Objectives

1. Home Sweet Home: The Experience of Returning Home after Living in a Nursing Home Paula Robinson, Relocation Service ManagerThe Houston Center for Independent Living Carmen Castro, Program ManagerThe University of TexasHealth Science Center Houston

2. Increase awareness of the Money Follows the Person Program • Identify successes and challenges faced by program participants • Comprehend the rights of consumers of long-term services and supports • Identify ways to overcome barriers to transitioning Objectives

3. Federal Background In 1999, in the case of Olmstead v. L.C. the United States Supreme Court ruled that states must serve individuals with disabilities in community-based settings.

4. Criteria for Returning to the Community • The state’s treatment professionals determine that such placement is appropriate • The affected individuals do not oppose the move, and • The placement can be reasonably accommodated taking into account the resources available to the state and the needs of others who receive state supported disability services State Background

5. Process for Returning to the Community • Nursing home resident states he/she wants to go home • Resident is referred to the relocation contractor to begin the transition process • Resident is evaluated by a managed care provider and if approved is enrolled • A home in the community is selected • Resident moves to the community Local Contact Agency Referral Background

6. Money Follows the Person (MFP) began demonstration grants in 2007 • It is available in 43 states and the District of Columbia • Through the Affordable Care Act funding for MFP increased from 1.75 billion to 4 billion and the program has been extended through to 2020 Money Follows the Person (MFP) Background

7. People institutionalized in the following settings: • Nursing homes • Intermediate care facilities for those with intellectual disabilities • Institutions for the mentally ill. • Hospital stays requiring rehab. Who May Qualify for MFP?

9. Since the program began in 2007 nearly 20,000 people have transitioned nationwide • Texas has led the nation in the number of transitions with over 5,300 compared to states like Delaware with only 66 transitions MFP(Money Follows the Person) Overview

12. Implementation analysis of the first four years • Descriptive analysis of participants benefiting from the MFP Demonstration • Trend analysis of state level transition, re-institutionalization and mortality rates • Individual utilization of healthcare services • Assessment of participant quality of life MFP (Money Follows the Person) Evaluation

14. MFP(Money Follows the Person) appears to be achieving its broad goals of: • Helping people successfully transition out of nursing homes • Helping states establish the infrastructure necessary to increase the capacity of long-term care systems to serve people in the community Evaluation Outcome

15. In Their Own Words:MFP(Money Follows the Person) Success Stories and the Challenges They Overcame

16. In Their Own Words:MFP(Money Follows the Person) Success Stories and the Challenges They Overcame http://www.youtube.com/watch?v=vfCSd9eK9F0

17. Be asked annually about returning to the community • Referred to the Local Contact Agency (LCA) • In Region 6, the thirteen (13) counties of the Gulf Coast it would be the Houston Center for Independent Living (HCIL) Rights of Residents Who Want to Transition

18. The Philosophy of Houston Center for Independent Living (HCIL) the Local Contact Agency (LCA) for Department of Aging and Disability Services (DADS) Region 6 – (13 Gulf Coast Counties)

19. Centers for Independent Living • The focus of the problem is not the individual, but the environment that includes not only the rehabilitation process but also the physical environment and the social control mechanisms in society-at-large. To cope with these environmental barriers, the disabled person must shed the patient or client role for the consumer role. Advocacy, peer counseling, self-help, consumer control, and barrier removal are the trademarks of the independent living paradigm. GerbenDeJong, 1979 A Different Model of Services & Advocacy The Independent Living Movement Houston Center for Independent Living (HCIL)

20. Centers for Independent Living The core values of the Independent Living philosophy became the backbone of CIL Advocacy and Services. • Consumer Control - At least 51% of CIL Board of Directors, and staff at all levels must be qualified persons with disabilities. • Cross Disability – CILs serve people with all types of disabilities. • Right to Fail - By promoting and supporting community living, CILs recognized that there are inherent risks, and prepared consumers for that eventuality. • Choice - CILs assist consumers in understanding what choices they have in all aspects of their lives, and support them throughout the decision-making process. The Independent Living Movement • Exercise of Power - Individuals and systems advocacy are a hallmark of CILs and unite the disability community to rise up against social injustice and other barriers to independence. Houston Center for Independent Living (HCIL)

