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

2. 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

3. 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

4. Colbert Consent Decree
On December 20, 2011, Illinois entered into a Consent Decree, settling the Colbert v. Rauner class action lawsuit, first filed in 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.

5. 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.

6. 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

7. 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)

8. 2017 Referral Sources

9. Transition Totals

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

11. 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

12. 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

13. MDS 3.0 Section Q
42 CFR 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?”

14. 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 Q 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.

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

16. 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."

17. Department on aging Video

18. 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)

19. Thank you for Your time! Questions?