Community Alternatives to Nursing Facilities for People with Intellectual and Developmental Disabilities (IDD)

Transcription

1 Community Alternatives to Nursing Facilities for People with Intellectual and Developmental Disabilities (IDD) 29 TH ANNUAL TEXAS COUNCIL OF COMMUNITY CENTERS CONFERENCE JUNE 19, 2014

2 Panelists o o o o o o Carey Amthor, Director of IDD Services, Heart of Texas Region MHMR Center Mendy Blevins, Program Specialist, Local Procedure Development and Support (LPDS) Unit, Department of Aging and Disability Services, Local Authority Section Susanne Elrod, Associate Director, Intellectual and Developmental Disabilities, Texas Council of Community Centers Ninfa Escobar, MA, Service Coordination/Continuity of Service Program Director, MHMRA of Harris County Stacy Lindsey, Manager, Local Procedure Development and Support (LPDS) Unit, Department of Aging and Disability Services, Local Authority Section Ashley R. Southerland, IDD Intake & Access Director, MHMR of Tarrant County

3 Presentation Objectives Understand and increase ability to fulfill Local Authority role for people with intellectual and developmental disabilities who live in, or are at risk of admission to, nursing facilities: o Articulate experiences of people succeeding in community instead of nursing facilities o Inform and educate effectively about community living options o Identify and plan person-centered community supports including health and medical care o Pursue successful community alternatives to nursing facilities transition and diversion

4 HCS Waiver Alternatives to Nursing Facilities DADS FY2014 HCS Enrollment Data as of June 2, 2014: o Individuals moving from nursing facilities: 101 authorizations released (Total: 120 in FY2014, 240 in FY2015) 37 enrolled 46 pre-enrolled/pending o Individuals diverted from nursing facility admission: 36 authorizations released (Total: 75 in FY2014, 75 in FY2015) 15 enrolled 21 pre-enrolled/pending

5 Success Stories & Lessons Learned o HEART OF TEXAS REGIONAL MHMR CENTER o MHMR TARRANT o MHMRA HARRIS

6 Heart of Texas Regional MHMR Center Doris and Terri o Followed Grandmother, their caregiver, into nursing facility in 2003 at age 41 o Promised Father to always to take care of Grandmother, refused to move o Aunt and Uncle live near Houston so Grandmother could move to NF there o Doris and Terri could enroll in HCS and still take care of Grandmother

7 Heart of Texas Regional MHMR Center Cedric o Lived with brother until swallowing accident required hospital admission o Went from hospital to nursing facility with tracheotomy o Required total physical care but brother wanted him home o Family built home in San Antonio with extra space for Cedric o Most happy being able to be outside regularly big smiles all the time

8 Heart of Texas Regional MHMR Center Richard o Lived with brother who could not maintain Richard s medications o Multiple hospital admissions due to diabetes and seizures o Nursing facility deemed only option for stabilization and ongoing care o Soon on medication for depression, even with positive family contact o All supported community move, including Richard o Now diabetes and seizures controlled, no depression o Regular trips to baseball games, shopping, out of town

9 Heart of Texas Regional MHMR Center Lemuel o Was in HCS but family issues led to Lemuel s admission to nursing facility in 2003 at age 21 o Mother went daily to nursing facility to care for his personal needs o She immediately accepted option offered by Service Coordinator for Lemuel to return home o Received offer of both CBA and HCS slots, ultimately moved home under CBA soon to become STAR PLUS

10 Heart of Texas Regional MHMR Center Robert o 68 years old, lives with sister, his mental and physical health in decline o Nursing facility admission seemed imminent to sister o Discussed diversion at meeting to educate about nursing facility o Diversion requested in fear of nursing facility admission slot received o Emergency colon surgery then led to rehabilitation in nursing facility o Foster Care (personal attendant) now first step to keep Robert at home

11 Heart of Texas Regional MHMR Center Lessons Learned Educate nursing facility staff about your role, before you start doing it: build that relationship. Families and guardians need to understand, too. Identify key nursing facility staff to whom you focus your communication. Train, train, train your staff so they fully understand their role as a PASRR Evaluator and then as a SC.

