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Of Finding Long-Term Care when a Hospital Stay is Ending

Avoiding the Panic

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What this session will cover?

• What can happen if you don’t have a long term care plan?

• What should be part of your long term care plan?

• What is currently in place to help you?

• What additional systems changes are needed?

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What can happen if you don’t have a plan?

• You could be faced with a nursing facility as the only option available

• You could go to a nursing facility for rehabilitation, lose your housing, lose your family and community support, lose your assets

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What should be part of your long term care plan?

• What does your insurance policy cover?• Do you have Long Term Care Insurance? • Is your home accessible or easily made

accessible? If not, do you know where you would be able to go during rehabilitation?

• What agencies and people will support you?

• What person or agency will take the lead in providing that advocacy and support?

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What should you know?

• What type of services could you need? • Home health care (skilled nursing, teaching

of skills, home health aids, physical therapist, speech therapy)? Where could you get these services?

• What are the eligibility requirements for services and how much will they cost?

• Where can I find assistive technology (cane, walker, wheelchair, automatic door opener, etc.)?

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Barbie: a success story

• Contacted Department of Human Services before she was hospitalized

• Learned what was needed to be discharged to her home

• Used a loan closet

• Meals on Wheels

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What should I do once I am hospitalized?

• Be a squeaky wheel and immediately ask for discharge planning

• Consistently ask for full and complete information

• Make sure that someone is visiting you at least once a day

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Tony Wong’s story

• Works for MACIL

• Convinced doctors that he could go home

• Knew the community support systems

• Asked questions

• Knew his health care coverage

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Citizens for Better Care can help

Lois Hitchcock

• What we can do

• People we have helped

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What is currently in place to help you?

• Your own ability to make a plan and get it in writing (with a lead person designated)

• Mi Choice Waiver Agents

• Area Agencies on Aging

• Centers for Independent Living

• Citizens for Better Care

• Community Mental Health

• Family and friends

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What systems changes are needed?

• More home and community based waivers. Average cost for people transitioned through NFTI who did use the MI Choice Waiver was $670 per month. Average monthly Medicaid savings was $3,066 compared to Nursing Facility.

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What systems changes are needed?

• More supports coordination - 58% of the people transitioned through NFTI did not need state funded Medicaid services from MI Choice or Adult Home Help, but couldn’t get the help they needed to transition

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What additional systems changes are needed?

• Supports coordination to help people put together long term care plans. When supports coordination was provided by Turner Geriatric, everyone was able to maintain housing and Community Supports. No one required Medicaid long term care.

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What additional systems changes are needed?

• Need a system to detect people in acute care setting at risk of NF placement

• Improved discharge planning

• After hours resource centers

• More affordable accessible housing

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What additional systems changes are needed?

• More affordable, barrier free, and accessible housing– Additional Housing Choice Vouchers– Community Supportive Housing Consortia– Visitability legislation– Community plans that consider accessibility

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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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Don’t give up because of complex support needs

• 3 heavy steel doors to enter building

• Could not unlock front door

• Could not reach the entrance buzzer

• No wheelchair accessible shower

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Happy endings

• New apartment• New opportunity thru NFTI

grant• Transition fund purchases

– Bathing system

– Automatic door opener

• Charlie’s achievements– On his own for 5 years

– Spoke at LTC public hearings

– Active in the local CIL

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Resources

• Centers for Independent Living Listings– www.macil.net

• Waiver Agent Listings– www.miseniors.net

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Resources

• State Long Term Care Ombudsman Office– (517) 517-335-0148– www.miseniors.net click on the

Ombudsman Program under Quick Links on the right hand side of the page

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Resources

• Citizens for Better Care: www.cbcmi.org – Fact Sheets– Contact information for many local

ombudsmen

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Resources

• Citizens for Better Care: www.cbcmi.org – Fact Sheets– Contact information for many local

ombudsmen

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Resources

• Corporation for Supportive HousingLisa Chapman (810)229-7712

• Michigan Disability Rights CoalitionRoAnne Chaney (517) 333-2477

• Sue Eby at ebys@michigan.gov