ct money follows the person quarterly report - uconn health · quarterly report quarter 4 , 2016:...
TRANSCRIPT
1
MFP Benchmarks 1) Transition 5200 people from qualified institutions
to the community 2) Increase dollars to home and community based
services 3) Increase hospital discharges to the community
rather than to institutions 4) Increase probability of returning to the community
during the six months following nursing home admission
5) Increase the percentage of long term care participants living in the community compared to an institution
CT Money Follows the Person
Quarterly Report
Quarter 4, 2016: October 1, 2016 – December 31, 2016 (Based on latest data available at the end of the quarter)
UConn Health, Center on Aging Operating Agency: CT Department of Social Services Funder: Centers for Medicare and Medicaid Services
Benchmark 1: The number of demonstration consumers transitioned = 3,927
(non-demonstration transitions = 285)
33% 33% 35% 38% 40% 41% 43% 45% 45% 49%
67% 67% 65% 62% 60% 59% 57% 55% 55% 51%
0%
20%
40%
60%
80%
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Benchmark 2CT Medicaid Long-Term Care Expenditures
Home and Community Care Institutional Care
47%47%
49% 50%
51% 52% 52% 52%54% 55%53% 53%
51%50%
49% 48% 48% 48%46%45%
40%
50%
60%
2007 2008 2009 2010 2011 2012 2013 2014 2015 Q12016
Benchmark 3Percentage of Hospital Discharges to Home and
Community Care vs. Skilled Nursing Facility
Home and Community CareSkilled Nursing Facility
24%27% 28% 31% 32% 31%
38% 35% 37%37%38% 35% 37%41%
0%
10%
20%
30%
40%
50%
Benchmark 4Percent of SNF admissions returning to the community
within 6 months
* Data for 3 months
52% 52% 53% 54% 55%56% 58% 59% 60% 60%
48% 48% 47% 46% 45%44%
42% 41% 40% 40%
30%
40%
50%
60%
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Benchmark 5: Percent Receiving LTSS in the Community vs. Institutions
Home and Community Care Institutional Care
60%
79% 77% 78%
40%
21% 23% 22%
0%
20%
40%
60%
80%
100%
baseline 6 month 12 month 24 month
Happy or unhappy with the way you live your life*
happy
unhappy
2
257
188
123
180163
193
119
220
317
159194
231
325341
327 311
372331
313
226214
604
709
352
565587
509
462503496
460438
0
100
200
300
400
500
600
700
800
Nu
mb
er
Re
ferr
ed
Quarter
Referrals to Transition Coordinatorsᵗ: Q1 2009 to Q4 2016
ᵗExcludes NH closure and Chelsea/TouchpointsManchester mass referrals 12/23/16 or later *Increase in referrals reflects the ongoing adjustment to MFP reorganization
1938
4362
6074
9883
66107
152109
114120
110166
132167
147
166121
117159
199163
215201
213209
181
207194
0 50 100 150 200 250
2009 12009 22009 32009 42010 12010 22010 32010 42011 12011 22011 32011 42012 12012 22012 32012 42013 12013 22013 32013 42014 12014 22014 32014 42015 12015 22015 32015 42016 12016 22016 32016 4
Number of Transitioned Referrals
Qu
arte
r
Number of Transitions by Quarter: 12/2008 - 12/31/2016
3
42% 38% 38% 41% 33%
21%10% 8% 7%
10%
35%47% 49% 46% 56%
3%5% 4% 6% 2%
BENCHMARK FORTRANSITIONS
Referrals (n=8302) Signed InformedConsents (n=6972)
Transitions (n=3942) Closed w/oTransitioning
(n=1851)
Target Population Summary for Referrals through Q4 2016(Demonstration Only)
Physical Disability Mental Health Elderly Developmental Disability
72.4%
13.7%
9.4%
2.4%2.0% 0.2%
Qualified Residence Type for Transitioned Referrals: 12/4/08 to 12/31/16Apartment Leased By Participant, Not AssistedLivingHome Owned By Family Member
Home Owned By Participant
Group Home No More Than 4 People
Apartment Leased By Participant, Assisted Living
Not Reported
360
1503
601
880
551
57 162 148 173 81
0
500
1000
1500
2000
Eastern North Central Northwest South Central Southwest
Cumulative Number of Clients Who Transitioned and Those with Home Modifications by Region
Transitioned Home Modification
Note: Track 2 referrals not included.
