Michigan’s Long-Term Care Conference Hilton Detroit, Troy March 23-24, 2006

1. Michigan Nursing Facility Transition Initiative Michigan’s Long-Term Care Conference Hilton Detroit, Troy March 23-24, 2006

2. What is NFTI? • 2001 Real Choice Systems Change Grant, Centers for Medicare and Medicaid • Administered by MDCH, Division of Community Living and DYNS Services, Inc. • Diverted 105 people from nursing facility placement • Transition 210 people from nursing facilities to community living • Built on experience of Michigan Centers for Independent Living transition work

3. NFTI Partners • Michigan Department of Community Health • Division of Community Living • Neighborhood Services Organization • MI Choice Waiver Program • Detroit Area Agency on Aging • Area Agency on Aging of Western Michigan • Michigan State Housing Development Authority • University of Michigan: Turner Geriatric Center

4. NFTI guiding principles • Promote major system change in long term care: • People should be able to chose where to live and be able to pick the least restrictive environment • People who do not need nursing care should not be in NF • Result in significant cost shift from institutional to community care • Housing is critical component of long term care program

5. NFTI Transition Component • Identify people in NF who express a desire to live in community • Develop person centered transition plans: • Housing component • Services Component • Build on existing community capacity in MI Choice Waiver • Coordinate with Housing providers

6. NFTI and MI Choice Waiver • Located a NFTI project at two MI Choice Waiver agents • Detroit Area Agency on Aging • Area Agency on Aging of Western Michigan • Developed “wrap around” model to coordinate NFTI with MI Choice Waiver

7. MI Choice Waiver History • Funded by State and Federal $ • Established in 1992 • Statewide coverage by 1998 • Served 15,000 in 2000 • Currently serves 8,600 people • Medical eligibility: “nursing home” LOC • Financial eligibility: 300% of SSI

8. Project Model • NFTI Coordinator at MI Choice Waiver Agent to develop transition plans with people who wished to leave nursing facility: • develop person centered transition plans • Housing • Services • Financial • implement plan

9. Preliminary Transition Results • 58% of the people transitioned did not need state funded Medicaid services from MI Choice or Adult Home Help • The average cost of those who did use the MI Choice Waiver was $670 per month • Average monthly Medicaid savings was $3,066 compared to Nursing Facility • 56% fell into lowest RUGs category (Reduced Physical Function)

10. Preliminary Transition Results continued… • Mi Choice Waiver agents provide effective and inexpensive methods for transitioning people from nursing facilities • Building community supports and housing is critical to returning to the community • Important to look at people who do not qualify for MI Choice waiver or Home Help

11. Case Histories • Transition participant: • 61 year old male, limited English, burned in house fire, after hospitalization was placed in NF for two years because he had no place to live, nursing facility social worker contacted NFTI program to arrange transition to community. Living in community since September 2004. • 32 year old quadriplegic, significant ADL and IADL support, moved to community in October 2004 with help of Section 8 housing

12. Recommendations, continued • Coordinate NFTI with Money Follows the Person project • Include NFTI in state Quality Improvement Initiative for long term care • Develop local collaboratives to support project including: Centers for Independent Living, Continuums of Care, MI Choice Waiver Agents, Community Mental Health Agencies, Hospitals and Nursing Facilities • Promote NFTI care facilitation model which will result in better care and less lengthy stay in acute care and long term care

15. Transition Participants

16. Transition Participants

17. Transition Participants

18. Transition Participants

19. Training and Education Component • Develop Transition education component, which builds on Center for Independent Living Project and NFTI experiences • Train wide variety of long term care professionals, participants and community resources

20. Recommendations • Incrementally expand Transition and Diversion projects statewide using NFTI model • Continue existing programs in Wayne and Kent counties • Continue evaluation to refine cost model/outcomes analysis • Modest expansion to one or two other regions per year • Target 10 to 12% of NF residents who do not need nursing care

21. Recommendations continued… • Coordinate NFTI with Money Follows the Person project • Include NFTI in state Quality Improvement Initiative for long term care • Expand local supportive housing consortia to other areas of state and to include: Centers for Independent Living, MI Choice Waiver Agents, Hospitals and Nursing Facilities.

22. Addressing Barriers • Fear of leaving institution • Care facilitator and Community Consortia • Lack of money, criminal history, poor credit history, lack of community supports • Care facilitator and Community Consortia • Lack of affordable, barrier free, and accessible housing • Section 8 Housing Certificates for ages 18 to 62 • Community Supportive Housing Consortia • Michigan Team

23. Local Consortia • Human Service Agencies • Co-led by social services, include Area Agencies on Aging, MI Choice Waiver Agents, Centers for Independent Living, mental health, substance abuse, jobs, and other service providers • Local Governments • Co-led by largest city or county • Include other local jurisdictions • Nonprofit sponsors and advocates • Some with housing experience • Some service providers