Cutler Institute for Health and Social Policy

Integrated Care for Older Adults in Rural Communities

Abstract: 

With a focus on community-dwelling older adults in need of integrated physical, behavioral health services, and long term services and supports (LTSS), this brief reviews the opportunities and challenges reform initiatives under the Affordable Care Act present for rural communities. The authors assessed four types of organizational models for delivering integrated care management. Each of these models has different strengths and drawbacks, weighing for and against implementation in rural areas.

KEY FINDINGS:

  • Introducing an integrated care model in a rural community requires an investment in building relationships with local providers and adapting to local culture and services.
  • Integrated care models that cannot adapt to the local delivery system are more likely to face resistance from local providers and those they serve and potentially duplicate or displace existing rural capacity.
  • Most models of integrated care management have an inherent bias toward larger organizations and infrastructure. Most are built on an investment in health information technology and other systems and capacities.
  • The potential success of any integrated care model is limited by gaps in the continuum of health care services and long term services and supports available in a rural community.
  • “Wraparound” integrated care models can fill gaps in existing care coordination capacity, offering a flexible approach that can adapt to a local rural delivery system.   
  • An investment of public resources in shared supports can lower the cost of integrating care in rural delivery systems.

Suggested Citation:  Griffin E, Coburn AF. Integrated Care for Older Adults in Rural Communities. Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center; May, 2014. Research & Policy Brief PB-54.

To view or download the full study, please visit the Maine Rural Health Research Center website at http://usm.maine.edu/muskie/cutler/mrhrc-publications

Publication Type: 
Research and Policy Brief
Publish Date: 
May 1, 2014
URL: 
http://muskie.usm.maine.edu/Publications/rural/Integrated-Care-Rural-PolicyBrief.pdf

Cutler Institute awarded $600,000 to help youth raised in foster system

Marty Zanghi

USM's Cutler Institute for Health and Social Policy has been awarded a $600,000 grant to help young people raised in Maine's foster system to prepare for college and the workforce.

The money comes from the Annie E. Casey Foundation as part of a $5.4 million national effort aimed at youth who are homeless or in either the foster care or juvenile justice systems.

"Many of these young people have suffered abuse or trauma and were raised in poverty and neglect," said Marty Zanghi, the Cutler Center's youth development director.

The money -- including an expected $400,000 more in matching funds -- will pay for contracted work with agencies in the target areas, starting with the greater Portland area and Penobscot, Kennebec and Somerset counties.

Nationally and in Maine, only about 3 percent of people who grow up in the foster care system achieve a college degree, he said.

"It's dramatically lower than the rate for the general population," Zanghi said. "It's a horrible outcome."

It doesn't have to be that way, though.

"There are young people that overcome these circumstances," he said. "I know people who have master's degrees and Ph.Ds."

The Casey Foundation's national effort is being called the "Learn and Earn to Achieve Potential" (LEAP) initiative.

The initiative is working on partnerships in Maine and nine other areas: Alaska, Arizona, California, Massachusetts, Michigan, Minnesota, Nebraska and New York. In each case, people will adapt two evidence-based models to meet the needs of these youth, including support to address the trauma they may have experienced in their lives.

In Maine, the work will include a pair of successful programs, Jobs for Maine Graduates (JMG) and Jobs for the Future. Results will be carefully tracked, Zanghi said.

After the first year, the program is expected to grow.

"Eventually, the additional help will be available to all children, 14 and over, in the foster care system in the state of Maine," Zanghi said.

New Chartbook on the Use of Maine's Long Term Services and Supports (LTSS)

Long Term Services and Supports Cover page image

Long term services and supports (LTSS) are a vital lifeline for the thousands of Maine adults who need them, and they account for a significant portion of the state's Medicaid (MaineCare) budget.This Chartbook prepared by the research staff at the USM Muskie School, provides information on all Maine adults who use LTSS: older adults; adults with physical disabilities; adults with intellectual disabilities/autism spectrum disorder or other related conditions; and adults with acquired brain injury.

The information provided in this Chartbook about the demographic trends that impact Maine's service system as well as data on the typical MaineCare service utilization and expenditures of different LTSS populations will inform the discussion among policymakers, providers, consumers, and advocates as they work together to ensure that Maine’s system of LTSS meets the needs of all its citizens.

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