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. 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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Nursing facility transition and diversion

Nursing Facility Transition and Diversion

Module 1:

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


Introductions

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


Overview of module 1

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


Myths and truths handout 3

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.


Myths and truths

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


Myths and truths1

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.


Myths and truths2

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.


Nursing facility transition nft work

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


Nursing facility transition nft work1

Nursing Facility Transition (NFT) Work

  • Steps in the process:

    • Outreach/Finding People to Transition

    • Initial Interview and Informed Choice


Nursing facility transition nft work2

Nursing Facility Transition (NFT) Work

  • Steps in the process continued

    • Working Agreement

    • Planning the Transition

    • Transition

    • Follow-up


Diversion

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


Diversion1

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


Essential characteristics of advocates

Essential Characteristics of Advocates

  • Patience

  • Persistence or Tenacity

  • Passion


Essential characteristics of advocates1

Essential Characteristics of Advocates

  • Listening Skills

  • Flexibility

  • Creativity

  • Organizational Skills, Reliability


Essential resources for transition

Essential Resources for Transition

  • Centers for Independent Living (CILs)

  • Waiver Agents

    • Area Agencies on Aging

    • Independent Waiver Agents


Landmark legislation and lawsuits

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


Landmark legislation and lawsuits1

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.”


Landmark legislation and lawsuits2

Landmark Legislation and Lawsuits

  • Olmstead versus L.C. & E.W.

    • Supreme Court Decision

    • Two women with mental disabilities

    • Moved back to community


Landmark legislation and lawsuits3

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


Landmark legislation and lawsuits4

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


Continued efforts in systems change

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


A real life transition story tenacious charlie

A Real Life Transition Story: Tenacious Charlie


Background

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


Housing

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


Accessibility

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


Care requirements

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


Financial

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


Other challenges

Other Challenges

  • In 2004, went back to nursing facility


Happy endings

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


For more information

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: [email protected]


Resources

Resources

  • Centers for Independent Living Listings

    • www.macil.net

  • Waiver Agent Listings

    • www.miseniors.net


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