Presentation on theme: "Enhanced Nursing Home Transition"— Presentation transcript:
1Enhanced Nursing Home Transition NHT Collaborative PartnersRegional MeetingsAugust 2006
2GoalsProvide a context for discussing change in Pennsylvania’s Long Term Living systemProvide key information for state staff to support Enhanced Nursing Home Transition
3Drivers of LTL System Change PA, Nation and the World are aging.Federal policy is promoting community living for people of all ages and disabilities--Americans with Disabilities Act, Olmstead Decision, New Freedom Initiative.Consumers of LTL services want to remain in their homes and communities.
4Drivers of LTL System Change Advocates are pushing for Home and Community-Based Care—ADAPT, AARP and others.Consumer Direction is sweeping the states.States are seeking ways to help people of all income levels find affordable options for both private pay and publicly supported services.
5National PolicyFor the first time ever, the Centers for Medicare & Medicaid Services (CMS) and the Administration on Aging (AOA) are partnering…and they are urging the states to do more to help people live in their homes and communities.
6“We are about to enter a new era of personal control, of New Freedom, in the Medicaid program. With a concerted effort, every state can rebalance its Medicaid program. With the tools we have now, it is time to end the institutional bias….”Dr. Mark McClellan, Administrator Centers for Medicare & Medicaid Services
7Josefina Carbonell, Assistant Secretary for Aging “This is an exciting time to be involved in long-term care. It is clear we are witnessing a fundamental change in federal policy that is guided by the New Freedom Initiative and directed at giving people more control over their care, as well as providing more support for community living.”Josefina Carbonell, Assistant Secretary for Aging
8States are either Leading or Following…but most are Moving Listening to older adults and people with disabilities.Balancing public dollars spent on long term care (living).Informing people about their options.Emphasizing the “critical pathways” to a nursing home admission.Assertively reaching out to people in nursing homes to help them return home.
9People in Nursing Homes Need Information about LTL Options Crucial for consumers, their familiesPeople enter a nursing home for many reasons; many can leave.Without information and help, many people in nursing homes cannot make an informed decision about where to receive services outside of an institution.
10Myth: Most People in Nursing Homes Need to be There Those who resist change say: “People in nursing homes today are too frail to live in the community. Only a few of them can really leave.”Fact: For every person in a nursing home who needs assistance with 3 or more activities of daily living, there are 1.83 people living in the community who have the same level of disability.
11Improving Access to LTC Options States are looking at best methods to avoid unwanted institutionalizationManaged Care (Arizona, Texas, New York)Various Nursing Home Transition programsNursing Home Transition programsLarge statewide programs (WA, NJ, Oregon)State employees (NJ, WA)Contracted organizations (CO)Small programs for most challenging (SC, CT)Locally based organizations (Centers for Independent Living, Area Agencies on Aging)
12Culture Change: Philosophy of Person-Centered Planning and Choice For Nursing Home Transition to work, all long-term living stakeholders have to see it as possible and desirable that consumers can choose and direct their services.Need to confront ageism and institutional bias.
13SummaryFederal policy and consumer activism are fueling historic, fundamental change in long-term livingStates are developing various models for making community living a real optionNursing home transition is a crucial component to balancing the LTL systemNot Easy, Not Fast, Worth it, Possible
14The Pennsylvania Picture Three Imperatives to Balance the Long Term Living System in PADemographic trendsConsumer choiceFiscal challenge
15Demographic Trends 85+ Population in PA Fastest-growing segment in the U.S., 9% increase since July, 2003 Medicaid long-term living utilization is consistent with demographic trendsMikePennsylvania is the nation’s third oldest stateThe baby boomer generation begins to turn 60 in 2006 and 65 in 201185+ demographic has grown 9% since 7/2003 aloneProjections show that total Medicaid Long Term Care demand will either grow in line with or below the rate of growth of the 85+ demographic in Pennsylvania through 2020Source: Penn State Data Center and PA Department of Public Welfare
16Consumer ChoiceThe vast majority of people with disabilities want to live independently and with dignity, free from the restrictions of institutional settings.Nine out of ten older adults prefer to “age in place” in their homes and communities.
