3.A.1 DHHS will maintain a tight supply of nursing home beds, using the Certificate of Need program administered by the Division of Facility Services.

3.A.2 DHHS will support slowing the rate of growth of adult care home beds, consistent with the moratorium in effect until August 26, 1999.

3.A.3 The Division of Facility Services will continue to work on assessing the supply of adult care home beds so that the General Assembly and DHHS can implement necessary controls to manage costs and assure appropriate placement.

3.A.4 DHHS will further study options to tighten restrictions on asset transfers to qualify for Medicaid and to strengthen estate recovery measures allowable by federal law and regulation. Transfer of assets restrictions and estate recovery are designed to promote self-support and reserve limited public funds for those individuals with no resources of their own.

3.A.5 DHHS will continue support of long-term care reform efforts that include potential cost savings from the application of managed care concepts to long-term care.

3.A.6 DHHS will continue to rely on cost reports to manage Medicaid reimbursement rates.

3.A.7 DHHS will continue efforts to assure that Medicare is billed whenever possible to avoid inappropriate billing of health and long-term care costs to Medicaid.

3.B.1 The Division of Aging will work with SHIIP in the Department of Insurance and with others to educate consumers and employers about the costs of long-term care and the use of private long-term care insurance as one way to prepare personally for these costs. The educational campaign will: inform about the risk of needing long-term care and provide details about the state tax credit for long-term care insurance premiums, seek to dispel myths about public funding of long-term care, identify other possible private financing options, and promote the "Consumer Bill of Rights for Potential Buyers of Long-term Care Insurance."

3.B.2 DHHS will work with the Department of Revenue to provide the Legislative Research Commission with information to assess the effectiveness of the income tax credit for long-term care insurance so that the Commission can report its findings and recommendations to the 2004 Regular Session of the 2003 General Assembly.

3.B.3 The Division of Aging will work with the Governor’s Advisory Council on Aging, the Senior Tar Heel Legislature, and other appropriate groups to consider the Long-term Care Insurance Partnership programs (including the development of a national model and reciprocal agreements among states) and what can be done to eliminate the federal restrictions that limit development.

3.B.4 DHHS will study the feasibility of a private "defined-contribution plan" for long-term care coverage, which would have Medicaid acting as "reinsurer" for older and disabled adults who are not eligible for Medicaid and who cannot afford private long-term care insurance premiums and/or cannot meet medical underwriting requirements.

3.C.1 The Division of Facility Services, the Division of Aging and other units within DHHS will collaborate in examining the problem of aide recruitment and retention, identifying innovative and successful strategies from facilities and home care settings, and recommending any policy and program changes that could strengthen the supply of paraprofessional aide workers to provide quality care.

3.C.2 DHHS will use a three-year grant from the Kate B. Reynolds Charitable Trust to develop and test ways to improve the recruitment and retention of paraprofessional aides.

3.C.3 The Division of Aging will keep the DHHS Long-Term Care Roundtable abreast of major activities to address aide recruitment and retention issues and will seek input from Roundtable members on these issues.

3.C.4 The Division of Facility Services, the Division of Aging, and other units within DHHS will collaborate with the Department of Community Colleges to encourage paraprofessional aides to enroll in specialized training courses.

3.D.1 The Division of Aging recommends additional state funds to help reduce the waiting list for in-home and community-based services for older persons who are not eligible for Medicaid and cannot pay privately for these services.

3.D.2 The Division of Social Services will work to implement a demonstration allowing State/County Special Assistance funds to be used in settings other than adult care homes to determine the fiscal impact and establish appropriate criteria for eligibility and payment.

3.D.3 DHHS will build upon the March 1998 report submitted to the General Assembly, Study and Comparison of Medicaid Eligibility Requirements, to analyze further the available options and recommend implementation of policies that support home and community-based services and address any bias toward institutional care. This could include increasing the eligibility level annually for the medically needy, based on the Consumer Price Index.

3.D.4 The Division of Aging will continue to encourage and support the development of affordable independent housing with access to personal care and other supportive services, so that more older adults have options for receiving the care they need in an independent setting.

3.D.5 The Division of Aging will continue support and training of service coordinators in independent housing for older people, to link residents with personal care and other services in the community.

3.D.6 The Division of Aging will provide staffing and support to the work of the NC Independent Housing with Services Advisory Committee, which was appointed by DHHS to address needs and issues, monitor development, and address informational needs concerning Multi-Unit Assisted Housing with Services (MAHS). MAHS enables independent housing managers to arrange personal care services for residents through a licensed home care agency.

3.E.1 DHHS will continue to provide technical assistance and support for a series of demonstration projects that will test new financing, service delivery, and administrative processes for an improved long-term care system.

