Real Choice Systems Change

Housing Within Reach is a project of the Tennessee Department of Mental Health and Developmental Disabilities. The project included a consumer driven longitudinal evaluation study across the state to document consumer perspectives on consumer housing preferences, and the availability, access and barriers to appropriate housing. The study included face-to-face interviews conducted with each study participant at baseline, and at six- and twelve-months.

This report provides an overview of 35 states’ initiatives to improve their LTC systems and includes lessons learned and recommendations that can guide states undertaking similar initiatives. Despite accomplishments and improvements, Grantees described continuing barriers including insufficient funding for home and community services; workforce shortages; lack of affordable and accessible housing and transportation; and outdated or inflexible administrative, statutory, and regulatory provisions.

These Person Centered Planning (PCP) presentations discuss how PCP allows consumers to plan for their preferences and do this throughout their lifespan. Presentations focus of the individual within his/her family and community and the relationships that affect PCP. The focus throughout is to identify personal preferences and to develop the plan for the future.

This report describes the hospital discharge planner (HDP) survey conducted in the beginning of 2006. The HDP questionnaires were disseminated to gather information about the awareness of choice and access to continuum of care services for the elderly and people with disabilities as well as to gather ideas about how to optimize choice and improve access to these services. Review the results and read about the barriers faced by discharge planners.

Interviews were conducted to identify current perceptions, patterns, themes, and suggestions for improving the choice and self-direction, quality and access to long term care supports. This research also identified ways to develop a mechanism to balance state resources for services, and to identify elements for the design and structure of a single point of entry mechanism. Groups included: consumers of HCBS, elderly and younger nursing home residents, family members of consumers, and providers.

Completed over an 18 month period in 2004-2005, this project was conceived of as an activity that met the objectives of the Maine Real Choice Systems Change grant and the mission of the Maine Personal Assistance Services Association to build recognition and opportunity for the direct care, direct support, and personal assistance workforce through education, public awareness and professional development. Each story evolves out of a series of in-depth interviews and is told in the worker’s voice.

Massachusetts was among the first states to receive a Real Choice grant and like many states, took a while to start the grant activities. The work of this collaboration did not always progress smoothly. Many setbacks were experienced by all parties. However, as the end of the grant drew near, key stakeholders looked back and realized that significant progress had been made. This report and a companion video documents lessons learned for policy makers and other stakeholders.

People Talking to People Building Quality and Making Change Happen accomplishes not just a system change, but also a paradigm shift. Their goal is to create a system of quality assurance and quality improvement that has consumers providing feedback. The feedback gathered during the three year period allows for system wide quality improvement by giving consumers and their family members a voice, thus able to control important choices and decisions in their own lives.

To help States build the infrastructure needed to remove barriers and create more consumer responsive LTC systems, CMS awarded $70 million in Real Choice Systems Change Grants. Fifty-two Grants were awarded in Sept. 2001 (25 Real Choice, 10 Community-Integrated Personal Assistance Services & Supports, 17 Nursing Facility Transition). This report describes the progress FY01 Grantees have made on their activities during the first year of the three-year Grant period (Oct 1, 2001-Sept 30, 2002.)

These three presentations provide information about the Utah Real Choice marketing and awareness efforts. The “UCare” program was established as part of the grant and the surveys were conducted in 2004, 2005 and 2006. Using telephone surveys, survey participants were asked about their awareness and understanding of the UCare program before and after the marketing campaign.