Michigan’s Long-Term Care Conference

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Michigan Nursing Facility Transition Initiative

• Michigans Long-Term Care Conference
• Hilton Detroit, Troy
• March 23-24, 2006

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What is NFTI?

• 2001 Real Choice Systems Change Grant, Centers
  for Medicare and Medicaid
• Administered by MDCH, Division of Community
  Living and DYNS Services, Inc.
• Diverted 105 people from nursing facility
  placement
• Transition 210 people from nursing facilities to
  community living
• Built on experience of Michigan Centers for
  Independent Living transition work

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NFTI Partners

• Michigan Department of Community Health
• Division of Community Living
• Neighborhood Services Organization
• MI Choice Waiver Program
• Detroit Area Agency on Aging
• Area Agency on Aging of Western Michigan
• Michigan State Housing Development Authority
• University of Michigan Turner Geriatric Center

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NFTI guiding principles

• Promote major system change in long term care
• People should be able to chose where to live and
  be able to pick the least restrictive environment
• People who do not need nursing care should not be
  in NF
• Result in significant cost shift from
  institutional to community care
• Housing is critical component of long term care
  program

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NFTI Transition Component

• Identify people in NF who express a desire to
  live in community
• Develop person centered transition plans
• Housing component
• Services Component
• Build on existing community capacity in MI Choice
  Waiver
• Coordinate with Housing providers

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NFTI and MI Choice Waiver

• Located a NFTI project at two MI Choice Waiver
  agents
• Detroit Area Agency on Aging
• Area Agency on Aging of Western Michigan
• Developed wrap around model to coordinate NFTI
  with MI Choice Waiver

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MI Choice Waiver History

• Funded by State and Federal
• Established in 1992
• Statewide coverage by 1998
• Served 15,000 in 2000
• Currently serves 8,600 people
• Medical eligibility nursing home LOC
• Financial eligibility 300 of SSI

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Project Model

• NFTI Coordinator at MI Choice Waiver Agent to
  develop transition plans with people who wished
  to leave nursing facility
• develop person centered transition plans
• Housing
• Services
• Financial
• implement plan

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Preliminary Transition Results

• 58 of the people transitioned did not need state
  funded Medicaid services from MI Choice or Adult
  Home Help
• The average cost of those who did use the MI
  Choice Waiver was 670 per month
• Average monthly Medicaid savings was 3,066
  compared to Nursing Facility
• 56 fell into lowest RUGs category (Reduced
  Physical Function)

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Preliminary Transition Results continued

• Mi Choice Waiver agents provide effective and
  inexpensive methods for transitioning people from
  nursing facilities
• Building community supports and housing is
  critical to returning to the community
• Important to look at people who do not qualify
  for MI Choice waiver or Home Help

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Case Histories

• Transition participant
• 61 year old male, limited English, burned in
  house fire, after hospitalization was placed in
  NF for two years because he had no place to live,
  nursing facility social worker contacted NFTI
  program to arrange transition to community.
  Living in community since September 2004.
• 32 year old quadriplegic, significant ADL and
  IADL support, moved to community in October 2004
  with help of Section 8 housing

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Recommendations, continued

• Coordinate NFTI with Money Follows the Person
  project
• Include NFTI in state Quality Improvement
  Initiative for long term care
• Develop local collaboratives to support project
  including Centers for Independent Living,
  Continuums of Care, MI Choice Waiver Agents,
  Community Mental Health Agencies, Hospitals and
  Nursing Facilities
• Promote NFTI care facilitation model which will
  result in better care and less lengthy stay in
  acute care and long term care

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Transition Participants
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Transition Participants
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Transition Participants
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Transition Participants
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Training and Education Component

• Develop Transition education component, which
  builds on Center for Independent Living Project
  and NFTI experiences
• Train wide variety of long term care
  professionals, participants and community
  resources

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Recommendations

• Incrementally expand Transition and Diversion
  projects statewide using NFTI model
• Continue existing programs in Wayne and Kent
  counties
• Continue evaluation to refine cost model/outcomes
  analysis
• Modest expansion to one or two other regions per
  year
• Target 10 to 12 of NF residents who do not need
  nursing care

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Recommendations continued

• Coordinate NFTI with Money Follows the Person
  project
• Include NFTI in state Quality Improvement
  Initiative for long term care
• Expand local supportive housing consortia to
  other areas of state and to include Centers for
  Independent Living, MI Choice Waiver Agents,
  Hospitals and Nursing Facilities.

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Addressing Barriers

• Fear of leaving institution
• Care facilitator and Community Consortia
• Lack of money, criminal history, poor credit
  history, lack of community supports
• Care facilitator and Community Consortia
• Lack of affordable, barrier free, and accessible
  housing
• Section 8 Housing Certificates for ages 18 to 62
• Community Supportive Housing Consortia
• Michigan Team

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Local Consortia

• Human Service Agencies
• Co-led by social services, include Area Agencies
  on Aging, MI Choice Waiver Agents, Centers for
  Independent Living, mental health, substance
  abuse, jobs, and other service providers
• Local Governments
• Co-led by largest city or county
• Include other local jurisdictions
• Nonprofit sponsors and advocates
• Some with housing experience
• Some service providers

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