1. Michigan Program for Background Checks Michigan’s Long-Term Care Conference March 24, 2006

2. Statement of the Problem Some LTC employees with direct access undergo background checks, but not all. Some LTC employees with direct access undergo background checks, but not all. Process was not comprehensive or systematic, no appeal process, and limited training on abuse and neglect. Process was not comprehensive or systematic, no appeal process, and limited training on abuse and neglect. There is a shortage of qualified health care workers. There is a shortage of qualified health care workers. Proportion of elderly and disabled is increasing. Proportion of elderly and disabled is increasing.

3. Current MI Background Check Laws and Status Currently only Nursing Homes, County Medical Care Facilities, Homes for the Aged and Adult Foster Care Facilities Currently only Nursing Homes, County Medical Care Facilities, Homes for the Aged and Adult Foster Care Facilities Primarily of a “name” check on the Internet Criminal History Tool (ICHAT) Primarily of a “name” check on the Internet Criminal History Tool (ICHAT) Not in state for at least three years = FBI fingerprint check Not in state for at least three years = FBI fingerprint check

4. Current MI Background Check Laws and Status Not Included: Psychiatric Hospitals, Hospices, Home Health Programs, Home Help, Long Term Care Hospitals, and ICF/MRs, New Health Professionals Not Included: Psychiatric Hospitals, Hospices, Home Health Programs, Home Help, Long Term Care Hospitals, and ICF/MRs, New Health Professionals Does not include all federally prohibited offenses and substantiated findings under abuse and neglect Does not include all federally prohibited offenses and substantiated findings under abuse and neglect Takes too long, inefficient, to often inaccurate Takes too long, inefficient, to often inaccurate

5. Michigan’s Response: September 2004, Michigan submitted Federal Background Check Pilot Project Grant under the Medicare Modernization Act of 2004 September 2004, Michigan submitted Federal Background Check Pilot Project Grant under the Medicare Modernization Act of 2004 CMS awarded $5,000,000 over thirty months beginning in January 2005 CMS awarded $5,000,000 over thirty months beginning in January 2005 One of Seven States in Pilot One of Seven States in Pilot

6. Michigan’s Response: Collaborative Partnership: Michigan Department of Community HealthMichigan Department of Community Health Michigan Department of Human ServicesMichigan Department of Human Services Michigan State PoliceMichigan State Police Office of Services to the AgingOffice of Services to the Aging Michigan State UniversityMichigan State University Multiple Advocacy and Provider GroupsMultiple Advocacy and Provider Groups Background Check and AANP AdvisorsBackground Check and AANP Advisors

7. Michigan’s Response: Six Key Features of the program: Expand the Scope of Michigan’s Laws Expand the Scope of Michigan’s Laws include Psychiatric Hospitals, Hospices, Home Health, Long Term Care Hospitals, and ICF/MRs (Michigan is including Home Help.)include Psychiatric Hospitals, Hospices, Home Health, Long Term Care Hospitals, and ICF/MRs (Michigan is including Home Help.) Strengthen Michigan’s Criminal Background Checks Strengthen Michigan’s Criminal Background Checks include prohibited offenses, substantiated findings of abuse and neglect, and registry checksinclude prohibited offenses, substantiated findings of abuse and neglect, and registry checks

8. Michigan’s Response: Six Key Features (Cont.): Provide Due Process Provide Due Process Create an Appeal ProcessCreate an Appeal Process Speed up the process--enhance accuracy Speed up the process--enhance accuracy Fixed and Mobile Locations (MSP /Identix) Fixed and Mobile Locations (MSP /Identix) Electronic Fingerprint (MSP) Electronic Fingerprint (MSP) Web-based Provider Interface (MSU) Web-based Provider Interface (MSU)

9. Michigan’s Response: Six Key Features (Cont.): Implement AANP Training Implement AANP Training BEAM—(OSA, MSU, MPRO)BEAM—(OSA, MSU, MPRO) Objective and rigorous evaluation Objective and rigorous evaluation MSU (Background Checks and AANP)MSU (Background Checks and AANP) Federal Contractor Federal Contractor

