Transition/Diversion from Institutions

As part of these demonstrations, six successful interventions that overcome barriers to independent living and employment for young adults are studied in-depth. The first document gives detailed information on the design of the study's evaluation. The second summarizes the core components, services, and strategies of each demonstration project.

To answer the question posed in the title, the authors studied HCBS spending and the availability of family members. Higher HCBS expenditures are found to be associated with lower risk of nursing home admission, but this association is statistically insignificant for older adults with living children. Doubling state HCBS expenditures would reduce the risk of nursing home admission among childless seniors by 35%.

Money Follows the Person (MFP) programs only target 0.9% of the people that could be eligible for transitioning out of institutions each year. However, there is a potential to increase rates to 15-40% annually depending on quality of program implementation, who is targeted, and how successful states are in overcoming barriers to transitioning high-needs people. The report looks at grantee states’ potential for accomplishing this rate increase.

As part of this Act, requirements were instituted involving the state's ADRCs and the global budgeting process used to support them. The Act provides specific directives that address financing and management plans, implementation and operation of the Medicaid LTC expenditure reforms, and requires an annual report, one of which is also included here, that documents reallocation of funds to home and community based care.

The authors present evidence in support of states investing in HCBS and nursing home diversion as strategies to deal with declining revenue. They review research reports illustrating how the balance of spending on institutional versus HCBS spending affects future long-term care costs. Using these data and case studies of Washington and Vermont programs, they conclude that HCBS is indeed cost-effective.

Help family caregivers better manage transitions in care with these guides. Available in English and Spanish, they help determine what issues to consider, how to seek assistance, how to manage medications, and how to better communicate with physicians and other health care professionals. The site, developed by United Hospital Fund, has resources for professionals as well.

The majority of NH’s long-term care (LTC) expenditures go to nursing homes, despite the fact that only 2% of surveyed AARP members prefer to receive care in that setting. The AARP surveyed 800 randomly-selected members to set their advocacy agenda in the state. Other opinions gauged deal with ability to pay for LTC, personal sources of LTC financing, volunteerism, and voting practices.

March 2-4, 2009 state program staff, CMS staff, and technical assistance providers met in Baltimore to discuss Money Follows the Person and other strategies for helping people move out of nursing homes. Speakers presented on topics ranging from service integration, housing finance strategies, mentoring, quality, and many others.

Program administrators, advocates, and researchers advise the Senate on ways to improve wellbeing and cost outcomes of long-term care by increasing access to HCBS. They speak on national demographics, successful HCBS programs of the past and present, state programs in Wisconsin and Florida, integrating acute and long-term care for dual eligibles, and program finance models. See “Video Contents Index” for time stamps and information on each testimony.

The Veterans Health Administration plans to partner with the Aging Network in order to be serving over 109,000 veterans using HCBS by 2011. February 25 and 26, 2009, these organizations met in Boston to develop the partnership, work out next steps, and identify challenges. Presentations provide details on existing infrastructure, Nursing Home Diversion, financial management services, and existing research on HCBS and self-direction.