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County moves to privatize care for disabled, frail

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For years, Pierce County has not been able to keep up with the needs of its disabled residents and frail elderly. Now it's asking the state to contract with a private organization to provide long-term care services in this region.

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The county board voted last week to not join in the creation of a regional managed-care organization. Instead, the county is asking the Wisconsin Department of Health and Family Services to solicit proposals from private management agencies to provide "redesigned" long-term care for the county's frail elderly and other adults with physical or developmental disabilities.

"What we're withdrawing from is us being the provider," said Long Term Support Supervisor Chuck Balzer.

The board also voted to apply for state funding to develop an Aging and Disability Resource Center as a one-stop customer service center for information and help on issues affecting older people and people with disabilities.

Because of budget constraints, no one has recently come off the long-term care waiting list unless there was a clear health or safety risk, said Balzer.

"It's more likely years rather than months," he said of the length of time a person can expect to wait for long-term care services.

Balzer said the theory behind a statewide push for reform is funds can be used more efficiently if one agency serves a large enough client population.

Pierce County was one of nine counties in a collaborative receiving a $250,000 grant last year to plan and implement regional managed long-term care. Four counties withdrew from the group, but Pierce and four others continued to plan for a delivery system administered by a private organization.

Pierce currently has 58 adults with disabilities and 19 frail elderly persons on the list waiting for community-based long-term care. Balzer said his program is providing services to approximately 220 adults.

Those services include personal care, supportive home services such as snow shoveling, counseling and therapeutic services, adult day care, transportation, case management, day and vocational services and, in some cases, group home or adult family home services.

Wisconsin has over 10,000 people on long-term care waiting lists. State officials feel using managed care will free up money to serve more people in a more comprehensive way, said Reggie Bicha, who was Pierce County's human services director until early March.

"We think there is a better model than what we are currently able to provide," Bicha told the county board.

He said the goal of the new managed system would be to integrate long-term care with health and dental care. Major benefits of the reform, said Bicha, include an emphasis on consumer self-determination, expanded choice of programs and services and an end to waiting lists for adult consumers.

The county will still be responsible for operating the new resource center, providing adult protective services and all long-term care services for children.

Pierce's entire long-term support budget, including programs for children, is $5.3 million, said Balzer. State and federal sources provide about 94 percent of that.

Most of the adults served are under some kind of Medical Assistance waiver program and, as they are enrolled in a managed care program, those dollars would become part of the funding stream for that program, said Balzer.

The county also receives a Basic County Allocation, and it would give up part of that funding.

"We're not sure what the percentage of that is," said Balzer. He said the details must be negotiated with the state.

Balzer doesn't expect the change will mean a reduction in county employees.

"Right now, we are pretty bare-bones," he said.

Long Term Support lost two social worker positions last year. Of the five social workers it has now, two will stay to work with children and three will be assigned to the resource center, said Balzer.

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