Nursing Facility Transition and Diversion

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Nursing Facility Transition and Diversion

• Module 1
• Overview of Transition and Diversion in the Long
  Term Care (LTC) System

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Introductions

• Who are you?
• Why are you here and what is your experience with
  transition?
• Please feel free to ask questions at any time
• Handouts 1 and 2

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Overview of Module 1

• Myths and Truths in Long Term Care
• Nursing Facility Transition Work
• Characteristics of Successful Advocates
• CILs and Waiver Agents
• Landmark Legislation and Lawsuits
• Continued Efforts in Systems Change
• Transition Story 1

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Myths and Truths (Handout 3)

• Long term care can only be provided in a nursing
  facility.
• People with disabilities and the elderly who have
  support needs are best served in nursing
  facilities for their own safety as nursing
  facilities provide 24 hour hands-on care.
• A felony background or poor credit history
  history can prevent successful transition.

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Myths and Truths

1. With proper support, anyone can live successfully
   in a community-based setting
2. Community based care is often more cost effective
   than nursing facility care
3. People who have guardians cannot live on their
   own in the community

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Myths and Truths

• Many people are lonely after transitioning back
  to the community.
• Housing is often the biggest obstacle in the
  transition planning process.
• Nursing facility staff are generally opposed to
  transition efforts.

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Myths and Truths

1. In order to be successful, people who are
   transitioning must direct the process and play a
   key role in identifying and signing up for needed
   supports.

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Nursing Facility Transition (NFT) Work

• Exciting, challenging work
• Addresses issues of Social Justice
• 14 of nursing facility residents are under age
  65
• Sometimes complex care needs
• Potential to have or maintain families and
  careers
• Most seniors prefer their own home
• Advocacy Role

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Nursing Facility Transition (NFT) Work

• Steps in the process
• Outreach/Finding People to Transition
• Initial Interview and Informed Choice

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Nursing Facility Transition (NFT) Work

• Steps in the process continued
• Working Agreement
• Planning the Transition
• Transition
• Follow-up

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Diversion

• Steps in the process
• Identify referral sources
• Identify people at risk of permanent nursing
  facility placement
• Intervene to prevent placement or
• Follow the person to the nursing facility and
  plan transition

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Diversion

• Home is a lot better than where I was. When I
  got home, I thought, God, I hope I make it. I
  hope we can make it together. It was scary for
  me to leave, because I didnt know if I could
  manage, but we are in good shapefor the shape
  were in! Without (my familys) help, though, I
  would not be here today.
• Mrs. A., home after 183 days in the hospital
• and 212 days in the nursing facility

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Essential Characteristics of Advocates

• Patience
• Persistence or Tenacity
• Passion

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Essential Characteristics of Advocates

• Listening Skills
• Flexibility
• Creativity
• Organizational Skills, Reliability

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Essential Resources for Transition

• Centers for Independent Living (CILs)
• Waiver Agents
• Area Agencies on Aging
• Independent Waiver Agents

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Landmark Legislation and Lawsuits

• Disability Rights Movement
• Began in 1970s
• Modeled after civil rights/womens rights
  movements
• Improved quality of life for people with
  disabilities
• Accessibility and safety

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Landmark Legislation and Lawsuits

• Americans with Disabilities Act
• Title IIState Local Governments
• Obligation to provide programs, services, and
  activities in the most integrated setting.

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Landmark Legislation and Lawsuits

• Olmstead versus L.C. E.W.
• Supreme Court Decision
• Two women with mental disabilities
• Moved back to community

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Landmark Legislation and Lawsuits

• Eager versus Engler/Granholm
• Michigans Olmstead lawsuit
• On behalf of nursing facility residents people
  who wanted to stay in the community with supports
• Settlement stipulated
• Admission to MIChoice Waiver
• Training on LTC
• Uniform Eligibility Criteria
• Waiting lists for MIChoice Waiver
• Establishment of Medicaid Long Term Care Task
  Force

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Landmark Legislation and Lawsuits

• Medicaid Long-Term Care Task Force
• Nine recommendations
• Person Centered Planning
• Money Follows the Person
• Single Point of Entry
• Services and Supports
• Prevention Activities
• Consumer Participation
• LTC Workforce
• Quality Management System
• Financing Structures

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Continued Efforts in Systems Change

• Implement Task Force recommendations
• Promote Legislation
• Statewide Efforts [phone] ext. 21 or
  visit http//www.copower.org
• National Efforts MiCASSA (Medicaid Community
  Attendant Services and Supports Act)
  http//ww.freeourpeople.org

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A Real Life Transition Story Tenacious Charlie
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Background

• In his late 60s
• Became transition client in December 2000
• Has cerebral palsy (CP)
• Lived most of life in state institutions
• Early attempt to live on his own failed

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Housing

• Needed a barrier free, subsidized apartment
• Long waiting lists for good housing
• Multiple apartment applications
• Several months to locate apartment
• Very limited funding available

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Accessibility

• 3 heavy steel doors to enter building
• Could not unlock front door
• Could not reach the entrance buzzer
• No wheelchair accessible shower
• Management was slow to resolve these issues

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Care Requirements

• Needed Medicaid Waiver Services
• Required help with all of his ADL needs
• In 2000, Waiver slots very limited
• Coordination of Housing and Waiver services

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Financial

• Very limited income
• Could not physically manage his own checking
  account or bills
• No family or long standing friends to assist
• Needed representative payee

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Other Challenges

• In 2004, went back to nursing facility

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Happy Endings

• New apartment
• New opportunity thru NFTI grant
• Transition fund purchases
• Bathing system
• Automatic door opener
• Charlies achievements
• On his own for 5 years
• Spoke at LTC public hearings
• Active in the local CIL

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For more information

• Real Choice Systems Change Grants
• http//www.communitylivingta.info/
• ADA, Olmstead, MiCassa, etc
• http//www.accessiblesociety.org/index.shtml
• Medicaid LTC Task Force
• http//www.healthteam.edu/imc/ltc/default.htm
• Nursing Facility Transition Initiative Data
  Stories http//nfti.prosynergy.org or email
  ebys_at_michigan.gov

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Resources

• Centers for Independent Living Listings
• www.macil.net
• Waiver Agent Listings
• www.miseniors.net