ct money follows the person quarterly report - …quarterly report quarter 2 , 2016: april 1, 2016...

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 2, 2016: April 1, 2016 – June 30, 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 = 3,543

(non-demonstration transitions = 266)

33% 33% 35% 38% 40% 41% 43% 45% 45%

67% 67% 65% 62% 60% 59% 57% 55% 55%

0%

20%

40%

60%

80%

2007 2008 2009 2010 2011 2012 2013 2014 2015

Benchmark 2 CT Medicaid Long-Term Services & Supports Expenditures

Home and Community Care Institutional Care

47% 47%

49% 50%

51% 52% 52% 52% 54% 53% 53%

51% 50%

49% 48% 48% 48% 46%

40%

50%

60%

Benchmark 3 Percentage of Hospital Discharges to Home and

Community Care vs. Skilled Nursing Facility

Home and Community Care Skilled Nursing Facility

28% 25% 24%

27% 28% 31%

32% 31%

38% 35%

37% 37% 38% 35%

37%

0%

10%

20%

30%

40%

Benchmark 4 Percent of SNF admissions returning to the community

within 6 months

52% 52% 53% 54% 55% 56% 58% 59% 60%

48% 48% 47% 46% 45% 44% 42% 41% 40%

30%

40%

50%

60%

2007 2008 2009 2010 2011 2012 2013 2014 2015

Benchmark 5: Percent Receiving LTSS in the Community vs. Institutions

Home and Community Care Institutional Care

60%

79% 78% 78%

40%

21% 22% 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

180 163

193

119

220

317

159 194

231

325 341 327 311

372

331 313

226 214

604

709

352

565 587

509

462

503 505

0

100

200

300

400

500

600

700

800

Nu

mb

er

of

Pe

op

le R

efe

rre

d

Quarter

Referrals to Transition Coordinatorsᵗ: Q1 2009 to Q2 2016

ᵗExcludes nursing home closures *Increase in referrals reflects the ongoing adjustment to MFP reorganization

19

38 43

62 60

74 98

83 66

107 152

109 114

120 110

166 132

167 147

166 121

117 159

199 163

215 200

213 208

181

0 50 100 150 200 250

2009 1

2009 2

2009 3

2009 4

2010 1

2010 2

2010 3

2010 4

2011 1

2011 2

2011 3

2011 4

2012 1

2012 2

2012 3

2012 4

2013 1

2013 2

2013 3

2013 4

2014 1

2014 2

2014 3

2014 4

2015 1

2015 2

2015 3

2015 4

2016 1

2016 2

Number of Consumers Who Transitioned

Qu

arte

r

Number of Transitions by Quarter: 12/2008 - 6/30/2016

3

42% 37% 38% 40% 32%

21% 9% 8% 8%

10%

35% 48% 49% 47% 56%

3% 5% 4% 5% 2%

BENCHMARK FORTRANSITIONS

Referrals (n=7427) Signed InformedConsents (n=6314)

Transitions (n=3549) Closed w/oTransitioning

(n=1517)

Target Population Summary for Q2 2016 Referrals (Demonstration Only)

Physical Disability Mental Health Elderly Developmental Disability

72.7%

13.5%

9.4%

2.3% 1.9% 0.1%

Qualified Residence Type for Transitioned Referrals: 12/4/08 to 6/30/16

Apartment 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

331

1352

524

808

477

52 140 128 150 69

0

500

1000

1500

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% (368) of participants who transitioned by June 30, 2015 were in an institution 12 months after their transition.

4

235

1317

1699

195 358

3 53 146 275

61 15 1 0

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

40% 41% 34%

56% 56% 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 workNot working but want to work

