ct money follows the person report - uconn health · ct money follows the person report february...
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 Report
February 2020 UConn Health, Center on Aging
Operating Agency: CT Department of Social Services Funder: Centers for Medicare and Medicaid Services
Benchmark 1: Total Transitions = 5,964 Demonstration = 5,576 (94%)
Non-demonstration = 388 (6%)
33%33% 35% 38%40% 41% 43% 45% 45% 49% 50%
53% 52%
67% 67% 65% 62% 60% 59% 57% 55% 55% 51% 50%
47% 48%
0%
20%
40%
60%
80%
Benchmark 2CT Medicaid Long-Term Care Expenditures
Home & Community Care Institutional Care
47%47% 49% 50%
51% 52% 52% 52% 54% 56% 57% 58%53% 53% 51% 50%
49% 48% 48% 48% 46% 44% 43% 42%
0%10%20%30%40%50%60%70%
Benchmark 3Percentage of Hospital Discharges to Home and
Community Care vs. Skilled Nursing Facility
Home & Community Care Skilled Nursing Facility
25%30% 32%
37% 36% 37% 36% 39% 40% 37%
0%
10%
20%
30%
40%
50%
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Benchmark 4Percent of SNF admissions returning to the
community within 6 months
52%52% 53% 54% 55%56% 58% 59%
60% 60% 61% 64%64%
48%48% 47% 46% 45%44% 42% 41% 40%40% 39% 36% 36%
0%10%20%30%40%50%60%70%
Benchmark 5: Percent Receiving LTSS in the Community vs. Institutions
Home & Community Care Institutional Care
85% 80%
15%20%
0%
20%
40%
60%
80%
100%
1 month 12 month
Happy or unhappy with the way you live your life
happy unhappy
2
748 707908
1296 1242
18782186
1893 1886 1719 1818
0
500
1000
1500
2000
2500
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Co
un
t
Year of Referral
Total Number of Referrals Assigned to the Field by Year
158315
434510
612 596
792 792636 577 535
0
200
400
600
800
1000
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Co
un
t
Year of Transition
Total Number of Transitions by Year
549 581509
462 501 497 460 435482 473
523
408 390
515
372443
400491 475 452
0100200300400500600
q12015
q22015
q32015
q42015
q12016
q22016
q32016
q42016
q12017
q22017
q32017
q42017
q12018
q22018
q32018
q42018
q12019
q22019
q32019
q42019
Co
un
t
Quarter
Referrals Assigned to the Field by Quarter
163
216 201 214 209181
207 195170 169
143 154 141 143 146 148119 123 134
159
0
50
100
150
200
250
q12015
q22015
q32015
q42015
q12016
q22016
q32016
q42016
q12017
q22017
q32017
q42017
q12018
q22018
q32018
q42018
q12019
q22019
q32019
q42019
Co
un
t
Quarter
Number of Transitions by Quarter
Note: Excludes nursing home closures
Note: Excludes nursing home closures
3
42% 40%47%
44%37% 34% 32% 35% 35%
40%36% 37%35%
42%
32%44%
50%54% 51% 45% 44%
44%39%
43%
21%17% 19%
8% 9% 7% 8%
15% 13% 12%20%
15%
3% 2% 2% 4% 4% 5%9%
5%9%
5%6% 5%
Target Population for Transitions by Year of Transition (Demonstration Only)
Physical Dis Older Adult Mental Health Developmental Dis
11.2% 12.1% 11.2%12.9%
10.4% 10.0%
0%
5%
10%
15%
2013 2014 2015 2016 2017 2018
Per
cen
t
Year of Transition
Participants Who Were in an Institution 12 Months after Transition Regardless of Length of Stay
6 8 9 13 10 7 612
19 1529
2216 2213
15 19
2720
18 171111
29
35
2622 23
46
16
18
138 16
2013 2014 2015 2016 2017 2018 2019
Eastern North Central Northwest South Central Southwest
69 8
1210
4
13 1214
33
9 810
547
1012
33
7 6
14
9
3
15
119
7
0
5
10
15
20
Eastern North Central Northwest South Central Southwest
Jan-Jun 2017 Jul-Dec 2017 Jan-Jun 2018 Jul-Dec 2018 Jan-Jun 2019 Jul-Dec 2019
4
56% 58%
43% 40%
2% 3%
0%
20%
40%
60%
80%
100%
1 month 12 month
Participants under age 65 who are working and those who would like to work
Working
Want to work
Don't want to work
68% 71%
29% 24%
4% 6%
0%
20%
40%
60%
80%
100%
1 month 12 month
Participants under age 65 who are volunteering and those who
would like to volunteer
Volunteering
Want to volunteer
Don't want to volunteer
82% 81%
17% 18%
1% 1%
0%
20%
40%
60%
80%
100%
1 month 12 month
Participants 65 years and older who are working and those who would like to work
Working
Want to work
Don't want to work
