CDPAP: An Innovative Model to Expand Access to Home Care in Cleveland
Over 340,000 residents of Cuyahoga County, or 21% of the population, are over the age of 60. This senior population is projected to grow by over 30% in the coming decade according to the Western Reserve Area Agency on Aging. With rising rates of chronic illnesses among aging and disabled populations, the demand for long term care continues outpacing the supply of qualified home health providers. These gaps in access disproportionately impact marginalized communities, forcing difficult decisions between struggling without adequate care, burdensome expenses for home services or premature nursing home admission.
Consumer Directed Personal Assistance Programs (CDPAP) have emerged as an innovative model empowering families to direct their own care while containing costs through Medicaid supports. With competent, affordable home care increasingly out of reach for Cleveland families, CDPAP presents an opportunity to fill urgent care needs while serving healthcare reform goals of affordability, choice and independence. As CDPAP continues growing, understanding best-practice approaches to personalized care delivery ensures optimal outcomes meeting each individual‘s medical, functional and lifestyle needs.
The Landscape of Home Care in Cleveland
Over 1 in 4 residents of Cuyahoga County over 65 have a disability impeding independent living. Chronic conditions like heart disease, diabetes and musculoskeletal disorders require consistent medical care coordination and support with daily living activities. With over 70% of seniors expressing a desire to age in place at home vs. institutional facilities, expanding access to home-based care is imperative yet strained by several key factors:
- High Costs & Limited Insurance Coverage: The median annual cost of home health aide services in Ohio is $54,000, forcing many to rapidly spend down assets to qualify for Medicaid coverage. For middle-income individuals, these expenses are out of reach. Medicare and supplemental insurances have strict limits on covering home personal, custodial care.
- Shortages of Home Health Workers: With low wages and high demands, insufficient workforces plague the home care industry, with over 300 open positions currently within a 10 mile radius per Home Care Pulse data. Agencies struggle meeting requests while burnout remains high among these essential workers.
- Strains on Family Caregivers: Family members provide over 75% of long-term care, often sacrificing careers and mental/physical health. Supports are lacking for families struggling to compensate for gaps in affordable access to skilled home care.
Without interventions like CDPAP alleviating these barriers, trends of rising disability rates and desire for home-based care are on pace to reach crisis levels for Cleveland elders, disabled individuals and families strained to provide care.
Barriers to Accessing Home Care
| Type | Description |
|---|---|
| Systemic Barriers | – Narrow eligibility criteria for Medicaid and other public programs – Medicare limits on personal care benefits – Workforce shortages/low wages/limited benefits in home care industry |
| Financial Barriers | – High hourly rates beyond middle-income affordability ($20-$26 per hour average) – Sparse insurance coverage for custodial long-term care – Rapid spend-down of assets to qualify for Medicaid |
| Logistical Barriers | – Audience/capacity strains on home care agencies – Continuity issues with staff turnover/burnout – Transportation issues accessing care |
Above outlines key obstacles Ohioans face securing essential home care due to flawed insurance systems, a fragmented long-term care infrastructure and the marginal position of home health workers. Innovative care models like CDPAP aim to dismantle these barriers through consumer empowerment and controls while stabilizing the workforce.
How CDPAP Addresses Gaps in Care
In contrast to restrictive, costly agency-directed care models, CDPAP puts the individual front and center in care decisions responsive to their needs. This paradigm shift is crucial to upholding dignity, choice and functional independence for those requiring personal assistance services.
Specifically, CDPAP addresses major gaps through:
- Affordability – Eligibility for Medicaid waiver funds plus participant direction controls costs
- Flexibility – Care schedule/tasks adaptable to needs/preferences
- Familiarity & Continuity – Ability to choose family members/friends as caregivers and oversee training minimizes staff turnover
- Independence – Participants direct their personalized plans and budgets according to individual priorities/lifestyles
Early data indicates states offering CDPAP programs through Medicaid waivers have realized cost savings ranging from 15-48% compared to projected institutional nursing home expenses. With nursing and group homes costing on average 300% higher than home care options, expanding CDPAP presents a cost-effective model granting dignity and independence.
The following case studies further illustrate CDPAP‘s life-changing impact:
Empowering Family Caregivers
James Smith had exhausted his life savings paying agencies $22/hour for care aides assisting his wife Nancy who has early-onset Alzheimer‘s. Their adult children rotated caring for Nancy but struggled balancing full-time jobs and their own families. CDPAP allowed James to hire his children as paid caregivers, train them on Nancy‘s routine himself and maximize the hours of Medicaid supports they qualify for. This stability has allowed Nancy to stay at home while reducing financial, emotional and logistic strains on the family.
