West Virginia RCSC Summary | advancingstates.org

<A NAME=\"WVRC\"></A> <P ALIGN=\"RIGHT\"><EM>Real Choice Systems Change</EM></P> <H2 ALIGN=\"CENTER\">WEST VIRGINIA</H2> <H3>Identified Problems with the State's Long-Term Care System</H3> <P> <UL> <LI>Lack of accessible services and lack of community supports.</LI> <LI>Lack of information for consumers, families, providers, and communities about the complex and fragmented system designed to support people with disabilities.</LI> <LI>Limited communication among providers, agencies and consumers.</LI> <LI>The Aged and Disabled (A/D) Waiver provides a maximum of 28 hours of services per week.</LI> <LI>Poor coordination of services among waiver, home health and community providers.</LI> <LI>Many people with disabilities or long-term illness are ineligible for waiver services and have limited supports under the Medicaid State Plan.</LI> <LI>Consumers and their families are generally excluded from the policy development process, from service decisions, and from quality assurance activities.</LI> <LI>Barriers to successful community inclusion are the medical model certificate of need process, nurse practice acts and licensure rules that limit who can provide services, and a "default" service approach that maintains congregate and segregated service systems.</LI> <LI>Lack of training opportunities to assist agencies, partners and communities to make the shift to consumer-directed services.</LI> </UL> </P> <H3>Perceived Strengths</H3> <P> <UL> <LI>Committed leadership at state level to implement systems change in accord with the Olmstead decision. In January 2001, the Governor established an interagency/consumer group to identify issues and look for models to improve the system.</LI> <LI>WV has an active core of consumer/advocates and grassroots advocacy organizations across disability groups that provide information to the legislature, and offer a variety of peer supports in rural communities.</LI> </UL> </P> <H3>Primary Focus of Grant Activities</H3> <P> <UL> <LI>Encourage collaboration among consumers and agencies/providers in the development of policy, the delivery of services, and in monitoring and evaluation activities.</LI> <LI>Collect and disseminate information for consumers, providers and agencies about services and supports available in local communities and statewide</LI> <LI>Provide consumer-directed training for consumers, providers and agencies.</LI> <LI>Develop peer-based community support models that can be replicated across settings.</LI> </UL> </P> <H3>Goals, Objectives, and Activities</H3> <P><STRONG>Overall Goal.</STRONG> To create enduring improvements in community long-term support systems so that individuals of any age who have a disability or long-term illness have the choice and necessary long-term supports to live and participate in their communities.</P> <P><STRONG>Goal.</STRONG> Consumers will plan, direct and evaluate community long-term supports and services with service agencies, and public and private partners.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Develop and maintain a Real Choice Partnership group with working subcommittees for Policy, Practice, Service and Legislative Supports. These subcommittees, assisted by grant staff, will carry out the broad systems change activities of the project.</LI> <LI>Develop and maintain an ongoing Consumer Oversight Commission (COC), comprising members from the Consumer Task Force (CTF) that developed the grant application and others.</LI> <LI>Develop and provide funding for a system of peer supports/services models.</LI> <LI>Arrange for continuation of the Partnership, COC and funded Peer Support Models after the grant period ends through state agency and provider supports, including: people, such as family and friends; places, such as churches and senior centers; things, such as food stamps and assistive technology; and activities, such as social, recreational and political (voting) involvement.</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Promote awareness and knowledge among all stakeholders regarding the importance and availability of community living opportunities for people with disabilities or long-term illnesses.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Provide information and training to consumers, families, advocates, public and private service and healthcare providers, and administrators and policymakers through statewide and regional workshops.</LI> <LI>Provide information and self-determination training that enables consumers to make informed choices and plan, direct and evaluate their financial support systems. Financial support system refers to sources of the consumer's income and who has control over how it is spent.