New York RCSC Summary

<A NAME=\"NYRC\"></A> <P ALIGN=\"RIGHT\"><EM>Real Choice Systems Change</EM></P> <H2 ALIGN=\"CENTER\">NEW YORK</H2> <H3>Identified Problems with the State's Long-Term Care System</H3> <P> <UL> <LI>Although New York's long-term care system is comprehensive in scope, the number and diversity of funding and administrative structures creates a complex environment that can often serve as a barrier to service access.</LI> <LI>Separate and independent silos of LTC information that target discrete populations acts as a barrier to consumers with care needs that cross multiple systems.</LI> <LI>Forms and processes involved in the program application and assessment process often intimidate consumers, caregivers and long-term care professionals.</LI> <LI>Lack of uniform and consistent provision of comprehensive, unbiased information and assistance in accessing desired long-term care programs and services.</LI> <LI>Lack of adequate consumer advocacy to effectively cover the multiple points at which consumers enter the long-term care system.</LI> </UL> </P> <H3>Perceived Strengths</H3> <P> <UL> <LI>Federal, state and local governments, as well as the private sector, have generously invested in the creation of a multitude of programs and services to serve the needs of special populations.</LI> <LI>Twenty-year history of developing community organizations whose functions include service planning for consumers with the dual goals of avoiding nursing home admission and maximizing the use of community resources and public programs.</LI> <LI>Office of Mental Retardation and Developmental Disabilities (OMRDD) has the continuing commitment of state policy makers to the expansion of its system, and to the consistent movement in the direction of greater choice and individualization of services, including a practical means of self-determination in which consumers control their own budget for services.</LI> <LI>OMRDD has forged partnerships with a variety of entities engaged in making affordable housing available to person with disabilities. These include both traditional and nontraditional not-for-profit organizations, state and municipal housing agencies and public housing authorities (PHAs).</LI> <LI>Quality assurance is a key component in the success of OMRDD's service system as a whole, as well as its HCBS waiver program.</LI> </UL> </P> <H3>Primary Focus of Grant Activities</H3> <P> <UL> <LI>Promote consumer independence and freedom of choice.</LI> <LI>Improve access to long-term care services by creating local single points of entry for information, assistance and advocacy (IA&amp;A).</LI> <LI>Identify and implement strategies to address barriers to community living.</LI> <LI>Foster collaboration between long-term care stakeholders in the community.</LI> <LI>Divert individuals who can live in the community from nursing home care and transition persons with developmental disabilities from intermediate care facilities (ICFs).</LI> </UL> </P> <H3>Goals, Objectives, and Activities</H3> <P><STRONG>Overall Goal.</STRONG> Provide long-term care stakeholders, e.g. consumers, families, caregivers, hospital discharge planners, providers, the aging network and local social services districts, with timely assistance in determining and securing the resources and supports that would enable consumers to return to or continue to lead lives in the community.</P> <P><STRONG>Goal.</STRONG> Divert from nursing home care individuals who can live in the community.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Inform people about their rights under the ADA and the Olmstead decision, through outreach activities and the use of Websites and other materials.</LI> <LI>Provide IA&amp;A in securing timely community services through the creation of local single point-of-entry systems.</LI> <LI>Develop and/or implement screening tools, processes and protocols that will be used to identify and divert individuals from institutional care.</LI> <LI>Improve the ability of consumers and caregivers to make informed independent choices when accessing long-term care services by providing accurate information about those services.</LI> <LI>Develop and implement public awareness initiatives and outreach campaigns.</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Develop partnerships that foster collaboration between long-term care stakeholders involved in advocating, arranging for, or providing long-term care services.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Promote coordination of care across funding and service systems through case management services and advocacy.</LI> <LI>Design and implement processes to ensure appropriate long-term care stakeholders' full participation in developing local strategies.</LI> <LI>Through collaboration of community stakeholders, identify individuals at risk of institutionalization who could benefit from community services and connect those individuals with the services necessary to avoid nursing facility placement.