Caring for the Elderly: Oregon\u27s Pioneers (Portland, Oregon)

This site visit looked at the continuum of care for its elderly and disabled citizens in the first state ever to secure Section 1915(c) and (d) waivers under Medicaid to support home- and community-based services. More than three-quarters of Oregon\u27s Medicaid clients now receive care in these settings. Site visitors were briefed on the history and development of long-term care in the state as well as the various care settings available. Panels discussed strategies and partnerships focused on alleviating workforce shortages and highlighted Oregon nurses\u27 authority to delegate certain caregiving tasks to laypeople. Multnomah County staff described county-level activities, especially the role of Area Agencies on Aging, and then escorted site visitors on small-group visits to various care facilities in the county. Other topics explored were consumer protection, consumer-directed care, and Medicare and Medicaid integration. Site visitors traveled to a health plan clinic facility to participate in a discussion of Medicare managed care in Oregon and to hear about the plan\u27s social HMO program. The integration of medical and custodial needs was pursued during tours of two PACE (Program of All-Inclusive Care for the Elderly) sites