On Saturday, June 11, 107 people from across the country came together to enjoy VOR’s 2005 Annual Meeting in Washington, D.C.  

Mary McTernan, President (2004–present)

Mary gave an informative message focusing on VOR’s many accomplishments in the past year.  She noted all VOR opportunities and successes are the direct resultof                         the unrelenting work of VOR members in every state.

Mary Jean Duckett, Deputy Director of the Disabled and Elderly Health Programs Group, Centers for Medicare and Medicaid (CMS)

Ms. Duckett has more than 38 years experience in federal service, more than half of which have been with the Medicaid program.

Ms. Duckett provided long term care (LTC) “facts and figures,” before sharing information about CMS’s quality assurance goals within the Home and Community-Based Services (HCBS) Waiver program.

As part of her “facts and figures” segment, Ms. Duckett noted that LTC spending ($89.3 billion) accounts for 32% of all Medicaid spending. Skilled nursing facilities and ICFs/MR account for 64% of all LTC Medicaid spending. She also provided an overview of CMS’s New Freedom Initiatives.

During her discussion on quality, Ms. Duckett shared a quote from CMS Director McClellan’s April 2005 House Energy and Commerce Testimony:

     “The administration is committed to providing quality services in the home and community-based setting and continues to engage in improving its role to ensure quality outcomes through federal and state monitoring.”

 There are 300 HCBS waivers in operation serving an estimated 1 million people. Ms. Duckett noted the challenge of ensuring quality in a program in which services are disperse throughout hundreds of thousands of locations in the community and expanding rapidly.

Ms. Duckett endured intense questioning from meeting participants. Foremost on attendees’ minds was the availability of legitimate choice among a full array of residential programs and supports. Many participants, citing examples in their own states, cited the struggle to enjoy true choice. Other participants were encouraged by the heightened attention to quality in community settings. All participants were grateful for Ms. Duckett’s time and detailed, expert information.

Panel: Achieving Quality in the Community: Promise and Problems

Panelists: Janice Zalen, American Health Care Association; Michael Strouse, CEO, Community Living Opportunities; and Kevin Walsh, DD Health Alliance. Moderated by Sybil Finken, VOR Board Member.

This panel discussed quality from the perspectives of research (Walsh), regulatory (Zalen), and practice (Strouse).

Every panelist cited the need to continually reassess how providers are measuring quality. While ICFs/MR regulations are nationally uniform, these regulations haven’t been revised since 1988. Zalen noted the need to consider how we defined “quality” in 1988 v. how we do now. Reinforcing this point Walsh noted, “Setting the ‘targets’ of quality improvement is based on VALUES and BELIEFS in the current service structure” (emphasis added).  

Strouse, a provider of nonprofit, parent-driven, community services, noted “Local boards driven by families and supported by the community, clinical, and university professionals are trusted and more likely to be supported across time.” He cited family involvement at the board level, alliances with professionals, and “a highly consistent workforce of talented, caring, highly vested care-givers/teachers” as key to ensuring consistent quality.

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