</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Promote consumer independence, freedom of choice and the ability to live in the most integrated setting appropriate to their needs.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Develop new or enhance existing IA&amp;A systems which will provide consumers, caregivers and human services professionals with accurate and impartial information and assistance in accessing New York State's broad spectrum of long-term care services.</LI> <LI>Develop materials to provide information regarding consumers' rights and to increase consumers', caregivers' and human services professionals' awareness of the availability of services and supports that assist individuals with disabilities to live in the most integrated settings appropriate to their needs.</LI> <LI>Develop and disseminate resource materials for nursing home diversion to be shared with long-term care stakeholders for use in outreach campaigns.</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Identify barriers that impede individuals from living in the most integrated settings appropriate to their needs and develop recommendations for systems change.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Collect information to support recommendations that address identified barriers to community living.</LI> <LI>Identify best practices, as they are developed through the demonstration projects, that effectively remove barriers and have the potential for replication. </LI> </UL> </P> <P><STRONG>Goal.</STRONG> Develop and implement a process for educating ICF residents about community living and transitions.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Identify ICFs for participation in the Real Choice Project.</LI> <LI>Identify and train outreach teams to provide information and peer mentoring to residents of ICFs selected to participate in the project.</LI> <LI>Engage residents, families and others in the person-centered planning process for each resident interested in exploring community-living options.</LI> <LI>Explore residential alternatives with identified residents of participant ICFs.</LI> <LI>Identify barriers to effective outreach, identification of interested residents, use of the person-centered planning approach and achievement of individualized residential outcomes, and develop and implement strategies to address those barriers.</LI> <LI>Develop, test, and finalize a curriculum based on project experience. This will include training in outreach and mentoring for self-advocate mentors and a template for training and team building of facility-specific implementation teams.</LI> </UL> </P> <H3>Key Activities and Products</H3> <P> <UL> <LI>Fund consortiums of long-term care stakeholders who will provide consumers, caregivers, and professionals, regardless of payer source, with comprehensive and unbiased information on available LTC services and programs.</LI> <LI>Provide assistance to consumers in obtaining needed services.</LI> <LI>Develop community awareness materials and information regarding consumer rights.</LI> <LI>Provide advocacy services when needs are not being appropriately met.</LI> <LI>Partner with the Self-Advocacy Association of NYS to provide information and peer mentoring to residents of participating ICFs/DD.</LI> <LI>Help ICF residents, who so choose, to transition to more integrated community settings through a person-centered planning process.</LI> </UL> </P> <H3>Consumer Partners</H3> <P> <UL> <LI>Consumers, family members and legally mandated advocates.</LI> <LI>The Long Term Care Workgroup comprises a broad spectrum of consumer and provider advocates and is currently working with state agencies to address Olmstead issues.</LI> <LI>The Self-Advocacy Association of NYS, Inc. (SAA) is a consumer-led non-profit organization that works on the local, regional and statewide level to help people with disabilities to advocate for themselves individually and collectively.</LI> </UL> </P> <H3>Consumer Partners and Consumer Involvement in Planning Activities</H3> <P> <UL> <LI>The SAA was a full partner in preparing the OMRDD portion of the grant application and in planning grant activities. Essential pieces of the project design, including peer mentoring and curriculum development, were brought forward by SAA.</LI> <LI>Individual consumers and parent advocates participated in early planning meetings and have maintained their involvement throughout.</LI> <LI>The Long-Term Care Workgroup participated in the grant planning meetings and provided input and feedback.</LI> </UL> </P> <H3>Consumer Partners and Consumer Involvement in Implementation Activities</H3> <P> <UL> <LI>Each demonstration site selected for the Department of Health's project will include significant consumer participation in its various workgroups and structures.</LI> <LI>The SAA has primary responsibility for developing the training for self-advocate mentors and will collaborate with OMRDD staff in development of the curriculum/template for the replication of the outreach and education activities piloted under the grant.