10. Legislation Process / Decisions Broad-Based Legislative Committee Broad-Based Legislative Committee Met several times, plus subcommitteesMet several times, plus subcommittees March 2005-January 2006March 2005-January 2006 Consensus-based processConsensus-based process Legislation takes effect April 1, 2006Legislation takes effect April 1, 2006 Federal CMS Compliance Review Federal CMS Compliance Review

11. Legislation Process / Decisions Decision Rules / Priorities Decision Rules / Priorities Medicaid / Medicare FundingMedicaid / Medicare Funding Quick Turn AroundQuick Turn Around Readily AvailableReadily Available Full Federal ComplianceFull Federal Compliance

12. Michigan Program for Background Checks Fingerprinting Process Fingerprinting Process Timothy Bolles, MSPTimothy Bolles, MSP Research and Evaluation Research and Evaluation Lori Post, MSULori Post, MSU IT Interface IT Interface Robert Fulk MSURobert Fulk MSU

13. FINGERPRINTING PROCESS FINGERPRINTING PROCESS TechnologyTechnology Collection AgencyCollection Agency Fingerprint Collection LocationsFingerprint Collection Locations Fingerprint Collection RequirementsFingerprint Collection Requirements Fingerprint Transmittal MethodsFingerprint Transmittal Methods

14. Michigan Program for Background Checks Fingerprinting Process Fingerprinting Process Timothy Bolles, MSPTimothy Bolles, MSP Research and Evaluation Research and Evaluation Lori Post, MSULori Post, MSU IT Interface IT Interface Robert Fulk MSURobert Fulk MSU

15. RESEARCH & EVALUATION

16. Research

17. Michigan Survey of Households with Family Members Receiving Long- Term Care Services Random Sample of Michigan Households Random Sample of Michigan Households N=1002 N=1002 Stratified by AANP Training Stratified by AANP Training Provides baseline data of abuse, neglect, and exploitation. Provides baseline data of abuse, neglect, and exploitation.

18. Total Abuse Incidents Last Year by Market

19. Research Impact of Aging on Michigan’s Population Impact of Aging on Michigan’s Population Labor Force Issues Labor Force Issues

20. Aging Michigan Population 1970 to 2030 1970 to 2030 Population Estimates and Projections. Population Estimates and Projections. Median age will increase by 5 years. Median age will increase by 5 years. Number of persons > 65 will double Number of persons > 65 will double Causation and correlates of abuse, neglect, and exploitation Causation and correlates of abuse, neglect, and exploitation

21. Evaluation ProcessImpactOutcome

22. Process Evaluation Document the steps to implement the legislation and new background check system Document the steps to implement the legislation and new background check system Barriers and Obstacles for duplication in other states Barriers and Obstacles for duplication in other states Did we accomplish what we set out to do. Did we accomplish what we set out to do.

23. Impact Evaluation Impact of Background Check System and legislation on reducing abuse, neglect and exploitation. Impact of Background Check System and legislation on reducing abuse, neglect and exploitation. Compare before and after measures of abuse, neglect, and exploitation. Compare before and after measures of abuse, neglect, and exploitation.

24. ADULT ABUSE & NEGLECT PREVENTION

25. Definition The Adult Abuse & Neglect Prevention grant is a program for direct access staff employees and managers of long-term care facilities and providers of service to adults that addresses the issues that precipitate abusive behavior and provides preventive solutions for reducing incidents of abuse and neglect and for improving the quality of care for patients with long term illnesses or disabilities. The Adult Abuse & Neglect Prevention grant is a program for direct access staff employees and managers of long-term care facilities and providers of service to adults that addresses the issues that precipitate abusive behavior and provides preventive solutions for reducing incidents of abuse and neglect and for improving the quality of care for patients with long term illnesses or disabilities.

