Nursing Facility Transition

This document offers recommendations for improving the efficiency and effectiveness of Older Americans Act (OAA) services upon its reauthorization. Recommendations are made under each Title of the Act. More general recommendations include increasing interaction and coordination with other federal programs that deliver services for older adults such as the Low-Income Energy Assistance Program (LIHEAP), Senior Corps, and Adult Protective Services.

The North Carolina MFP demonstration project assists Medicaid-eligible individuals who live in inpatient facilities to move into their own homes and communities, and to help identify and address barriers to receiving quality, community-based care. Their website includes historical information, forms, contact information, presentations and outreach materials that can be used as templates for other states seeking to develop similar materials.

The authors of this report conclude that in the 10 years since the Olmstead decision, there has been little national (though some individual state) progress moving people with disabilities out of nursing facilities and public institutions and into communities with supports. The report includes an overview of Olmstead, institutional data, and recommendations for improvement.

How can states incorporate social networking sites into their marketing? To engage business partners in new ways, the Maine MIG project built information/networking sites on FaceBook, LinkedIn and Twitter. The first use of these sites was to generate interest in their Fall Business Conference. These sites will also be used to engage business in other ways, provide information and interaction on many issues related to employment and disability. It is a model that could be useful to other states.

Find an article produced for the general public discussing the progress of Money Follows the Person. The author cites study findings suggesting reasons for states’ slow movement in nursing home transition: problems finding affordable housing, resistance from nursing homes, stringent federal rules limiting eligibility and types of community settings individuals can move into. Included are links to a related video and interactive map showing each state’s goals and transitions made to date.

Review the screening tool and instructions for the The Live Well At Home Program Rapid Screen©, used to identify the risk of older persons for nursing home admission and/or spend down to Medical Assistance. Upon completion of the Rapid Screen© the older person will know their risk category and have a list of up to seven identified evidence-based risk factors. Background information on the project can be obtained through their website.

What are some of the highlights and milestones of the CLP programs? Review the presentations given at the The Gerontological Society of America Annual Meeting on November 19-22, 2009. Officials from the Administration on Aging and representatives from Connecticut, Georgia, Massachusetts and New York on presented.

Vermont developed this brochure to introduce the Nursing Home Diversion Program to consumers.

Transitioning out of a care facility can be a challenging time for patients and their caregivers. This checklist will help these people and their support workers plan ahead of the discharge to ensure everyone involved understands the patient’s needs and can avoid any interruption in care. The resource also includes instructions and contact information for finding appropriate support from local, state, and federal agencies.

The Arkansas MFP application will transition 305 individuals who have resided in institutions six months or longer into qualified home and community-based programs. This website offers program highlights, operational protocol, benchmarks participant recruitment and enrollment information and benefits and services. Users can also find a variety of stakeholder involvement opportunities including conference dates, the Governor's Task Force List and an Organizational Structure Chart.