June 21, 2017
By David Griffith
Millions of Americans, including children, adults and seniors, need long-term-care services as a result of disabling conditions and chronic illnesses. These services range from institutional care, such as nursing homes, to community-based supports, such as having a home health aide. Long-term-care services are generally needed when daily tasks, such as eating, bathing and dressing, become difficult for someone to do on his or her own.
Structuring and maintaining a system that ensures that all older adults are able to age with maximum supports poses many challenges. Older adults encounter a wide array of physical, emotional and cognitive issues, requiring specialized care and highly trained staff. For many, the costs of long-term care are prohibitive. Funding sources for many long-term-care services are currently facing uncertainty, particularly with proposed cuts to Medicaid, the primary payer across the nation for long-term-care services. Additionally, the pay for direct-care workers remains low, making it difficult to recruit and retain a workforce requiring specialized training and skills.
Most older adults prefer to age in their own homes for as long as possible, rather than in institutional-care settings. LGBT people in particular often express fears of being discriminated against in long-term-care settings, or having to go back into the closet in order to access care. Improving the structure of the long-term-care system and the delivery of services to older adults will allow more people to successfully age in their own homes and ensure that those who do require a higher level of care will be able to access services that are welcoming and inclusive.
Fortunately, older Pennsylvanians are advocated for by a statewide advisory committee working to improve the long-term-care system in the commonwealth. The Pennsylvania Long-Term-Care Commission is an advisory body tasked with providing informed recommendations that improve the commonwealth’s long-term services and supports system. Commissioners include state representatives, heads of statewide agencies, directors of aging-services organizations and community advocates. The commission is chaired by the Pennsylvania Secretary of Aging. All commissioners are appointed by the governor.
The commission is responsible for developing strategies that will improve access to services, quality of services and the cost-effectiveness of care. This requires looking not only at the needs of older Pennsylvanians, but also at the needs of long-term-care agencies and the direct-care workers providing these services.
Four subcommittees operate as part of the commission: Outreach, Access, Workforce and Quality. Each subcommittee develops strategies and recommendations relating to their given topic, focusing on ways to better inform older adults about long-term-care services, improve access to care for all Pennsylvanians, ensure that available services are effective and efficient and empower and support the workforce that delivers these services.
Given the great diversity of Pennsylvania’s older-adult population, each subcommittee must consider the unique needs, challenges and concerns of Pennsylvanians of all religions, races, ethnicities, gender identities, sexual orientations, ages, abilities and geographic locations. The ability of the long-term-care system to meet the needs of diverse consumers is essential in providing effective person-centered care.
Improving the LGBT cultural competence of Pennsylvania’s long-term-care services and supports is very much on the radar of the commission. In the fall of 2016, the LGBT Elder Initiative’s Heshie Zinman was appointed by Gov. Tom Wolf to join the Long-Term Care Commission.
As a member of the outreach and workforce subcommittees, Zinman’s goals include bringing greater sensitivity and understanding about the need for culturally competent services and supports. The outreach subcommittee has been developing strategies to ensure that outreach efforts are inclusive of the cultural values of all communities in Pennsylvania, including the LGBT communities. Meanwhile, the workforce subcommittee is looking to elevate the workforce to become more culturally competent and better able to serve these diverse populations experiencing unique needs and barriers to care.
Zinman believes that the theme of cultural competence, including for LGBT populations, will be evident in the work of all four subcommittees, stating, “We believe that there will be language on LGBT cultural competence in all of the recommendations. We need to make sure that all citizens of the commonwealth are recognized and have access to services that are welcoming and inclusive.”
The recommendations should ultimately lead to LGBT older adults having better access to LGBT-friendly in-home supports, adult day centers, assisted-living facilities and nursing homes. For example, Zinman notes that the work of the commission will “mean that your home-health aide will be better trained, better supervised and better able to handle situations in a culturally competent manner.”
Given the complexities of providing long-term-care services to older adults all across the commonwealth, the efforts of the Long-Term Care Commission are an important step in ensuring that older Pennsylvanians are able to age successfully at every age.