Transition/Diversion from Institutions

Review materials generated by the Central Texas ADRC providing information about the program, and many state-specific forms and documentation. Also included is a detailed Guidebook for participants in their Veteran-Directed Home and Community Based Services program. These materials (guidebook, sample budgets, emergencies, employment forms, job descriptions and trainings) can be used as templates for other states involved in similar initiatives.

Find two fact sheets geared towards assisting state and local aging network entities in their implementation of the VD-HCBS program in partnership with local VA Medical Centers. These documents offer information on target population, referral, services and goods, rate information and criteria for allowable expenditures.

Support Options is a CLP demonstration program that invites consumers who are at-risk of nursing home placement and Medicaid spend-down to actively participate in managing their own services within an established budget. Find marketing materials and a training manual for the Determination of Need (DON) Functional Assessment, a standardized assessment tool used that measures functional impairment and unmet need for care.

What are you going to do after High School? As part of its MIG grant, Florida's Agency for Persons with Disabilities asked this question in a presentation to disabled teenagers about to graduate high school. By presenting a need for qualified workers, the importance of work on self-esteem and the resources to facilitate this transition, Florida is working to get more of its young disabled population into the workforce. This could be helpful to other states interested in this demographic.

The fragmentation of care for dually eligible beneficiaries is an ongoing concern. This brief discusses potential methods of reducing this fragmentation and improving nursing facility care for this population. Recommendations involve concentrating responsibility and accountability for prescription drug use, providing financial incentives for nursing facilities to reduce avoidable hospitalizations, and shifting responsibility for long-term nursing facility care from Medicaid to Medicare.

Review efforts to measure and reduce potentially avoidable hospitalization and improve care transitions for individuals who use long-term care. Three areas in which progress is needed are described. The authors conclude with questions deserving more research to fill gaps in knowledge on how best to improve care quality. You can also visit the LTQA website link for more information on the Quality Alliance.

Explore how Medicaid policies have been used in some states to expand the range and availability of services. Third in a series, this brief explains why these policies lead to so much variation in current state Medicaid long-term care programs. It also draws lessons from innovative states to suggest reforms in national Medicaid policies that would make home and community based services accessible to more program participants.

CIAIP was authorized by Congress to assist communities in their efforts to enable older adults to sustain their independence and age in their homes and communities. Grantees are striving to assess their communities to identify barriers to aging in place and collaborate with other community organizations to identify innovative strategies for linking older individuals to programs that provide comprehensive and coordinated health and social services. Visit this website for more information.

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.

How are work incentives and transition planning practices being approached for the blind community? Utah is training its teachers, at the Utah School for the Blind, to prepare their students for a successful transition and work life, as early as preschool. Funded by the Medicaid Infrastructure Grant, Work Ability Utah has provided their training presentations here, which could be helpful to other states dealing with a specific population or disability.