Washington RCSC Summary

<A NAME=\"WARC\"></A> <P ALIGN=\"RIGHT\"><EM>Real Choice Systems Change</EM></P> <H2 ALIGN=\"CENTER\">WASHINGTON</H2> <H3>Identified Problems with the State's Long-Term Care System</H3> <P> <UL> <LI>Inflexibility of the separate funding systems for long-term care programs leads to consumers overall needs not being met.</LI> <LI>Lack of coordination between some programs to develop community living plans for clients with multiple needs or who are receiving services from multiple programs.</LI> <LI>Lack of coordination of training programs. For example, a training program for self-directed care may not be coordinated with a training program for mental health transition services, resulting in confusion for consumers.</LI> <LI>Lack of trained caregivers due to high staff-turnover and difficulties in providing training in rural areas.</LI> <LI>Lack of a common assessment tool to evaluate client needs across programs.</LI> <LI>Lack of integration of quality assurance into the current automated assessment process.</LI> <LI>Lack of training and knowledge necessary to develop community living plans for clients with multiple needs.</LI> <LI>The current payment system does not yet allow for direct client payment options.</LI> <LI>Current rates for nursing homes, adult family homes and in-home personal care are based on care setting, not on client need.</LI> <LI>Insufficient information and awareness among consumers and family members about the opportunities for people with disabilities to utilize community living options.</LI> </UL> </P> <H3>Perceived Strengths</H3> <P> <UL> <LI>The state is committed to and focuses on community living for long-term care clients. Washington has emphasized community placement since 1990 and operates several home and community-based waivers. Washington has also downsized its institutions for people with developmental disabilities from a high of over 4,000 residents to a current population of 1,047 and the legislature is currently contemplating closing one of five remaining institutions.</LI> <LI>Extensive use of Medicaid Personal Care and Medicaid Waivers to fund community care.</LI> <LI>Committed, professional and experienced staff in the three major long-term care programs.</LI> <LI>Availability of financial incentives for integrating mentally disabled individuals into the community. For example, the managed care payment system for Mental Health provides incentives for cost-effective community integration rather than institutionalization.</LI> </UL> </P> <H3>Primary Focus of Grant Activities</H3> <P> <UL> <LI>Enhance consumer, caregiver and case management skills needed for self-directed care and community living.</LI> <LI>Improve coordination of services and transition to community living.</LI> <LI>Increase consumer-directed service payment options.</LI> </UL> </P> <H3>Goals, Objectives, and Activities</H3> <P><STRONG>Overall Goal.</STRONG> Provide education, case management, and new payment mechanisms to support community living.</P> <P><STRONG>Goal.</STRONG> Enhance skills needed for self-directed services, support, and community living for individuals with disabilities, caregivers and case management staff.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Conduct a Community Living Conference to share knowledge of options to meet the needs of consumers with multiple needs.</LI> <LI>Create and support six local councils, made up of self-advocates, parents, providers, and other local county partners, to prepare and disseminate information on service availability and self-direction.</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Develop and implement statewide cross-system case management coordination models for consumers with multiple disabilities.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Support discharge and transition processes for long-term psychiatric hospital residents who can appropriately live in community settings by coordinating services and increasing community options.</LI> <LI>Replicate successful models of case management coordination for individuals with multiple disabilities most at risk for institutionalization through development of criteria and evaluation tools.</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Develop consumer assessment tools to support the implementation of client-directed service payment options.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Develop payment rates for community services using a community-based case-mix payment model.</LI> <LI>Develop an automated assessment tool with a quality assurance/outcome measurement component.</LI> </UL> </P> <H3>Key Activities and Products</H3> <P> <UL> <LI>Develop materials for education and training to teach self-directed services through locally planned and sponsored forums, including consumers and families of individuals with developmental disabilities.