1988 Finalist
State of Wisconsin
Innovations in American Government Awards
Innovations in American Government Awards

State and federal public policies for human services support elderly or disabled persons in the most independent, community-based, and least restrictive manner. Despite such intentions and the overwhelming preference of elderly or disabled persons to remain at home, over 80 percent of all public funding for such persons in Wisconsin in 1981 was devoted to institutional care, principally in nursing homes. In addition, the fastest growing population group in the state consists of elderly persons. Wisconsin residents over age 85, almost a third of whom now reside in nursing homes, lead all age cohorts and are expected to increase by 21 percent in the next 5 years compared to 3.7 percent for the Wisconsin population as a whole. Improvements in modern health care are also resulting in greater longevity for disabled persons of all ages, thereby increasing the demand for a coordinated long-term care system.

The Wisconsin Community Options Program (COP) is an effective response to the many challenges posed by an aging population. The program is a unique public effort to provide a comprehensive system of community alternatives to nursing home care. The program is available to all elderly and disabled people, regardless of disability label, income, or assets, who are at risk of nursing home entry or currently reside in nursing homes.

Every person at risk of entry to a nursing home is first offered a comprehensive assessment of their needs, preferences, and abilities. The possibilities for living at home are fully explored and explained. At the person's request, a case plan is then developed specifying the services necessary to enable the person to live at home and ongoing services are then provided as part of a comprehensive package of community care. Once an assessment and case plan are completed at no charge, persons eligible for Medicare or who would become Medicare-eligible within 6 months in a nursing home are provided with publicly funded services of their choice. Other persons may purchase needed on-going support on a private pay basis.

Service funding by COP is tailored to the individual's need: there are no disallowed services, only disallowed settings. COP is designed to avoid recreating institutional environments by promoting service in homes and limiting the size of group living arrangements. COP has covered expenses for everything from simple home health care to purchasing adaptive equipment that makes the individual less dependent on ongoing home health care, from meals-on-wheels to adapting a kitchen to enable an individual to prepare meals independently, from specialized transportation to adapting an individual's vehicle to make it road-ready once again.

Four measures are used to evaluate program success. The first measure is the program's ability to serve persons in all age groups at all levels of care in the community. COP has served the most impaired persons from all age and disability groups, including ventilator-dependent individuals rejected by nursing homes. Each COP applicant is rated by level of care using a screening instrument based on the same criteria as nursing home screens. Statistical information from 1987 and 1986 indicate that 92 percent of COP recipients are at intermediate level 2 or higher compared to 96 percent for nursing homes. The difference between the two is primarily due to the special eligibility allowance in COP for Alzheimer's victims and persons with chronic mental illness. The second measure is the program's ability to contain nursing home utilization and absorb the impact of demographic pressures. In 1987, nursing home costs were below the budgeted amount for the second year in a row. Since the beginning of COP, nursing home utilization has consistently decreased when compared to demographic increases in the elderly population. In 1982, the utilization rate for nursing home beds for the elderly over age 85 was 31.2 percent. In 1986, it was 28.5 percent. The third measure is the program's ability to satisfy COP consumers. All COP consumers are annually surveyed regarding program satisfaction. For the last two years, counties have reported that over 95 percent of their COP consumers are satisfied with COP services. The fourth measure that is used is the program's ability to provide a more comprehensive array of community services at costs no greater than nursing home costs. In 1987, an independent study (Legislative Audit Bureau) found that the Community Options Program cost 50 percent of the cost of average nursing home care within the state. In 1984, the Department's Evaluation Division found that the COP program cost 60 percent of the cost of average nursing home care.