12 Heart of Texas Regional MHMR Center Lessons Learned Learn nursing facility routines and processes to best coordinate staff time, respect time needed for other work. Have nursing facility staff with you in first interaction with resident so your message is not misconstrued. Power of attorney is not guardianship!

13 Heart of Texas Regional MHMR Center Lessons Learned Know resident before community referral: absolutely not doesn t always mean no. Essential and non-essential CLDP supports: know what nursing facility and provider can do under existing standards, e.g., MHMs, 30-day med supply. Schedule quarterly IDT meetings with quarterly nursing care plan meetings. Address concerns immediately don t let issues fester.

14 OVERVIEW MHMR Tarrant County has received 20 slots for individuals who desired alternative placement We have transitioned 10 people out of nursing facilities Had many challenges along the way

15 ANNE Anne is 45 years old, during her stay at a Tarrant County nursing facility she lost both her father and mother Brother became primary correspondent, he moved from Bexar County to Tarrant County Anne and family wanted to choose HCS Service Coordinator assisted with finding a provider

16 ANNE: THE BARRIERS Difficulty finding a provider due to her needs Nursing facility attempted to discharge her before transition was complete and without proper notice Nursing facility staff did not understand the transition process and importance of it Anne did not have a wheelchair, we waited for her chair to be delivered Was hospitalized twice for recurrent UTIs

17 ANNE: THE SUCCESSES Made a good match with the provider Several meetings with individual, family and nursing facility staff Pre-placement visit MHMR brought psychologist and medical specialist to review for additional support

18 JOHN John is 24 years old and is diagnosed with a spinal stenosis that qualified him for PASRR services He didn t feel like he was able to live the life that a grown man of his age should be able to live Explore options Wanted to live in a specific area of Tarrant County, and did not want to have restrictions on when he needed to be in at night

19 JOHN: THE SUCCESSES Made a good match with his provider Provider made several visits to see him Pre-placement visit John had his own advocacy skills and he was driven Worked closely with nursing facility to transition John

20 OPPORTUNITIES Through this program we have established and strengthened new programs PALS grant RN Care Management IDD Behavioral Health Services (START model)

21 MHMRA of Harris County Carolyn and Peggy o Lived all their life with their mother until she passed away in February of Both were diagnosed with Intellectual Disabilities and required continuous assistance to ensure health and safety. o No immediate family could provide a home for both sisters but extended family continued to try and financially support their needs to prevent admission to a nursing facility. o Second cousin searched for available programs to assist and found contact information of the MHMRA PASRR Program Director which began the journey to diversion. o Now both sisters live in an HCS group home.

22 MHMRA of Harris County Carolyn and Peggy o In checking back in with their family, the family wanted to share the following: We really want everyone to know how this type of diversion fills a gaping hole in the system for people like Carolyn & Peggy who have never spent a day outside their own home in an institutional setting in their entire life and should never have to. For our family, this was more than a useful diversion program. It was the answer to a prayer that let us keep our promise to Carolyn & Peggy s dearly departed mother to never take her daughters out of their own home and institutionalize them because of their disability. For that, we are eternally grateful for this diversion program and to all those who helped us take advantage of it.

23 MHMRA of Harris County Lessons Learned/Recommendations When first beginning the process, it is important to remember that anyone (including family) is considered a referring entity and can complete the PASRR Level 1 Screening to get the process started. Also, remember that if a family member is completing the Level 1 screening it might be harder for them to complete due to the terminology used, etc. Recommendation: The PASRR Level 1 Screening instructions are on the DADS website so they can be used to assist families in completion of the Level 1 Screening.

24 MHMRA of Harris County Lessons Learned/Recommendations Similar to other diversions [from institutional facilities], sometimes person/family circumstances arise when diversion has not actively been considered--may not seem like true diversion. Recommendation: DADS has been an amazing support in talking through these types of diversion. Continue to consult with DADS for guidance.

25 MHMRA of Harris County Lessons Learned/Recommendations The initial meeting with family to discuss diversion is important to ensure the individual receives necessary services. Thus it is important to fully explore the medical needs that resulted in family seeking out of home placement. At times the Service Coordinator may not fully understand all implications due to limited experience with medical terminology. Recommendation: Include a nurse to attend the initial meeting with the Service Coordinator after completing PASRR Evaluation to help further identify medical needs.