15% 13% 14%

85% 86% 85%

1% 1% 1%

0%

20%

40%

60%

80%

100%


Consumers 65 years and older who are working and those who would like to work

Currently workingNot working and don't want to workNot working but want to work

31% 31% 28%

63% 61% 64%

7% 8% 9%

0%

20%

40%

60%

80%

100%


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% 14% 12%

79% 82% 84%

4% 3% 4%

0%

20%

40%

60%

80%

100%


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% 89%

26%

12% 11% 11%

0%

20%

40%

60%

80%

100%


Happy or unhappy with your help around the house or in the community*

happy

unhappy

33%

85% 85% 80%

26%

6% 6% 8%

42%

9% 10% 13%

0%

20%

40%

60%

80%

100%


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 06/30/2016

83% 95% 95% 94%

17% 5% 5% 6%

0%

20%

40%

60%

80%

100%


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%


Depressive Symptoms*

yes

no

4.08

5.15 5.15 5.07

0

1

2

3

4

5

6


Average number of areas of choice and control*

44% 54% 58% 58% 57%

46% 43% 42%

0%

20%

40%

60%

80%

100%


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 06/30/16) Baseline interviews done prior to transition, n=3,898 6 month interviews done 6 mos after transition, n=2,874 12 month interviews done 12 mos after transition, n=2,458 24 month interviews done 24 mos after transition, n=1,644

13% 15% 13% 13%

87% 85% 87% 88%

0%

20%

40%

60%

80%

100%

baseline 6 month 12 month24 month

Healthcare unmet need*

yes

no

90% 90% 90%

36% 29% 28%

0%

50%

100%

6 month 12 month 24 month

Have or Need Assistive Technology (AT)?

Have AT Need AT*

84% 92% 93% 93%

16% 8% 7% 7%

0%

20%

40%

60%

80%

100%


Personal care - unmet needs*

0 unmet needs 1 or more

2.16

2.06

2.07

2.17

1.00

2.00

3.00


me

an s

um

mar

y sc

ore

Activities of Daily Living scores Range 0 - 6; 0=can do all ADLs independently;

6=need assistance with all

3.97

4.16 4.22

4.26 3.00

4.00

5.00


me

an s

um

mar

y sc

ore

Instrumental Activities of Daily Living scores Range 0-7; 0=can do all IADLs

independently; 7=need assistance with all*

7.4% 11.7% 11.1% 11.8%

49.6% 43.7% 43.7% 42.1%

35.7% 33.5% 34.3% 35.5%

7.3% 11.1% 10.9% 10.6%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Rate Your Overall Health*

excellent good fair poor

7

Transition Challenges through 06/30/16

Transition coordinators (TCs) and specialized care managers (SCMs) complete a standardized challenges checklist for each consumer. There were a total of 10,864 MFP referrals to SCM Supervisors. Challenges checklists were completed for 7,393 of these referrals, representing 6,842 consumers. Excluding the referrals which indicated “no challenges,” the challenges checklist generated 43,964 separate challenges. Of these, the most frequently chosen challenge was physical health (17.1%), followed by challenges related to housing (15.5%), services and supports (14.2%), mental health (12.6%), and consumer engagement (9.7%).

5%

17% 20%

13% 14%

30%

40%

55%

31% 27%

38%

58%

6%

19% 20% 23%

13%

26%

39%

53%

42% 45% 51%

68%

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, 68 percent had a physical health challenge. Conversely, 58 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, 1.3%

Facility related, 2.8%

Other involved individuals, 3.5%

Legal issues, 4.2%

MFP office /TC, 4.4%

Financial issues, 7.5%

Waiver/HCBS, 7.2%

Consumer engagement, 9.7%

Mental health, 12.6%

Services and supports, 14.2%

Housing, 15.5% Physical health, 17.1%

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

http://uconn-aging.uchc.edu/money_follows_the_person_demonstation_evaluation_reports.html

8

Types of Challenges – through 06/30/2016

Shown below are the six most common challenge types

55% 32%

5%

2%

7%

Physical health Current, new or undisclosedphysical health problem

Inability to manage physicaldisability or physical illness incommunity

Medical testing issues ordelays

Missing or waiting for physicalhealth documents

Other physical health issues

17%

35% 28%

16%

4%

Mental health

Current or history ofsubstance/alcohol abuse w/risk of relapse

Current, new, or undisclosedmental health problem

Dementia or cognitive issues

Inability to manage mentalhealth in community

Other mental health issues

6% 3%

16%

6%

48%

4% 18%

Housing Delays related to housingauthority, agency or housingcoordinator

Delays related to lease, landlord,apartment manager, etc.

