This paper needs to be corrected & updated based on the teacher notes on the paper. The paper also needs more information on the subject below and it should follow the rubric. I will pay a price today but if i receive a grade higher than a b i will pay extra and i don't mean a little either.
Select one of the following issues. Write 10-12 double-spaced pages (not including the title page or references) on your chosen issue. Use information from the textbook, extra handouts distributed in class, and information tracked down from other sources. Cite a minimum of five information sources (may include textbook and credible, government or organizational web sites, and peer-reviewed articles). The paper should show insight in discussing issues, not just a verbatim repeat of data from the text.
All papers should be typewritten or word processed (i.e., no handwritten papers accepted), and checked for spelling and grammar. The due date for the paper is given on the syllabus. No more than 15% of the words should be direct quotes.
Your state is attempting to integrate services for people needing long-term care. Using an organization chart or list, identify all the departments and programs run by the state that potentially are related to long-term care and thus should be involved in the integration effort. Describe how this initiative should be orchestrated (i.e., the process for coordinating this change). Outline services and financing programs that should be involved; participation may be phased in over time. Explain how the integration should be implemented at the local client level and how staff and offices will be prepared to accomplish integration.
Grading Rubric: Issues Paper (Week 5)
A. Paper Style/Formatting/Submitted on time
B. Description of the selected scenario with enough detail to provide the background for the remainder of the paper.
C. Description of the problems being addressed and purpose of the paper.
E. Paper reflects the knowledge student has learned in all prior health care administration courses ? including finance, accounting, epidemiology, legal and ethical, health information systems, human resource management, and health care research courses.
F. Conclusions in the paper are logical and highlight the main points of the paper.
G. The student?s paper is creative.
Running Head: LONGTERM CARE 1 You are missing a title
Octavia L. Davis
HCA 330/ Mr. Hopper
Long-term Care LONGTERM CARE 2 Life is such that no one visualizes himself or herself spending his or her later years in a
nursing home. Yet, majority of old people find their way into a nursing home for long-term care
since they cannot afford to pay for care at the convenience of one?s home. Long-term care aims
at helping the old and people ? do you mean old people? Or perhaps ? the elderly? living with
disabilities accomplish everyday tasks that prove hard for them due to old age and the
disabilities. The number of elderly in the United States of America is on a continuous rise and is
expected to continue for a longer period, as the generation of the baby boomers reach 65 years.
This continues to increase the number of the proportion of the United States people who are
elderly. As such, long-term care has become an urgent issue among policymakers. ?There is a
concern on how to care for the increasing number of the elderly with disabilities prompting the
need for planning for the long-term care cost, quality of the care, and an increasing concern on
how to share the burden with the individuals, family, and the whole society for the long-term
care? (Matthews, 2008, page#?). This paragraph doesn?t help to answer the rubric questions?At
least in its current position?
The problem in Virginia is no exception from the other states in the United States.
Virginia hails as one among identified seven states in America where the population of those
aged 65 years and above is increasing with an increasing number of those disabled and/or with
dementia and is projected to continue in the next several decades. As such, long-term care
financing in Virginia will continue to be a huge burden for the government. As it stands,
Medicaid is the principal fund for long-term care across the country as well as in Virginia, which
is strenuous to the federal and state revenue. Yet, in Virginia, private sources to finance long-term
care that could supplement the Medicaid program have not been implemented. ? I am not sure
that I follow? implemented by whom? The government doesn?t control private funds? Thus, LONGTERM CARE 3 the state is continuously using Medicaid to finance long-term care. ?It then prompts the need for
implementing private sources of financing to reduce financial pressure laid on the government
and taxpayers by reassessing the long-term care financing? (Kane & West, 2005, page #?).
These two paragraphs are confusing ? at times ? and don?t really help you to achieve your
objective, which seems to be in completing the third bullet on the issues paper options. I would
rework in this way?
Start with an introduction. Your introductory paragraph should serve as the roadmap for readers
to follow. In a relatively short paper like this one (as opposed to a book), you would place the
introduction first? You also don?t want to posit questions in the introduction? I will have more
to say after reading your next paragraph?
This paper will attempt to look at these issues. There is a currently a huge concern about
long-term care for the elderly in United States and expensive for the taxpayers. The fact that the
baby boomers generation is aging ? isn?t everyone aging? ? getting older? will increase the longterm care need by whom and for whom? and radicalize ? wrong word choice? the cost of this
care, which is a strain on the federal and state budgets. The government ? which government?
aspires to rebalance care from institution-based to programs that are based on community and
home. Having this in mind, what initiatives can the government in Virginia implement to expand
the Medicaid program? ? I thought that you wanted to transition things to private hands (from
your last paragraph)? How can it make long-term care attractive to more people while offering
high quality care that is efficient and accessible for all? In addition, how can the state
government of Virginia implement private financing to long-term care to reduce the financial
pressure already felt by the government and taxpayers? By thus doing reduce heavy dependency
on the social programs that elicit a state of entitlement among the citizens. ?Focusing on these LONGTERM CARE 4 highlighted problems facing the state of Virginia, policymakers will be in a position to ensure
system of long-term care is balanced so as to survive in the future while expanding the Medicaid
program to incorporate private revenue.? (Kane, West, 2005).
