Rhode Island NFT Summary

<HR ALIGN=\"left\" ALT=\"Horizontal rule dividing sections\"> <A NAME=\"RINFT\"></A> <P ALIGN=\"RIGHT\"><EM>Nursing Facility Transitions</EM></P> <H2 ALIGN=\"CENTER\">RHODE ISLAND</H2> <H3>Identified Problems with the State's Long-Term Care System</H3> <P> <UL> <LI>Insufficient information on available options for community living.</LI> <LI>Access to services is confusing and difficult, and services tend to be provided in discrete packages geared to one primary need, even though many people have multiple cross-system challenges.</LI> <LI>Insufficient informal supports in the community to provide safety oversight for those with more severe cognitive disabilities.</LI> <LI>Lack of day programs suitable to the needs of younger people with disabilities.</LI> <LI>Most of the state's assisted living settings are not equipped to handle the needs of people with severe cognitive and/or behavioral disabilities.</LI> <LI>A shortage of accessible and affordable housing slows the transition process for many consumers, in part due to long waiting lists for subsidized housing.</LI> </UL> </P> <H3>Perceived Strengths</H3> <P> <UL> <LI>Rhode Island has six HCBS Waivers (Aged Disabled Waiver, Developmentally Disabled Waiver, Habilitative Services Waiver, Department of Elderly Affairs Waiver, Severely Physically Disabled Waiver, Assisted Living Waiver).</LI> <LI>Although there are some gaps in services, the state has an extensive network of group homes, psychiatric rehabilitation services, and support services.</LI> <LI>Several statewide consortia of consumers, families, advocates, providers, and state agencies have been examining long-term care systems change issues (The Children's Roundtable, Living Rite and, The TBI Planning Process).</LI> </UL> </P> <H3>Primary Focus of Grant Activities</H3> <P> <UL> <LI>Disseminate information on community service options to institutionalized individuals of all ages and their families.</LI> <LI>Transition institutionalized individuals, who indicate interest, into a suitable community living arrangement with all necessary supports based on needs and preferences.</LI> <LI>Enhance the home and community services system capacity to serve individuals with multiple and/or complex needs.</LI> </UL> </P> <H3>Goals, Objectives, and Activities</H3> <P><STRONG>Overall Goal.</STRONG> Develop a system that can be maintained under cost neutrality provisions, that has flexibility to allow individuals options, choice, and sometimes non-traditional services, and that is sufficiently intense to insure health and safety, even for those with significant cognitive challenges and minimal family support.</P> <P><STRONG>Goal.</STRONG> Expand the target population of consumers approached to transition from people with traumatic brain injury to all adults with disabilities and seniors through outreach to institutionalized individuals, and bolster the state's system of information and referral as well as the capacity of home and community services to successfully transition at least 75 people from nursing facilities to community living.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Case managers will contact at least 200 people in nursing facilities and the case managers will conduct a community needs assessment and inform them of available community support options.</LI> <LI>Existing brochures from the Department of Human Services and Department of Elderly Affairs containing information on home and community options will be distributed to hospitals (and discharge planners), nursing facilities, and community agencies for consumer use.</LI> <LI>Use the state's Medicaid Management Information System to analyze those consumers repeatedly going in and out of nursing facilities and identify a likely candidate pool to approach about transitioning to a community living arrangement.</LI> <LI>Use contact data from the PARI Independent Living Center Nursing Home Liaison for people with traumatic brain injury to identify those consumers who desired to transition to community living but for whom there was insufficient family support.</LI> <LI>Obtain referrals from the departments of human services, elderly affairs, and mental health, retardation and hospitals, as well as rehabilitation centers, nursing homes, Independent Living Centers, community agencies, consumers and/or family members.</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Transition institutionalized individuals who indicate a desire for a community living arrangement.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>At least 75 people will be provided with intensive assistance to coordinate and access community services needed in order to leave their institutional setting.</LI> <LI>Formally refer those who appear likely candidates for transition to the Level One PASARR screen to community service coordinators for follow-up.</LI> <LI>Independent living and elderly case management systems will cosponsor state-funded, biannual training sessions on community services (including housing and transportation resources) to be attended by all case managers in both the institutional and HCBS long-term care systems.</LI> <LI>The Rhode Island Housing Resources Commission (which includes public housing authorities and assisted living residences) will share housing resource information (including the availability of Section 8 vouchers) with the transitioning program case managers.</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Expand the choices consumers with complex needs have with regard to their transitional needs and their community living options.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Successfully transition at least 75 institutionalized people with a combination of at least two different types of support needs (cognitive, psychiatric, behavioral and/or physical disabilities).</LI> <LI>Explore Medicaid payment for specialized programs in assisted living residences with consumers, advocates, and assisted living provider organizations and agencies specializing in services to people with cognitive, behavioral, or psychiatric disabilities.</LI> <LI>Establish a habilitative day program to meet the needs of people with an adult onset disability who do not qualify for vocational rehabilitation or existing mental health supports, but for whom daily structured intervention and peer support is likely to result in enhanced capacity to function independently.</LI> </UL> </P> <H3>Key Activities and Products</H3> <P> <UL> <LI>Successfully transition at least 75 consumers with a combination of at least two different types of support needs (cognitive, psychiatric, behavioral and/or physical disabilities).</LI> <LI>Bolster the state's system of information and referral and the capacity of home and community services.