Nursing Facility Transition and Diversion

1. Nursing Facility Transition and Diversion Module 1: Overview of Transition and Diversion in the Long Term Care (LTC) System

2. 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

3. 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

4. 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.

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

6. 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.

7. Myths and Truths • 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.

8. 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

9. Nursing Facility Transition (NFT) Work • Steps in the process: • Outreach/Finding People to Transition • Initial Interview and Informed Choice

10. Nursing Facility Transition (NFT) Work • Steps in the process continued • Working Agreement • Planning the Transition • Transition • Follow-up

11. 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

12. 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 didn’t know if I could manage, but we are in good shape…for the shape we’re in! Without (my family’s) help, though, I would not be here today.” Mrs. A., home after 183 days in the hospital and 212 days in the nursing facility

13. Essential Characteristics of Advocates • Patience • Persistence or Tenacity • Passion

14. Essential Characteristics of Advocates • Listening Skills • Flexibility • Creativity • Organizational Skills, Reliability

15. Essential Resources for Transition • Centers for Independent Living (CILs) • Waiver Agents • Area Agencies on Aging • Independent Waiver Agents

16. Landmark Legislation and Lawsuits • Disability Rights Movement • Began in 1970’s • Modeled after civil rights/women’s rights movements • Improved quality of life for people with disabilities • Accessibility and safety

17. Landmark Legislation and Lawsuits • Americans with Disabilities Act • Title II—State & Local Governments • Obligation to provide programs, services, and activities in the “most integrated setting.”

18. Landmark Legislation and Lawsuits • Olmstead versus L.C. & E.W. • Supreme Court Decision • Two women with mental disabilities • Moved back to community

19. Landmark Legislation and Lawsuits • Eager versus Engler/Granholm • Michigan’s “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

20. 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

21. Continued Efforts in Systems Change • Implement Task Force recommendations • Promote Legislation • Statewide Efforts: (800) 760 4600 ext. 21 or visit http://www.copower.org • National Efforts: MiCASSA (Medicaid Community Attendant Services and Supports Act) http://ww.freeourpeople.org

22. A Real Life Transition Story: Tenacious Charlie

23. Background • In his late 60’s • 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

24. 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

25. 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

26. 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

27. 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

28. Other Challenges • In 2004, went back to nursing facility

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

30. 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@michigan.gov

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