In our view, advance care planning is an essential residents’ rights issue. What could be more important than to have one’s wishes respected at the end of life? For this reason, the OOIE was actively engaged in activities associated with National Healthcare Decisions Day and we have been working with a statewide group of stakeholders to implement the recently passed Physicians Orders for Life Sustaining Treatment or POLST law.
POLST is another advance planning tool designed for those who wish to further design their preferences for healthcare. POLST is a medical order that doctors or advance practice nurses fill out with patients and is based on the person’s current medical condition and wishes stated verbally or in written advance directives. The POLST document identifies the type of care that individuals want to receive. The goal of POLST is to ensure effective communication between health care practitioners and individuals receiving care so that decisions are sound and based on individuals’ understanding of their conditions, their prognoses, the benefits and burdens of care, and, most importantly, their goals of care.
MANAGED LONG-TERM CARE SUPPORTS AND SERVICES
We are also engaged in statewide stakeholder meetings regarding the state’s Comprehensive Medicaid Waiver. New Jersey is actively pursuing a policy to rebalance the long-term supports and services system (spending equal amounts on both nursing home care and home and community-based care). One aspect of that effort is working with the federal government to shift New Jersey’s Medicaid long-term supports and services to managed care. This basically means that people on Medicaid who are in nursing homes or other long-term care facilities would be enrolled in HMOs and that those HMOs would pay for those long-term care services and supports, not just acute medical care.
In order to ensure a smooth transition to managed care, the state is convening workgroups to develop contract language with HMOs, which are now referred to as Managed Care Organizations or MCOs. Our office is serving on three of the four workgroups – Assessment to Appeals, Access to Services, and Quality Monitoring. We are most particularly concerned with ensuring that:
- individuals can access protective and advocacy services if they are the victims of abuse, neglect, or exploitation;
- the states and MCOs effectively communicate with and educate individuals about their options and their rights;
- the process is transparent for consumers;
- and all those who need and would benefit from holistic care management receive it.
OLDER AMERICAN’S ACT RE-AUTHORIZATION
The Older Americans Act (OAA) is the federal law that governs long-term care ombudsman programs as well as many programs that provide critical services to seniors (such as nutrition services for people in the community). Congress is currently working on amendments to the law, and we have been following the process to ensure that residents in long-term care facilities continue to receive services to enhance their ability to make choices for themselves and to have their rights are protected.