Needs housing modificationsbefore transition

Ineligible or waiting for approvalfrom RAP or other housingprograms

Lacks affordable, accessiblecommunity housing

Housing related legal, criminal orcredit issues, including evictionsor unpaid rent

Other housing related issues

9%

15%

11%

53%

13%

Waiver /HCBS Current waivers or HCBSprograms do not meetconsumer needs

Ineligible for or denial of HCBSprogram or waiver services

Targeted waiver full

Waiting for evaluation,application review from waiveror HCBS agency/contact

Other HCBS or waiver programissues

6%

12%

9%

38%

19%

5%

7% 4%

Services and supports

Lack of alcohol, substanceabuse, or addiction services

Lack of AT or DME

Lack of mental health servicesor supports

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

For the full report on transition challenges through 06/30/2016, use the link on page 7 to

get to the Center on Aging website.

12%

35% 35%

10% 8%

Consumer engagement

Disengagement or lack/lossof motivation

Lack of awareness orunrealistic expectations

Lack of independent livingskills

Language or communicationskills

Other consumer relatedissues

9

39%

17%

14%

13%

6%

4%

2% 2% 2% 1%

Percentage of Closed Cases by Closure Reason: April - June 2016

Transitioned to community before informed consent signed Participant changed their mind and would like to remain in the facility Participant would not cooperate with care planning process COP/Guardian refused participation

Reinstitutionalized for 90 days or more

Other

Exceeds physical health needs

Participant not aware of referral & does not wish to participate Participant moved out of state

Exceeds mental health needs

197

117

284

156 168

109 119

362

171

287

214

604

709

352

566 587

508

462

503 505

121 117

159

199 163

214 201 206 208 181

92

19 40

44 30

19 23

78

34

57

57 19 22

57

29

36 40 45

41

36 0

100

200

300

400

500

600

700

800

Jan-Mar 14April-Jun14 Jul-Sep 14 Oct-Dec 14Jan-Mar 15April-Jun15 Jul-Sep15 Oct-Dec15*

Jan-Mar 16 April-Jun16

Nu

mb

er

Quarter

Comparison of Closures, Referrals and Transitions per Quarter

Total closures excluding: died, nursing home closure, completed participation, non-demo transition servicescompletedNew referrals excluding nursing home closures

Total cases transitioned

Closures per 100 new referrals

Transitions per 100 new referrals

* Note: Total closures this quarter were higher due to clearing the backlog at Central Office.

10

Meet Melanie Korotash “It takes a village”

Melanie Korotash began a long, hard journey in 2004 when she was diagnosed with stage four vulvar cancer. Due to issues with her lymphatic system, her right leg was amputated in 2007. Then in 2013, her left leg was amputated. After nearly two and a half years of living in nursing facilities, she began to wonder, “Am I ever going to get out—this is not the way I intend on spending the rest of my life.” Then, Melanie heard of the MFP program. She learned that it is a way “to get people who were ready, willing and able to leave an institution and go back into the community. And I said, ‘Oh yeah!’”

Melanie admits the transition process was rocky at first due to her own physical issues and MFP complications. She became her own advocate and was assigned a wonderful housing and transition coordinator. Melanie says, “[MFP staff] worked hard. And they showed me a lot of places, so I am very grateful to have this. But, it takes dedication on their part—and a good support team. It really did take a village to get me here.” Melanie explains her housing coordinator took her to a lot of homes and started to learn her preferences. They found an accessible apartment and her housing coordinator worked to secure it for her. Her transition coordinator worked with her in many ways and helped to set up the apartment, purchasing furniture, groceries and other household items. Melanie explains, “I am just a cog in the wheel and if all of the cogs aren’t working, the wheel is not going to turn. So I owe them a lot.” Melanie explains, “[without MFP] God knows what I would be doing now. I would not be flourishing. People don’t appreciate what they have until they are taken out of society. And then it is a pretty nice life when you are out [in the community].”

Melanie describes her greatest success in the community as, “living life as normally as I can with a disability.” Living in her one-bedroom apartment, Melanie has the luxury of personal choice and control. “This provides me with a home. I can cook when I want, I can go bed when I want—without [a] roommate having to have the light on all the time. It really is just living life as closely as you can before [becoming] handicapped,” she says. She is now able to choose what she does out in her community. To her, “that means going shopping, that means going out to dinner, that means going to plays, concerts. It’s getting back into life.”

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: Kaleigh Ligus

ct money follows the person quarterly report - …quarterly report quarter 2 , 2016: april 1, 2016...

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