76% 74%
23% 20%
1% 7%
0%
20%
40%
60%
80%
100%
1 month 12 month
Participants 65 years and older who are volunteering and those who
would like to volunteer
Volunteering
Want to volunteer
Don't want to volunteer
72%
14%
10%
2% 2%
Qualified Residence Type for Transitioned Referrals: 12/4/08 to 12/31/19
Apartment Leased By Participant, Not Assisted Living
Home Owned By Family Member
Home Owned By Participant
Group Home No More Than 4 People
Apartment Leased By Participant, Assisted Living
Participants who are Working and/or Volunteering (data 1/1/19-12/31/19)
5
55% 53%45% 47%
0%
20%
40%
60%
80%
100%
1 month 12 month
Did any unpaid family members or friends help you with things around the house?
yes no
37%50%
63%
50%
0%
20%
40%
60%
80%
100%
1 month 12 month
Depressive Symptoms*
yes no
*Questions are different at 1m vs 12m
99% 96%
38%22%
0%
20%
40%
60%
80%
100%
1 month 12 month
Have or Need Assistive Technology (AT)?
Have AT Need AT
87%80%
5% 6%9%13%
0%
20%
40%
60%
80%
100%
1 month 12 month
Do you like where you live?
yes sometimes no
61%
70%
72%
82%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
Planning your time and activities
Staff listen and communicate well
Choosing the services that matter to you
Staff are reliable and helpful
HCBS CAHPS Composite Measures: Percent with Highest Score (e.g. always, yes)
* Data for 1 month survey
MFP Quality of Life Dashboard
Number of Quality of Life Interviews Completed from 1/1/19 - 12/31/19: 1 month interviews done 1 month after transition, n=347 12 month interviews done 12 months after transition, n=377
6
Physical health, 17.5%
Mental health, 14.8%
Financial issues, 8.6%
Consumer engagement, 10.7%
Services/supports, 19.3%
Waiver/HCBS, 2.9% Housing, 13.9% Legal issues, 5.6%
Facility related,
2.8%
Other involved individuals, 2.0%
MFP office /TC, 1.7%
Other challenges, 0.2%
Transition Challenges for Participants Referred in 2019
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Frequency of Transition Challenges by Year of Referral
Physical health Mental health Financial issues Consumer engagement
Services/supports Waiver/HCBS Housing Legal issues
Facility related Other involved individuals MFP office /TC Other challenges
Challenges to Transition as Recorded by TCs and SCMs
7
1%
27%20% 16%
28%
49%
68% 70%
15%
49% 58%
78%
1%
23% 22% 17%
32%46%
73%59%
20%
43%
60%
78%
2%
21% 22%
4%17%
46%
66%55%
19%
47%58%
76%
0%
20%
40%
60%
80%
100%
Participants with Each Challenge who Transitioned by Referral Year
2017 2018 2019
5%
17%
10%
39%
13%
3% 12%
1%
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 servicesor supports
58%31%
7%2% 2%
Physical health Current, new or undisclosedphysical health problem
Inability to manage physicaldisability or physical illnessin community
Medical testing issues ordelays
Missing or waiting forphysical health documents
Other physical health issues
15%
38%26%
20%
1%
Mental healthCurrent or history ofsubstance/alcohol abuse w/ risk ofrelapse
Current, new, or undisclosed mentalhealth problem
Dementia or cognitive issues
Inability to manage mental health incommunity
Other mental health issues
1%
1%
15%
13%60%
7%
2%
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, accessiblecommunity housing
Housing related legal, criminal orcredit issues, including evictions orunpaid rent
Other housing related issues
Types of Challenges for Referrals: 1/1/2019 - 12/31/2019 Below are the four most common challenge types for 2019
8
0% 5% 10% 15% 20% 25% 30%
Participant changed mind
Wouldn't cooperate w/ care planning
Transitioned before informed consent signed
COP/Guardian refused participation
Exceeds physical health needs
Reinstitionalized for 90+ days
Exceeds mental health needs
Not aware of referral
Moved out of state
Other
Frequency of Closure Reason by Year of Closure
2017 (n=992) 2018 (n=990) 2019 (n=1440)
204234
325
223201
321
425
283
411410 389
522
371
443
400
491475
452
154139 141 147 146
119 123 134159
