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Part I Introduction to Nutrition Care in Older Adults

contained numerous provisions expanding health cov- erage to Americans, increasing benefits, and lowering cost for consumers, as well as providing new funding for public health and prevention. Out of the ACA came CMS’s Triple Aim: better health care by improving all aspects of patient care, better health by encouraging healthier lifestyles, and lower cost through improve- ment in promoting preventive medicine.

Home and Community-Based

Services Waiver Program Home- and community-based services (HCBS) waivers included in Medicaid programs are one option avail- able to states that make long-term care services avail- able in home and community-based settings. Programs aid distinct groups, such as older adults, those with mental illnesses, and those with disabilities (ie, intel- lectual, developmental, and/or physical). Programs can offer both standard medical and nonmedical services. The HCBS waiver program provides a cost-

effective option for states when compared with provid- ing similar care in nursing facilities. The services vary by state, and provision of services is determined by assessing the individual’s needs and whether the indi- vidual meets the level of care criteria for service (40). Examples of services available include the following:

● ● ● adult daycare,

assistive devices, chore services,

● emergency response system, home-delivered meals, ● homemaker services,

● ● ● ● ● ●

home/vehicle modification, mental health outreach, nursing,

nutrition counseling, respite care,

● denior companion, and transportation.

●

ELDERCARE LOCATOR Community-based services available in any community in the nation can be located by using the Eldercare Locator provided by the HHS AoA (www.eldercare. gov/Eldercare.NET/Public/Index.aspx or 800-677- 1116) (38). This nationwide service connects older Americans and their caregivers with information on senior services, outreach materials, contact informa- tion, and the aging network.

● AGING AND DISABILITY RESOURCE

CENTERS The No Wrong Door (NWD) system comprising Aging and Disability Resource Centers, a collaborative effort of the Administration for Community Living (ACL), formerly the Administration on Aging; CMS; and the Veterans Health Administration—supports older adults and individuals with disabilities in locating state intia- tives and provides access to long-term services and support (LTSS) options. The goal of the NWD system is to simplify access to LTSS; NWD systems are a key component to LTSS systems reform (41). NWD systems are highly visible and trusted places. They are available in every community across the country. People can go to the NWD system to get infor- mation and one-on-one person-centered counseling on all LTSS options for people of all ages, incomes, and disabilities. Nationally, NWD systems have taken important steps toward meeting ACL’s and CMS’s vision by doing the following (41):

●

“creating a person-centered, community-based environment that promotes independence and dignity for individuals”;

●

“providing easy access to information and one- on-one counseling to assist consumers in explor- ing a full range of long-term support options”; and

“providing resources and services that support the needs of family caregivers.”

The task of finding the right services might be overwhelming for individuals and their family members. The current LTSS system involves numerous funding streams and is administered by multiple government agencies using complicated intake, assess- ment, and eligibility processes. There is also an increas ing number of options for services and supports in home, residential, and institutional settings. Indiv- iduals trying to access the multitude of new LTSS frequently find themselves confronted with a maze of agencies, organizations, and bureaucratic requirements at a time when they may be incredibly vulnerable. These issues often lead them to use the most expensive forms of care, including institutional care, such as nursing homes or extended hospitalization. This can cause a person to quickly exhaust his or her own resources (41).

ADDITIONAL CARE AND SERVICES

Adult DayCare/Adult Day Health Adult day care provides personal care for dependent adults in a nonresidential, supervised, protective, con- gregate setting during some portion of a 24-hour day,