21. Title VII of the Rehabilitation Act, as amended in 1984 defined core CIL services. Centers for Independent Living • Information and Referral - To persons with disabilities, service providers, families and community members on disability and independent living topics and issues; and, referral assistance to link individuals with appropriate organizations, services and resources. • Peer Counseling - A majority of staff have disabilities and serve as role models to consumers, providing information and support, and facilitating decision making. • Skills Training - Training activities which focus on consumer skill development to achieve or increase independence. TheIndependentLiving Movement • Advocacy - A service process emphasizing consumer control and self-reliance.  An array of approaches aimed at assisting persons with disabilities to take charge or the life choices, act on their own behalf, and overcome situations that reduce the potential for independence. Houston Center for Independent Living (HCIL)

22. The Houston Center for Independent Living (HCIL) was created in 1979 by people with disabilities, to serve people with disabilities. HCIL was the first Center for Independent Living opened in the State of Texas, second in the Nation. In 2007, the Texas Health and Human Services Commission awarded HCIL a four year contract as the Local Contact Agency (LCA). The LCA contract was renewed in 2010. We believe that people with disabilities have the right to make choices affecting their lives, a right to take risks, a right to fail and a right to succeed HCIL encourages people with disabilities to live as independently as possible. To date, HCIL has successfully relocated over 1050+ consumers. Houston/Gulf Coast Region Relocation Services Who We are………and Houston Proud! Houston Center for Independent Living

23. Referral Services for: Health Care Mental Health and Addiction Support Housing Transportation Volunteering/Employment Advocacy Financial Resources Personal Assistance Assistive Technology Community Integration Case Management for Medicaid Residents CBA CLASS CWP, DBMD, HCS or MDCP Options Counseling for Non-Medicaid Residents Follow-Up Houston/Gulf Coast Region Relocation Services Services We Offer… Houston Center for Independent Living

24. HOUSTON/GULF COAST REGION RELOCATION SERVICES My Home My Choice Money Follows the Person (MFP) to community living Home is where the Hert is…HCIL can help you make it happen! Houston Center for Independent Living

25. Houston/Gulf Coast Region Relocation Services Money Follows the Person Target Service Population • Medicaid eligible nursing facility residents who desire to relocate back into the community. • Individuals with intense service needs, including but not limited to the following: • Residence in a nursing facility for longer than six months • History of mental health services • History of substance/chemical abuse • Desire to relocate to a rural area • Lack of a home to return to • Need for assistance with five or more activities of daily living (ADLs) • Presence of mental retardation with other cognitive disabilities Houston Center for Independent Living

26. To respond to the nursing facility staff referral and to the nursing facility resident within 14 days Provide information about available community-based long-term care supports and services. To provide assistance to the nursing facility resident so that he/she will be able to decide if relocation is a viable option. Houston/Gulf Coast Region Relocation Services HCIL’s Responsibilities Houston Center for Independent Living

27. Houston Center for Independent Living

28. Can make living in the community possible. Can empower individuals. Can make the process of community integration easier and simpler. Houston/Gulf Coast Region Relocation Services Together We… Houston Center for Independent Living

29. Advocate for residents of nursing facilities and assisted living facilities • Provide information about the how to select a facility and how to get quality care • Investigate and resolve problems • Represent the resident’s perspective in monitoring laws, regulations, and policies and in making recommendations about needed changes Role of the Ombudsman

30. Educate and inform residents and their families about MFP (Money Follows the Person) • Educate long-term care staff about MFP Role of the Ombudsman

31. Q&A

32. “The Harris County Long-Term Care Ombudsman Program is supported, in part, by the City acting as the Harris County Area Agency on Aging and the Texas Department on Aging and Disability Services.” Acknowledgments

33. Thank you!

34. References Government Accountability Office. (2012). Medicaid: States’ plans to pursue new and revised options for home and community-based services. Washington, DC. http://www.gao.gov/assets/600/591560.pdfMathematica Policy Research. (2012). Money follows the person 2011 annual evaluation report.http://www.mathematica-mpr.com/publications/PDFs/health/MFP_annual_report_2011.pdf