26. Facilities & Providers Skilled Nursing Facilities/Nursing Homes Skilled Nursing Facilities/Nursing Homes Long Term Care Hospitals, Swing Beds Long Term Care Hospitals, Swing Beds Intermediate Care Facilities (ICFs/MRs) Intermediate Care Facilities (ICFs/MRs) Psychiatric Hospitals Psychiatric Hospitals Hospices Hospices

27. Facilities & Providers (cont’d) Assisted Living Facilities Assisted Living Facilities including Adult Foster Care Homes & Homes for the Agedincluding Adult Foster Care Homes & Homes for the Aged Home Health Agencies Home Health Agencies Adult Services Home Help Workers Adult Services Home Help Workers Individual personal care providers not associated with personal care agencies Individual personal care providers not associated with personal care agencies

28. Geographic Regions Upper Peninsula Upper Peninsula Midland/Saginaw/B ay City/Flint Midland/Saginaw/B ay City/Flint Southeast Michigan including Detroit Southeast Michigan including Detroit Southwest Michigan including Kalamazoo Southwest Michigan including Kalamazoo

29. Goals Create an expanded adult abuse and neglect prevention curricula incorporating methods of staff empowerment, culture change, and person-centered care. Create an expanded adult abuse and neglect prevention curricula incorporating methods of staff empowerment, culture change, and person-centered care. Thus, leading to… Thus, leading to…

30. Increased staff awareness Increased staff awareness Reduced abuse and neglect incidents by employees Reduced abuse and neglect incidents by employees Reduced abuse and neglect incidents by residents or patients Reduced abuse and neglect incidents by residents or patients Improved organizational culture Improved organizational culture

31. Evaluate the impact of the background check information and the AANP training on recognition and reporting of suspected abuse and neglect. Evaluate the impact of the background check information and the AANP training on recognition and reporting of suspected abuse and neglect.

32. Establish a process to ensure AANP is implemented on a regular basis after 2007. Establish a process to ensure AANP is implemented on a regular basis after 2007.

33. Curricula Definitions: Definitions: “What is abuse?”“What is abuse?” Reporting: Reporting: Procedures for each group of providersProcedures for each group of providers Prevention: Prevention: Conflict Resolution Stress Management De-escalation Techniques Person Centered Care Principles

34. Timeline…2005 Establish collaborations Establish collaborations (MDCH, OSA, MSU, PHI, CBC, WSU)(MDCH, OSA, MSU, PHI, CBC, WSU) Convene Advisory Committee Convene Advisory Committee Develop curricula Develop curricula Identify & recruit trainers Identify & recruit trainers 11 Primary Trainers11 Primary Trainers 75-80 Specialized Trainers75-80 Specialized Trainers Offer Orientations in each region Offer Orientations in each region Identify and begin surveying participants Identify and begin surveying participants

35. Timeline…2006 Ongoing communication with Advisory Committee Ongoing communication with Advisory Committee Trainers in place Trainers in place Begin training of 11,000 DAS Begin training of 11,000 DAS Review and modify curricula as needed Review and modify curricula as needed TeleSage Survey with MSU TeleSage Survey with MSU Compile Data Compile Data

36. Timeline…2007 Ongoing communication with Advisory Committee Ongoing communication with Advisory Committee Complete training of 11,000 DAS Complete training of 11,000 DAS Complete surveys Complete surveys Compile data Compile data Draft proposed policy recommendations Draft proposed policy recommendations Develop steps to implement AANP statewide Develop steps to implement AANP statewide

37. End Result A statewide, tested, training program (including manuals) for all direct access staff in the long term care continuum that offers cognitive ways to prevent abuse. A statewide, tested, training program (including manuals) for all direct access staff in the long term care continuum that offers cognitive ways to prevent abuse. Michigan’s Adult Abuse & Neglect Prevention Program is the pilot selected by the Centers for Medicare & Medicaid Services to be offered nationwide to ensure the care, safety, and comfort of our vulnerable adults in the long term care continuum. Michigan’s Adult Abuse & Neglect Prevention Program is the pilot selected by the Centers for Medicare & Medicaid Services to be offered nationwide to ensure the care, safety, and comfort of our vulnerable adults in the long term care continuum.

38. CONTACT INFORMATION  Gloria Lanum, MDCH--Background Check Grant Manager— lanumg@michigan.gov  Lauren Swanson, OSA—AANP Grant Manager—swansonla@michigan.gov Manager—swansonla@michigan.gov  Ellen Hayes, MSU—Background Check Project Manager— hayse@msu.edu