</LI> <LI>Provide a Community Living Conference for 500 consumers, families, staff, caregivers and advocates to share information, training, and solutions to community living issues.</LI> <LI>Support discharge and transition processes for long-term psychiatric hospital residents who can appropriately live in community settings by coordinating services and increasing community options.</LI> <LI>Replicate successful models of case management coordination for individuals with multiple disabilities most at risk for institutionalization through development of criteria and evaluation tools.</LI> <LI>Provide consumer-directed service payment options such as vouchers or cash and counseling by developing a community-based case-mix payment model as the foundation.</LI> <LI>Create a quality assurance, outcome measurement tool that will be integrated with the new automated assessment tool funded by the Department of Social and Health Services (DSHS).</LI> </UL> </P> <H3>Consumer Partners</H3> <P>The Community Living Initiative is the name of Washington's Real Choice Grant. <UL> <LI>The Community Living Initiative Consumer Task Force members include three self-advocates, a parent advocate, and representatives from community non-profit advocacy agencies for aging, mental health, and developmental disabilities. Participating with the Task Force are state grant staff members from aging, mental health, developmental disabilities, the Olmstead coordinator, and the Nursing Home Transition Grant staff.</LI> <LI>A variety of formal statewide consumer and family member forums will be used to assist in the development and improvement of services for persons with disabilities and to provide feedback and input during the implementation of grant activities.</LI> </UL> </P> <H3>Consumer Partners and Consumer Involvement in Planning Activities</H3> <P> <UL> <LI>Using the Starter Grant, the Consumer Task Force (CTF) was formed in 2001 to make recommendations for the original grant application. Consumers met with state staff to identify and prioritize goals. They communicated both in person for concept development, by email and mail to review drafts, and in person for follow-up discussions.</LI> <LI>The Department of Social and Health Services (DSHS) reconvened the CTF to make recommendations for the revised grant application. Recommendations from the CTF meeting were presented to the DSHS Steering Committee and were approved. The revisions included in the application directly reflect those recommendations.</LI> </UL> </P> <H3>Consumer Partners and Consumer Involvement in Implementation Activities</H3> <P> <UL> <LI>A variety of formal consumer and family member forums will be used to assist the Department in the development and improvement of services for persons with disabilities. As the grant activities are implemented, these groups will continue to contribute input on program efficiency and strategies for improvement, and will participate in activities such as the Community Living Conference.</LI> </UL> </P> <P>CTF members have varying interests for participation in specific activities: <UL> <LI>Consumers with interests in the mental health transition activities are involved with several mental health consumer groups and give continuous feedback to the grant program staff.</LI> <LI>Developmental disabilities parent advocates and agency members are taking an active role in the local council grants for developing training curricula and educational materials.</LI> <LI>Other members are particularly interested in planning and implementing the Community Living Conference for 2004. They meet as a group, as well as gathering input by email and mail, and members make recommendations and provide input on overall activities.</LI> </UL> </P> <H3>Public Partners</H3> <P> <UL> <LI>Adult and Disabilities Services Administration.</LI> <LI>State Independent Living Council.</LI> <LI>State Council on Aging.</LI> <LI>Governor's Committee on Disability Issues.</LI> <LI>Traumatic Brain Injury Committee.</LI> <LI>Employment and the Rehabilitation Council.</LI> <LI>Counties.</LI> </UL> </P> <H3>Private Partners and Subcontractors</H3> <P> <UL> <LI>Centers for Independent Living.</LI> <LI>Washington Senior Citizen's Lobby.</LI> <LI>Local nonprofit organizations.</LI> <LI>Schools.</LI> <LI>Local organizations such as the Chamber of Commerce, Rotary, etc.</LI> </UL> </P> <H3>Public and Private Partnership Development/Involvement in the Planning Phase</H3> <P><STRONG>Public</STRONG></P> <P>Public partners provided input during the development and planning phase of the project. County public health departments, major universities, and community agencies sent letters of support for the grant application. State agency staff provided ideas for implementation, as well as for staff participation.