50 60 62 6045
80 8760
91
38 36 27 40 33 30 25 2835
0
100
200
300
400
500
600
Oct-Dec 17 Jan-Mar 18 Apr-Jun 18 Jul-Sep 18 Oct-Dec 18 Jan-Mar 19 Apr-Jun 19 Jul-Sep 19 Oct-Dec 19
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
9
Betty Lichtenstein’s Story
Betty describes herself as an active, “never been a sitting around” type of person. After graduating from Western Connecticut State University, having a career in human resources, creating a home for her family and enjoying her hobbies, life took a downward turn. Complications from diabetes led to a stroke and a single leg amputation 8 years ago followed by two years living in a skilled nursing facility. While in the nursing facility, Betty experienced more than physical losses. Her mother and brother died and she could not attend the funerals due to lack of suitable transportation.
The rehabilitation department at the nursing facility suggested Money Follows the Person (MFP) to assist her in transitioning back into the community. Although excited, Betty was fearful and anxious, having to begin again. Betty just wanted a place that felt like home and had two requests when it came to finding housing: a place where she could garden and a place where her grandsons, “the light of her life,” could visit freely. Since 2014, Betty’s MFP transition team (the housing coordinator, the transition coordinator and care manager) continues to work with her. The MFP housing coordinator was able to find Betty an end unit,
which provided her with a bigger yard. Now, she looks out her bedroom window to a lovely bird feeder and raised garden beds, where she grows carrots and tomatoes. She enlists her grandsons to help and now they can visit her in an environment where they can play outside. The apartment is not only wheelchair accessible with wider doorways, and a roll-in shower, but the MFP
team were instrumental in finding special medical equipment, like a Rifton transfer lift, assistive technology for her vision loss and environmental controls for greater independence to control the lights and fan.
Betty has adjusted well to “the new normal.” She continues to stay active and involved in her community. Utilizing transportation provided by Ability Beyond, she is able to attend her grandsons’ basketball and football games, concerts in town, and nearby shopping centers. Due to her central location and level of independence, she is also able to take herself downtown and to her alma mater, WCSU’s campus to get some fresh air. Betty enjoys giving back to her community, crocheting for charities. Every year she donates 25-30 hats to homeless shelters and 10-20 infant hat and blanket sets to Birthright, an organization that helps single mothers. Betty continues on a path of self-improvement and staying positive in her life. She enjoys attending a free all-day retreat at a Buddhist Monastery in New York, which brings her comfort and strength. She also visited the family plots at the cemetery to find closure with her losses.
Both Betty and the MFP team admit to having a rocky start, with lots of staff turnover. Betty’s advice to others who have to hire their own Personal Care Assistants (PCAs) is to go by word of mouth and know someone who has worked with an aide and trusts them. Betty self manages PCAs for over 80 hours a week and has learned to juggle PCA and Independent Living Skills Training (ILST) worker hours within her budget. Over the past four months, Betty has undergone 4 surgeries, including a second leg amputation. “MFP has changed my life!” Having the aides in place after her surgeries allowed her to go back home where she received in-home and then outpatient services. “I don’t see any reason I should ever have to go to a nursing home again.”
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.
Photo credit: Christine Bailey
Photo credit: Betty Lichtenstein
Photo credit: Betty Lichtenstein
Photo credit: Betty Lichtenstein