Reports

This paper reports the outcome of focus groups, interviews and written surveys conducted in 2003 by a consultant working for the Northern Area Agency on Aging in Wisconsin under a contract with the Department of Health and Family Services. Groups of elders, family members and long-term care professionals were asked to address the question of how, when and why older people make the decisions they do about long-term care.

Massachusetts was among the first states to receive a Real Choice grant and like many states, took a while to start the grant activities. The work of this collaboration did not always progress smoothly. Many setbacks were experienced by all parties. However, as the end of the grant drew near, key stakeholders looked back and realized that significant progress had been made. This report and a companion video documents lessons learned for policy makers and other stakeholders.

People Talking to People Building Quality and Making Change Happen accomplishes not just a system change, but also a paradigm shift. Their goal is to create a system of quality assurance and quality improvement that has consumers providing feedback. The feedback gathered during the three year period allows for system wide quality improvement by giving consumers and their family members a voice, thus able to control important choices and decisions in their own lives.

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.)

This paper explores and analyzes selected state approaches to engage nursing facility operators to be part of systems change activities that offer individuals additional, less restrictive choices to live more independently with appropriate supports. The strategies described offer other states lessons learned that may be replicated as part of a broader approach to meet changing and growing demand for home and community-based services. Efforts in IN, IA, MI, MN, NE, ND, NY, and WI are described.

This report provides a comprehensive framework for Wisconsin’s Functional Screen Quality Assurance. Wisconsin’s Functional Screen system (a web-based application that collects information about an individual’s functional status, health and need for assistance for various programs) is comprised of three separate screens: Adult Long Term Care Functional Screen (LTC FS), Children’s Long Term Support Functional Screen (CLTS FS), and Mental Health/AODA Functional Screen (MH/AODA FS).

Part of the Wisconsin QA/QI grant was to develop a framework to evaluate long-term care services. The framework was based on desired personal-experience outcomes. Once desirable outcomes were recorded, they were used as benchmarks for quality management and outcomes measurement.

The “Quality Close to Home” papers are part of Wisconsin’s process to review the existing quality management system for Home and Community Based Services. The report on local practices was the result of a series of interviews conducted with local informants who conduct quality management activities. The second paper outlines the scope of quality management, challenges of quality management, federal rules and regulations, and provides a design for an improved quality management system.

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 following two reports are the result of face-to-face and mailing surveys to evaluate user experiences. The face-to-face surveys were conducted with people who are 18 years of age and older who receive Medicaid waiver or Intermediate Care Facilities for Persons with Mental Retardation (ICF/MR) Program Services. The Children/Family Surveys were mailed to families of children under 18 years of age who received services in programs operated by the Department in 2005.