</P> <P><STRONG>Private</STRONG></P> <P>Private partners such as the Centers for Independent Living and the Washington Senior Citizens' Lobby provided input during the development and planning phase of the project and some representatives attended meetings and reviewed the grant application as part of the CTF.</P> <H3>Public and Private Partnership Development/Involvement in Implementation</H3> <P><STRONG>Public</STRONG> <UL> <LI>Public partners will continue to participate through consumer/advocate advisory meetings, as well as through the previously described Task Force membership.</LI> <LI>County personnel will participate on the local councils to help with dissemination of information and education.</LI> </UL> </P> <P><STRONG>Private</STRONG> <UL> <LI>The Centers for Independent Living have made a commitment to assist in the implementation of the Initiative through education of consumers and peer support/mentorship programs.</LI> <LI>Six local councils, made up of self-advocates, parents, providers, and other local county partners, will develop education and training materials using small grants that are funded by the Real Choice Grant.</LI> <LI>A large cross-systems hospital to community transitional workgroup is implementing the psychiatric transitions project.</LI> <LI>An event coordinator will be subcontracted to meet with multiple consumer groups to plan the Community Living Conference in 2004.</LI> <LI>Schools will participate on the local councils to help with dissemination of information and education.</LI> </UL> </P> <P><STRONG>Existing Partnerships That Will Be Utilized to Leverage or Support Project Activities</STRONG> <UL> <LI>The Mental Health Division has partnered with the Divisions of Developmental Disabilities and Aging and Disabilities Services to do cross training and develop community residences for individuals who are dual-diagnosed. This collaboration will support the grant activities that are centered around transitioning individuals from institutions to community settings.</LI> <LI>Community long-term care providers, Centers for Independent Living, and the HUD pilot to prioritize Section 8 vouchers for persons leaving institutions are some of the existing partnerships that are currently working together to support the grant's transition activities.</LI> </UL> </P> <H3>Oversight/Advisory Committee</H3> <P>The Community Living Initiative Consumer Task Force includes broad representation among various disability groups and includes consumers and family members. The CTF will meet or teleconference quarterly to review the progress of the projects undertaken to implement the grant and will make recommendations to the DSHS Community Living Steering Committee for quality improvement.</P> <H3>Formative Learning and Evaluation Activities</H3> <P> <UL> <LI>The CTF and the DSHS Staff Workgroup will review progress reports on grant activities to provide feedback and further recommendations.</LI> <LI>The DSHS Community Living Steering Committee will receive reports quarterly from the grant coordinator to monitor the status of implementation. The Steering Committee will review and make final decisions regarding any recommendations for quality improvements received from the CTF or Staff Workgroup.</LI> <LI>Formal consumer and family member forums will continue to contribute input on program efficiency and strategies for improvement, while ongoing feedback from consumers, advocates, and providers as activities are implemented will be instrumental in revising project goals and strategies.</LI> <LI>Each local council is required to evaluate the effectiveness of their activities quarterly and report on any necessary changes.</LI> </UL> </P> <H3>Evidence of Enduring Change/Sustainability</H3> <P> <UL> <LI>The training and educational materials that are developed by local councils through the grant funds will be disseminated through the Community Living Conference. The conference attendants will then use the materials and provide them to local consumers and stakeholders.</LI> <LI>The training and teaching components and the self-direction of services developed by Local Councils will be integrated into existing local systems. Each local council is required to address in their proposal how they will sustain changes after the grant funding has finished.</LI> <LI>The financial savings resulting from the transition of individuals from state hospitals to community settings are expected to fund two DSHS transition positions, one with the Mental Health Division and one with the Aging and Disabilities Services Administration, on an ongoing basis after the grant period ends.</LI> <LI>Criteria and assessment tools will reduce duplication of services across programs, allowing more time and resources for service delivery and crisis planning.</LI> </UL> </P> <H3>Geographic Focus</H3> <P>Statewide.</P>