ct money follows the person quarterly report...referrals to tcs: 2009 to q3 2012 19 38 43 62 60 74...
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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 1, 2013: January 1, 2013 – March 31, 2013 University of Connecticut Health Center
Operating Agency: CT Department of Social Services Funder: Centers for Medicare and Medicaid Services
Benchmark 1: The number of demonstration consumers transitioned = 1394
(non-demonstration transitions = 154)
0%
20%
40%
60%
80%
2007 2008 2009 2010 2011 2012
Benchmark 2 CT Medicaid Long-Term Care Expenditures
Home and Community Care Institutional Care
53% 53% 51% 50%
49% 49% 47% 47%
49% 50%
51% 51%
40%
50%
60%
2007 2008 2009 2010 2011 Q12012
Benchmark 3 Percentage of Hospital Discharges to SNF
vs. HCBS
SNF HCBS
30% 28% 28% 25% 24% 27% 29% 31% 34% 32%
0%
10%
20%
30%
40%
Benchmark 4 Percent of SNF admissions returning to the community
within 6 months
30% 28%
28% 25% 24% 27%
29% 31% 34%
32% 36%
0%
10%
20%
30%
40%
Benchmark 4 Percent of SNF admissions returning to the
community within 6 months
30.5% 28.4% 27.5% 24.7% 24.0% 27.0% 29.3% 30.3% 31.8% 31.1%
0%
10%
20%
30%
40%
Benchmark 4: Percent of SNF admissions returning to the community
within 6 months
30.5% 28.4% 27.5% 24.7% 24.0% 27.0% 29.3% 30.3% 31.8% 31.1%
0%
10%
20%
30%
40%
Benchmark 4 Percent of SNF admissions returning to the
community with 6 months
40%
45%
50%
55%
60%
2007 2008 2009 2010 2011 2012
Benchmark 5: Percent Receiving LTSS in the Community vs. Institutions
Home and Community Care Institutional Care
62%
79% 77% 77%
39%
21% 23% 23%
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
61%
78% 78% 78%
39%
22% 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
61%
78% 78% 78%
39%
22% 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
124
180 163
193
119
221
317
159
194
231
326
371
329 312
372
0
50
100
150
200
250
300
350
400
Referrals to Transition Coordinators: 2009 to Q1 2013
257
188
124
180 163
193
119
221
317
159
194
231
326
371
329 317
374
0
50
100
150
200
250
300
350
400
Referrals to Transition Coordinators: 2009 to Q1 2013
257
188
124
180 163
193
119
221
317
159
194
231
326
370
330 316
0
50
100
150
200
250
300
350
400Referrals to Transition Coordinators: Q1 2009 to Q4 2012
257
188
124
180 163
193
119
221
317
159
194
231
326
370
330 316
0
50
100
150
200
250
300
350
400Referrals to Transition Coordinators: 2009 to Q4 2012
257
188
124
180 163
193
119
221
317
159
194
231
326
370
330
0
50
100
150
200
250
300
350
400Referrals to Transition Coordinators: 2009 to Q4 2012
288
223
140
200 195
227
139
248
356
177
212
252
359 374
356
0
50
100
150
200
250
300
350
400
Referrals to TCs: 2009 to Q3 2012
19
38
43
62
60
74
98
83
66
107
152
109
114
120
109
164
131
0 20 40 60 80 100 120 140 160 180
q1 2009
q2 2009
q3 2009
q4 2009
q1 2010
q2 2010
q3 2010
q4 2010
q1 2011
q2 2011
q3 2011
q4 2011
q1 2012
q2 2012
q3 2012
q4 2012
q1 2013
Number of consumers who transitioned
Number of transitions by quarter: 12/2008 - 3/31/2013
3
42% 35% 38% 41% 33%
21% 10% 11% 10%
17%
35% 44% 44% 42% 46%
3% 3% 3% 3% 3%
Benchmark forTransitions
Referrals Signed InformedConsents
Transitions Closed w/oTransitioning
Target Population Summary
Physical Disability Mental Health Elderly Developmental Disability
75%
14%
7%
2%
2% 0.4%
Apartment Leased By Participant, Not AssistedLiving
Home Owned By Family Member
Home Owned By Participant
Apartment Leased By Participant, AssistedLiving
Group Home No More Than 4 People
Not Reported
14
51 51 47
23
0
20
40
60
Eastern North Central Northwest South Central Southwest