</LI> <LI>Develop a legislative agenda and use it to inform and educate policymakers within all departments and at the legislative level.</LI> <LI>Incorporate methods developed through the grant in the ongoing information systems available through advocacy organizations by modifying or extending current systems and training personnel on updating and maintenance.</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Enlarge and/or amend the long-term support infrastructure and capacity to provide people with a disability or long-term illness with greater opportunities for community living.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Evaluate current supports in terms of accessibility, quantity, quality, accountability and responsibility.</LI> <LI>Modify Medicaid State Plan and waiver services to fully support community living.</LI> <LI>Increase consumer control of personal assistance services.</LI> <LI>Modify nurse practice regulations and licensure requirements as appropriate to permit non-licensed personnel to provide certain services in home and community settings.</LI> <LI>Train healthcare and service providers, case managers and discharge planners in person-centered approaches.</LI> <LI>Build the capacity of service providers to continue to respond to consumer needs after the Real Choice Project ends.</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Consumers of all ages will be able to choose from a variety of home and community services and supports.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Collect information about housing in West Virginia for inclusion in a new Resource Directory and pursue options to expand housing opportunities.</LI> <LI>Develop recreational, leisure and friendship opportunities through model demonstrations.</LI> <LI>Investigate methods for increasing transportation accessibility and develop a replicable model of accessible transportation</LI> <LI>Review supports and services provided to children and adults that ensure quality education as part of community inclusion.</LI> <LI>Develop employment information and resources for consumers.</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Expand and improve the quality of services and supports.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Collect data on the movement of individuals from institutional to community settings and the diversion of individuals from nursing or segregated facilities. A segregated facility would be a group home, HUD 811 facility, ICF/MR homes and other such sites where people are segregated based on the fact that they have a disability.</LI> <LI>Evaluate cost-effectiveness and cost benefits of services/supports provided in the community.</LI> <LI>Utilize the Plan, Act, Study and Do (PASD) model of improvement to monitor the success of systems change efforts.</LI> <LI>Make recommendations to agencies and policymakers for changes needed in Medicaid state plan services, the waiver program, nurse practice acts and licensure requirements, and service delivery mechanisms.</LI> <LI>Conduct a consumer satisfaction survey to determine which grant activities should continue.</LI> </UL> </P> <H3>Key Activities and Products</H3> <P> <UL> <LI>Develop and maintain an ongoing Real Choice Partnership group (60 percent consumers/advocates) with successfully working subcommittees.</LI> <LI>Develop trainings with consumers/advocacy groups and disseminate curriculum on community-based issues to raise awareness at multiple levels.</LI> <LI>Construct, advertise, and maintain a toll-free line and Website, and develop a hard copy and Web-based Resource Directory that describes statewide and local community long-term service and support resources.</LI> <LI>Review and make recommendations regarding Medicaid State Plan and waivers to enhance their compatibility for fully supporting community-living.</LI> <LI>Within the framework of an inclusive community template, review, analyze, and recommend solutions for increasing transportation accessibility, recreational/leisure opportunities, educational supports and services, and accessing employment.</LI> <LI>Fund community-based mini-projects to serve as community support models.</LI> <LI>A brochure regarding accessible housing requirements will be developed and disseminated to landlords, judges, contractors, housing organizations, welfare offices and realtors.</LI> <LI>Utilize the PDSA model to monitor change effort success.</LI> </UL> </P> <H3>Consumer Partners</H3> <P> <UL> <LI>A 23 member Consumer Task Force, made up of individuals with disabilities, their families, and advocates, and several members of the Olmstead Task Force.