As New Jersey sets out to improve its ability to deliver the long-term support and services that older and disabled residents need, there is no shortage of proposals — some of which are already under way — on how to best achieve this goal.
One of the chief reasons that state policymakers — along with healthcare industry representatives, advocates, and analysts — see room for improvement is that AARP recently scored New Jersey 26th in the country for these services. The AARP scorecard was analyzed and assessed at an NJ Spotlight webinar yesterday.
Foremost among potential legislative proposals is a bill, A-2955/S-2127, that would require hospitals to ask patients if they want to designate a caregiver who would then be notified before the patient is discharged and provided with a plan describing what help the patient will need.
Bill sponsor Sen. Joseph F. Vitale (D-Middlesex) said the bill would help caregivers understand how to meet the needs of family members who are returning home. He said he has heard several times about residents “having loved ones come home and not having the right tools and the right information about how to care” for them.
The scorecard, prepared with the help of the Commonwealth Fund and the SCAN Foundation, ranked New Jersey 36th in the country in the effectiveness of the transitions between residents’ homes, nursing homes, and hospitals. The state did particularly poorly in the percentage of nursing-home residents with dementia who face multiple burdensome transition at the end of life.
Susan C. Reinhard, senior vice president for AARP, said the issues raised by the bill reflect a broader set of concerns — both in New Jersey and nationally — regarding how healthcare professionals interact with patients and their caregivers. She said that too frequently, nurses and other providers assume that tasks that they are familiar with, such as using a wheelchair, will be easy for a patient.
“You kind of get into the routine that this isn’t hard because we do it all the time,” said Reinhard, who has served as deputy commissioner for the Department of Health and Senior Services. “ Part of it is, every professional — nurses, social workers, doctors, pharmacists. We all have to remember that we know more than the people we are caring for, and we can’t forget that — not to lord it over them — but to try to remember that this is mysterious, this is difficult, this is stressful, and that they really don’t know what to ask you.”
There are also areas where the state is making progress.
Lowell Arye, who oversees the state Division of Aging as deputy human services commissioner, said the state has increased access to caregivers of essential information through its Aging and Disability Resource Center. The ADRC link:http:www.adrcnj.org|website] includes contact information for services and providers, as well as tips on how to handle specific issues, from bathing to tax preparation.
The state has increased the training of ADRC staff members through a certification program developed with Rutgers University, Arye added.
But the change that will make the biggest impact is the shift to managed care for long-term support and services as part of the state’s comprehensive Medicaid waiver. This transition, which occurred on July 1, will provide more resources to residents who are receiving services in their homes or in community settings rather than in nursing homes.
Arye added that several developers of assisted-living communities have recently expressed an interest in expanding into New Jersey, and state officials believe they were attracted by the introduction of managed care for long-term support and services.
New Jersey can also draw inspiration from states that performed better on the scorecard, such as Minnesota, which ranked No. 1. While that state has seen strong political shifts in recent years, its human services officials have stuck to a state plan to provide long-term services.
“It’s a plan that they did years ago and they updated it, but they stick to their strategic plan and it’s communicated to all citizens,” Reinhard said, adding that this has built a “culture” in support of high-quality services. “They are able to maintain this when there are different governors, when there are different parties in control.”