Nursing Facility Diversion and Transition: Potential roles for Nursing Home Ombudsmen

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Nursing Facility Diversion and Transition
Potential roles for Nursing Home Ombudsmen

• NASUA Teleconference,
• February 15, 2007
• by
• Darlene (Dee) OConnor, Ph.D.
• Director, Long-Term Care Policy

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Diversion Study Background

• Major barriers to community supports
• Lack of knowledge on the part of consumers,
  families and health care professionals
• Lengthy eligibility process for community
  supports
• Complex medical, psychiatric and substance abuse
  issues
• Lack of affordable, accessible housing
• Insufficient incentives for diversion/transition
  planning

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Current Pathways for Long-Term Supports


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Diversion and transition approaches across the
country

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Diversion/Transition Recommendations

• Increase public awareness about available options
• Develop legislative commitment to promoting
  community options
• Educate hospital (and nursing home) staff and
  patients regarding long-term support options in
  the community.
• Replicate successful features of Aging and
  Disability Resource Center (ADRC) model for
  outreach
• Screen nursing facility residents who may become
  eligible for Medicaid in 90 days
• Use the Minimum Data Set (MDS) data to identify
  potential transition candidates
• Use the PASRR process to support diversion and
  transition

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Diversion/Transition Recommendations

• Expedite eligibility for community-based supports
• Amend HCBS waivers to allow for presumptive
  financial eligibility
• Reduce Medicaid processing time for redetermining
  eligibility when an individual seeks to leave a
  nursing facility and return to the community
• Expedite access to personal care assistance and
  durable medical equipment

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Diversion/Transition Recommendations

• 3. Increase care coordination services for
  targeted groups
• Devote additional resources to care coordination
• Employ dedicated transition staff to the extent
  possible given resources
• Tailor care coordination to needs of discrete
  populations, e.g. language minorities including
  Deaf clients, individuals with more intensive
  needs
• Enhance clinical (including mental health)
  support to assist care coordinators

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Diversion/Transition Recommendations

• 4. Expand accessible housing opportunities
• Expand transitional housing in existing
  congregate settings
• Encourage development of affordable, accessible
  housing units
• Encourage public awareness and interest in
  universal design elements to ensure
  visitability
• Develop options that integrate housing with
  supportive services for specific populations

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Diversion/Transition Recommendations

• 5. Increase incentives for diversion/transition
• Use a combination of Medicaid and State funds to
  support transitions
• Amend/develop waivers to obtain more federal
  funding for transition costs
• Explore innovative funding mechanisms to
  encourage diversion and transition
• use systems change grant funds and process to
  identify effective ways to Shift more resources
  from nursing facilities to the community
• Develop and implement a consistent method for
  measuring diversion/transition activities

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Proposed Interventions to Increase Diversion to
Community-Based Services

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Deficit Reduction ActNew community options

• Expanded access to HCBS as Medicaid State Plan
  Option (individuals up to 150 FPL not
  restricted to nursing home level)
• Self-directed personal assistance
• Money follows the person demonstration
• HCBS alternatives to psychiatric residential
  treatment for children

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Money Follows the PersonKey Components

• Pilot project for one year
• Incentive for transition from nursing facility
• State receives up to 50 increase in matching
  funds for 12 months for each individual
  transitioned
• State must continue services at its regular match
  rate after the pilot

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Money Follows the PersonStates selected for
first awards

• Arkansas (139,519)
• California (90,000)
• Connecticut (1,313,823)
• Indiana (860,514)
• Iowa (307,933)
• Maryland (1,000,000)
• Missouri (3,398,225)
• Michigan (2,034,732)
• Ohio (2,079,488)

• Oklahoma (3,526,428)
• Nebraska (202,500)
• New Hampshire (297,671)
• New York (192,981)
• South Carolina (34,789)
• Texas (143,401)
• Washington (108,500)
• Wisconsin (8,020,388)
• Total Awards 23,750,892

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Potential Roles for Ombudsmen in
Diversion/Transition

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• For further information contact
• Darlene.oconnor_at_umassmed.edu
• 508-856-8148
• For copies of the report
• Diversion and Transition Services in the U.S.
  Promising Practices and Options for the Future
• go to
• www.communityfirstgrant.org/relatedactivity