Connections to Community Living

http://www.dhs.wisconsin.gov/ccl

Introduction and History

• 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.

Successful community living by:

Key events related to community initiatives

• 2001 – President Bush New Freedom Initiativehttp://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

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%.

Nursing Home & Intermediate Care Facilities/Intellectually Disabled (ICF/ID)

CY Trend in number of facilities

2006 2007 2008 2009 2010 2011 20120

50100150200250300350400450

22 19 16 14 14 13 13

403 402 399 399 399 400 397

FDDs NHs

Nursing Home & ICF/ID - CYTrend in licensed beds

2006 2007 2008 2009 2010 2011 20120

5000

10000

15000

20000

25000

30000

35000

40000

1354 1190 1102 989 939 908 798

3870038106 37494 36557 36022 35661 35161

FDDs NHs

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

2006 2007 2008 2009 2010 20110

100

200

300

400

500

600

700

800

372

176

52 54 8120

561

724660

607693

359

FDDs NHs

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

2006 2007 2008 2009 2010 20110

5000

10000

15000

20000

25000

30000

35000

40000

45000

40054 39296 38596 37546 36961 36569

933 900 712 621 774 379

LTC beds

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

2006 2007 2008 2009 2010 20110.00%

0.50%

1.00%

1.50%

2.00%

2.50%2.35% 2.29%

1.84%1.65%

2.09%

1.04%

Relo to beds

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 a long-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.

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.

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.

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.

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

NH Beds by ADRC (3/2012)

!

$

Washburn 140

Burnett 50

Bayfield 75

Sawyer 109

Ashland 258

Iron 101

Vilas 50

Oneida 292

Price 213

Polk 372

Barron 493

Rusk 112

Chippewa 302

St. Croix 531

Dunn 249

Taylor 209

Lincoln 324

Langlade 166

Forest 100

Florence 76

Marinette* 532

Oconto 234

Clark 385

Marathon 939 Shawano 408

Wood 611

Portage 214

Waupaca 1346

Menominee

Door 210

Kewaunee 126

Brown 1282

Pierce 271

Pepin 100

Buffalo 100

Tremp- Ealeau 420

Eau Claire 686

La Crosse 907

Monroe 284

Juneau 196

Adams 85

Waushara 50

Outagamie 956

Manitowoc 721

Sheboygan 876

Sauk 414

Vernon 247

Crawford 130

Richland 129

Grant 622

Iowa 182

Lafayette 80

Green 301

Rock 819

Kenosha 1087

Racine 844

Wash Ington 605

Ozaukee 404

Columbia 395

Dane 1737 Jefferson

292

Dodge 991

Waukesha 2112

Milwaukee 4853

Fond du Lac 825

Marq- uette 50

Green Lake 167

Winnebago 1028

Calu- met 199

Jackson 145

Wal- worth 533

Douglas 430

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).

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 barriers to 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 goals for 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

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.

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

Change Name and Create Logo

Before

• Nursing Home Relocation and Diversion

After

• Connections to Community Living

New Brochure

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).

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.

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

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.

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

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

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