Reinstitutionalization: 13% (417) of participants who transitioned by Dec 31, 2015
were in an institution 12 months after their transition.
4
258
1480
1865
228376
356 160301
66 16 10
500
1000
1500
2000
ABI PCA Elder DDS Mental Health Katie Becket
Cumulative Number of Clients Who Transitioned and Those with Home Modifications by Waiver
Transitioned Home Modification
41% 41% 34%
55% 55% 61%
4% 4% 5%
0%
20%
40%
60%
80%
100%
6-month 12-month 24-month
Consumers under age 65 who are working and those who would like to work
Currently workingNot working and don't want to work
Not working but want to work
15% 14% 14%
84% 85% 85%
0.5% 1% 1%
0%
20%
40%
60%
80%
100%
6-month 12-month 24-month
Consumers 65 years and older who are working and those who would like to work
Currently workingNot working and don't want to work
Not working but want to work
31% 32% 28%
62% 61% 63%
7% 8% 9%
0%
20%
40%
60%
80%
100%
6-month 12-month 24-month
Consumers under age 65 who are volunteering and those who
would like to volunteer
Currently volunteering
Not volunteering and don't want to volunteer
Not volunteering but want to volunteer
17% 15% 12%
79% 82% 84%
4% 3% 4%
0%
20%
40%
60%
80%
100%
6-month 12-month 24-month
Consumers 65 years and older who are volunteering and those who
would like to volunteer
Currently volunteering
Not volunteering and don't want to volunteer
Not volunteering but want to volunteer
5
74%
88% 89% 90%
26%
12% 11% 10%
0%
20%
40%
60%
80%
100%
baseline 6 month 12 month 24 month
Happy or unhappy with your help around the house or in the community*
happy
unhappy
32%
85% 84%80%
27%
6% 6% 8%
42%
9% 10% 13%
0%
20%
40%
60%
80%
100%
baseline 6 month 12 month 24 month
Do you like where you live?*
yessometimesno
48% 46% 43%52% 54% 57%
0%
20%
40%
60%
80%
100%
6 month 12 month 24 month
Did family or friends help you with things around the house?*
yes
no
MFP
Quality of Life Dashboard
As of 12/31/2016
83%95% 95% 94%
17%5% 5% 6%
0%
20%
40%
60%
80%
100%
baseline 6 month 12 month 24 month
Do the people who help you treat you the way you want them to?*
yes
no
58%53% 53% 53%
42% 47% 47% 47%
0%
20%
40%
60%
80%
100%
baseline 6 month 12 month 24 month
Depressive Symptoms*
yes
no
4.09
5.16 5.16 5.08
0
1
2
3
4
5
6
baseline 6 month 12 month 24 month
Average number of areas of choice and control*
43%54% 57% 58%57%
46% 43% 42%
0%
20%
40%
60%
80%
100%
baseline 6 month 12 month 24 month
Community integration - Do you do fun things in the community?*
yes
no
*indicates statistically significant differences
6
Quality of Life Interviews Completed
(Cumulative data through 12/31/16) Baseline interviews done prior to transition, n=4,275 6 month interviews done 6 mos after transition, n=3,090 12 month interviews done 12 mos after transition, n=2,790 24 month interviews done 24 mos after transition, n=1,879
13% 15% 13% 12%
87% 85% 87% 88%
0%
20%
40%
60%
80%
100%
baseline 6 month 12 month24 month
Healthcare unmet need*
yes
no
90% 91% 90%
35% 29% 27%
0%
50%
100%
6 month 12 month 24 month
Have or Need* Assistive Technology (AT)?
