Nursing Facility Transitions

WYOMING

Grant Information


Name of Grantee

Wyoming Department of Health, Aging Division

Title of Grant

Project Out

Type of Grant

Nursing Facility Transitions, State Program

Amount of Grant

$600,000

Year Original Funding Received

2002

Expected Completion Date

September 2006

Contact Information


Dorothy Thomas, Project Director
6101 Yellowstone Road, Room 259B
Cheyenne, WY 82002
307-777-8566
dthoma@state.wy.us

Subcontractor(s)

Wyoming Independent Living Rehabilitation, Inc.
305 West 1st Street
Casper, WY 82601

Target Population(s)


Institutional residents who could reside in a community setting.

Goals


  • Incorporate stakeholder participation for plan development.
  • Conduct a needs assessment process.
  • Develop new community services and support infrastructure.
  • Develop transition services to prepare individuals for a change in placement.
  • Perform data collection which is individualized and tied to individual program plans.
  • Identify outcomes measurement and target dates.
  • Develop a quality assurance program.
  • Develop resources to be used in nursing facility transition.
  • Review, revise, and update the plan every 2 years or as needed.

Activities


  • Subcontract with Wyoming Independent Living Centers (ILCs) to provide the transition services, using Independent Living Specialists to also work as case managers when appropriate.
  • Develop a multidisciplinary assessment tool.
  • Establish a collaborative effort with social workers, discharge planners, and medical professionals to assess potential clients for transition to the community.
  • Develop a coordinated housing strategy on a statewide basis and local strategies to secure accessible, affordable housing for individuals transitioning out of nursing facilities.
  • Educate consumers, families, and partners who provide services within communities.
  • Develop statewide transition services to prepare individuals for a change in placement.
  • Conduct monitoring and quality assurance activities to be completed through a contract with the University of Wyoming.

Abstract


The purpose of this project is to develop a model in Wyoming for assisting nursing home residents who desire to transition into a less-restrictive environment/community living. The project will identify existing supports and barriers to transitions, develop infrastructure within the State, and develop pilot projects at two centers for independent living. These two ILCs will assist 10 individuals in transitioning from nursing homes in the first year of the project, 30 individuals in Year 2, and 45 individuals in Year 3. They will also conduct education and outreach to communities, professional service providers, and consumers. The Department of Health will develop statewide transition services to prepare individuals for a change in placement and evaluate project consumer satisfaction and cost-effectiveness of the transition program. The grant will be utilized to identify and develop adequate resources and authority to implement long-term care services and supports "in the most integrated setting." The Aging Division will subcontract with the centers for independent living in the State in a collaborative effort to include multiple partners in the process of developing and implementing transition plans for nursing home residents. Working with consumers, private service providers, and multiple government agencies, "Project OUT" will identify barriers and the costs associated with transitioning residents from nursing homes. The project will continue attempts to secure improved funding for housing, transportation, and community health and support services.

Ultimate outcomes of the project include an increase in new and/or changes in Medicaid waivers/waiver slots and enlargement of the provider base; Housing and Urban Development (HUD) Section 8 voucher changes statewide for housing; State of Wyoming Department of Transportation commitments for improved transportation programs for individuals with disabilities; and state general funds to allow for the sustainability and continuation of the Aging Division's Olmstead efforts.