Nebraska NFT Summary | advancingstates.org

<HR ALIGN=\"left\" ALT=\"Horizontal rule dividing sections\"> <A NAME=\"NENFT\"></A> <P ALIGN=\"RIGHT\"><EM>Nursing Facility Transitions</EM></P> <H2 ALIGN=\"CENTER\">NEBRASKA</H2> <H3>Identified Problems with the State's Long-Term Care System</H3> <P> <UL> <LI>Significant numbers of aging persons and adults with disabilities currently living in nursing homes could be residing in alternative settings, including many private pay individuals likely to become Medicaid-dependent in a few months.</LI> <LI>Lack of knowledge about current home and community alternatives to nursing homes among the general public.</LI> <LI>Cultural bias among medical professionals favoring nursing facilities as the only long-term care option for anyone requiring 24hour care.</LI> <LI>Shortfall in care provider resources.</LI> <LI>Lack of consistent method for integrating clients' goals for transition into hospitals' discharge plans or into nursing facilities' care plans.</LI> <LI>Lack of <EM>on-time</EM> response to clients' service needs during or following crises and contingencies; thus, clients who could return to a home or community setting, with services support, are "defaulted" to a nursing facility.</LI> </UL> </P> <H3>Perceived Strengths</H3> <P> <UL> <LI>Because of the collaborative relationships established through the 1year transition grant, the partners that will be vital to this project are already committed to making tangible systems changes, with a strong understanding of the issues that precipitate their need.</LI> <LI>Because of the Nursing Facility Conversion Grant program, many nursing facilities are replacing some of their unused beds with assisted living apartments.</LI> <LI>Due to a unique relationship with contracted agencies to provide services coordination, the Nebraska Department of Health and Human Services System (NDHHSS) is able to serve waiver participants more cost effectively through a more seamless service delivery system.</LI> <LI>NDHHSS contracts with the Area Agencies on Aging (AAA) and the Independent Living Centers (ILCs) to assist with provider recruitment.</LI> <LI>The Lincoln AAA, Lincoln Information for the Elderly (LIFE) office, has had in place for 6 years the HUD Congregate Housing Services Program (CHSP), which established a partnership between HUD, the Lincoln Housing Authority, and residents in three elderly high-rise apartment buildings in Lincoln for the provision of services.</LI> <LI>LIFE has also entered into partnership with the United Church of Christ Health and Human Services Ministries from Long Beach, California, which has been awarded a HUD Section 208 grant to provide services coordination for frail elderly and disabled residents.</LI> </UL> </P> <H3>Primary Focus of Grant Activities</H3> <P> <UL> <LI>Implement communication/marketing campaign to effect a cultural change in the way stakeholders view long-term care options.</LI> <LI>Enlist nursing facility staff in partnership with AAAs to facilitate successful transitions.</LI> <LI>Develop and implement a statewide toll-free number for nursing facility transition assistance.</LI> <LI>Improve consumers' capacity to exercise choice about their living arrangements.</LI> <LI>Identify early opportunities for transition.</LI> </UL> </P> <H3>Goals, Objectives, and Activities</H3> <P><STRONG>Overall Goal.</STRONG> To bring Nebraska's long-term care services together as a continuum of care, with (1) components that meet consumers' needs at the right time and (2) a streamlined, seamless method for these components to work together. Aging persons and adults with disabilities will have both the awareness and the ability to exercise a choice about the type of living environment that is most appropriate to them.</P> <P><STRONG>Goal.</STRONG> Increase awareness of alternative living environments as a viable option among both residents and candidates for residence in nursing facilities, as well as their key influencers.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Under contract, Northeast Nebraska Area Agency on Aging (NENAAA) will develop a communication campaign and provide marketing materials to promote the concept of transition and HCBS alternatives.</LI> <LI>Under contract, the three pilot AAAs will provide training in the transition communication/ marketing campaign and materials to remaining AAAs across the state.</LI> <LI>Under contract, the three pilot AAAs implement marketing strategies with target publics across the state. Radio, television, and print products disseminated statewide.</LI> <LI>At least 50 Medicaid nursing facility residents will receive presentations and materials.</LI> <LI>Evaluate marketing plan effectiveness by conducting random surveys among target population.</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Create transition partnerships among AAAs and the nursing facilities in their territories. The AAA and NF partnering staffs will identify residents who are likely candidates for transition, inform candidates and their key influencers about choices in how to live, where to live, and help facilitate successful transitions for those candidates who so choose.