Arkansas NFT Summary | advancingstates.org

<HR ALIGN=\"left\" ALT=\"Horizontal rule dividing sections\"> <A NAME=\"ARNFT\"></A> <P ALIGN=\"RIGHT\"><EM>Nursing Facility Transitions</EM></P> <H2 ALIGN=\"CENTER\">ARKANSAS</H2> <H3>Identified Problems with the State's Long-Term Care System</H3> <P> <UL> <LI>Most waivers and other home and community programs cannot provide 24hour support.</LI> <LI>Difficulties with recruitment and retention of front-line workers.</LI> <LI>The application process for Medicaid HCBS waivers is lengthy and complicated.</LI> <LI>Despite consumer preferences for home and community services, there is a disproportionate share of funding to institutional facilities.</LI> </UL> </P> <H3>Perceived Strengths</H3> <P> <UL> <LI>Nursing home usage is declining due to the effectiveness of HCBS waivers.</LI> <LI>The state's award winning Medicaid Personal Care program (ConnectCare) has also been effective in diverting individuals from nursing homes.</LI> </UL> </P> <H3>Primary Focus of Grant Activities</H3> <P> <UL> <LI>Develop a working model for a diversionary process from nursing homes.</LI> <LI>Develop a "fast-track" process to reduce the eligibility wait time for Medicaid waiver applications.</LI> <LI>Establish an ombudsman program for HCBS waiver clients to improve quality assurance.</LI> <LI>Develop a Website to provide information on the array of long-term care services available.</LI> <LI>Develop housing resources for transitioning individuals.</LI> </UL> </P> <H3>Goals, Objectives, and Activities</H3> <P><STRONG>Overall Goal.</STRONG> Divert hospital discharges into the community and establish a housing resource network for them to utilize.</P> <P><STRONG>Goal.</STRONG> Create a process to expedite initial applications for home and community Medicaid services for persons in hospitals.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Develop an intervention plan for patients who are at risk of transferring to a nursing home directly from the hospital.</LI> <LI>Field test the newly created process in one urban area and one rural area in collaboration with the Real Choice Grant's development of a "fast-track" process to expedite applications for Medicaid waivers.</LI> <LI>Build on the outreach material developed under the state's previous nursing facility transition grant to apprise community resource staff of the availability of alternatives to institutionalization.</LI> <LI>Distribute posters and brochures about the nursing facility transition program at hospitals, residential care facilities, senior centers, area agency on aging offices, physician's offices, clinics, and county offices.</LI> <LI>Hire and manage social workers to be stationed in hospital settings to facilitate transitions.</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Create enduring collaboration with local public housing authorities throughout the state.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Increase communication with public housing authorities to expand understanding of the housing issues that affect the elderly and persons with disabilities.</LI> <LI>Develop professional relationships with the state's 142 public housing authorities and establish formal partnerships with all of them by the third year of the grant.</LI> <LI>Partner with the Supported Housing Office of Arkansas Rehabilitation and the AR Governor's Task Force on Supported Housing to educate local housing authorities on the principles of universal design and housing needs of persons with disabilities and the services available to help persons avoid precipitous placement in nursing facilities. A minimum of four regional seminars will be held in the state and printed materials will be developed.</LI> <LI>Collaborate with Arkansas Development Finance Authority to recruit and identify individuals currently at high risk of being institutionalized or those currently in nursing homes and capable of living in the community, to assess the housing and support service needs of those individuals, and to link those persons with support service providers.</LI> </UL> </P> <H3>Key Activities and Products</H3> <P> <UL> <LI>Develop outreach materials, including posters and brochures.</LI> <LI>Create an intervention plan for patients who are at risk of transferring to a nursing home directly from the hospital. The intervention plan will be a key product of the grant.</LI> <LI>Develop a Web-based consumer information resource, personal assessment , and a directory of services for elderly persons and all people with disabilities, including developmental disabilities and mental illness. The online resident information, assessment, and directory will provide 24hour direct access through the World Wide Web for any member of the public to assess service or long-term care needs for themselves or others, learn about appropriate and available services, and locate these services in their community.</LI> <LI>Develop a single, standardized assessment form to establish eligibility for both nursing facilities and HCBS waivers.</LI> <LI>Establish a Community Bridge Fund with grant funds that will help pay for items that are necessary for an individual to remain in the community or assist individuals to return to the community.</LI> </UL> </P> <H3>Consumer Partners</H3> <P>The Consumer Task Force for the Real Choice Grant has 16 members: <UL> <LI>There are seven consumers; four are persons with disabilities and three are elderly.</LI> <LI>There are also four family members of persons with developmental disabilities.</LI> <LI>There are five organizations represented: NAMI, Arkansas People First, two Independent Living Centers and an Arkansas Area Agency on Aging.