This paragraph contains a number of grammatical/structural errors. More importantly, you
introduction doesn?t serve as a viable roadmap for the reader ? at least not if you are answering
the questions posed in bullet point #3 on the issues paper instructions/rubric sheet.
Suggested improvements ? for the introduction
The Commonwealth of Virginia is attempting to better coordinate long-term care services
in an effort to provide better service to its growing elderly population. As a first step, the state
put together a list of ___. Next, it created a three-step action plan for integrating key, long-term
care related functions across these departments. As part of this process, the commonwealth
identified the key programs that it needs to integrate. Finally, it created an action plan for
ensuring that requisite changes take place not only at the state level but also in each locality.
As noted above, the baby boomer generation in Virginia advances with a threat of the
population of those with 85 years and above rising as well. Research indicates that Virginia longterm care cost is approximately the same as the national cost. As such, a relatively large
proportion of the Medicaid program in Virginia accounts for the intensive needs for long-term
care, which is the primary payer for long-term care. There is need for rebalancing the Medicaid
program in a bid to improve long-term care. The state government wishes to rebalance from the
preferred institutional based services to home and community-based services (HCBS) and by
doing so save money. One solution offered by rebalancing the Medicaid program is using
waivers. Unlike personal care offered by the state plan, waivers allow control of Medicaid fund LONGTERM CARE 5 utilization. Including waivers for the aged, the blind, and the disabled to receive long-term
services and support from the community will make the Medicaid fund more attractive to many.
As such, as people approach the age where one requires long-term care, one will plan to pay for
his or her long-term care using the established Medicaid plan. ?While this may not necessarily
result into money saving, it will result into people moving from institutionalized care to HCBS.?
(Matthews, 2008) -- Might apply to Medicaid ? but instead, you want to be talking about
integrating the various services/programs? So, I have read through your paper?The entire document refers to Medicaid ? with a dash of
public education and regulation mixed in?; however, the Commonwealth of Virginia manages
or funds (or both) quite a few programs, which are related to long-term care. I am not sure how
much of the paper you can actually use? You will have to eliminate most of the narrative. In its
place, I have created headers that will cover each of the sections you need to
cover?.Additionally, please refer to the introduction; you should use it to help guide you?.
The Reasons for this Initiative
You can use some of the information in the previous paragraphs. However, you want to
ensure that you create strong topic sentences that focus your reader?s attention on the reason why
Va is doing this? Something like Virginia can __ (save money?) and improve services for the
elderly by __.
Departments and Programs Related to Long-Term Care
In this section, you want to identify the top seven or eight key programs or services for
the elderly. You want to let the reader know a) what it is/what it does, b) why it is important LONGTERM CARE 6
Key Steps in the Integration Process Convince Relevant Stakeholders
Alert the Public
Create a Coordinated Communications Network
Integrate __ and ___
Merge __ and __
Measure the Success of these Integration Efforts
Implementing these Changes at the Local Level
Currently, you don?t really cover many of the key points on the instruction sheet. If I graded this
one on a rubric, I wouldn?t be able to give you that high of a grade. At the same time, I realize
that you put a lot of effort into this one. I will give you a 60%. Additionally, I?d be happy to
review a draft of your new paper on Monday morning (if you can send it to me by then).
The other issue facing the government of Virginia as it endeavors to move from
institutionalized care to HCBS is how to provide quality care to the patients. The biggest
challenge lies on how to reimburse the caregivers adequately for the work the services they offer.
Proper reimbursement stands as one of the incentives for care providers. Owing to the fact that
there is an expected rise in the number of individuals who will need long-term care in the near
future, there is need for a plan to motivate caregivers through proper reimbursement. ?Otherwise,
a problem will arise in the state where there will not be enough caregivers to cater for the rising LONGTERM CARE 7 number of patients under the waiver regime, as caregivers cut on hours they offer their services
to the long lists of individuals needing care.? (Kane, West, 2005).
To cut on the pressure placed on Medicaid as the single payer of caregivers?
reimbursement, the government in Virginia is integrating private financing to add to Medicaid.