</LI> <LI>Twenty-three individuals from seven regions of the state will form a COC to provide monitoring and problem solving for the project. Sixty percent of these individuals will be primary or secondary consumers (family members). The other 40 percent will be representatives of advocacy organizations.</LI> <LI>Members of a Real Choice Partnership will include consumers and family members representing a range of disabilities and age groups. The Policy, Practice, Service and Legislative subcommittees will include additional consumer, public and private entities, which have expertise or a special interest in these areas.</LI> </UL> </P> <H3>Consumer Partners and Consumer Involvement in Planning Activities</H3> <P> <UL> <LI>The CTF developed this Real Choice application.</LI> <LI>Eight public meetings around the state were advertised by newspapers and advocacy groups to maximize the input of consumers, providers and the general public in the development of the grant application.</LI> </UL> </P> <H3>Consumer Partners and Consumer Involvement in Implementation Activities</H3> <P> <UL> <LI>A Partnership will be developed comprising 60 percent consumers and advocates, public and private service providers, and state agencies, and will meet quarterly to plan and carry out grant activities.</LI> <LI>Subcommittees of the Partnership, which will include consumers, will meet on a monthly basis to review and make recommendations regarding Policy (Medicaid State Plan, waivers, etc.); practice (licensure and practice acts); service (direct services, wages, consumer control, case management and personal assistance); and legislative affairs (cost factors and benefits).</LI> <LI>The COC will meet bimonthly and communicate regularly with grant staff to provide guidance for grant activities.</LI> <LI>The COC will review applicants for demonstration models of peer support/services and vote to fund two or three of these each year of the project.</LI> <LI>The COC will assist Real Choice staff in designing and providing information and training for consumers that builds self-advocacy and self-determination skills.</LI> <LI>The curriculum writing team for trainings will include consumers who have developed and conducted training as well as individuals with expertise in curriculum formats and multimedia.</LI> </UL> </P> <H3>Public Partners</H3> <P> <UL> <LI>Bureau of Senior Services.</LI> <LI>Children with Special Healthcare Needs, a division within the West Virginia Department of Health and Human Resources.</LI> <LI>Department of Education.</LI> <LI>Department of Labor (Ticket to Work and Work Incentives Improvement Act).</LI> <LI>Developmental Disabilities Council.</LI> <LI>Division of Rehabilitation Services.</LI> <LI>Housing and Urban Development.</LI> <LI>Bureau for Behavioral Health and Health Facilities.</LI> <LI>State Independent Living Council.</LI> <LI>State Rehabilitation Council.</LI> </UL> </P> <H3>Private Partners and Subcontractors</H3> <P> <UL> <LI>AARP.</LI> <LI>ADAPT WV.</LI> <LI>Brain Injury Association.</LI> <LI>Centers for Independent Living.</LI> <LI>Fair Shake Network.</LI> <LI>Home Health Services.</LI> <LI>Health South Rehabilitation Centers.</LI> <LI>Long-Term Care Ombudsman Program.</LI> <LI>Mental Health Planning Council.</LI> <LI>West Virginia Advocates.</LI> <LI>West Virginia Assistive Technology System.</LI> <LI>West Virginia Behavioral Health Centers.</LI> <LI>Center for Excellence in Disabilities at West Virginia University (CED).</LI> </UL> </P> <H3>Public and Private Partnership Development/Involvement in the Planning Phase</H3> <P> <UL> <LI>Three state agency meetings were held to discuss the current system of supports and the vision that state agencies have in modifying the system to fully support people with disabilities and/or long term illness.</LI> <LI>State agencies, along with public and private healthcare and service providers, have been meeting with consumers and advocates on the state's Olmstead Task Force and many of the recommendations being offered by that group were subsequently included in the grant application.</LI> <LI>State agencies and public and private partners attended the eight statewide public meetings and teleconferences where objectives of the Real Choice application were reviewed.</LI> <LI>Drafts of the application were shared with state agencies and public and private partners through an interactive listserv. Phone conversations and informal meetings also occurred during the application development.</LI> </UL> </P> <H3>Public and Private Partnership Development/Involvement in Implementation</H3> <P> <UL> <LI>Public and private partners will be members of the Partnership and its subcommittees, described above under Consumer Involvement.