</LI> <LI>The SAA's network of local self-advocacy groups, along with OMRDD's regional Developmental Disabilities Services Offices (DDSOs), will provide the foundation for the outreach teams that will be established under this grant.</LI> <LI>Consumer and parent members of the OMRDD Real Choice advisory group will continue in that capacity to provide guidance and oversight to the project.</LI> <LI>Evaluation and selection of proposals for demonstrations submitted in response to the Request for Applications (RFA) will be conducted by a team that includes representatives of consumer-controlled or consumer-directed groups, providers, state staff and local governments.</LI> <LI>The Long Term Care workgroup will be consulted on the RFA and evaluation design, and will be involved in the problem-solving process as demonstration awardees identify access problems and issues. The Workgroup's experience and insight into these issues will be essential to understanding and resolving the problems.</LI> </UL> </P> <H3>Public Partners</H3> <P> <UL> <LI>Alternative Service Agencies.</LI> <LI>Area Agencies on Aging.</LI> <LI>Bureau of Hospital and Primary Care Services.</LI> <LI>Commission on Quality Care for the Mentally Disabled.</LI> <LI>Office of Mental Health.</LI> <LI>Office of Mental Retardation and Developmental Disabilities (OMRDD).</LI> <LI>Office of the Advocate for Persons with Disabilities.</LI> <LI>State Office on Aging (SOFA).</LI> </UL> </P> <H3>Private Partners and Subcontractors</H3> <P> <UL> <LI>New York State Association of Community and Residential Agencies (NYSACRA).</LI> <LI>Parent-to-Parent of NYS.</LI> <LI>Independent Living Centers.</LI> <LI>Person-centered planning consultants.</LI> </UL> </P> <H3>Public and Private Partnership Development/Involvement in the Planning Phase</H3> <P><STRONG>Public</STRONG> <UL> <LI>OMRDD, a full partner in the Real Choice Grant, prepared OMRDD's portion of the grant application.</LI> <LI>The Department of Health (DOH) partnered with Commission on Quality Care for the Mentally Disabled, Office of the Advocate for Persons with Disabilities, and local district service providers to develop the grant application. The State Office on Aging (SOFA) was also involved in developing grant activities and were the primary writers with the lead agency.</LI> </UL> </P> <P><STRONG>Private</STRONG> <UL> <LI>New York State Association of Community and Residential Agencies (NYSACRA) was involved in early planning meetings.</LI> <LI>Parent-to-Parent Network was consulted to obtain support from its regional staff and the participation of individual parents in the activities of the project.</LI> </UL> </P> <H3>Public and Private Partnership Development/Involvement in Implementation</H3> <P><STRONG>Public</STRONG> <UL> <LI>OMRDD will focus on transitioning persons with developmental disabilities from ICFs to residential settings.</LI> <LI>Evaluation and selection of proposals for demonstrations submitted in response to the RFA will be conducted by a team to include Area Agencies on Aging, Alternative Service Agencies, and other public partners listed above.</LI> <LI>SOFA will be involved in the problem-solving process as demonstration sites identify access problems and issues through the monthly meetings of the lead agency's Real Change Workgroup, and will be instrumental in the coordination of the grant.</LI> <LI>A range of other state agencies such as the Office of Mental Health, the Office of the Advocate for Persons with Disabilities, OMRDD, and the Commission on Quality Care for the Mentally Disabled will provide valuable information and experience in the delivery and coordination of community long-term care services.</LI> <LI>OMRDD's regional DDSOs, along with the SAA's network of local self-advocacy groups (see Consumer Partners), will provide the foundation for the outreach teams that will be established under this grant.</LI> <LI>Bureau of Hospital and Primary Care Services, responsible for licensure, certification and quality assurance and policy development for hospitals and primary care providers, will participate in demonstration activities on an ad hoc basis.</LI> </UL> </P> <P><STRONG>Private</STRONG> <UL> <LI>Evaluation and selection of proposals for demonstrations submitted in response to the RFA will be conducted by a team to include ILCs.</LI> <LI>Representatives of NYSACRA serve on OMRDD's Real Choice advisory group.</LI> <LI>Consultation on person-centered planning will be made available through the grant to each OMRDD outreach team and participating ICF to assist them in working with the support network of individual residents.</LI> <LI>Outreach teams will facilitate contact with the local Parent-to Parent Network to engage parents and other family members and enable them to support transitioning individuals.