Transition/Diversion from Institutions

The 7th CMS New Freedom Initiative Conference was held March 5-7 in Baltimore. Presentations are available in both PDF and text formats. “Choice and Independence” is a key pillar of CMS’ vision for a person-centered long term services and supports system for the future. The 2007 conference focused on the policies, programs, and tools -including opportunities authorized by the Deficit Reduction Act– available to shape and carry out the vision.

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.)

The Compendium contains basic information about each of the Real Choice Systems Change Grant awards in FY03–FY04 plus the Family to Family and Systems Transformation Grantees awarded in FY05 and FY06. The Compendium will help Grantees identify others with similar goals and activities. Learn more about how the grants will be used to allow more people of all ages with a disability or long term illness to live and participate in their communities. The sixth edition replaces all previous editions.

Various informative documents about the Ohio Access Success Project, a grant sponsored project aimed at nursing facility transition. documents include a presentation and fact sheet for consumer on the program and a fact sheets about frequently asked questions on nursing homes.

The Ohio Access Success project has shared various forms associated with their project aimed at nursing facility transition. The forms aid the planning and implementation of the transition process. Forms include Consumer Assessment, Referral Form, Relocation Plan and a Role Matrix.

A publication that may be useful for legal guardians as they consider or prepare for a a transition planning process for the person they represent. This book guides the process in determining if a person can live in the community, and what that community living environment would need to look like. The purpose of this guidebook is to provide information about the variety of community residential options available to adults with developmental disabilities who relocate from State Centers.

This study was conducted as part of the Nebraska Nursing Facility Transition (NFT) Grant. The target population included children living in nursing facilities who meet the criteria for transition to home and community-based settings and children living at home identified as at-risk for nursing facility placement. The goals of this paper were to decrease the number of children in nursing facilities, identify risk factors, and to develop a plan to keep children in home and community settings.

The Turner Geriatric Clinic Social Work Department established a community-hospital liaison as part of the Michigan Nursing Facility Transition grant. This report discusses the goals of the project, its development and implementation, challenges and successes, and the end results.

This series of worksheets provides examples of what the Michigan Nursing Facility Transition grant used in planning the transition from the nursing facility to the community. Review the worksheets for Daily Living, Employment Planning, Financial Planning, Health Planning, Housing Planning, Planning Template, Self-Determination, Social and Transportation Planning.

Michigan developed a six-part training on transition and diversion. Module 6, the final module in this series, is an overview of organizational impact and collaboration in nursing facility transition. This section provides information on how developing nursing facility transition capacity may impact an organization and team. It also provides information on “bringing all the resources” together. The Appendix is also included.