Courtney Burke

In a recent commentary for the Rockefeller Institute of Government (“Health Care Reform: Thinking Long Term,” March 2009), Courtney Burke, director of the institute’s New York State Health Policy Research Center, brought attention to the role of U.S. states in modeling effective reforms for long-term care.

“For decades, states have been experimenting with ways to improve [long-term care’s] quality and reduce its costs,” she wrote. “State innovations could serve as models for nationwide reforms.”

Burke lists four examples:

• The expansion of home and community-based care programs through the use of Medicaid waivers.
• THE GREEN HOUSE® Project, which is active in several states, and which has been shown to “increase resident satisfaction, health outcomes, and staff retention as care and the living environments are personalized to create a sense of community, characteristics sometimes lacking in large nursing facilities.”
• The many individual-choice and consumer-directed programs such as Cash and Counseling, which have “been shown to improve patient satisfaction, reduce unmet care needs, improve caregiver satisfaction and not adversely affect health outcomes.”
• Programs of All-Inclusive Care for the Elderly (PACE), which, with federal incentives, help states to manage long-term care more effectively in multiple areas (adult day care, physician medical care, home health care, social services, and more).

“For those programs that have proven impacts on cost or quality, now is the time for government to go beyond experiments and to better diffuse innovative methods of care delivery that have proved to be successful,” she wrote. “Innovation is needed if the nation’s longer-term challenges are to be met in the next decade.”

Expanding on these thoughts, Burke told PHI this week that the federal government could “assist states by encouraging using these models” either through financial means or “by giving flexibility on federal regulations to make it easier.”