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Perspectives on Delivering Long-Term Services and Supports in Rural Washington State.

Tianna Fallgatter, Suzanne J. Wood*, Paul A. Fishman

This study explores stakeholders? perceptions regarding factors that promote or impede progress on a sustainable solution for delivering Long Term Services and Supports (LTSS) in rural Washington State. Our examination may signal to Community-based Long-term Care Network (CBLTCN) members and policy makers which LTSS priorities should drive future reform efforts. Using Health Resources and Services Administration (HRSA) eligibility criteria, we identified ten CBLTCN-member Public Health Districts (PHDs) classified as Critical Access Hospitals (CAHs), three regional representatives from Area Agencies on Aging (AAA), and three additional state government informants for participation in this study (n=16 representing a total population of about 213,000 Washington residents). The resulting geographic distribution represented variations in the State?s rural populations. Drawing from the Nevada Department of Health and Human Services Comprehensive Gaps Analysis of Behavioral Health Services (2013), we then employed a semi-structured interview instrument. Results of this study uncovered perceived gaps and strengths among the CBLTCN members. Associated interviews supported key assumptions from the literature about barriers to access and challenges facing rural health systems. Identified also were emerging themes, which differed by stakeholder level, local, regional, and state, and required further examination. Thematically, select results pointed to a lack of transportation options and the need for behavioral health providers, workforce challenges and budget limitations, and requirements for increased cultural competence and organizational efficiency. Our findings indicate no two CBLTCN members are identical but the struggles they face are almost universal, thus the environment has prompted efforts to develop creative solutions for immediate problems. Most PHDs believe that they can meet LTSS needs, yet resource shortages pose ongoing challenges. Future initiatives should include integration between rural PHDs and Home and Community Based Services (HCBS) to capitalize on existing structures and resources to stabilize Washington?s rural hospitals.