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Michigan’s Long-Term Care ConferenceHilton Detroit, TroyMarch 23-24, 2006

Michigan Nursing Facility Transition Initiative

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What is NFTI?

2001 Real Choice Systems Change Grant, Centers for Medicare and MedicaidAdministered by MDCH, Division of Community Living and DYNS Services, Inc.Diverted 105 people from nursing facility placementTransition 210 people from nursing facilities to community livingBuilt on experience of Michigan Centers for Independent Living transition work

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NFTI Partners

Michigan Department of Community Health Division of Community Living

Neighborhood Services Organization MI Choice Waiver Program

Detroit Area Agency on Aging Area Agency on Aging of Western Michigan

Michigan State Housing Development AuthorityUniversity of Michigan: Turner Geriatric Center

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NFTI guiding principles

Promote major system change in long term care: People should be able to chose where to live

and be able to pick the least restrictive environment

People who do not need nursing care should not be in NF

Result in significant cost shift from institutional to community care

Housing is critical component of long term care program

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NFTI Transition Component

Identify people in NF who express a desire to live in communityDevelop person centered transition plans: Housing component Services Component

Build on existing community capacity in MI Choice WaiverCoordinate with Housing providers

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NFTI and MI Choice Waiver

Located a NFTI project at two MI Choice Waiver agents Detroit Area Agency on Aging Area Agency on Aging of Western

Michigan

Developed “wrap around” model to coordinate NFTI with MI Choice Waiver

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MI Choice Waiver History

Funded by State and Federal $Established in 1992Statewide coverage by 1998Served 15,000 in 2000Currently serves 8,600 peopleMedical eligibility: “nursing home” LOCFinancial eligibility: 300% of SSI

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Project Model

NFTI Coordinator at MI Choice Waiver Agent to develop transition plans with people who wished to leave nursing facility: develop person centered transition

plans Housing Services Financial

implement plan

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Preliminary Transition Results

58% of the people transitioned did not need state funded Medicaid services from MI Choice or Adult Home HelpThe average cost of those who did use the MI Choice Waiver was $670 per monthAverage monthly Medicaid savings was $3,066 compared to Nursing Facility56% fell into lowest RUGs category (Reduced Physical Function)

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Preliminary Transition Results continued…

Mi Choice Waiver agents provide effective and inexpensive methods for transitioning people from nursing facilitiesBuilding community supports and housing is critical to returning to the communityImportant to look at people who do not qualify for MI Choice waiver or Home Help

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Case HistoriesTransition participant: 61 year old male, limited English, burned in

house fire, after hospitalization was placed in NF for two years because he had no place to live, nursing facility social worker contacted NFTI program to arrange transition to community. Living in community since September 2004.

32 year old quadriplegic, significant ADL and IADL support, moved to community in October 2004 with help of Section 8 housing

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Recommendations, continued

Coordinate NFTI with Money Follows the Person projectInclude NFTI in state Quality Improvement Initiative for long term careDevelop local collaboratives to support project including: Centers for Independent Living, Continuums of Care, MI Choice Waiver Agents, Community Mental Health Agencies, Hospitals and Nursing FacilitiesPromote NFTI care facilitation model which will result in better care and less lengthy stay in acute care and long term care

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Transition Participants

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Transition Participants

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Transition Participants

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Transition Participants

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Training and Education Component

Develop Transition education component, which builds on Center for Independent Living Project and NFTI experiences Train wide variety of long term care professionals, participants and community resources

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Recommendations

Incrementally expand Transition and Diversion projects statewide using NFTI model Continue existing programs in Wayne and

Kent counties Continue evaluation to refine cost

model/outcomes analysis Modest expansion to one or two other

regions per year

Target 10 to 12% of NF residents who do not need nursing care

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Recommendations continued…

Coordinate NFTI with Money Follows the Person projectInclude NFTI in state Quality Improvement Initiative for long term careExpand local supportive housing consortia to other areas of state and to include: Centers for Independent Living, MI Choice Waiver Agents, Hospitals and Nursing Facilities.

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Addressing BarriersFear of leaving institution Care facilitator and Community Consortia

Lack of money, criminal history, poor credit history, lack of community supports Care facilitator and Community Consortia

Lack of affordable, barrier free, and accessible housing Section 8 Housing Certificates for ages 18 to 62 Community Supportive Housing Consortia Michigan Team

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Local Consortia Human Service Agencies Co-led by social services, include Area

Agencies on Aging, MI Choice Waiver Agents, Centers for Independent Living, mental health, substance abuse, jobs, and other service providers

Local Governments Co-led by largest city or county Include other local jurisdictions

Nonprofit sponsors and advocates Some with housing experience Some service providers

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