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Nursing Home Resident Relocations Age Odyssey June 17 th, 2013 1.

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Presentation on theme: "Nursing Home Resident Relocations Age Odyssey June 17 th, 2013 1."— Presentation transcript:

1 Nursing Home Resident Relocations Age Odyssey June 17 th, 2013 1

2 Objectives Overview of the law, history, scope and applicability Overview of resident relocation process Know where to find helpful resources Be prepared with strategies to meet challenges that may arise 2

3 Resident Relocation Process What is it all about ? A thoughtful and systematic approach to the relocation of residents in situations where a nursing facility (NF) is undergoing a partial or complete closure 3

4 Nursing Facility (NF) Closure History In the MA program: Total NFs (1998) = about 434 NFs closed about 75 New NFs about 14 Today = 373 4

5 Closure History not counting partial closures or changes in operations where resident relocations also occur – 19983 – 19990 – 200013 – 20014 – 20026 – 20036 – 200410 – 20056 – 20063 – 20076 – 20086 – 20093 – 20103 – 20112 – 20123 – 20131 (as of 5/1/13) 5

6 Pre-Resident Relocation Law Concerns Closures went very fast Residents often received little or no notice No information about where residents went Residents were often given no choice 6

7 Intent of the Resident Relocation Law To recognize that involuntary relocations can be especially difficult for nursing home residents – to reduce transfer trauma Expecting that new state policies would lead to some closures – to be prepared To provide equity in access to available beds/services To provide oversight 7

8 Development of the Law Participants included: – Minnesota Department of Health (MDH) – Minnesota Department of Human Services (DHS) – Counties – Ombudsman – NH trade associations – Provider representatives 8

9 Purpose of 2013 revisions Align with new federal regulations Incorporate twelve years of experience, current practice and circumstances and best practices Clarify and simplify the language Reduce unnecessary burden on all parties 9

10 Facility Costs Concerns over facility costs of compliance – 50% rate increase Accountability 10

11 Overview of Process Initial notice from licensee Coordinated planning process – facility interdisciplinary team – county of location involvement – ombudsman involvement – notice to Managed Care Organizations (MCOs) – notification to and possible involvement of DHS/MDH 11

12 Overview of Process Development of the “relocation plan” – agreement of parties on the process – identify residents, resources and timelines – what best meets needs of residents Facility begins reporting the week following development of relocation plan 12

13 Overview of Process Notice to residents/family by closing facility – 60 day notice of closure – meetings with families/resident councils Preparation for resident relocation – sufficient preparation – relocation options/information – site visits – transfer or retention of medical records and forms – resident property, communication devices 13

14 Overview of Process Licensee provides final discharge notice – resident – responsible parties – managed care organization, if applicable – physician 14

15 Overview of Process Physical relocation of residents – facility responsible for transport of resident – facility responsible for transport of property & funds – facility responsible for reconnection of communication devices – facility must provide staff escort – no disruption in meals or treatment 15

16 Overview of Process County Role – participatory – helps to coordinate relocation process – serves as a resource – monitors facility compliance with plan – reports to state – conducts follow-up assessments 16

17 Overview of Process Other noteworthy provisions – refrain from public notice of closure (until 60 day notice) – no new admissions after notice (on complete closures only) – licensee and administrator bear responsibility 17

18 Definitions change in operations/closure/reduction facility types “responsible party” 18

19 Initial Notification Process allows MCOs to begin planning process may provide additional resources in relocation process, through MCO involvement allows county to begin determining the involvement of other case managers 19

20 allows county to conduct some advance planning for individuals with special needs clarifies facility responsibilities and allows county to monitor changes 20 Initial Notification Process

21 facilities still face difficulty identifying specific county contacts challenges with multiple party involvement and the risk of public “leak” of closure 21

22 Planning Process ensures that parties are working together, by instituting a deadline for developing the relocation plan provides for an outline of items included in the plan community assessment by lead agency will assist residents seeking alternative placements 22

23 Planning Process difficulty in finding the right county staff contact person may result in delays or could result in the county not being in compliance with their role in process - NF follow up needed places responsibility of sharing information with MCOs on other parties, when MCO not involved in planning 23

24 Responsibilities of Licensee outlines facility responsibilities outlines repercussions if out of compliance with statute 24

25 Responsibilities of Licensee, cont. 60 day notice to residents and others census concurrent with notice weekly status reports MCO 25

26 Placement Information sufficient preparation and options allow for resident placement choice lead agency assessors can identify relocation options other than NFs 26

27 Placement Information finding community options takes time and is difficult under time pressures 27

28 Meeting with Residents/Responsible Parties and Site Visits county/ombudsman should be present at each meeting to assist, answer questions and provide assurances and options county/ombudsman presence essential for problem-solving and successful transitions having facility responsibility for site visits in writing clarifies their responsibility and allows for resident choice 28

29 Meeting with Residents/Responsible Parties and Site Visits if facility ill-prepared, creates difficult position for county and ombudsman 29

30 Resident Property, Funds and Communication Devices Property Funds Communication devices 30

31 Final Written Discharge Notice & Responsibilities During the Relocation final notice notification process of discharge date of discharge 31

32 Responsibilities of County Social Service Agency flexibility in staff assignments county as a resource is especially important for potential HCBS services lead agency community assessment will assist residents seeking alternatives 32

33 Responsibilities of County Social Service Agency required concurrent resident notice by county agency provides residents/responsible party with added assurance that process will be followed and advocacy provided county serves as monitor for state regulatory agencies and on behalf of MCOs (when applicable) 33

34 Responsibilities of County Social Service Agency county role in this process remains unfunded no direction on what unit of county government should be responsible for participating in meetings and these activities 34

35 Role of Ombudsman Monitor and protect resident rights Investigate complaints Monitor quality of care for residents Provide technical assistance to facility staff Participate in planning process Resident follow-up visits 35

36 Resident Rights To be treated with respect, dignity, and consideration Right to choice and individual preference Freedom from abuse and unnecessary restraints Freedom of association and communication Right to not be transferred without proper notice Right to make complaints and express grievances Right to keep possessions 36

37 Transfer Trauma What is it? “ combination of medical and psychological reactions to abrupt physical transfer that may increase the risk of grave illness or death” 37

38 Transfer Trauma Characteristics: – Depression manifesting as agitation – Increase in withdrawn behavior – Confusion – Change in eating and sleeping habits 38

39 Transfer Trauma Characteristics, cont.: – Self-care deficits – Increase in falls – Diagnoses of dementia and Alzheimer's: exaggerated symptoms, including hallucinations and delusions 39

40 Perspectives Resident: – “Little things all add up to important things” – “The resident council needs to be more proactive...” – “ What will happen to my belongings, what if things get lost or broken?” – “Can I see the new place first?” – “I want the same staff to care for me at the new place” 40

41 Perspectives Family: – “I don’t want my husband to move” – “Will this cost more money?” – “We know what is best for our loved one” – “Need for a strong family council…” 41

42 Resources Relocation Resource Guides – Nursing Facility Resource Guide – County Resource Guide Local County Social Services Agency DHS or MDH staff Office of Ombudsman for Long-Term Care 42

43 Q &A Audience Questions ? 43

44 Thank You ! Sue Fehr, Hennepin County Robert Held, MN Dept. of Human Services (DHS) Cheryl Hennen, Office of Ombudsman for Long- Term Care Thom Johnson, Ramsey County Louise Starr, Dakota County Munna Yasiri, MN Dept. of Human Services (DHS) 44

45 Questions ? Contact: Munna Yasiri (651) 431-2264 45

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