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Eastern Nebraska Office on Aging (ENOA, an AAA) will employ a "transition specialist" strategy in order to network with each of the 35 nursing facilities within ENOA's area; the dedicated specialist will market and refine the project processes.</LI> <LI>ENOA will compile a report of nursing facility transition (NFT) partnership "best practices" that can be studied by agencies statewide as they formulate their transition strategies.</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Develop and employ a computerized tracking program for Medicaid clients entering nursing facilities, for the purpose of identifying earliest opportunity for transition back to home and community settings.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>The Lincoln Area Agency on Aging (LAAA) will develop and field-test a computerized tracking system that will enable Senior Care Options (SCO) staff to more precisely monitor clients who are admitted to a nursing facility and identified as a potential transition back to home and community settings. The system will also collect transition outcome data for analysis, and aid in developing quality enhancements.</LI> <LI>LAAA resource developers will recruit and train service providers for NDHHSS's "Take Me Home" Aged and Disabled Waiver service, which also pays for up-front costs that people experience when transitioning from nursing facilities to the community.</LI> <LI>LAAA will compile a report on using information systems to track Medicaid clients entering nursing facilities for transition "best practices" that can be studied by agencies statewide as they formulate their transition strategies.</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Develop and implement a statewide toll-free number for NFT assistance.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG></P> <P>NDHHSS will establish a statewide toll-free number for NFT assistance. When a person calls the number, the call will automatically be routed to the appropriate AAA based on the area code of the call. The toll-free number will become available after NDHHSS trains AAAs throughout the state in transition strategies and after the statewide communication/marketing campaign is launched.</P> <P><STRONG>Goal.</STRONG> Reduce the number and length of Medicaid nursing facility stays through expansion of SCO services.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Train SCO staff to use BRASS screening tool, an instrument intended to be administered at hospital admission, designed to identify patients at risk for prolonged hospital stays and in need of discharge planning services. Nebraska will use an adapted tool created by the Colorado Department of Health Care Policy and Financing for their "Fast Track" program for long-term care preadmission screening of people admitted into acute care facilities.</LI> <LI>Implement SCO prescreening and counseling program with private pay residents, many of whom would be likely to spend down quickly in nursing facilities and thus become eligible for Medicaid. (Total goal: 160 additional persons will be screened.) SCO is already mandated for Medicaid-eligible people.</LI> <LI>Implement follow-up screening with all residents (private pay and Medicaid) who received initial SCO screen using the BRASS instrument.</LI> <LI>Evaluate effectiveness of SCO prescreening with private pay residents using data regarding the number of people served, consumers' cost, length of stay, and functional capacity.</LI> </UL> </P> <H3>Key Activities and Products</H3> <P> <UL> <LI>Communication/marketing plan and products designed to promote the concept of transition and HCBS alternatives to target groups across the state, and evaluate the plan's effectiveness.</LI> <LI>Report of transition partnership "best practices" from ENOA's strategy to employ a dedicated "transition specialist" to work with nursing facilities.</LI> <LI>Report of computerized tracking system of Medicaid clients entering nursing facilities to identify early opportunities for transition.</LI> <LI>Evaluation of the effectiveness of SCO prescreening with private pay residents (cost data, length of stay, number served, functional data).</LI> </UL> </P> <H3>Consumer Partners</H3> <P>Consumers were closely involved in the initial research conducted to inform the project (see planning below) and will continue to provide feedback during grant implementation activities.</P> <H3>Consumer Partners and Consumer Involvement in Planning Activities</H3> <P>Consumer input was provided through communication/marketing research interviews of 146 stakeholders, including transition candidates, recently transitioned clients, their family members, physicians, religious leaders, nursing facility staff, hospital discharge staff, AAA and CIL staff, and Nebraska Health and Human Services supervisors and workers. The research was the foundation for the current transition strategies being field-tested.</P> <H3>Consumer Partners and Consumer Involvement in Implementation Activities</H3> <P> <UL> <LI>Partners in this grant will continue to collect consumer feedback and advice using professional research and interview tactics developed by Bailey Lauerman, an internationally recognized communication/marketing firm.</LI> <LI>As the activities of this grant develop, consumer involvement will primarily be the feedback and advice collected through ongoing survey instruments.