Assessments

The Utah Real Choice grant produced “The Caregiver Guide” and they have shared several modules. Topics covered include: Community Supports to Stay at Home, Caring for a family member with mental illness, Hiring and managing personal assistants, Assistive technology, Creating an accessible home, and Caring for a child with special needs. Modules are also available in Spanish.

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.

This is a planning document developed by the Ozaukee County Aging Services Department that helps individuals gather thoughts and discuss them with their family by asking, What Do You Want? This document, subtitled “Your Personal Guide for Planning a Happy Healthy & Independent Long Life” helps individuals take an inventory of the values and preferences. The guide recommends recording what you want and reviewing the list periodically with those closest so they can carry out the plans.

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 3 discusses outreach activities in nursing facility transition and diversion. It reviews different methods of outreach and how they can be developed to be effective forms of marketing. In addition, information for outreach contacts and resources is provided.

Michigan developed a six-part training on transition and diversion. Module 2 is an overview of independent living and person-centered planning. It discusses the history and philosophy of independent living programs and definitions of person-centered planning. This module particularly emphasizes interacting and communicating with persons with disabilities.

Michigan developed a six-part training on transition and diversion. Module 1 is an overview of transition and diversion in the long-term care system. After a brief introduction to nursing facility transition programs, the presentation dispels some myths about the outcomes of transition and diversion programs. In addition, Module 1 discusses different aspects of nursing home transition and the legislation and lawsuits that have affected this process.

In laying the groundwork for sustainable improvements in the infrastructure for LTC policy and program implementation, Massachusetts Real Choice grantees conducted an assessment of current Service Coordination practices across State agencies. The research objective was to better understand present service coordination practices among agencies dealing with elderly and individuals with disabilities with the intention of identifying “promising practices”. This report presents the review results.

MA grantees hired an independent evaluator to conduct qualitative assessments of consumers’ experiences at two and nine months of participation. At two months, the successes included connections to community supports and services. Identified challenges included developing and managing an individual budget. Successes at 9 months include increased independence, self-determination, and availability of workers and supports. Challenges included community liaison training and out-of-pocket spending.

As part of the Massachusetts Independence Plus grant, the workgroup recognized there was a certain amount of risk associated with individualized budgeting. They devised a “Incident Reporting” System that would document any incidents (such as fall, funding problems, injuries) that would compromise the health of an individual with disabilities being served under the program. The forms were created to assist a future Massachusetts IP waiver and have not yet been adopted