THE PROVISIONS OF THIS SECTION, A CLIENT
18 SHALL NOT BE REQUIRED TO MOVE FROM THE NURSING FACILITY WHERE HE
19 OR SHE RESIDES TO AN ALTERNATIVE CARE FACILITY, NOR SHALL THE
20 CLIENT, ONCE MOVED, BE REQUIRED TO STAY IN AN ALTERNATIVE CARE
21 FACILITY IF HIS OR HER FUTURE CONDITION NECESSITATES CARE IN A
22 NURSING FACILITY.
23 (4) THE STATE DEPARTMENT SHALL PROMULGATE RULES AND
24 SHALL SEEK ANY FEDERAL AUTHORIZATION NECESSARY TO IMPLEMENT
25 AND ADMINISTER THE PILOT PROGRAM.
26 (5) ON OR BEFORE SEPTEMBER 1, 2013, SEPTEMBER 1, 2014, AND
27 SEPTEMBER 1, 2015, THE STATE DEPARTMENT SHALL SUBMIT A WRITTEN
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REPORT TO THE JOINT BUDGET COMMITTEE O 1 F THE GENERAL ASSEMBLY,
2 THE HEALTH AND HUMAN SERVICES COMMITTEE OF THE SENATE, OR ANY
3 SUCCESSOR COMMITTEE, AND THE HEALTH AND ENVIRONMENT COMMITTEE
4 OF THE HOUSE OF REPRESENTATIVES, OR ANY SUCCESSOR COMMITTEE,
5 CONCERNING THE DESIGN, IMPLEMENTATION, AND OUTCOME OF THE PILOT
6 PROGRAM. THE REPORT SHALL INCLUDE, AT A MINIMUM, DATA AND
7 INFORMATION CONCERNING CLIENT HEALTH OUTCOMES, COST OF CARE,
8 AND CLIENT SATISFACTION, AND SHALL INCLUDE A COMPARISON OF THOSE
9 OUTCOMES, IF THE DATA AND INFORMATION ARE AVAILABLE, FOR SIMILAR
10 CLIENTS RESIDING IN NURSING FACILITIES DURING THE DURATION OF THE
11 PILOT PROGRAM.
12 (6) THIS SECTION IS REPEALED, EFFECTIVE JULY 1, 2016.
13 SECTION 2. Act subject to petition - effective date. This act
14 takes effect at 12:01 a.m. on the day following the expiration of the
15 ninety-day period after final adjournment of the general assembly (August
16 8, 2012, if adjournment sine die is on May 9, 2012); except that, if a
17 referendum petition is filed pursuant to section 1 (3) of article V of the
18 state constitution against this act or an item, section, or part of this act
19 within such period, then the act, item, section, or part will not take effect
20 unless approved by the people at the general election to be held in
21 November 2012 and, in such case, will take effect on the date of the
22 official declaration of the vote thereon by the governor.
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