</LI> <LI>The Fair Shake Network, Centers for Independent Living, the State Rehabilitation Council, State Independent Living Council, ADAPT WV, West Virginia Assistive Technology Systems and AARP will disseminate information about the Real Choice grant, the materials the grant produces, and the resources it collects. The information will be disseminated through the newsletters, Websites, conferences and other formal and informal networks of the organizations named.</LI> <LI>Grant staff, the Service subcommittee of the Partnership and several disability programs with an interest in transportation, will form a Transportation Coalition to investigate the feasibility of a rural dispatch service and a Central Transportation Hub that identifies and shares transportation resources statewide. Members of the coalition will include the West Virginia Traumatic Brain and Spinal Cord Injury Program, the West Virginia Assistive Technology System, the Bureau of Senior Services, and potentially, the Department of Transportation.</LI> <LI>The West Virginia University Center for Excellence in Disabilities (WVUCED) will assist in the design of the Consumer Satisfaction Survey instrument and will train staff on phone survey methodology.</LI> </UL> </P> <P><STRONG>Existing Partnerships That Will Be Utilized to Leverage or Support Project Activities</STRONG> <UL> <LI>Established Information and Referral systems such as Family Matters will be contacted for the sharing of information. Family Matters is an established statewide information and referral system with a massive database of resource information on supports for children and families. Real Choice hopes to develop a collaboration with Family Matters to share resource information that might be pertinent to Real Choice, such as community organizations that might provide services for children and families of Real Choice consumers. In return, information collected by Real Choice staff that Family Matters might not have will be shared.</LI> <LI>Grant funds will be given to advocacy agencies such as the Developmental Disabilities Council's Partners in Policymaking and Northern West Virginia Center for Independent Living (NWVCIL) that already provide training. Real Choice hopes to increase participation in already existing self-determination and leadership trainings offered by the advocacy organizations.</LI> <LI>In collaboration with the West Virginia Home of Your Own project and HUD, grant staff and the Partnership will investigate methods for increasing housing for people with disabilities through partnerships with private businesses.</LI> </UL> </P> <H3>Oversight/Advisory Committee</H3> <P>A COC comprising consumers, family members or significant others, and advocacy organizations will serve as the monitoring body for the grant. It will oversee all grant activities including the formulation of policies and recommendations on practice, licensure and services.</P> <H3>Formative Learning and Evaluation Activities</H3> <P> <UL> <LI>The Real Choice Partnership and COC will continually monitor grant activities and make modifications as needed.</LI> <LI>A statewide conference will be held at the beginning of Year Two to describe the maturing West Virginia system and obtain input regarding continuing unmet needs.</LI> <LI>The project will gather data to determine whether services and supports met the needs of those attempting to transition from nursing homes to the community.</LI> <LI>Six months before the grant ends, staff will conduct a statewide Consumer Satisfaction Survey to determine which grant activities and resulting systems changes are valued by consumers and should continue after the grant ends.</LI> </UL> </P> <H3>Evidence of Enduring Change/Sustainability</H3> <P> <UL> <LI>The Real Choice Partnership will be maintained after the grant period through shared "hosting" by the agencies represented. Partner members will be asked to rotate hosting of partnership meetings at their sites by providing facilities and funding staff participation.</LI> <LI>State agencies, advocacy organizations, and providers will develop methods to maintain the information and referral system after the grant ends.</LI> <LI>The training curriculum will become part of the state's service and support systems, offering a process to educate personnel within state and private organizations to make the shift from traditional services to a self-determination model.</LI> <LI>Recommendations for legislative and policy change will be presented for agency, legislative and the Governor's review. It is anticipated that a majority of these recommendations will be implemented.</LI> <LI>The grant will develop projects demonstrating creative ways to provide peer services and consumer-directed supports. These projects will serve as models that can be replicated throughout the state.</LI> </UL> </P> <H3>Geographic Focus</H3> <P>Statewide.</P>