One such ways is putting strict rules so that the social program caters fully for the poor in the
state while those in the middle and high class spend on their private resources. The federal
government puts eligibility for all, the poor and the rich alike, to benefit from the Medicaid longterm financing without significant private expenditure. However, as shown in Virginia, the rate
of growth of the elder generation is on the rise in a way that is straining the state resources. As
such, the state government should develop an asset send down plan where the rich utilize the
savings they accumulated for retirement. Arguably, it is only fair that people receiving long-term
care by public funds while they retaining personal wealth reimburse the Medicaid program to
sufficiently cater for all, especially those who have no wealth on their own (United States, 2006)
In addition, most old people own homes. While the Medicaid program offers a Medicaid
home equity exemption, incorporating home equity conversion in Virginia will go a long way in
saving the Medicaid funds. In so doing, many people would use their home converted equity to
pay for long-term care before depleting it to rely on Medicaid. Moreover, people who are 62
years and above can reverse their mortgages on their homes when the individual owner becomes
too ill for mobility, or when mortality begins. The equity extracted from the mortgage reversion
could be used to fund for private HCBS. Per the adventure that the families of the elderly person
wants to retain the home, the family could come through and pay for the long-term care of the
individual. Lastly, the Virginia government should encourage the purchase of private long-term
care insurance among the citizens early before individuals become old and in need of long-term LONGTERM CARE 8 care. ?The government should invest in a public campaign to educate the public on the need for
such insurance and work with insurance companies to set realistic premiums for the covers.?
(Pratt, John, 2016).
All the programs that potentially relate to long-term care for the elderly and disabled are
under the umbrella of Virginia Association of Area Agencies on Aging (V4A) The V4A will work
with all the 25 agencies involved with providing long-term care to the elderly and the disabled in
Virginia. As a non-profit organization, V4A advocates for the needs of the elderly in Virginia,
serves as the mediation between the state and national organizations while providing solutions to
the problems faced by the elderly. By thus doing, V4A endeavor to help the elderly live with
dignity in their communities. The agencies and programs under V4A that will be incorporated in
the integration efforts include Virginia department for the aging, together with other public and
private agencies such as New River Valley Agency on Aging, District Three Governmental
Cooperative, and Appalachian Agency for Senior Citizens Inc. among others (United States,
The department of the medical assistance services (DMAS), division of long-term care is
the sole pursuant of all-inclusive programs for the elderly in Virginia as authorized by a special
session of Virginia ACTS Assembly, 2006. The special session was set in motion as a reform of
the Virginia Medicaid long-term care programs. To integrate acute and long-term care system in
the state, the DMAS seeks a community-based model program of all-inclusive care for the
elderly (PACE) in keeping with the efforts by the state government to rebalance long-term care
from institutions to HCBS. The program, PACE, is an all-inclusive program that provides longterm care services to the elderly in the community without discriminating or placing a limitation
of time or dollars, as long as an individual meets the nursing facility criteria and chooses to LONGTERM CARE 9 continue staying in his or her community. Funding to the program combines Medicaid, Medicare,
and private pay thereby avoiding costly stays at a nursing facility. By providing the services
within a community setting and using a financial mix for funding, the program helps to reduce
the burden placed on the state government to fund for long-term care and reduce the number of
individuals in institutions (Matthews, 2008).
Having the V4A on board, the transition efforts will be easier. This is because the
organization provides a network for exchange of information among the area agencies. The
organization also provides an opportunity for developing ideas, and discussions of the potential
solutions to the problems facing the elderly. The V4A utilize the available resources to operate
long-term care for the Ombudsman Program. As such, the organization acts as the primary
mediation between for all the programs involved in the integration efforts. The Ombudsman
program is mandated to include community-based long-term care among the elderly in the
society. While the core role of the program is to promote consumer care by responding to
complaints and providing education, its integration with V4A, a contract under Virginia
Department for the Aging enable the program to work with all the private and public area
agencies on aging (Kane, West, 2005).
To orchestrate the change, the incorporation of Medicaid with private financing for longterm care in Virginia, the process will start with discussions by all the area agencies mediated by
Virginia Association of Area Agencies on Aging. Being an already established organization that
go between area agencies, this will be the best starting point. The talks will look at the problems
facing the state at the moment and the implied impact in the future. With an established direction
to take for the state, the agencies will look at how to incorporate the recommended private
financing proposals and how to incorporate them in their programs. ?After the discussions that LONGTERM CARE 10 incorporate all the area agencies, the V4A will take the initiative of training and educating the
public.? (United States, 2006)
Public education will feature asset spent down and estate recovery so that those that have
accumulated wealth, middle class and the upper class fellows, reimburse the long-term care
funded by Medicaid in helping the state government efficiently finance for long-term care for
poor who do not have any wealth to rely on apart from the social programs.V4A will educate the
public on home equity conversion where citizens who own homes could sell their homes to fund
for their long-term care. Alternatively, those who are 62 years and older can reverse their
mortgages for equity to fund community-based long-term care. In addition, V4A will educate the
public on private long-term care insurance so that those who are young can make an investment
before getting to the age when they need the care. The education will focus on the advantage of
having private funding including consumer control. Under Medicaid, what one buys is federally
stated and as such one does not have control to the much or little one requires. With private
financing, one purchases the much or little one foreseehe or she needs thereby retaining dignity
and independence while practicing autonomy. ?Public education will focus on individual
targeting insurance companies that are not out to make ambiguous profits thereby offering
quality investment to its consumers.? (Ronch, Weiner, 2003).