17Chronically Ill Adults Chronically Ill Adults Fiscal ChallengeThe Elderly and Persons with Physical Disabilities Use the Greatest Share of Medicaid ResourcesChronically Ill Adults$1.0 billion 8%Elderly$4.7 billion35%Elderly$4.7 billion35%Children & Families$3.2 billion24%Disabled$4.3 billion33%MikeDespite representing about a third of the Medicaid eligible population, the Elderly and Persons with Physical Disabilities account for more than 2/3 of Medicaid expendituresChildren & Families$3.2 billion24%Disabled$4.3 billion33%Chronically Ill Adults$1.0 billion 8%Source: PA Department of Public Welfare
18Long-Term Living Spending Increasing investment in long-term living services to serve Elderly and Persons with Physical DisabilitiesMikeThe Commonwealth’s ability to meet the long-term living needs of Pennsylvania’s elderly and persons with physical disabilities has been improved through increasing investments, including those in home and community-based care alternatives.In these three categories of long term living spending a $1 billion increase sinceSource: PA Department of Public Welfare
19Nationwide Comparison of LTC users in NF versus HCBS Nationwide trends show sustained commitment is necessary to rebalancing74%86%65%25%70%43%26%14%35%75%30%57%0%10%20%40%50%60%80%90%100%NationalPAMNORVTWAState% of Consumers% NF% HCBSMikeWe’ve made significant progressHave a strong framework on which to buildStill have a ways to goThis is 2002, so we have made progress since this data was collected.Also shows services other states have been able to achieve in balancing their long term care system.Sources: Thomson Medstat and Kaiser Family Foundation, 2002
20Pennsylvania’s Progress Share of HCBS waiver users have increased sinceMikeAll of these investment in HCBS have allowed Pennsylvania to make significant progress in beginning to rebalance its long-term living system.Share of HCBS recipients has more than doubled since 2002/2003, while Nursing Home uses has grown at a much slower rate18% in HCBS Services in 2002/2003 to 27% in 2005/2006 to almost 30% in FY2006/2007Source: PA Department of Public Welfare
21Long Term Living Council Subset of Governor Rendell’s Health Care Reform CabinetIn November of 2005, Governor Rendell established the Long Term Living Council aimed at:Accelerating reforms of the Commonwealth Long Term Living System, building on successful initiatives implemented to-datePositioning the Commonwealth to meet future demand for services while addressing the short-term and long term fiscal challenge this will entailImproving coordination across state departments in support of LTL reform agenda.Council Members include Cabinet Secretaries from Aging, DPW, Budget, and Policy; Director of the Office of Health Care Reform and Deputy Chief of StaffMichael Nardone named as Executive Director; cross-agency staff teams formed to support work of the CouncilMikeMention involvement of other Secretaries: DCED, DOH, Insurance
22Rendell Long-Term Living Reform Agenda Governor Rendell’s vision is to offer consumers choice as to where they receive long-term living services, ensuring high-quality care in the most clinically-appropriate, most cost-effective environmentTo achieve this goal, the LTL Council will work to:Enhance and expand efforts to assist nursing home residents who wish to leave a facility-based care setting, and can safely return to their home or communityEnsure that the supply of nursing home beds appropriately meets the need for such care, while providing opportunities for facilities to expand their continuum of careEnsure consistency in the application of eligibility criteria for long-term living services, while removing barriers to receiving home and community-based waiver servicesMaximize available waiver resources to serve as many consumers as possible, while ensuring provision of high-quality care and services
23Enhanced Nursing Home Transition Priority for PDAOpportunity for the AAA’s to provide for a more formal outreach and a method to increase consumers access to H&CBS.
