Home Sweet Home: The Experience of Returning Home after Living in a Nursing

Home

Paula Robinson, Relocation Service ManagerThe Houston Center for Independent Living

Carmen Castro, Program ManagerThe University of Texas

Health Science Center Houston

Objectives

» Increase awareness of the Money Follows the Person Program

» Identify successes and challenges faced by program participants

» Comprehend the rights of consumers of long-term services and supports

» Identify ways to overcome barriers to transitioning

Federal BackgroundIn 1999, in the case of Olmstead v. L.C. the United States Supreme Court ruled that states must serve individuals with disabilities in community-based settings.

State Background» Criteria for Returning to the Community

1. The state’s treatment professionals determine that such placement is appropriate

2. The affected individuals do not oppose the move, and

3. The placement can be reasonably accommodated taking into account the resources available to the state and the needs of others who receive state supported disability services

Local Contact Agency Referral Background

» Process for Returning to the Community1. Nursing home resident states he/she wants to go

home2. Resident is referred to the relocation contractor to

begin the transition process3. Resident is evaluated by a managed care provider

and if approved is enrolled4. A home in the community is selected5. Resident moves to the community

Money Follows the Person (MFP) Background

» Money Follows the Person (MFP) began demonstration grants in 2007

» It is available in 43 states and the District of Columbia

» Through the Affordable Care Act funding for MFP increased from 1.75 billion to 4 billion and the program has been extended through to 2020

Who May Qualify for MFP?

» People institutionalized in the following settings: 1. Nursing homes2. Intermediate care facilities for those with

intellectual disabilities3. Institutions for the mentally ill.4. Hospital stays requiring rehab.

MFP (Money Follows the Person) Overview

» Since the program began in 2007 nearly 20,000 people have transitioned nationwide

» Texas has led the nation in the number of transitions with over 5,300 compared to states like Delaware with only 66 transitions

MFP (Money Follows the Person) Evaluation 1. Implementation analysis of the first four

years2. Descriptive analysis of participants

benefiting from the MFP Demonstration3. Trend analysis of state level transition,

re-institutionalization and mortality rates4. Individual utilization of healthcare

services 5. Assessment of participant quality of life

Evaluation Outcome

» MFP (Money Follows the Person) appears to be achieving its broad goals of:1. Helping people successfully transition out of

nursing homes2. Helping states establish the infrastructure

necessary to increase the capacity of long-term care systems to serve people in the community

In Their Own Words:MFP (Money Follows the Person) Success Stories and the Challenges

They Overcame

In Their Own Words:MFP (Money Follows the Person) Success Stories and the Challenges

They Overcame

http://www.youtube.com/watch?v=vfCSd9eK9F0

Rights of Residents Who Want to Transition

» Be asked annually about returning to the community

» Referred to the Local Contact Agency (LCA) » In Region 6, the thirteen (13) counties of the

Gulf Coast it would be the Houston Center for Independent Living (HCIL)

The Philosophy of Houston Center for Independent Living (HCIL) the Local Contact Agency (LCA) for Department of Aging and Disability Services (DADS) Region 6 – (13 Gulf Coast Counties)

The Independent Living Movement

Centers for Independent Living˃ The focus of the problem is not the individual, but the

environment that includes not only the rehabilitation process but also the physical environment and the social control mechanisms in society-at-large. To cope with these environmental barriers, the disabled person must shed the patient or client role for the consumer role. Advocacy, peer counseling, self-help, consumer control, and barrier removal are the trademarks of the independent living paradigm.

Gerben DeJong, 1979Houston Center for Independent Living (HCIL)

A Different Model of Services & Advocacy

The Independent Living MovementCenters for Independent Living

The core values of the Independent Living philosophy became the backbone of CIL Advocacy and Services.

Houston Center for Independent Living (HCIL)

Cross Disability – CILs serve people with all types of disabilities.

Consumer Control - At least 51% of CIL Board of Directors, and staff at all levels must be qualified persons with disabilities.

Right to Fail - By promoting and supporting community living, CILs recognized that there are inherent risks, and prepared consumers for that eventuality. Choice - CILs assist consumers in understanding what choices they have in all aspects of their lives, and support them throughout the decision-making process.

Exercise of Power - Individuals and systems advocacy are a hallmark of CILs and unite the disability community to rise up against social injustice and other barriers to independence.

The Independent Living Movement

» Title VII of the Rehabilitation Act, as amended in 1984 defined core CIL services.

Houston Center for Independent Living (HCIL)

Information and Referral - To persons with disabilities, service providers, families and community members on disability and independent living topics and issues; and, referral assistance to link individuals with appropriate organizations, services and resources.

Peer Counseling - A majority of staff have disabilities and serve as role models to consumers, providing information and support, and facilitating decision making. Skills Training - Training activities which focus on consumer skill development to achieve or increase independence.