3.E.2 DHHS will encourage the UNC Institute on Aging and other institutions to add relevant studies of long-term care to their research agendas.

3.E.3 DHHS will examine ways to enhance its information systems to collect and analyze relevant data.

3.E.4 DHHS will monitor the effect of increasing the Medicaid categorically needy eligibility level to 100 percent of poverty and determine the impact of new state appropriations on the waiting lists for home and community-based services and on access to prescription drugs.

3.F.1 The Division of Aging recommends state funding to establish a position to lead the design and enhancement of information and referral and case assistance services across the state that assist older consumers and family caregivers in accessing information, services, and supports.

3.F.2 The Division of Aging will sponsor with the Governor’s Advisory Council on Aging and the Senior Tar Heel Legislature a special event to examine the results of the Robert Wood Johnson "Cash and Counseling" programs, to determine the effectiveness of these consumer-directed care models and their applicability for North Carolina.

3.F.3 The Division of Aging will work with the North Carolina Citizens for Business and Industry and other groups to highlight eldercare issues and successful partnerships between providers of aging services and the business community.

3.F.4 The Division of Aging recommends an increase in the annual allocation of state funds for the Alzheimer’s Association chapters in the state.

3.G.1 The Division of Facility Services will continue to serve as a source of education, support, and encouragement for nursing homes and adult care homes implementing the Eden Alternative. It will continue to collect data to evaluate the effect of Edenization on infections, pressure sores, significant declines and improvements in condition, incontinence, allergies, mobility, mood/behavioral problems, medication use, discharges, and staff turnover and absenteeism.

3.G.2 The Division of Facility Services recommends state funding to establish additional staff positions to increase the state’s capacity for monitoring long-term care facilities to address the health and safety of residents and ensure regulatory compliance.

3.G.3 The Division of Social Services recommends state funding for county departments of social services to hire additional Adult Homes Specialists to improve the local oversight of adult care homes.

3.G.4 The Division of Facility Services will further emphasize the training of Adult Homes Specialists to improve the local oversight of adult care homes.

3.G.5 The Division of Social Services recommends state funding to expand the capacity of county departments of social services to meet the legal requirements for providing guardianship and adult protective services (establish new positions for both APS and guardianship, and create a fund for essential services for APS clients); add a position of Guardianship Coordinator in the division office; and support a contract with the Attorney General’s Office for an attorney to specialize in APS and guardianship issues.

3.G.6 The Division of Aging recommends state funding to expand the capacity of the Ombudsman Program to ensure that the growing demands on the program can be met effectively and in accordance with state and federal mandates.

3.G.7 The Division of Aging will conduct a study of the experience of other states that have implemented an "ombudsman-type" program for home and community-based care.

3.G.8 DHHS will study the merits of regulations addressing long-term care facilities that offer special care for residents with Alzheimer’s disease or other forms of dementia.

3.G.9 DHHS will study the merits of regulations to address the safety of elderly residents in adult care homes that also house young residents with mental illness.

3.G.10 The Division of Medical Assistance recommends state funding to increase the personal care aide/resident ratio in adult care homes from 1 to 20 on the first and second shifts to 1 to 15.

3.G.11 The Division of Aging recommends state funding to support projects committed to reforming long-term care systems in ways consistent with the concepts and goals of DHHS.

3.G.12 The Division of Services for the Deaf and Hard of Hearing recommends state funding for the Regional Resource Centers, whose services would include training of caregivers, including those in nursing and adult care homes, to be better prepared to serve the special needs of persons who are hard of hearing.

3.G.13 DHHS is evaluating the effects of Senate Bill 864, which established new cost-reporting requirements for adult care homes receiving State/County Special Assistance, created a program of independent client assessment and case management, established minimum training requirements for adult care home personal care aides, and increased state-level oversight of adult care homes. The Division of Facility Services is leading the evaluation, assisted by the Divisions of Social Services; Medical Assistance; Mental Health, Developmental Disabilities, and Substance Abuse Services; and the DHHS Office of Internal Auditor. Results of the evaluation, including a recommendation regarding the feasibility of continuing the requirements established by the legislation, will be reported to the Joint Legislative Commission on Governmental Operations and the Study Commission on Aging.

3.G.14 The Division of Social Services recommends state funding to increase the personal needs allowance by $10 per month for adult care home residents receiving State/County Special Assistance (SA). The current rate is $31 per month, and this is the only source of income for residents to pay for clothing, shoes, prescriptions beyond the six covered by Medicaid, and personal items not furnished by the home (such as shaving cream and razors, deodorant, toothpaste and toothbrushes, and cosmetics). The last increase in the SA personal needs allowance was on July 1, 1994.