</LI> </UL> </P> <H3>Consumer Partners and Consumer Involvement in Planning Activities</H3> <P>Several planning sessions were held with the Real Choice Consumer Task Force prior to the development of the grant applications for the Real Choice and Nursing Facilities Transition Grants. A number of priorities were established and included in the grants.</P> <H3>Consumer Partners and Consumer Involvement in Implementation Activities</H3> <P>The Consumer Task Force will be involved in developing the guidelines for the Community Bridge Fund and the program for the Ombudsman for HCBS waivers. Their assistance will be sought in developing materials for the Web-based consumer information resource.</P> <H3>Public Partners</H3> <P> <UL> <LI>Arkansas Supported Housing Office.</LI> <LI>Division of County Operations.</LI> <LI>Division of Medicaid Services.</LI> <LI>Arkansas Development Finance Authority.</LI> <LI>Division of Developmental Disabilities.</LI> <LI>Governor's Task Force on Supported Housing.</LI> </UL> </P> <H3>Private Partners and Subcontractors</H3> <P> <UL> <LI>Area Agencies on Aging.</LI> <LI>St. Bernard's Regional Medical Center in Jonesboro, AR.</LI> <LI>Independent Living Centers.</LI> </UL> </P> <H3>Public and Private Partnership Development/Involvement in the Planning Phase</H3> <P>No partners were involved.</P> <H3>Public and Private Partnership Development/Involvement in Implementation</H3> <P><STRONG>Public Partners</STRONG> <UL> <LI>Division of County Operations will assist in the development of the "Fast-track" eligibility process.</LI> <LI>Division of Medicaid Services will provide statistical information.</LI> <LI>Arkansas Supported Housing Office and the Governor's Task Force on Supported Housing will collaborate to educate local housing authorities on the principles of universal design and housing needs of persons with disabilities and the services available to help persons avoid precipitous placement in nursing facilities. </LI> <LI>Arkansas Development Finance Authority has agreed to set aside $300,000 of its annual HOME program allocation for bridge rental subsidies to be used for those qualifying for home and community-based waiver services.</LI> </UL> </P> <P><STRONG>Private Partners</STRONG> <UL> <LI>Area Agencies on Aging manage low-income housing funded through HUD subsidies.</LI> <LI>St. Bernard's Regional Medical Center in Jonesboro will be involved in the diversionary process.</LI> <LI>Independent Living Centers will provide diversionary services.</LI> </UL> </P> <P><STRONG>Existing Partnerships That Will Be Utilized to Leverage or Support Project Activities</STRONG> <UL> <LI>The state will use existing collaborations with hospitals and discharge planners to facilitate the transition of individuals to the community. Most Arkansas hospitals participate in the Medicaid in-patient hospital program and are also providers of Medicaid Home Health and Personal Care services and would be interested in providing services to persons who choose home care over institutionalization.</LI> <LI>The Division of Aging and Adult Services collaborates with the Area Agency on Aging of Southwest Arkansas and the Housing Authority of the City of North Little Rock. This collaboration will assure that the elderly and persons with disabilities are afforded priority consideration in the development of new and existing housing.</LI> <LI>This grant project will collaborate with the Real Choice Grant's development of a "fast-track" process to expedite applications for Medicaid waivers.</LI> <LI>The Website to provide information on long-term care options will build on an existing collaboration between Real Choice and CPASS Grants, which were awarded in 2001.</LI> </UL> </P> <H3>Oversight/Advisory Committee</H3> <P>There is no oversight/advisory committee.</P> <H3>Formative Learning and Evaluation Activities</H3> <P> <UL> <LI>Arkansas will continue to use and build on the database from the nursing facility transition program, which provides detailed client demographic information for evaluation and monitoring. This data will track diversionary plan information, services needed to divert from a nursing facility, expenses related to administrative costs and problems associated with diverting. </LI> <LI>MMIS coupled with the Decision Support System will allow Medicaid claims data to be retrieved for analysis. This data will track information about utilization and cost of all Medicaid services for persons diverted from nursing facilities. It will assist in the analysis of the cost of home care versus the cost of institutionalization.</LI> <LI>The Arkansas Client Eligibility System created to track application and eligibility information will be used for evaluation and monitoring. This information will track the amount of time from application to eligibility determination for HCBS waivers. </LI> <LI>Participants will complete pre- and post-transition surveys providing data for analysis and anecdotal information. This information will track the failures and successes of the program, barriers to diverting from nursing facilities, identify additional service needs, and the amount of time that participants have remained in the community.</LI> <LI>Reports will be created monthly and analyzed at least quarterly.</LI> </UL> </P> <H3>Evidence of Enduring Change/Sustainability</H3> <P> <UL> <LI>State decision-makers will provide administrative support reapportioned from nursing home savings to maintain a permanent intervention program.</LI> <LI>State decision-makers will support an ombudsman program to advocate for participants in the HCBS waiver programs and to assure the quality of provided services.</LI> <LI>The Web-based consumer information resource includes an online personal assessment and a directory of services. The DHS Director hopes to make this the model for the DHS Consumer Information Bureau when additional funding becomes available.</LI> </UL> </P> <H3>Geographic Focus</H3> <P>Statewide.</P>