1. Nursing Facility Transition and Diversion Module 1: Overview of Transition and Diversion in the Long Term Care (LTC) System

2. Introductions Who are you? Why are you here and what is your experience with transition? Please feel free to ask questions at any time Handouts #1 and #2

3. Overview of Module #1 Myths and Truths in Long Term Care Nursing Facility Transition Work Characteristics of Successful Advocates CILs and Waiver Agents Landmark Legislation and Lawsuits Continued Efforts in Systems Change Transition Story #1

4. Myths and Truths (Handout #3) 1. Long term care can only be provided in a nursing facility. 2. People with disabilities and the elderly who have support needs are best served in nursing facilities for their own safety as nursing facilities provide 24 hour hands-on care. 3. A felony background or poor credit history history can prevent successful transition.

5. Myths and Truths 4. With proper support, anyone can live successfully in a community-based setting 5. Community based care is often more cost effective than nursing facility care 6. People who have guardians cannot live on their own in the community

6. Myths and Truths 7. Many people are lonely after transitioning back to the community. 8. Housing is often the biggest obstacle in the transition planning process. 9. Nursing facility staff are generally opposed to transition efforts.

7. Myths and Truths 10. In order to be successful, people who are transitioning must direct the process and play a key role in identifying and signing up for needed supports.

8. Nursing Facility Transition (NFT) Work Exciting, challenging work Addresses issues of Social Justice  14% of nursing facility residents are under age 65  Sometimes complex care needs  Potential to have or maintain families and careers  Most seniors prefer their own home Advocacy Role

9. Nursing Facility Transition (NFT) Work Steps in the process:  Outreach/Finding People to Transition  Initial Interview and Informed Choice

10. Nursing Facility Transition (NFT) Work Steps in the process continued  Working Agreement  Planning the Transition  Transition  Follow-up

11. Diversion Steps in the process:  Identify referral sources  Identify people at risk of permanent nursing facility placement  Intervene to prevent placement or  Follow the person to the nursing facility and plan transition

12. Diversion “Home is a lot better than where I was. When I got home, I thought, ‘God, I hope I make it. I hope we can make it together.’ It was scary for me to leave, because I didn’t know if I could manage, but we are in good shape…for the shape we’re in! Without (my family’s) help, though, I would not be here today.” Mrs. A., home after 183 days in the hospital and 212 days in the nursing facility

13. Essential Characteristics of Advocates Patience Persistence or Tenacity Passion

14. Essential Characteristics of Advocates Listening Skills Flexibility Creativity Organizational Skills, Reliability

15. Essential Resources for Transition Centers for Independent Living (CILs) Waiver Agents  Area Agencies on Aging  Independent Waiver Agents

16. Landmark Legislation and Lawsuits Disability Rights Movement  Began in 1970’s  Modeled after civil rights/women’s rights movements  Improved quality of life for people with disabilities  Accessibility and safety

17. Landmark Legislation and Lawsuits Americans with Disabilities Act  Title II—State & Local Governments Obligation to provide programs, services, and activities in the “most integrated setting.”

18. Landmark Legislation and Lawsuits Olmstead versus L.C. & E.W.  Supreme Court Decision  Two women with mental disabilities  Moved back to community

19. Landmark Legislation and Lawsuits Eager versus Engler/Granholm  Michigan’s “Olmstead” lawsuit  On behalf of nursing facility residents & people who wanted to stay in the community with supports  Settlement stipulated Admission to MIChoice Waiver Training on LTC Uniform Eligibility Criteria Waiting lists for MIChoice Waiver Establishment of Medicaid Long Term Care Task Force

20. Landmark Legislation and Lawsuits Medicaid Long-Term Care Task Force  Nine recommendations Person Centered Planning Money Follows the Person Single Point of Entry Services and Supports Prevention Activities Consumer Participation LTC Workforce Quality Management System Financing Structures

21. Continued Efforts in Systems Change Implement Task Force recommendations Promote Legislation  Statewide Efforts: (800) 760 4600 ext. 21 or visit http://www.copower.org http://www.copower.org  National Efforts: MiCASSA (Medicaid Community Attendant Services and Supports Act) http://ww.freeourpeople.orghttp://ww.freeourpeople.org

22. A Real Life Transition Story: Tenacious Charlie

23. Background In his late 60’s Became transition client in December 2000 Has cerebral palsy (CP) Lived most of life in state institutions Early attempt to live on his own failed

24. Housing Needed a barrier free, subsidized apartment Long waiting lists for good housing Multiple apartment applications Several months to locate apartment Very limited funding available

25. Accessibility 3 heavy steel doors to enter building Could not unlock front door Could not reach the entrance buzzer No wheelchair accessible shower Management was slow to resolve these issues

26. Care Requirements Needed Medicaid Waiver Services Required help with all of his ADL needs In 2000, Waiver slots very limited Coordination of Housing and Waiver services

27. Financial Very limited income Could not physically manage his own checking account or bills No family or long standing friends to assist Needed representative payee

28. Other Challenges In 2004, went back to nursing facility

29. Happy Endings New apartment New opportunity thru NFTI grant Transition fund purchases  Bathing system  Automatic door opener Charlie’s achievements  On his own for 5 years  Spoke at LTC public hearings  Active in the local CIL

30. For more information Real Choice Systems Change Grants: http://www.communitylivingta.info/ ADA, Olmstead, MiCassa, etc: http://www.accessiblesociety.org/index.shtml Medicaid LTC Task Force: http://www.healthteam.edu/imc/ltc/default.htm Nursing Facility Transition Initiative Data & Stories: http://nfti.prosynergy.org or email: ebys@michigan.gov http://nfti.prosynergy.org ebys@michigan.gov

31. Resources Centers for Independent Living Listings  www.macil.net www.macil.net Waiver Agent Listings  www.miseniors.net www.miseniors.net