Central assessment and alternate care days: reorganizing a long term system

In New York State, as elsewhere, health planners and gerontologists have come to view long term care as a crucial issue for health care delivery. In particular, the problem of alternate care days, older persons remaining in acute care hospitals while awaiting long term care placement, has been a major focus of attention. This problem is particularly critical for both Medicaid recipients and the Medicaid program. The purpose of this paper is to examine central assessment as the proposed strategy for developing a coordinated system of long term care placement. The basic goals of this strategy are to improve the utilization of home care services and to reduce the number of alternate care days. First the paper reviews several models for central assessment, including ACCESS and Triage, and compares these existing programs with he Community Alternative Systems Agency (CASA) Program in New York State. This is followed by outlining the development of a central assessment model, the Cortland County (New York) Coalition for Long Term Care, that incorporates various features of these model programs. This outline includes discussions of the design, planning, and implementation of this Coalition central assessment model Policy issues, specifically problems of agency cooperation, funding mechanisms, and financial barriers to long term care are reviewed. Finally, the paper addresses the issue of alternate care days and how the Coalition model was developed to cope with this problem.