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Connections to Community Living

Connections to Community Living. http://www.dhs.wisconsin.gov/ccl. Introduction and History. Successful community living by: . Integrating long-term services and supports with health care and housing; Building on full community participation for everyone. .

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Connections to Community Living

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  1. Connections to Community Living http://www.dhs.wisconsin.gov/ccl

  2. Introduction and History

  3. Successful community living by: • Integrating long-term services and supports with health care and housing; • Building on full community participation for everyone. Wisconsin’s continued efforts to assure sustainable long term care program, to assure that people can remain safely at home, and to promote community connections.

  4. Key events related to community initiatives • 2001 – President Bush New Freedom Initiative http://www.hhs.gov.newfreedom/init.html • 2008 – Money Follows the Person (MFP) http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Support/Balancing/Money-Follows-the-Person.html • 2009 - President Obama “The Year of Community Living” http://www.whitehouse.gov/the_press_office/President-Obama-Commemorates-Anniversary-of-Olmstead-and-Announces-New-Initiatives-to-Assist-Americans-with-Disabilities • 2012 - Secretary Sebelius establishes the Administration for Community Living (ACL) http://www.hhs.gov/news/press/2012pres/04/20120416a.html

  5. In 1980 Wisconsin ranked 2nd nationally in the number of nursing homes beds per capita with 87 nursing home beds per 1,000 residents 65 years of age and over. Thirty years later that ranking has improved to 20th nationally with 46 nursing home beds per 1,000 residents 65 years of age and over, an improvement of 47%.

  6. Nursing Home & Intermediate Care Facilities/Intellectually Disabled (ICF/ID)CY Trend in number of facilities

  7. Nursing Home & ICF/ID - CYTrend in licensed beds

  8. Nursing Home & ICF/ID - FYTrend in relocations to the community

  9. LTC licensed beds (CY) compared to relocations to community (FY)

  10. Percentage of Relocations (FY) to licensed LTC beds (CY)

  11. Project Goals • Ensure that individuals living in nursing homes are aware of the supports and options available to live in less restrictive settings in the community. • Increase relocation of people residing in nursing homes to home and community based settings through: • Diversion. Provide early intervention to help people admitted for short term rehab avoid becoming long term residents. • Relocation. Assist people in Nursing Homes on along-term basis who wish to relocate. • Reduce Medicaid expenditures by assisting individuals living in nursing homes to live in more cost-effective home and community based settings, where appropriate. • Increase participation in the Money Follows the Person (MFP) demonstration and enable the state to claim enhanced MFP match.

  12. Strategies • Articulate mission, goals and areas of mutual benefit. • Outreach to stakeholders to inform them of the initiative and seek cooperation. • External stakeholder input group/meetings • Nursing Home industry; • Ombudsmen; • Managed Care Organizations (MCOs); • IRIS; • Aging and Disability Resource Center (ADRCs); • Hospitals; • Home care and other community service providers. • Develop informational materials geared toward people living in Nursing Homes and their families. • Develop materials geared towards hospital discharge planners and Nursing Home staff.

  13. Strategies • Work with the Division of Quality Assurance (DQA) and facilities to increase appropriate referrals for possible relocation (based on responses to the MDS-Q). • DQA membership on DHS Steering Committee. • Define role for DQA in increasing referrals: • Survey process and enforcement • Training and communication with providers • Clarify role of NH admissions and discharge planning related to initiative.

  14. Strategies • Deploy Community Living Specialists • Target areas identified through data analysis. Cover 10 counties (primarily in Eastern WI); based on concentrations of MA-funded Nursing Home residents. • Recruit five community living specialists beginning November 2012. Full implementation expected by January 2013. • Responsibilities include: • Outreach to people residing in Nursing Homes • Outreach to Nursing Home staff • Problem solve/overcome barriers and coordinate relocations for people. • Work with partners to ensure smooth/timely relocations.

  15. Areas with High # of NH Residents on Medicaid (non-DD) # of Non-DD residents on MA as of 6/30/2011 purple = 1,700 pink = 500-1,699 yellow = 350-499

  16. NH Beds by ADRC (3/2012)

  17. Strategies • ADRC Activities to Support Relocation • Identifying ADRC best practices related to: • Outreach to providers/relationship building • Outreach to people residing in Nursing Homes • Working with people on short-term admissions and those with private resources funding their placement • Processes that are effective in relocating people in long-term placements at a Nursing home • Overcoming challenges/barriers to relocation and diversions • Provide ADRCs with information re: acuity and Medicaid utilization in local NHs. • Developing Technical Assistance and training with the goal of standardizing effective processes/activities that achieve increased relocations. • Deliverables/Outcome Measures • Systems change outcome measures • Reporting requirements (potential use of automated MDS-Q system) • Relocation goals for each ADRC (based on NH beds and budget saving projections).

