Tennessee: Long-term care bill signed into law

Gov. Phil Bredesen signed into law a long-term care bill Tuesday that he said will be “a legacy piece” of his administration.

“This is something that’s going to have an awful lot of impact on a lot of Tennesseans for many, many years to come,” Gov. Bredesen said to legislators, advocates, media and long-term care patients gathered in Chattanooga. “What this is about is families having additional choices, having options and having a greater number of Tennesseans in need of care be able to have that care and stay in their homes.”

As one in a series of ceremonial bill-signing events, Gov. Bredesen signed into law the Long-Term Care Community Choices Act of 2008, which passed unanimously in the House and Senate last month. The legislation expands access to home and community-based services for Tennessee's elderly and disabled by restructuring the long-term care system and reallocating funding for less intensive and more affordable alternatives to nursing home care.

The signing followed the governor’s stops Tuesday in Kingsport, Tenn., and Knoxville. The governor is scheduled to travel today to Nashville, Memphis and Jackson, Tenn., for similar events, administration officials said.

Rep. JoAnne Favors, D-Chattanooga, a registered nurse who supported the bill, said at Tuesday’s event that support for the bill in the Legislature was widespread.

“It went across party lines. Everybody was interested because we all know one thing: If we aren’t called home, we will also be in the same situation as our elderly people,” she said.

The law makes the state’s nine Area Agencies on Aging and Disability the single point of entry into the state’s long-term care system and speeds up the approval process to get on the home- and community-based care waiver, said Steve Witt, director of the Southeast Tennessee Area Agency for Aging and Disability, which administers the area’s home- and community-based services.

“One of the purposes of the bill is to streamline the process so it doesn’t take as many days from the time you are assessed to the time you get in,” he said.

On average it takes two months to get approved for home- and community-based care services, he said. That wait can be too long for a patient waiting to be discharged from a hospital or who cannot live entirely independently, and the delay may mean that patient ends up in a nursing home unnecessarily, he said.

Before signing the legislation, Gov. Bredesen thanked nursing-home industry officials in the state for looking at the legislation’s emphasis on nursing-home alternatives as an opportunity for their facilities to expand services.

Other governors trying to reform their states’ long-term care systems confronted harsh resistance from the nursing-home industry, Gov. Bredesen said.

In a telephone interview Tuesday, Deborah Heeney, director of government relations for the Tennessee Health Care Association, acknowledged lingering worries that the bill could affect the nursing-home industry adversely.

“I think initially we probably did have some of those concerns, and I don’t know that those concerns have totally gone away, but overall the industry and THCA is trying to look at this as an opportunity,” Ms. Heeney said.

The bill emphasizes the need to rebalance funding for long-term care options. In the fiscal year that ends June 30, about 98 percent — or almost $940 million — of the state’s $1.1 billion in long-term care funds went to nursing homes, state officials have said.

In the fiscal year 2009 budget, Gov. Bredesen also added $12 million in funds to support 2,300 more people on the state’s home- and community-based care Medicaid waiver, which now can cover 3,700 Tennesseans.

The bill singing was held in Chattanooga at the Alexian Brothers Community Services’ PACE program site, a community-based nursing home alternative for Hamilton County residents over 55 who meet the eligibility requirements for nursing home-level care.

Viston Taylor, president and chief executive officer of Alexian Brothers’ Community Services in Chattanooga, said the new legislation is “historical.”

“It’s not that nursing homes are a bad thing. There are times when people truly need a nursing home,” he said. But many people who can be certified for nursing-home care actually could thrive in an at-home setting as long as they get some help, Mr. Taylor said.

“We’re establishing state policy for the first time which provides the structure for reallocating state resources, not just monopolized by the nursing-home industry, but ... giving citizens choice in what kind of long-term care services he or she wants,” he said.