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Reforms are coming to Indiana's nursing home system. Here's what they mean for Hoosiers.

Indianapolis Star logo Indianapolis Star 1/23/2021 Emily Hopkins, Indianapolis Star
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Officials from the state's Family and Social Services Administration revealed new details on Thursday about proposed reforms that could increase the quality of care for aging Hoosiers.

Secretary Jennifer Sullivan and Chief Medical Officer Dan Rusyniak laid out a four point plan that would allow more Hoosiers to age at home and would incentivize quality care for residents of the state's nursing homes.

The reforms come after an 18-month IndyStar investigation revealed longstanding problems with the quality and funding of Indiana nursing homes, leaving vulnerable residents at risk when the coronavirus pandemic struck. 

a person standing in front of a sign: A person is loaded into an ambulance outside Cardinal Nursing and Rehabilitation on Tuesday, April 14, 2020, in South Bend, Ind. © Robert Franklin/South Bend Tribune via USA TODAY Network A person is loaded into an ambulance outside Cardinal Nursing and Rehabilitation on Tuesday, April 14, 2020, in South Bend, Ind.

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Managed care means more choice

Under Indiana's current system, many Hoosiers who wish to age at home are instead receiving care in nursing homes. That's in part due to the fragmented long-term care system that is difficult to navigate, Sullivan said. That's why the state is pursuing a managed care system that would allow Hoosiers to access information about the different types of care that are available, including home care.

Under a managed care system, an organization or company becomes the clearing house for directing residents and their families towards the care they need. More than 80% of Indiana's Medicaid spending is already coordinated through managed care. Indiana would be joining 25 other states that already administer long-term care through a managed care system.

"That will make sure that they're getting the right care from the right provider in the right environment at the right time," Rusyniak said.

Sullivan said moving to a managed care system has long been a priority for the state, but a ban on managed care passed by the legislature prevented Gov. Eric Holcomb's administration from moving forward.

"Since day one, four years ago, we have been hampered from (pursuing) a comprehensive plan by a pre-existing managed care moratorium" for long-term care, Sullivan said. That moratorium is set to expire at the end of the year, barring an extension by the general assembly.

Faster approvals

In October, state officials announced a pilot program for several Indiana counties that allowed them to expedite approvals for home or community-based care. Patients can now get approval within 48 to 72 hours, whereas before the process would take six weeks or more, Rusyniak said. More than 600 Hoosiers have been approved through the pilot program already.

Support for family caregivers

"To allow more individuals to stay home really requires supporting the largest unpaid workforce in healthcare and that is families," Rusyniak said. To that end, building supports for family caregivers is another priority for FSSA.

Indiana was the first state to introduce an essential family caregiver program during the coronavirus pandemic, Rusyniak said. The program, which has been criticized by some as insufficient, allows family members to provide care to nursing home residents. Building on that program and providing more support to family caregivers could help increase quality care in nursing homes and at home, Rusyniak said. That could come in many forms, such as education or funding for small remodeling projects to make homes more accessible.

Focus on quality

FSSA will also link funding to quality outcomes, though specific details are yet to be seen. IndyStar's investigation found that the state's nursing homes and county hospitals had exploited a Medicaid loophole to draw down billions of dollars in extra funds for nursing home care since 2003. But a large portion of that funding never makes it to the nursing homes and instead has been spent on county hospitals, which own more than 90% of the state's nursing homes. Meanwhile, quality at the homes remains poor.

That extra funding won't go away, Sullivan said, but the state is working on a "value-based purchasing system" that would link funding to quality outcomes.

"What that allows us to do is supplement our funding to pay for the quality initiatives that we decide as a group... are important," Sullivan said, referring to not only the state but also the nursing home industry and advocacy groups, who will be involved in designing the program.

Better data tracking by the state

Across Indiana's long-term care system, a person could end up in seven or eight disconnected databases, Rusyniak said. Integrating those systems will allow the state to measure whether aging Hoosiers are getting the right services.

Bringing these systems together will also allow the state to assess providers and determine which are the best and worst performers.

Emily Hopkins is a data reporter for IndyStar's investigative team. Reach them at 317-444-6409 or emily.hopkins@indystar.com.

This article originally appeared on Indianapolis Star: Reforms are coming to Indiana's nursing home system. Here's what they mean for Hoosiers.

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