  18. Strategies • MCO Activities to Support Relocation • Identify best practices for use by MCOs to increase the number of relocations and accomplish this in a timely manner. • Identify barriersto Nursing Home relocations and diversions to develop strategies for overcoming barriers and engaging MCOs in the early stages of relocation efforts. • Develop technical assistance and training to support MCOs relocation efforts. • Identify relocation goalsfor MCOs related to relocations. Provide acuity and MA bed information. • Deliverables/Outcome Measures • Incorporate MCO relocation performance into QA activities • Relocation goals • Systems change outcome measures • Reporting requirements

  19. Strategies • Money Follows the Person (MFP) • MFP enhanced federal match dollars save state GPR when eligible participants relocate from institutions to MFP-approved settings in the community. • MFP does not supplant established waiver services which already fund relocation. Receipt of enhanced match “follows” the person upon successful relocation; after 365 days in the community, the state is rewarded for decreasing expensive institutional stays. • Increased communication with ADRCs, MCOs, nursing homes, and other community partners regarding MFP requirements for participation and subsequent tracking and reporting of data will lead to increased resources for the community-based long-term supports.

  20. Stakeholder Outreach Aging & Disability Resource Centers (ADRC) Regional Ombudsman and supervisor Division of Quality Assurance (DQA) Management Team Long Term Care Advisory Council Home Care Consumer Advisory Committee Area Administration DQA, Provider Community and Advocate meeting Home Care Industry Advisory Committee Family Care - Managed Care Organization (MCO) Leadership meeting DQA, Bureau of Nursing Home Resident Care Management meeting WI Director of Nurses Council Workshop WI Nursing Home Social Worker Association National Money Follows the Person (MFP) Project Directors DQA FOCUS conference presentation and booth Ongoing coordination with Virtual PACE Future will include local outreach by the Community Living Specialists

  21. Change Name and Create Logo Before After Connections to Community Living • Nursing Home Relocation and Diversion

  22. New Brochure

  23. ADRC Activity Outreach Best practices compiled and distributed. ADRCs across the state are increasing outreach to nursing homes, residents and families and increasing community outreach. Private pay residents ADRCs are increasing their role with this population both while in the nursing home and after discharge. Increased staff time Some ADRCs hired full-time or part-time staff that are dedicated to relocation activity. Thoughtful planning is occurring re: roles and responsibilities within the ADRC for these activities. Development of new materials Process improvement projects underway in some ADRCs (implementing new processes and determining whether it leads to improved outcomes).

  24. MCO Activity Outreach Meetings with MCO Leadership Discussions related to role and responsibility of Community Living Specialists New Contract Language (Money Follows the Person Relocation Incentive Payment) The Department will provide an incentive payment to the MCO of $1,000 for each member of an MCO who is relocated from an institution into a community setting consistent with federal Money Follows the Person (MFP) guidelines. The amount of payment provided to an MCO will be determined after the end of the contract year. The MCO will submit before December 31 of the contract year a list of members for whom the MCO anticipates a receipt of an incentive payment. The Department will compare the MCO’s list of member’s to the Department’s list of Medicaid members for whom the Department is receiving an enhanced Medicaid match through the MFP program to determine the number of relocations to use for calculation the incentive payment to the MCO.

  25. Community Living Specialists (CLS) Recruitment through a contract First interview conducted in De Pere, Milwaukee and Madison Second interview with lead candidates completed Hired 3 CLS, start date 2/4/2013 Re-recruitment for Southeast WI One week of formal group class room training Individual field training after that

  26. New Website History, Frequently Asked Questions (FAQ), brochures, resources, helpful links Geared to different audiences – consumers, nursing home staff, ADRCs, MCOs Deploy by February 1st.

  27. Preliminary data4/1/2012 – 10/31/2012 2,324 responded that they would like to talk to someone about the community (Section Q) 56% of the total were there for short term rehab 32% referred to ADRC; 49% referral “not needed”; 19% referral “not made” Of the 746 referrals made to the ADRC, 289 or 39% were discharged to the community Of those discharged to the community, 83% were in the nursing home for rehab and 17% were long term residents

  28. Preliminary data4/1/2012 – 10/31/2012 197 or 49% of 399 nursing homes made at least one referral to the local contact agency during the 7 month period Of the nursing homes that made a referral, an average 3.8 referrals were made during the 7 month period or 0.5 per month per facility Considering all nursing homes, the numbers drop to an average of 1.9 referrals made during the 7 month period or 0.3 per month per facility

  29. Resources Division of Long Term Care • http://www.dhs.wisconsin.gov/aboutdhs/DLTC/ Family Care • http://www.dhs.wisconsin.gov/ltcare/ ADRCs • http://www.dhs.wisconsin.gov/ltcare/adrc/professionals/index.htm Connections to Community Living • http://www.dhs.wisconsin.gov/ccl

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