</LI> <LI>Development of a day habilitation program for those with significant cognitive and/or behavioral service needs who do not qualify for any existing state programs.</LI> </UL> </P> <H3>Consumer Partners and Consumer Involvement in Planning Activities</H3> <P>Consumers comprise the Living Rite development, Consumer Advisory Council, and Traumatic Brain Injury Planning Initiative and were involved at every point where significant grant planning and program developments occurred.</P> <H3>Consumer Partners and Consumer Involvement in Implementation Activities</H3> <P> <UL> <LI>The Consumer Advisory Council of the Center for Adult Health will send a representative to sit on the Transition Oversight Committee.</LI> <LI>The Consumer Advisory Council will receive monthly grant activities updates and have the opportunity to provide input.</LI> </UL> </P> <H3>Public Partners</H3> <P> <UL> <LI>Department of Elderly Affairs.</LI> <LI>Rhode Island Housing Resource Commission.</LI> <LI>Governor's Permanent Advisory Committee on Traumatic Brain Injury.</LI> </UL> </P> <H3>Private Partners and Subcontractors</H3> <P> <UL> <LI>Rhode Island Assisted Living Association.</LI> <LI>Rhode Island Adult Day Care Association.</LI> <LI>People Actively Reaching Independence (PARI) Independent Living Center.</LI> <LI>Ocean State Independent Living Center (OSCIL).</LI> </UL> </P> <H3>Public and Private Partnership Development/Involvement in the Planning Phase</H3> <P><STRONG>Public Partners</STRONG></P> <P>None were involved.</P> <P><STRONG>Private Partners</STRONG></P> <P>The grant application was written in close collaboration with People Actively Reaching Independence (PARI) Independent Living Center and Ocean State Independent Living Center (OSCIL) who also submitted, together, a joint proposal for Independent Partnerships.</P> <H3>Public and Private Partnership Development/Involvement in Implementation</H3> <P><STRONG>Public Partners</STRONG> <UL> <LI>The Governor's Permanent Advisory Commission on TBI will provide professional consultation to ensure best practices are followed during program implementation as well as lending technical assistance and expertise in the request for proposals and the review of proposals for a day habilitation program.</LI> <LI>The Rhode Island Housing Resource Commission will provide technical assistance and linkages to access public housing.</LI> <LI>The Department of Elderly Affairs case managers will coordinate with the nursing facility transitions program coordinator to perform transition case management for referred consumers.</LI> </UL> </P> <P><STRONG>Private Partners</STRONG> <UL> <LI>The Rhode Island Assisted Living Association and Rhode Island Adult Day Care Association will help to identify providers to serve people leaving nursing facilities.</LI> <LI>The Independent Living Centers (PARI ILC and OSCIL) will facilitate linkages with community services and provide outreach and information and referral for transitioning consumers, as well as coordination between the institutional and community systems.</LI> </UL> </P> <P><STRONG>Existing Partnerships That Will Be Utilized to Leverage or Support Project Activities</STRONG> <UL> <LI>Rhode Island received a Nursing Home Transition Demonstration Grant in 1998 to transition adults with brain injuries into community living and the state collaborated with the Brain Injury Association of Rhode Island and PARI ILC to implement the grant.</LI> <LI>PARI ILC administered the Severely Disabled Waiver which most of the consumers used. In Year Two of the demonstration grant, Rhode Island DHS and PARI ILC signed a memorandum of understanding that allowed for referrals by the department of people identified through the level one PASARR screening of nursing facility admissions.</LI> </UL> </P> <H3>Oversight/Advisory Committee</H3> <P> <UL> <LI>A Transition Oversight Committee will comprise representatives from each of the Grant's public and private partners (the RI Housing Resource Commission, PARI and OSCIL Independent Living Centers, Rhode Island Assisted Living Association and the Adult Day Care Association, and the Governor's Permanent Committee on Traumatic Brain Injury)</LI> <LI>The committee will have at least two consumer participants: one designated by the Consumer Advisory Council and the other designated by the Traumatic Brain Injury planning initiative.</LI> </UL> </P> <H3>Formative Learning and Evaluation Activities</H3> <P> <UL> <LI>Maintain detailed data on individuals served in the transitions process, including age of consumer, referral source, reason for institutionalization; whether trial use of community services while still institutionalized is necessary; availability of housing, transportation and daily support services; time from first encounter with the grant project to actual discharge from the institution; time necessary to have each of transportation, housing and support services in place; and preferred community following transition.</LI> <LI>The oversight committee will discuss the data in each category on a quarterly basis to determine whether there are specific problems that need to be addressed. For example, if referrals are coming from limited sources, a targeted outreach may be indicated to potential referral sources.</LI> </UL> </P> <H3>Evidence of Enduring Change/Sustainability</H3> <P> <UL> <LI>The grant supplements Rhode Island's Real Choice Systems Grant by targeting system capacity needs most critical for people to transition to community living primarily in suitable day habilitative services and supportive living arrangements.</LI> <LI>Development of a day habilitation program using Medicaid service payments as adult day care for those with significant cognitive and/or behavioral service needs who do not qualify for any existing state programs.</LI> <LI>The Elderly and Adult Disabled Service Systems will forge professional relationships through training and program collaboration in order to share successful strategies across systems.</LI> <LI>Distribution of long-term care service and support information will provide the ongoing benefit of giving people the information they need to make informed choices. The service networks established during the grant will be sustained by providing each with the central contact at DHS to receive more brochures, and updated brochures, as needed.</LI> <LI>Development of wrap-around service packages for assisted living will be a first and necessary step to create supported living arrangements suitable to the needs of people with severe, complex, and/or multiple functional challenges.</LI> <LI>Quality of services will be enhanced through cross-training between the senior services and independent living center staff by providing both with in-depth knowledge of each other's expertise that can be passed onto client services.</LI> </UL> </P> <H3>Geographic Focus</H3> <P>Statewide.</P>