System Principles:

1. System Principles: The Path to Real Long Term Care Reform

2. Strategic Principles • Participant-Driven • Choice, Equity, and Quality • Build on High Quality Local Systems • Effective relationship with local acute care system • Integral Long Term Planning • Provider Accountability

3. Participant-Driven • Consumers and Families are active participants in all stages of design and implementation • Cornerstone is Person-Centered Planning • System honors the preferences of consumers • System supports Self-Determination

4. Choice, Equity, and Quality • Choice of caregivers, services, supports, and residential options • Quality and Accountability Outcomes • Competent, committed, and valued workforce • Adequate amount of services and supports statewide

5. High Quality Local Systems • Maximize supports and services resources • Consider impact of all changes on existing community supports • Flexibility of supports; clarity in outcomes • Encourage and support innovation locally

6. Relationship with Acute Care • Be distinct from the locally available acute care system • Have a clearly articulated method of coordination with the acute care system • Clear and unambiguous financial and functional eligibility criteria • Easy and universal access across settings. • No loss of current supports

7. Integral Long Term Planning • Independent actuarial evaluation • Savings expand supports • Independent PCP facilitation • Timely Implementation quality • Service limitations are over the whole program, not on individuals

8. Provider Accountability • Explicit contractual responsibility for quality of services and their delivery • State maintains a system of effective monitoring and measurement of quality • Sanctions, including payment refusal, for low quality • Uniform, timely appeal system • Independent investigation of critical incidents, abuse, neglect, and rights violations

9. Operational Principles • Logistical • Social • Coordination • Decision-Making • Waiting Lists • Transition and Diversion • Consumer Input • Workforce

10. Logistical and Coordinative • Rollout in staggered phases to assure effectiveness • Subcontract with existing community organizations with expertise • Pilot untested components • Expand only after thorough evaluation

11. Social • LTC services must not be medically driven. • Social models using PCP must frame any medical services • Linkage to acute care must be seamless • Access to LTC must not be fragmented (SPE)

12. Coordination • Service Coordination must be independent • Service Coordinators must be qualified by: • Experience with seniors and persons with disabilities • Deep understanding of consumer control • Local program understanding and experience • Knowledge of person-centered planning

13. Decision-Making • Medical recommednations made by trained providers who know and treat the person • Authorizations made by those who know the person • Both internal and independent conflict resolution systems • Timely process to accommodate emergencies

14. Waiting Lists • Dynamic plan to reduce waiting lists • No reduced access through utilization monitoring • No reduced access to prescription drugs • Shift savings into reducing waiting lists

15. Diversion and Transition • Everyone who wants out gets out • Use outcomes as evaluated by the person in the community • Ensure enough community providers

16. Consumer Input • Free access to all program and provider information • All Committees have at least 50% consumers • Self-Determination in every program option

17. Workforce • Plan to expand wages and benefits • Free training and skill building programs • Use of registry as work recruitment system • Effective backup system • Consumer can hire, manage, and fire

18. Resources • LTC Scan http://radio.weblogs.com/0139791/ • Transition Curriculum http://nfti.prosynerg.com • Consumer Consortium http://www.copower.org/mfp/index.php • LTC Blog http://fan-the-flame.blogspot.com/