</LI> </UL> </P> <H3>Public Partners</H3> <P>There are no public partners.</P> <H3>Private Partners and Subcontractors</H3> <P> <UL> <LI>Area Agencies on Aging.</LI> <LI>Nebraska Health Care Association.</LI> <LI>Bailey Lauerman & Associates (a communication/marketing firm).</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>Private Partners</STRONG> <UL> <LI>The Nebraska Health Care Association will give in-kind services including letters to member nursing facilities. The letters will introduce the AAA representatives conducting transition activities, and lend NHCA endorsement to the transition activities.</LI> <LI>NDHHSS will contract with Bailey Lauerman & Associates to provide marketing materials, train, implement marketing strategies, and conduct and evaluate all surveys.</LI> <LI>The Eastern Nebraska Office on Aging AAA will network with each of the 35 nursing facilities in its locale to market the transition partnership project. They will also compile a reference report of "transition specialist" and transition partnership best practices.</LI> <LI>Lincoln AAA will develop and field-test a computerized, close-tracking program for monitoring Medicaid clients and identifying earliest opportunities for transition, and will compile a reference report on their transition monitoring "best practices."</LI> <LI>Lincoln AAA will also recruit and train service providers for the state's "Take Me Home" Aged and Disabled waiver service, which also pays for up-front transitioning costs such as rental deposits.</LI> <LI>Each AAA will create transitioning partnerships with the nursing facilities in their locales to identify residents who are likely candidates for transitioning and inform candidates about community living options.</LI> <LI>AAAs will share communication/marketing products and expenses, and meet regularly to evaluate their individual strategies, share findings and cross-pollinate ideas.</LI> <LI>At end of Grant Year One, ENOA, LAAA & NENAAA will combine their field-tested, best practices into a Transition Strategic Plan which they will market to the remaining AAAs statewide. The plan will encompass the proven, most effective strategies from communication/marketing, "transition specialist," nursing facility networking, and computerized tracking of Medicaid clients entering nursing facilities.</LI> </UL> </P> <P><STRONG>Existing Partnerships That Will Be Utilized to Leverage or Support Project Activities</STRONG></P> <P>The partnership between HUD, the Lincoln Housing Authority, and residents in three elderly high-rise apartment buildings in Lincoln will provide additional opportunities for people leaving nursing facilities in Lincoln to access housing and community services in the high-rise buildings.</P> <H3>Oversight/Advisory Committee</H3> <P>The Advisory Committee comprises experienced NDHHSS and Area Agency on Aging executives, administrators and program managers. The Nebraska Health Care Association and Bailey Lauerman & Associates will also participate. The committee will analyze consumer input provided by the survey instruments conducted during the field tests of the transition strategies.</P> <H3>Formative Learning and Evaluation Activities</H3> <P> <UL> <LI>A survey of the marketing campaign's target population will be used to evaluate the communication/marketing campaign's effectiveness.</LI> <LI>A survey of consumers will be used to evaluate the effectiveness of the transition partnership between ENOA and nursing facilities.</LI> <LI>A survey of consumers will evaluate the effectiveness of the computerized tracking of Medicaid clients entering nursing facilities.</LI> <LI>A survey of callers will evaluate the visibility and usefulness of the toll-free, transition assistance phone service.</LI> <LI>To evaluate the effectiveness of Senior Care Options prescreening with private pay residents, the grant will analyze data on the number of people served, the cost of their services, their length of stay, and their functional capacity.</LI> </UL> </P> <H3>Evidence of Enduring Change/Sustainability</H3> <P> <UL> <LI>The Advisory Committee has already met and developed a cohesive relationship over the last year, and will operate in an advisory capacity to the Medicaid program indefinitely.</LI> <LI>The materials and skills to market community alternatives will have been developed and will require few resources to maintain them.</LI> <LI>The transition partnerships developed between AAAs and the nursing facilities in their territories will remain active and result in successful transitions.</LI> <LI>The computerized tracking concept will be adopted by other AAAs statewide and result in successful transitions.</LI> <LI>The expansion of SCO through this project will provide evidence for the Legislature to support expansion of initiatives designed to enhance transition, including "Take Me Home" Medicaid Waiver service and the "Waiver While Waiting" policy that provides waiver services for functionally eligible waiver applicants who are applying for Medicaid and who are likely to be eligible for Medicaid. The waiver pays for services if the person qualifies for the waiver. Otherwise, the state pays for services using other revenues.</LI> </UL> </P> <H3>Geographic Focus</H3> <P>Statewide, with pilots in Lincoln, Omaha and Norfolk areas.</P>