While public education is ongoing, private insurance companies will work together under
the insurance regulation board to standardize the amount of premiums individuals will pay. The
autonomy given to insurance companies makes them independent so that a company can model
an insurance product and charge at whatever premium. However, allowing the insurance
companies to work independently without regulation as in the past has seen the rise of premiums
so that individuals run away from private insurance. Since the government in Virginia hopes to LONGTERM CARE 11 encourage individuals to purchase private insurance to cater for long-term care, one of the
strategies to encourage consumers to purchase private long-term care insurance is to regulate the
insurance companies. ?Further, regulation will stop insurance companies from making supernormal profits at the expense of the consumers.? (Pratt, John, 2016).
Anotherimportant step is the integration of the acute and long-term care so that long-term
care for the elder and the younger generation living with disabilities access long-term care in a
similar way. As such, agencies that has arbitrary age restrictions for long-term care beneficiaries
will revoke the restrictions and operate on an all-inclusive approach. Agencies in both the private
and the public sector should come together under a governmental organization for proper
monitoring of the services offered to the public so that anyone in need of long-term care accesses
it as a basic health care without discrimination on age and/or wealth. In this case, the V4A will
operate as the monitoring organization and the organization between the people, the agencies in
the state, and the federally ran agencies. ?As a state, have an umbrella body that oversees the
operations of the member agencies especially in regards to incorporating the acute and long-term
care.? (Ronch, Weiner, 2003).
Importantly, with the corporation of private financing, discussions on the method of
reimbursing the caregivers in the home and community based services should arise. As discussed
earlier, the rise in the number of the elderly generation plus the inclusion of the young living with
disabilities in the long-term care programs necessitates the need for proper reimbursement of the
pare providers. More so with the inclusion of private financing for long-term care. Further, the
move from institutionalized care to home and community-based services will increase the
number of people who require long-term care in the community. As such, proper reimbursement LONGTERM CARE 12 is a huge discussion so that there will be enough care providers to deal with the long queues at
the community services and the diverse needs (Kane, West, 2005).
In addition to proper reimbursement of the care providers, sufficient talks need to prevail
on how to provide quality care at the community-based services. Bearing in mind that there is an
increasing number of the elderly, and the number is expected to keep n the rise, there is need to
increase the number of the care providers in the community services who will proportionately
share the number of individuals they look out for without being overwhelmed. It is evident that
when one care provider has a big number of people to take care for, the levels of tiredness are
highand the result in most cases is unsatisfying care. It is imperative that having paid for one?s
long-term care, one receives the kind of care one is paying for. Hence, it is important that the
number of care providers be increased in the community-based services to balance the ratio of
the care providers with the patients. Further, the equipment and facilities available at the HCBS
ought to be the kind that will offer quality care to the patients. There is a need for the care
provider to be knowledgeable on how to operate these equipment and gain additional sills n how
to provide the desirable quality of care (Pratt, John, 2016).
In conclusion, Virginia is among the states where the proportion of the elderly and those
in need of long-term care is on the rise and is expected to keep on the rise in some decades to
come. As the state moves the long-term care from institutions to home and community-based
services, there is a need to bring the agencies working with the elderly and disabled together in a
bid to provide quality long-care to consumers. ?Further, there is need for the state to incorporate
private financing from Medicaid for all to reduce the burden that has on the government and the
taxpayers.? (Matthews, 2008) LONGTERM CARE References
Matthews, J. L. (2008). Long-term care: How to plan and pay for it. Berkeley, CA: Nolo
Pratt, John R. 2016. Long-term care: managing across the continuum.
Don?t indent first line? Kane, R. L., & West, J. C. (2005). It shouldn't be this way: The failure
of long-term care. Nashville: Vanderbilt University Press.
Don?t indent first line? Ronch, J. L., & Weiner, A. W. (2003). Culture change in long-term
care. New York, NY: Haworth Press. Did you retrieve this from a source?
Don?t indent first line? U.S. Government Accountability Office. United States.
Indent (March 2006). Long-term care facilities: Information on residents who are
registered sex 13 LONGTERM CARE 14 offenders or are paroled for other crimes. Darby, PA: Diane Pub. Co. Retrieved from
No indentation in the first line Evashwick, Connie. (2005). The continuum of long-term care.
Indent the second line New York: Thomson/Delmar Learning. Retrieved from
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