ALABAMA
Grant Information
- Name of Grantee
- Alabama Department of Senior Services, State Unit on Aging
- Title of Grant
- Nursing Facility Transportations Program Grant
- Type of Grant
- Nursing Facility Transitions, State Program
- Amount of Grant
- $770,000
- Year Original Funding Received
- 2002
Contact Information
Melissa Galvin, Executive Director
770 Washington Avenue
RSA Plaza Suite 470
Montgomery, AL 36130
334–242–5743
mgalvin@adss.state.al.us
Subcontractor(s)
University of Alabama at Birmingham, Alabama Tombigbee Regional Commission (ATRC) (Area Agencies on Aging [AAA])
Jefferson County Office of Senior Citizens Services (AAA)
Target Population(s)
Persons currently enrolled in or eligible for the Alabama Department of Senior Services
(ADSS) Medicaid Waiver program who are hospitalized and are at risk of nursing home placement, and persons recently admitted into Medicaid–eligible nursing home residences.
Goals
- Facilitate hospital–to–home transitions for ADSS Medicaid Waiver–eligible individuals with dementia who wish to remain in the community by implementing the "Hospital–to–Home" program that places ADSS Medicaid Consultants within hospitals.
- Field test a nursing home–to–community transition program for individuals with dementia residing in nursing homes located in the Jefferson County and ATRC AAA regions.
Activities
- Develop and implement an educational program targeting Hospital Discharge Coordinators Training will emphasize (1) the importance of making community living a viable option for persons with dementia, (2) the unique challenges faced by caregivers of dementia patients, (3) the resources available to caregivers in the community, (4) basic problem solving techniques, and (5) the role of ADSS Case Manager in assisting discharge coordinators and family caregivers with obtaining needed resources.
- Implement a consultant service that (1) places an ADSS Medicaid Waiver specialist within the hospital to assist with the identification of patients with dementia who are "at risk" of nursing home placement and (2) assist the Hospital Discharge Planner in the development of individualized home care plans that reduce the risk of nursing home placement.
- Inform all nursing homes in Jefferson County and the ATRC region about the transition project.
- Identify resident characteristics that would appear to predict successful community transition.
- Implement a system for identifying Medicaid–eligible nursing home residents who appear to be candidates for successful transition.
- Transfer a maximum of 10 nursing home residents from each of the two AAA areas from nursing home to home living using enhanced ADSS Medicaid Waiver services.
- Enhance ADSS Medicaid Waiver services by implementing an extensive training system for ADSS Case Managers in problem–solving techniques to assist them in managing the multiple and complex demands faced by caregivers of persons with dementia who are transitioned to the home.
- Provide additional support services through funds initially provided by this grant, but sustained by funding changes to the Medicaid Waiver program by the State of Alabama. These support services may include in–home respite services, home health aid services, nursing home hold days, adult day care, or any other service not currently covered by the waiver but is needed for transition back to the community.
- Evaluate the acceptability and feasibility of the "nursing home–to–home" transition program.
Abstract
The ADSS proposes to collaborate with the state's 13 AAAs, the Alabama State Nursing Home Association, the Alabama Hospital Association, Alabama Medicaid Department, Governor's Office on Disability, the Olmstead Core Workgroup, and the Dementia Care Research Program of the University of Alabama at Birmingham to enhance support services provided by the Elderly and Disabled Medicaid Waiver program to assist persons with dementia living in the community. The project institutes a comprehensive system to support enduring changes in the delivery of community based assistance for Medicaid eligible persons with dementia. The project targets two populations of Medicaid eligible persons with dementia: (1) community dwelling persons with a recent admission to the hospital and (2) recently admitted Medicaid eligible nursing home residents. We have chosen two AAAs because they provide both rural and urban settings, a significant number of low–income, minority residents, and sufficient staff capacity for program management. Our program will integrate ADSS Medicaid Waiver services into other formal care services and into family
caregiving, maximizing the benefit of both formal and informal services available to Medicaid Waiver participants.