Living Life on Her Terms
Paralyzed from amyotrophic lateral sclerosis (ALS), 58 year-old Karen Morris requires round-the-clock assistance with mobility and activities of daily living. With high staff turnover and unreliable schedules, traditional agency services limited Karen‘s ability to engage with friends and pursue her passions. By directing CDPAP services herself, Karen trained her personal assistant in specialized mobility transfers to safely join art classes and volunteer work she cherishes rather than remaining homebound. Her aide of 5 years supports Karen in living life on her terms thanks to CDPAP customizable supports.
CDPAP Funding and Policy Considerations
In Ohio, CDPAP is funded largely through Medicaid Disability Waivers allowing states flexibility designing home and community-based care. Obtaining these waivers involves intensive federal approval processes. Currently over 140,000 residents remain on Ohio waiver waitlists though just a portion indicate preference for self-directed models like CDPAP.
Current enrolled CDPAP participants statewide:est. 7,500
To expand access, key policy changes include:
- Federal review adding additional Medicaid Disability Waivers in Ohio
- Increasing waiver budgets to move waitlists and enrollment
- State review of eligibility criteria and enrollment processes
- Ohio Medicaid Managed Care Plan incentives to improve CDPAP provider networks and streamline authorizations
States leading the country in CDPAP supports like Oregon, Washington and New York have implemented consistent growth in program funding, achieved provider partnerships ensuring necessary care access regardless of location or condition, and conducted participant surveys to continually improve the model. As more data emerges on long-term cost savings over $200 billion annually, increased political will to address gaps in long term care through innovative programs like CDPAP is expected.
Growth Potential and Future Outlook
Current enrollment in Ohio‘s CDPAP program is estimated under 20% of eligible participants according to the Paramount Advantage CDPAP Association. At an aging pace 3 times the national average, meeting Cleveland‘s demand for qualified home care requires tapping into new workforce pools, skills training and tailored supports through CDPAP‘s flexible infrastructure.
Active waitlists and rapidly rising costs for seniors reinforce the need to strengthen public funding towards Home and community-based alternatives before individuals decline to the point of forced skilled nursing home admission costing over 3 times more than comparable home care models.
Pilot programs through Western Reserve Area Agency on Aging found nearly 25% of nursing facility residents assessed could return home with proper CDPAP supports stabilizing medical needs and assisting activities of daily living all at average monthly savings of $3,900 per individual transitioned.
Early cost-benefit analysis indicates a $17 return per every $1 spent over the first year of transition from nursing facilities through continuity of care promoting independent living. States doubling down on HCBS spending are yielding significant taxpayer savings while empowering greater choice, quality of life and dignity through programs like CDPAP.
Resources for Navigating CDPAP
Understanding eligibility, gathering necessary approvals and constructing workable care plans can pose challenges to accessing CDPAP. Below guides break down key steps to navigating this life-changing, but often complex system:
CDPAP Eligibility Criteria
| Criteria | Description |
|---|---|
| Financial eligibility | Must qualify under income and asset thresholds for Ohio Medicaid waiver programs |
| Level of care eligibility | Requires assessment showing nursing facility level of care required |
| Residency | Ohio residency status |
| Consumer participation | Able to self-direct care or designate a caretaker or legal guardian for participation |
Enrollment Checklist
| Step | Description |
|---|---|
| Contact your local Medicaid Managed Care Plan | Managed Care case managers conduct initial intake assessing functional eligibility |
| Undergo assessment | Local Area Agencies on Aging or Bureau of Worker‘s Compensation determine level of care qualifications |
| Develop Transitional Care Plan | Draft initial plan for types and hours of assistance requested for approval |
| Select your caregiver | Designate family member, neighbor or aid of choice to provide supports |
| Establish training | Provide instruction, shadowing to ensure caregiver competence on required tasks |
| Set schedule | Finalize regular schedule of CDPAP hours approved under your budget |
Ongoing, be in communication with your Medicaid plan case manager regarding changes to condition or care plan. Always maintain documentation on hours worked, tasks performed and backup caregivers as needed.
This overview just touches the surface of navigating CDPAP enrollment and implementation. Additional county and statewide resources to assist finding the right supports are available below:
Ohio Department of Aging: (800) 266-4346
Western Reserve Area Agency on Aging: (216) 621-0303
Direction Home Akron Canton Area Agency: (800) 421-7277
While CDPAP involves intensive coordination, this innovative model provides Cleveland older adults, people with disabilities and vulnerable communities a lifeline to quality care at home, on their own terms when faced with limited choices to support independence. As healthcare policy continues the overdue shift from institutionalization toward consumer-centered solutions, CDPAP paves a path forward to help aging populations direct their own care. Leveraging the powerful Medicaid infrastructure supporting coordinated strategies between hospitals, home care agencies, families and caregivers, Cleveland is positioned to lead statewide implementation of these life-changing programs.