RTI - Systems Change Evaluation

Listen to a recorded webinar that analyzes the recently enacted legislation, highlighting the CLASS Act, the direct care workforce, Medicare payment for post-acute care, care coordination, and quality of care in nursing homes. It was presented by Joshua M. Wiener. Ph.D., a Senior Fellow and Program Director for Aging, Disability and Long-Term Care at RTI International.

The purpose of this report is fourfold: 1) to present a brief overview of the results of the Systems Change grants awarded from FY 2001 through FY 2004, 2) to describe the remaining challenges to community living that Grantees identified, 3) to provide Grantees’ recommendations for actions needed at the state and federal level to further improve their long-term care systems, and 4) to discuss the key lessons learned regarding factors that are needed to improve states’ long-term care systems.

CMS awarded the fourth round of 3-year grants for RCSC in Sept 2004. Three categories of grants were awarded: Research and Demonstration grants (40), Technical Assistance grants (10), and Feasibility Study and Development grants (2). This report focuses on the outcomes and Enduring Systems Improvements in Housing, Comprehensive Systems Reform, Mental Health Systems Transformation, Quality, Rebalancing, and Family to Family Grantees.

One goal of long-term care policy is to increase the use of HCBS and to reduce reliance on institutional care. The use of nursing homes as measured by the number of residents in facilities on a single day has declined over the past two decades. Despite the centrality of this issue for balancing efforts, there has been no systematic effort to examine the reasons. This report begins to fill the gap by conducting descriptive analyses of factors. In most cases, analyses were to extend to 2007.

RTI is preparing a series of reports to document outcomes from the Systems Change grants. Divided into six parts, the first four provide an overview of the enduring improvements, continuing challenges, lessons learned, and recommendations of the 48 Research & Demonstration Grantees, organized by the four types of grants: CPASS, MFP, IP, & QA/QI. Part 5 provides summaries of the FTF Grants. Part 6 reviews the Respite for Adults and Children and Community-Based Treatment Alternatives for Children.

In September 2004 CMS provided $3.6 million to fund MHST grants to encourage states to develop mental health systems infrastructure to implement and sustain evidence-based and recovery-oriented practices. Grants were awarded to 12 states under the Systems Change grants program. This report describes the initiatives with a focus on implementation issues and challenges and how they addressed them. Four Grantees focused solely on evidence-based practices, six on recovery practices, and two on both.

The purpose of this report is to inform the efforts of states that are trying to develop and improve QA/QI systems by describing and analyzing how selected Systems Change Grantees went through this process. The initiatives examined fall into six categories: administrative technology and information technology; standards for services; discovery; remediation; workforce; and public information.

This publication provides a summary overview of the accomplishments and enduring changes brought about by all of the Systems Change NFT Grantees Despite bringing about many enduring systems improvements, Grantees reported that many transition barriers remain. Grantees made recommendations to help states address continuing barriers to nursing facility transition and diversion so that no one need live in a nursing home simply because sufficient community services and supports are unavailable.

The Compendium contains basic information about each of the Real Choice Systems Change Grantees receiving awards in FY 2004. It includes information for the Family-to-Family and Systems Transformation Grantees who received awards in FY 2005 and FY 2006 plus the Person-Centered Planning Implementation awards in FY 2007. It is divided into sections corresponding to the different types of grants and year of award; the report helps Grantees identify others with similar goals and activities.

This report provides an overview of 33 states’ initiatives (FY02 CPASS and Real Choice Grantees) to improve their LTC systems and the enduring improvements achieved. It includes lessons learned and recommendations that can guide states that are undertaking similar initiatives. Grantees made enduring systems improvements in five major areas—many states in more. Virtually all agreed that prior to introducing new policies and programs, it is essential to obtain stakeholder buy-in and commitment.