Number of clients with home modifications - by region
Qualified Residence Type for Transitioned Referrals: 12/4/08-3/31/2013
4
5
76
90
13 11 1
0102030405060708090
100
ABI PCA Elder DDS Wise Katie Becket
Number of clients with home modifications - by waiver
28% 26% 26%
70% 72% 71%
2% 2% 3%
0%
20%
40%
60%
80%
100%
6-month 12-month 24-month
Consumers who are working and those who would like to work
Currently working
Not working and don't want to work
Not working but want to work
23% 22% 20%
72% 71% 72%
5% 7% 8%
0%
20%
40%
60%
80%
100%
6-month 12-month 24-month
Consumers 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
76% 88% 89% 88%
24% 12% 11% 12%
0%
20%
40%
60%
80%
100%
baseline 6 month 12 month 24 month
Happy or unhappy with your help around the house or in the community*
happy unhappy
76% 87% 89% 89%
24% 13% 11% 11%
0%
20%
40%
60%
80%
100%
baseline 6 month 12 month 24 month
happy
unhappy
35%
85% 83% 80%
23%
7% 7% 8%
42%
8% 10% 12%
0%
20%
40%
60%
80%
100%
baseline 6 month 12 month 24 month
Do you like where you live?*
yes sometimes no
35%
85% 83% 81%
23%
7% 6% 8%
43%
8% 10% 11%
0%
20%
40%
60%
80%
100%
baseline 6 month 12 month 24 month
Do you like where you live?*
yes sometimes no
34%
85% 83% 81%
23%
7% 7% 8%
43%
8% 10% 11%
0%
20%
40%
60%
80%
100%
baseline 6 month 12 month 24 month
Do you like where you live?* yessometimesno
49% 48% 45% 51% 53% 55%
0%10%20%30%40%50%60%70%
6 month 12 month 24 month
Did family or friends help you with things around the house?
yes no
47% 47% 44% 53% 53% 56%
0%
20%
40%
60%
6 month 12 month 24 month
Did family or friends help you with things around the house?
yes no
49% 45% 40%
51% 55% 60%
0%
20%
40%
60%
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
3/31/2013
81% 94% 95% 91%
19% 6% 5% 9%
0%20%40%60%80%
100%
baseline 6 month 12 month 24 month
Do the people who help you treat you the way you want them to?*
yes no
80% 94% 95% 91%
20% 6% 5% 9%
0%20%40%60%80%
100%
baseline 6 month 12 month 24 month
Do the people who help you treat you the way you want them to?*
yes no
81% 94% 95% 90%
19% 6% 5% 10%
0%
20%
40%
60%
80%
100%
baseline 6 month 12 month 24 month
Do the people who help you treat you the way you want them to?*
yes
no
59% 54% 54%
58%
41% 47% 46% 42%
0%
20%
40%
60%
80%
baseline 6 month 12 month 24 month
Depressive Symptoms*
yes no
59% 54% 54% 56%
41% 46% 46% 44%
0%
20%
40%
60%
80%
baseline 6 month 12 month 24 month
Depressive Symptoms
yes no
47% 41% 42% 43%
53% 59% 58% 57%
0%
20%
40%
60%
80%
100%
baseline 6 month 12 month 24 month
Depressive Symptoms* yes
no
4.01
5.17 5.12 5.13
0
1
2
3
4
5
6
baseline 6 month 12 month 24 month
Average number of areas of choice and control*
43%
54% 58% 62%
57%
46% 42% 38%
0%
20%
40%
60%
80%
baseline 6 month 12 month 24 month
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 3/31/13)
Baseline interviews done prior to transition, n=1567
6 month interviews done 6 mos after transition, n=1131
12 month interviews done 12 mos after transition, n=868
24 month interviews done 24 mos after transition, n=436
12% 15% 15% 11%
88% 85% 86% 89%
0%
20%
40%
60%
80%
100%
baseline 6 month 12 month 24 month
Healthcare unmet need*
yes no
12% 15% 14% 11%
88% 85% 86% 89%
0%
20%
40%
60%
80%
100%
baseline 6 month 12 month 24 month
Healthcare unmet need
yes no
12% 15% 15% 11%
88% 85% 85% 89%
0%
20%
40%
60%
80%
100%
baseline 6 month 12 month 24 month
Healthcare unmet need yesno
87% 85% 86%
42% 36% 37%
0%
50%
100%
6 month 12 month 24 month
Have or Need Assistive Technology (AT)?
Have AT Need AT
87% 85% 86%
43% 38% 39%
0%
50%
100%
6 month 12 month 24 month
Have or Need Assistive Technology (AT)?