Advocacy - A service process emphasizing consumer control and self-reliance.  An array of approaches aimed at assisting persons with disabilities to take charge or the life choices, act on their own behalf, and overcome situations that reduce the potential for independence.

Centers for Independent Living

Houston Center for Independent Living

• The Houston Center for Independent Living (HCIL) was created in 1979 by people with disabilities, to serve people with disabilities.

• HCIL was the first Center for Independent Living opened in the State of Texas, second in the Nation.

• In 2007, the Texas Health and Human Services Commission awarded HCIL a four year contract as the Local Contact Agency (LCA). The LCA contract was renewed in 2010.

• We believe that people with disabilities have the right to make choices affecting their lives, a right to take risks, a right to fail and a right to succeed

• HCIL encourages people with disabilities to live as independently as possible.

• To date, HCIL has successfully relocated over 1050+ consumers.

Houston/Gulf Coast Region Relocation Services

Who We are………and Houston Proud!

Houston Center for Independent Living

Referral Services for: Health Care Mental Health and

Addiction Support Housing Transportation Volunteering/Employment Advocacy Financial Resources Personal Assistance Assistive Technology

Community Integration Case Management for

Medicaid Residents CBA CLASS CWP, DBMD, HCS

or MDCP Options Counseling for

Non-Medicaid Residents

Follow-Up

Services We Offer…

Houston/Gulf Coast Region Relocation Services

HOUSTON/GULF COAST REGION RELOCATION SERVICES

My Home My Choice

Money Follows the Person (MFP) to

community living

Home is where the Hert is… HCIL can help you make it happen!

Houston Center for Independent Living

Money Follows the Person Target Service Population

Medicaid eligible nursing facility residents who desire to relocate back into the community.

Individuals with intense service needs, including but not limited to the following:

Residence in a nursing facility for longer than six monthsHistory of mental health servicesHistory of substance/chemical abuseDesire to relocate to a rural areaLack of a home to return toNeed for assistance with five or more activities of daily living (ADLs)Presence of mental retardation with other cognitive disabilities

Houston/Gulf Coast Region Relocation Services

Houston Center for Independent Living

Houston Center for Independent Living

To respond to the nursing facility staff referral and to the nursing facility resident within 14 days

Provide information about available community-based long-term care supports and services.

To provide assistance to the nursing facility resident so that he/she will be able to decide if relocation is a viable option.

HCIL’s Responsibilities

Houston/Gulf Coast Region Relocation Services

HCIL – Houston Center for Independent Living

ACTION STEP 8

Follow Up Process

Minimum 90 Days

ACTION STEP 7

Make It Happen Day

DADS, HMO, Nursing Home, Family, Service Orgs

ACTION STEP 6

Target Relocation

Houston/Gulf Coast Region 6 Relocation Services

Assess Location, Access TAS & TLC

ACTION STEP 5

Relocation Coordination of Services and Supports

Housing, service providers, transportation, family members, etc.

ACTION STEP 4

Application for MFP Services

Applications for Service and Independent Living Plan

ACTION STEP 3

Assessment

Conduct “DADS Approved” assessment

ACTION STEP 2

Verification of Relocation Request

Occurs within 14 days

ACTION STEP 1

Referrals

Consumer Self Referral, DADS, HMO,

Nursing Homes, Family, Service Orgs

ACTION STEP 1 ACTION STEP 2 ACTION STEP 3 ACTION STEP 4 ACTION STEP 5 ACTION STEP 6 ACTION STEP 7 ACTION STEP 8

Money Follows the Person (MFP) Relocation Action Steps Process

Houston Center for Independent Living

Houston Center for Independent Living

Can make living in the community possible.

Can empower individuals.

Can make the process of community integration easier and simpler.

Houston/Gulf Coast Region Relocation Services

Together We…

Role of the Ombudsman

» Advocate for residents of nursing facilities and assisted living facilities

» Provide information about the how to select a facility and how to get quality care

» Investigate and resolve problems» Represent the resident’s perspective in monitoring

laws, regulations, and policies and in making recommendations about needed changes

Role of the Ombudsman

» Educate and inform residents and their families about MFP (Money Follows the Person)

» Educate long-term care staff about MFP

Q&A

Acknowledgments» “The Harris County Long-Term Care

Ombudsman Program is supported, in part, by the City acting as the Harris County Area Agency on Aging and the Texas Department on Aging and Disability Services.”

Thank you!

Government Accountability Office. (2012). Medicaid: States’ plans to pursue new and revised options for home and community-based services. Washington, DC. http://

www.gao.gov/assets/600/591560.pdf

Mathematica Policy Research. (2012). Money follows the person 2011 annual evaluation report.http://www.mathematica-mpr.com/publications/PDFs/health/MFP_annual_report_2011.pdf

References