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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


  • 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


  • 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


“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

    • National Efforts: MiCASSA (Medicaid Community Attendant Services and Supports Act)


  • 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


  • Needed a barrier free, subsidized apartment

  • Long waiting lists for good housing

  • Multiple apartment applications

  • Several months to locate apartment

  • Very limited funding available


  • 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


  • 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

  • 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:

  • ADA, Olmstead, MiCassa, etc:

  • Medicaid LTC Task Force:

  • Nursing Facility Transition Initiative Data & Stories: or email:


  • Centers for Independent Living Listings


  • Waiver Agent Listings