Illinois Nursing Home Transitions November 2017 National consumer Voice Conference Presentation by: Jamie M. Freschi, State Ombudsman

Money Follows the Person (MFP) Authorized by the Deficit Reduction Act of 2005 and extended under Section 2403 of the Affordable Care Act. Collaboration with the following Illinois Departments: Housing Development Authority Healthcare and Family Services Human Services Divisions of: Mental Health Rehabilitation Servicers Developmental Disabilities

Goals of Money Follows the Person Increase the use of Home and Community Based Services (HCBS) and reduce unnecessary institutionalization Costs savings to the state Strengthen the ability of Medicaid programs to assure continued provision of HCBS to those individuals who choose to transition Ensure that procedures are in place to provide quality assurance and continuous quality improvement of HCBS

Colbert Consent Decree On December 20, 2011, Illinois entered into a Consent Decree, settling the Colbert v. Rauner class action lawsuit, first filed in 2007. The lawsuit sought a remedy to alleged violations of Title II of the Americans with Disabilities Act (ADA), and Section 504 of the Rehabilitation Act and the Social Security Act. Plaintiffs alleged that members of the class were: unnecessarily segregated and institutionalized in nursing facilities, and denied opportunity to live in appropriate community integrated settings where they could lead more independent and productive lives.

Goals of Colbert For the State to provide Class Members the necessary supports and services to allow Class members to live in the most integrated settings appropriate to their needs in community based settings Eligible Class Members must currently live in a nursing home located in Cook County, Illinois. Class Members must be receiving or be eligible to receive Medicaid.

Ombudsman Involvement from 1/1/09 – 3/31/2017 MFP Referrals 2,911 MFP Consultations to individuals 7,040 MFP Consultations to facility staff 2,260 MFP Community Education 214 MFP Resident Council Meetings 113

Community Programs Case Coordination Unit (Department on Aging) = ages 60 and over Centers for Independent Living = ages18-59, traumatic brain injury Department of Human Services = serious mental illness, intellectual and physical disabilities (any age)

2017 Referral Sources

Transition Totals

Housing Options Supportive Living Facilities (SLF) Medicaid Waiver Most of our 65 and over transitioned to SLFs Public/senior housing Family members’ homes

Roadblocks Mitigating risks Inadequate assessments Lack of Resources for individuals with serious mental illness Funding Housing Transportation in rural areas Family support Knowledge about the program

Ombudsman Frustrations Roadblocks Ombudsman were the “face” of MFP Lack of follow up on the part of the transition coordinators Key parties not allowing the resident the chance to succeed or fail in the community Lack of resources Section Q

MDS 3.0 Section Q 42 CFR 483.20 requires Nursing Facilities participating in Medicare and Medicaid programs to complete the Minimum Data Set (MDS) assessment on all residents at admission and on a regularly prescribed schedule thereafter. Nursing Facilities are mandated to submit referrals for residents who respond, “Yes” to MDS-Q0500B:“Do you want to talk to someone about the possibility of leaving this facility and returning to live and receive services in the community?”

MDS 3.0 Section Q Q0300 – Resident’s overall expectation. Complete only for the first assessment after admission or reentry to the building. Q0400 – Discharge plan. Employs a “skip pattern”. If an active discharge plan is in place for return to the community, skip to Q0600 Q0490 – Resident’s preference to avoid being asked Q0500B. “Does the resident’s clinical record document a request that this question be asked only on comprehensive assessments? If yes, skip to Q0600 Q0500B – Return to community. “Do you want to talk to someone about the possibility of leaving this facility and returning to live and receive services in the community?” Done on Admission, Quarterly and Annual Assessments, unless altered by response to Q 0400 or Q0490. Q0550 – Resident’s preference to avoid being asked question Q0500B. Similar to Q0490. Intent of the item is to provide sensitivity to those individuals who may be unable to voice their preferences or who may be upset by being asked question Q0500 B in the assessment process.

Mixed Results Disappointments: Successes: Ken’s story Mike’s story Mary and Brian’s Story

Mary and Brian As they talk about the accidents that left them living in a nursing home, Mary and Brian break into broad smiles. "Mary and I were the life of the facility," Brian says. Mary had experienced a severe brain injury and Brian's accident left him paralyzed. The couple's relationship blossomed in the nursing home and they were engaged. Soon after, the Elgin- based Center for Independent Living used the MFP program to assist the couple to move into their own apartment. "It works out nice," Mary says. "I am his legs, he is my memory."

Department on aging Video https://www.youtube.com/watch?v=c2E8d2Zh1SY

Next Steps in Illinois Colbert Transitioning to another State Agency Referrals made on-line Mental health services provided by a MCO or Community Mental Health Center Enhanced Deinstitutionalization Initiative (EDEI)

Thank you for Your time! Questions?