TABLE OF CONTENTS

• Senate Concurrent Resolution No. 33 and Senate Resolution No. 27
• Limitations and Focus of Study
• Organization of the Study

2. CONCEPT OF A SINGLE ENTRY POINT

• Concept of Single Entry Point (SEP)
• Horizontal and Vertical Integration
• System Fragmentation
• SEP as One Component of an Integrated Long-Term Care System
• A Horizontally Integrated SEP Process
• Obstacles to Service Integration
• A Vertically Integrated SEP Process
• Gatekeeper in a Managed Care System
• Preadmission Screening -- Financial Eligibililty Determination
• Medicaid Payments for Home Health Services and Nursing Homes
• Screening and Functional Eligibility
• Assessment -- Capacity for Independent Functioning
• Sample Assessment Tool
• Standardized Assessments -- Difficulties
• Numerical Assessments -- Gatekeeper Function
• Case Management
• Functional and Financial Eligibility Determination
• Service Authorization -- Advocacy and Cost Control

3. LONG-TERM CARE SERVICES

• Overview
• Single Entry Point and Long-Term Care Services
• Nursing Homes and Community- and Home-Based Long-Term Care
• Long-Term Care and Long-Term Care Populations
• Long-Term Care Populations
• Long-Term Care Services as Supports for Functional Limitations
• Long-Term Care Services -- A Continuum
• Inconsistent Terminology
• Home Care -- Informal Support by Family Caregivers
• Home Care -- Personal Care and Homemaker Services
• Adult Day Care and Adult Day Health Centers
• Adult Day Health Centers
• ADCCs and ADHCs in Hawaii
• Social/Health Maintenance Organizations for Elders
• Hawaii -- ADHCs and PACE
• Alternative Living Arrangements
• Congregate Housing, Adult Foster Homes, Board and Care Homes, and Residential Facilities
• ARCHs in Hawaii
• Categorical Versus Generic (Functional) Approach
• Advantages of a Categorical Approach
• Disadvantages of a Categorical Approach
• The Generic Approach
• Advantages of a Generic (Functional) Approach
• Disadvantages of a Generic (Functional) Approach
• The Disabled as a Functional and Categorical Group
• The Developmentally Disabled
• Long-Term Nature of Services and System Integration
• Living Arrangements for the DD
• Federal Programs for the Developmentally Disabled
• DD Services
• Federal Payment Sources and DD Services
• Family Support Services

4. OTHER STATES

• Target Populations
• Single Entry Point (SEP)
• Colorado Study
• Indiana Study
• North Dakota Study
• Texas Study
• The Six Study States
• Arkansas
• Illinois
• Maine
• Maryland
• Oregon
• Wisconsin
• Other States
• Summary

5. HAWAII

   PART I

• The Department of Health
  • Access to the Long-Term Care System by Multiple Populations
  • Access and Eligibility to DOH Programs and Services for the Elderly
  • Access and Eligibility to DOH Programs and Services for Disabled Children
  • Access and Eligibility to DOH Programs and Services for Disabled Non-Elderly Adults

• The Department of Human Services
  • Community Long-Term Care Branch (CLTCB)
  • Populations Served
  • CLTCB Programs
  • Family and Adult Services Division -- Project Malama

• The Executive Office on Aging
  • Functions of the Executive Office on Aging (EOA)
  • Services
  • Statutory Duties of the EOA and Administrative and
  • Program Support
  • System Access

   PART II

• View of the Department of Health
  • Recommendations of the Department of Health
  • The DOH: Advantages and Disadvantages of a Single Entry Point
  • View of the Department of Human Services
  • The DHS: Advantages and Disadvantages of a Single Entry Point
  • View of the Executive Office on Aging
  • The EOA: Advantages and Disadvantages of a Single Entry Point

6. RECOMMENDATIONS AND RESERVATIONS

• Concept of Single Entry Point
• Advantages of a Single Entry Point
• Disadvantages of a Single Entry Point
• Cautions
• Support for System Coordination

RECOMMENDATION

• Two-Phase Pilot Project
• Phase One
• Broad Guidelines
• Flexibility Must Be Maintained
• Phase Two
• Funding for Phase One
• Funding for Phase Two

ENDNOTES

APPENDICES

A. Senate Concurrent Resolution No. 33

B. Model Long Term Care Assessment Tool (not yet available online)

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