</LI> </UL> </P> <P><STRONG>Existing Partnerships That Will Be Utilized to Leverage or Support Project Activities</STRONG></P> <P>A long-standing partnership with the NYS Developmental Disabilities Planning Council (DDPC) has enabled OMRDD to undertake a number of innovative initiatives to expand the housing opportunities of persons with developmental disabilities. The DDPC's support of both the OMRDD and DOH portions of the Real Choice Grant will be essential to achieving the goals of transitioning individuals from ICFs to the community and preventing institutionalization of others at risk.</P> <H3>Oversight/Advisory Committee</H3> <P> <UL> <LI>Each RFA applicant will be expected to form its own advisory board to guide the development process. This board must include appropriate local and, if appropriate, regional long-term care stakeholders.</LI> <LI>The DOH Real Choice Systems Change team will be chaired by the principal investigator and comprises project staff and staff and division directors from several state agencies. The team will meet periodically with representative consumers and their advocates, local social services districts and provider representatives to obtain meaningful input. The team will facilitate resolution of issues transcending individual initiatives.</LI> <LI>The OMRDD Real Choice advisory group, comprising self-advocates, parents of persons with developmental disabilities, representatives of NYSACRA, and OMRDD central office staff provide essential input to and oversight of OMRDD's portion of the Real Choice grant activities.</LI> </UL> </P> <H3>Formative Learning and Evaluation Activities</H3> <P> <UL> <LI>The DOH will develop mid-course corrections with demonstration projects in Years Two and Three.</LI> <LI>The principal investigator will meet monthly with project staff to ensure that goals and activities of the grant are coordinated, critical information is communicated, and input from advocates, consumers and agencies is integrated into project activities.</LI> <LI>The Person Centered Planning contractor will monitor implementation, modify the process to make it more efficient and effective, teach modifications to the teams, and evaluate effectiveness.</LI> <LI>OMRDD and DOH will monitor the outcomes achieved, assess these against expectations and identify barriers to successful performance.</LI> <LI>Feedback from participants, both residents of ICFs and ICF administrators and staff, will be an essential element in the identification of problems and their resolution.</LI> </UL> </P> <H3>Evidence of Enduring Change/Sustainability</H3> <P>Project applicants will be required to describe or identify the following: <UL> <LI>Written commitments demonstrating the involvement from local organizations and stakeholder groups in long-term care systems development.</LI> <LI>Evidence of formal linkages for collaboration with major sources of community services and the anticipated systems change that will result from the partnerships.</LI> <LI>Plans that will detail continuation of activities including identified potential funding streams after the demonstration project has ended.</LI> <LI>Project applicants will be required to collect consumer demographic information for use by the state and localities in future long-term care planning. The state will seek future funding of those models that best reflect systems change and which can be replicated statewide.</LI> <LI>The DOH will assist projects in transitioning from grant funds to other sources of funding, and develop and pursue strategies for sustainability of projects and statewide adoption of lessons learned.</LI> <LI>The OMRDD will develop, test, modify and ultimately institute a method of engaging residents of relatively large ICFs as a routine way of informing ICF residents about alternative community-living options and providing the opportunity for exploring those options.</LI> <LI>The OMRDD activities will also be distilled into a curriculum or model for outreach, education and person-centered planning for residents of ICFs, which will be usable not only in ICFs, but in nursing homes and other institutional settings.</LI> <LI>The self-advocate peer mentors developed under this grant and the foundation established through the work of the consultants in person-centered planning will be integral to the sustainability of this systems change initiative. OMRDD will provide all support and oversight as its in-kind contribution to this project, allowing the maximum amount of grant funding to be dedicated to costs related to the peer mentors and the person-centered planning consultants. The additional benefit of this strategy is that the foundation established during the period of the grant will enable OMRDD, in partnership with the SAA, to expand this approach to ICFs statewide and maintain the system change created by this project.</LI> <LI>With reviews from multiple demonstration sites, the state will be able to compare processes across sites taking into consideration differences in local circumstances. Common denominators will be explored, both for problems and successes. State staff will evaluate project deliverables and, in consultation with the Long Term Care Workgroup and local social services districts, make recommendations for future policy development.</LI> </UL> </P> <H3>Geographic Focus</H3> <P>Statewide.</P>