Have AT Need AT
86% 85% 87%
44% 38% 38%
0%
20%
40%
60%
80%
100%
6 month 12 month 24 month
Have or need AT? Have AT
Need AT
74%
88% 90% 88%
26% 13% 10% 12%
0%
20%
40%
60%
80%
100%
baseline 6 month 12 month 24 month
Personal care - unmet needs*
0 unmet needs 1 or more
2.06
1.9
1.94
1.81 1.00
2.00
3.00
baseline 6 month 12 month 24 month
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
4.02
4.19 4.19
4.16
3
4
5
baseline 6 month 12 month 24 month
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
9% 12% 11% 12%
46% 43% 44% 43%
37% 33% 34% 33%
9% 11% 11% 13%
0%
10%
20%
30%
40%
50%
baseline 6 month 12 month 24 month
Rate your overall health*
excellent good fair poor
9% 13%
11% 12%
46% 42% 44% 43%
37% 34% 34%
32%
9% 11% 12% 13%
0%
10%
20%
30%
40%
50%
baseline 6 month 12 month 24 month
Rate your overall health* excellent
good
fair
poor
9% 13%
11% 12%
46% 42% 44% 44%
37% 33% 34%
31%
8% 11% 12% 13%
0%
10%
20%
30%
40%
50%
baseline 6 month 12 month 24 month
Rate your overall health* excellent
good
fair
poor
7
Transition Challenges through 3/31/13
Transition coordinators complete a standardized challenges checklist for each consumer. There were a total of 4764 MFP referrals to TCs. Transition coordinators had completed challenges checklists for 3,154 of these referrals, representing 3,000 consumers. Excluding the referrals which indicated “no challenges,” the challenges checklist generated 15,437 separate challenges. Of these, the most frequently chosen challenge was physical health (16.9%); followed by challenges related to housing (13.7%); mental health (12.7%); waiver program (12.6%) and consumer engagement, awareness, or skills (11.3%).
6% 12%
17% 14%
16%
27% 28%
46% 44%
29% 36%
52%
7% 12% 17%
21%
12%
19% 24%
34%
55%
46% 48%
60%
0%
10%
20%
30%
40%
50%
60%
70% Transitioned Closed before transitioning
6% 12%
16% 14% 17%
27% 26%
44% 44%
29% 36%
52%
7% 12%
17% 20%
12%
19% 24%
34%
55%
46% 48%
60%
0%
10%
20%
30%
40%
50%
60%
70%Transitioned Closed before transitioning
5% 12%
17% 14% 17% 26% 26%
43% 44%
30% 37%
53%
7% 11%
17% 20% 12%
19% 23%
32%
54% 46% 47%
59%
0%
20%
40%
60%
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 indicated each challenge. For example, of the referrals which closed without transitioning, 60 percent indicated physical health was a challenge. The challenges and sub-challenges are checked off by the individual transition coordinator who is working with that consumer.
Nine of the twelve listed challenges indicated statistically significant differences between the two groups.
Other challenges, 1.8%
Facility related, 3.1%
Legal issues, 3.2%
Other involved individuals, 4.0%
MFP office /TC, 4.2%
Financial issues, 6.9%
Services and supports, 9.7%
Consumer engagement,
11.3%
Waiver program, 12.6%
Mental health, 12.7%
Housing, 13.7%
Physical health, 16.9%
Transition Challenges by Type
Other challenges,
2.1% Legal issues, 3.2%
MFP office /TC, 4.1%
Other involved individuals, 4.3%
Facility related, 4.5%
Financial issues, 6.4% Services and
supports, 9.0%
Consumer engagement, 11.5%
Waiver program, 11.9%
Mental health, 12.5%
Housing, 12.8% Physical health,
16.3%
Transition Challenges by Type
Other challenges, 1.8%
Facility related, 3.2%
Legal issues, 3.2%
Other involved individuals, 4.0%
MFP office /TC, 4.2%
Financial issues, 6.8%
Services and supports, 9.4%
Consumer engagement, 11.5%
Waiver program, 12.7%
Mental health, 12.9% Housing,
13.4% Physical health,
17.0%
Transition Challenges by Type
Other challenges, 2%
MFP office/TC, 4% Other involved individuals, 4%
Facility related, 3% Legal issues, 3%
Housing, 13%
Waiver program, 13%
Services and supports, 9%
Consumer engagement, 12%
Financial issues, 7%
Mental health, 13% Physical
health, 17%
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
*indicates statistically significant differences
8
Types of Challenges – through 3/31/2013
Shown below are the five most common challenge types
51% 32%
5% 3%
9%
Physical health Current, new orundisclosed physicalhealth problem
Inability to managephysical health or illness inthe community
Medical testing issues ordelays
Missing or waiting forphysical health documents
Other physical healthissues
19%
29% 29%
18% 5%
Mental health Current or history ofsubstance/alcoholabuse w/ risk ofrelapseCurrent, new, orundisclosed mentalhealth problem
Dementia or cognitiveissues
Inability to managemental health incommunity
Other mental healthissues
11%
34% 36%
9% 10%
Consumer engagement Disengagement or lack/loss
of motivation
Lack of awareness orunrealistic expectations
Lack of independent livingskills
Language or communicationskills
Other consumer relatedissues
14%
32% 34%
9% 10%
Consumer engagement
Disengagement or lack/lossof motivation
Lack of awareness orunrealistic expectations
Lack of independent livingskills
Language or communicationskills
Other consumer relatedissues
9%
15%
4%
58%
14%
Waiver program
Current waivers do not meetconsumer needs
Ineligible for or denial ofwaiver services
Targeted waiver full
Waiting for evaluation,application review fromwaiver agency
Other waiver programissues
7% 4%
15%
6%
40%
27%
Housing Delays related to housingauthority, agency or housingcoordinator
Delays related to lease, landlord,apartment manager, etc.