Have AT Need AT*
85%91% 93% 93%
15%9% 7% 8%
0%
20%
40%
60%
80%
100%
baseline 6 month 12 month 24 month
Personal care - unmet needs*
0 unmet needs 1 or more
2.15
2.03
2.052.21
1.00
2.00
3.00
baseline 6 month 12 month 24 month
me
an s
um
mar
y sc
ore
Activities of Daily Living scoresRange 0 - 6; 0=can do all ADLs independently;
6=need assistance with all*
3.95
4.14 4.17
4.27
3.00
4.00
5.00
baseline 6 month 12 month 24 month
me
an s
um
mar
y sc
ore
Instrumental Activities of Daily Living scoresRange 0-7; 0=can do all IADLs
independently; 7=need assistance with all*
7.4% 11.5% 11.4% 12.4%
49.8% 43.4% 43.3% 41.6%
35.6%34.0% 34.4% 35.3%
7.2% 11.2% 10.9% 10.7%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
baseline 6 month 12 month 24 month
Rate Your Overall Health*
excellent good fair poor
7
Transition Challenges through 12/31/16
Transition coordinators (TCs) and specialized care managers (SCMs) complete a standardized challenges checklist for each consumer. There were a total of 11,709 MFP referrals to SCM Supervisors. Challenges checklists were completed for 8,036 of these referrals, representing 7,417 consumers. Excluding the referrals which indicated “no challenges,” the challenges checklist generated 45,738 separate challenges. Of these, the most frequently chosen challenge was physical health (17.0%), followed by challenges related to housing (15.7%), services and supports (14.5%), mental health (12.7%), and consumer engagement (9.8%).
5%
17%20%
13%14%
31%
42%
57%
30% 28%
39%
59%
6%
19% 20% 24%
13%
26%
41%
56%
40%46%
53%
69%
0%
10%
20%
30%
40%
50%
60%
70%
80% Transitioned Closed before transitioning
Type of challenge by
transition status The figure below shows the percentage of each group (those who transitioned and those who closed before transitioning) which had each challenge. For example, of the referrals that closed without transitioning, 69 percent had a physical health challenge. Conversely, 59 percent of referrals that did transition had physical health challenges.
Seven of the twelve challenge categories had statistically significant differences between the two groups.
Other challenges, 1.2%
Facility related, 2.8%
Other involved individuals, 3.5%
Legal issues, 4.3%
MFP office /TC, 4.3%
Waiver/HCBS, 7.0%
Financial issues, 7.6%
Consumer engagement, 9.8%
Mental health, 12.7%
Services and supports, 14.5%
Housing, 15.7%Physical health,
17.0%
Be sure to check the LINK to the full Transition Challenges report. http://uconn-aging.uchc.edu/money_follows_the_person_demonstation_evaluation_reports.html
8
Types of Challenges – through 12/31/2016
Shown below are the six most common challenge types
56%30%
5%
2%7%
Physical health Current, new or undisclosedphysical health problem
Inability to manage physicaldisability or physical illness incommunity
Medical testing issues or delays
Missing or waiting for physicalhealth documents
Other physical health issues
18%
35%28%
16%
4%
Mental healthCurrent or history ofsubstance/alcohol abuse w/ risk ofrelapse
Current, new, or undisclosedmental health problem
Dementia or cognitive issues
Inability to manage mental healthin community
Other mental health issues
6%3%
16%
7%49%
4% 16%
Housing Delays related to housing authority,agency or housing coordinator
Delays related to lease, landlord,apartment manager, etc.
Needs housing modifications beforetransition
Ineligible or waiting for approval fromRAP or other housing programs
Lacks affordable, accessible communityhousing
Housing related legal, criminal or creditissues, including evictions or unpaidrent
Other housing related issues
13%
32%
17%
17%
21%
Financial
Consumer credit or unpaidbills
Lack of or insufficientfinancial resources
SSDI, SSI, SAGA, SSA, VA orother cash benefits
Medicaid eligibility orinsurance issues
Other financial issues
6%
12%
9%
37%
19%
6%
8%4%
Services and supports
Lack of alcohol, substance abuse,or addiction services
Lack of AT or DME
Lack of mental health services orsupports
Lack of PCA, home health, orother paid support staff
Lack of transportation
Lack of any other services orsupports
Lack of unpaid caregiver toprovide care/informal support
Other issues related to services orsupports
For the full report on transition challenges through 12/31/2016, use the link on page 7 to
get to the Center on Aging website.