24Enhanced Nursing Home Transition Focus on new admissionsMDS DataLTL CounselingStrengthened collaborationsActive engagement of AAAs and DPW NHT partnersIncentives for agencies to achieve successful transitions
25Focus on New Admissions NHT program has demonstrated that the loss of housing and community supports is major barrier to successful transitionNeed to inform and educate consumers, families and caregivers before resources and supports disappear
26MDS DataCollected by nursing homes on all new admissions to develop plan of care06-07 rate agreement requires data to be submitted within 7 days of completionMDS data will be used to focus NHT efforts on new admissions
27LTL CounselingProvide information and guidance to consumers in need of LTL servicesEnsure that all options are explained fullyEnable consumers to make informed choices about where and how they receive LTL services.Ensure that scheduled discharges occur as plannedPurpose of LTL Counseling:enable consumers to make informed choices about where and how they receive LTL services.· provide information and guidance to people newly admitted to nursing facilities, using the MDS on new admissions.· ensure that all options are explained fully
28Strengthened Collaborations Opportunity to strengthen and expand existing collaborationsClearly define roles and responsibilitiesIncrease and improve inter-agency communicationInclude additional community partners to support NHT, e.g. housing agencies, faith based organizations, community service organizations, other county agencies
29Coordination between LTL and NHT activitiesAAA NHTResponsible for transition services andsupports to over 60 consumers; actively workswith each consumer to complete a successfultransitionLong Term Living CounselorProvide information and guidance to consumersEnsure that all options are explained fullyEnable consumers to make informed choices about where and how they receive LTL servicesLocal CollaborationShares knowledge, expertise, and resources tosupport successful transition; case conferencingaround difficult transitions; other activatesdepending on local arrangementsOSP Agency NHTResponsible for transition services and supportsto under 60 consumers; actively works witheach consumer to complete a successfultransition
30Active Engagement of All Partners AAAs will conduct LTL CounselingAAA will be responsible for over 60 transitionsDPW NHT partners will be responsible for under 60 transitionsCollaborative partners will share experience, expertise and resources to support successful transitions
31Unified Data TrackingModule has been created in OMNIA to collect LTL Counseling and transition dataAll agencies will use the same systemReal time data collection to allow ready access to critical information
32Technical Assistance Roll-out Meetings Monthly Regional TA Calls NHT Conference in OctoberRegional Housing TA MeetingsState Staff:PDA – Tim Hoskins, (717)DPW – Kim Kramer, (717)GOHCR – Lynne Miles, (717)Sort data by short term, long term, uncertainDementia, under 60 consumers, over 60 consumersWithin the first 30 days of admission prior to loss of housing and informal supports. Will make transitions easierAAA will take an active role in doing transition work.All agencies will have training before August 31, Training will walk you through the process.Supports available for technical transitionMonthly Regional Technical Assistance CallsQuality & Compliance SpecialistTim Hoskins from PDADennis DeSantis and Sue Getgen
33Summary of Enhanced NHT Identification of NH Admissions through MDS DataEarly LTL counselingActive engagement of AAA and DPW NHT agencies in transition activitiesStrengthened collaborationsIncentives for successful outcomesSort data by short term, long term, uncertainDementia, under 60 consumers, over 60 consumersWithin the first 30 days of admission prior to loss of housing and informal supports. Will make transitions easierAAA will take an active role in doing transition work.All agencies will have training before August 31, Training will walk you through the process.Supports available for technical transitionMonthly Regional Technical Assistance CallsQuality & Compliance SpecialistTim Hoskins from PDADennis DeSantis and Sue Getgen
35Proposed Incentive Plan The Commonwealth is proposing to invest in AAAs and DPW NHT agencies through the incentive programAgencies will have the opportunity to earn additional dollars in incentive payments through this incentive poolTwo part system rewards performance and provides support for agency restructuring
36Incentive Plan Principles It is meaningful for agencies large and small;It will result in necessary restructuring;It strengthens partnerships;It balances these needs with existing agency capacity; and It will not require a recurring expenditure for success.
37Incentive Plan Components Restructuring IncentiveGoal is to reward agencies for meeting transition goalsIncentives are based on agencies performing specific functions and to restructure operations to support Enhanced NHTOne-time, non recurring expenditure
38Incentive Plan Components Goal Based IncentivesEach agency has been given specific transition goalsIncentive funds will be earned based on successful attainment of goals
40BHCBS Partners Total Incentive Examples TierCountyTotal GoalRestructuring2nd Quarter4th QuarterTotal Possible1CIL of Central PA10$15,000$5,000$10,000$30,0002VFI30$20,000$40,0003CRI66$25,000$65,0004Liberty125$50,000$95,000DRAFT