Housing modification issues
Ineligible or waiting for approvalfrom RAP or other housingprograms
Lack of or insufficient housing
Other housing related issues
For the full report on
transition challenges
through 3/31/2013, use the
link on page 7 to get to the
Center on Aging website.
9
15%
4%
9%
1% 4%
4%
10%
12%
32%
3% 5%
0% 1%
Percentage of Closed Cases by Closure Reason: January-March 2013
Closed transitioned to community before informed consent signed
Closed, exceeds mental health needs
Closed, exceeds physical health needs
Hospitalized 90 days with no discharge date
Left without approved transition plan
Other (describe below)
Reinstitutionalized for 90 days or more
Withdrawal, COP/Gaurdian requested closure
Withdrawal, participant changed their mind and would like to remainin the facilityWithdrawal, participant decline to agree with program requirements
Withdrawal, participant declines assessment
Withdrawal, participant moved to another state without MFPtransitional servicesWithdrawal, participant would not cooperate with care plandevelopment
66
107
152
109 114 120
109
164
131
75
101 90
129
177
109
216
172
100
317
159
194
231
326
371
329 312
372
24
64
46
56 54
29
66 55
27 21
67
78
47 35 32 33
53
35
0
50
100
150
200
250
300
350
400
Jan-Mar 11 Apr-Jun 11 Jul-Sep 11 Oct-Dec 11 Jan-Mar 12 Apr-Jun 12 Jul-Sep 12 Oct-Dec 12 Jan-Mar 13
Comparison of Closures, Referrals and Transitions per Quarter
Total cases transitioned
Total closures excluding: died, nursing home closure, completed participation, non-demo transition servicescompleted
New referrals excluding nursing home closures
Closures per 100 new referrals
Transitions per 100 new referrals
10
Meet Matthew Crowe
“You Betch Ya”, a “Hi-5” and a big smile! Matthew Crowe’s greeting of a “Hi-5” and a smile reflects his positive attitude toward his healing journey and his accomplishments to date. He has unique understanding of his ABI injury and recovery, from the tragic car accident that left him comatose for four months, to the months of rehabilitation to his continuing work and exercise to keep on improving. He has a bucket list of goals and can see himself having a productive life, going back to work, having his own place, driving again and helping his mother as much as possible. To all of this, he says, “You betch ya, I can do it!” With the help of MFP and involved care agencies, specialized equipment, his independent living coach, the support of a network of friends and family and personal diligence, Matthew is in the process of overcoming numerous obstacles to regain his independence. Although he still uses a motorized wheelchair, he is able to move around his home and yard independently, and enjoys giving his toddler nephew a ride. He is currently putting great effort into learning to walk with braces and a walker. He is very proud of his newly renovated accessible bathroom which gives him a measure of personal independence. Matthew’s desire to engage in life led to several acquisitions. One is an accessible van which allows him to go out, engage socially and follow opportunities, such as advocating for seatbelts, warning everyone to always “buckle up.” He hopes to learn to drive the van himself someday. Another is technology. His iPad and iPhone play a large part in his ongoing communications; and more recently, working with his former employer, his iPad was upgraded enabling him to do security checks on the business property. With repeated practice and therapy, he is re-learning to use his hands and fingers to write and to get back to his pre-accident love of drawing and art; and is finding a renewed interest in his prized baseball card collection. He is looking forward to summer so he can swim in the family pool, using a specialized floating chair, and, as he says, “I’ll kick my legs like a banshee.” Since he loves the outdoors, he has not given up on his dream of landscaping. To that end, Matthew is working on getting his GED and is currently engaged in the English course, with math coming next. He is not sure when he will finish his degree, but is confident that he will.
picture
Matthew Crowe Photo credit: Sandi Noel
Matthew’s healing progress has recently been featured in an award winning video produced by William Backus Hospital, Norwich CT. He is thankful for all the help and the people who have brought him this far. “They didn’t think I’d make it, but ‘you betcha’, I showed them all!” 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 the elderly and disabled population to a community based orientation.
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