12%
36%36%
10%7%
Consumer engagement
Disengagement orlack/loss of motivation
Lack of awareness orunrealistic expectations
Lack of independent livingskills
Language orcommunication skills
Other consumer relatedissues
9
23%
23%
17%
16%
6%
5%
4%4%
2% 0.3%
Percentage of Closed Cases by Closure Reason: Oct- Dec 2016*Participant would not cooperate with care planning processParticipant changed their mind and would like to remain in the facilityTransitioned to community before informed consent signedCOP/Guardian refused participation
Exceeds physical health needs
Participant not aware of referral & does not wish to participateOther
Reinstitutionalized for 90 days or more
Exceeds mental health needs
Participant moved out of state
* Excludes NH closure and Chelsea/TouchpointsManchester mass referrals 12/23/16 or later
284
156 168
109119
362
171
287
202
303
709
352
566587
508
462503 505
461438
159199
163
214 201 206 208181
207 194
40
4430
19 23
78
34
57 4469
22
57
29
36 40
45
41
36 45 440
100
200
300
400
500
600
700
800
Jul-Sep 14 Oct-Dec 14 Jan-Mar 15 April-Jun15 Jul-Sep15 Oct-Dec 15* Jan-Mar 16 April-Jun 16 Jul-Sep16 Oct-Dec 16
Nu
mb
er
Quarter
Comparison of Closures, Referrals and Transitions per Quarter
Total closures excluding: died, nursing home closure, completed participation, non-demo transition services completed
New referrals excluding nursing home closures
Total cases transitioned
Closures per 100 new referrals
Transitions per 100 new referrals
10
MFP Demonstration Background The Money Follows the Person Rebalancing Demonstration, created by Section 6071 of the Deficit Reduction Act (DRA) of 2005 (P.L. 109-171), supports States’ efforts to “rebalance” their long-term support systems. The DRA reflects a growing consensus that long-term supports must be transformed from being institutionally-based and provider-driven to person-centered and consumer-controlled. The MFP Rebalancing Demonstration is a part of a comprehensive coordinated strategy to assist States, in collaboration with stakeholders, to make widespread changes to their long-term care support systems. One of the major objectives of the Money Follows the Person Rebalancing Demonstration is “to increase the use of home and community based, rather than institutional, long-term care services.” MFP supports grantee States to do this by offering an enhanced Federal Medical Assistance Percentage (FMAP) on demonstration services for individuals who have transitioned from qualified institutions to qualified residences. In addition to this enhanced match, MFP also offers states the flexibility to provide Supplemental Services that would not ordinarily be covered by the Medicaid program (e.g. home computers, cooking lessons, peer-to-peer mentoring, transportation, additional transition services, etc.) that will assist in successful transitions. States are then expected to reinvest the savings over the cost of institutional services to rebalance their long-term care services for older adults and people with disabilities to a community-based orientation.
Meet Gregory Johnson
“Godsend” As a native of New York, Gregory Johnson made a living in real estate. When he came to Connecticut, he had the opportunity to change careers. Greg was required to complete a physical examination for a new job and when he saw the results of the health screening, he was stunned. He had multiple conditions that forced him to go directly to an emergency room. This led to a hospital stay which led to a nursing home admission where Greg stayed for over a year. He reflects, “You get better in places like nursing homes and that is why I went. It took longer than I thought, but I got better. From not walking—all the rehab—to the walker and the wheelchair—to the canes.” He had heard other residents were moving out through the Money Follows the Person (MFP) program and when he was approached, he took the chance. Greg recognizes, “It is a wonderful program.” Greg worked with a transition coordinator and housing coordinator to find his one bedroom apartment. Greg reflects on these times fondly, “I have been very fortunate [with] the people I had to deal with. The people that I have met in the program have been incredible…I got a lot of help with paperwork. [MFP] took the extra steps.” Greg has strong family ties and appreciates the support system he has. He recalls, “My son said, ‘Seeing you in that [hospital] bed, made me feel that we were all vulnerable.’” At one time Greg was afraid his family would have to care for him, but those days are gone. He is active in the community, using mass transportation in his city as a way to do his favorite activities. He shops independently and visits with family and friends. He says, “I’d like to get a bike eventually. I’d like to ride, I don't feel comfortable with that right now. Walking around… I do that and that is enjoyable.” Greg has lived in his apartment for a year and has decided to make another transition. Greg’s transition coordinator is helping him find a better apartment setting, one with more personal space and better amenities, like a fully accessible bathroom. He is thankful for the help he has gotten from MFP, especially his workers. He has an optimistic outlook on life, “when your intentions are good […] people come into your life. It’s a positive light.” He states, “I have been fortunate, it is like a Godsend. My end of the bargain is to do what I am supposed to do, I am responsible.”
Photo credit: Kaleigh Ligus