CT Money Follows the Person Quarterly Report - UConn Health · Quarterly Report Quarter 4 , 2016: ... Target Population Summary for Referrals through Q4 2016 (Demonstration Only)

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 4, 2016: October 1, 2016 – December 31, 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 = 3,927

(non-demonstration transitions = 285)

33% 33% 35% 38% 40% 41% 43% 45% 45% 49%

67% 67% 65% 62% 60% 59% 57% 55% 55% 51%

0%

20%

40%

60%

80%

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Benchmark 2CT Medicaid Long-Term Care Expenditures

Home and Community Care Institutional Care

47%47%

49% 50%

51% 52% 52% 52%54% 55%53% 53%

51%50%

49% 48% 48% 48%46%45%

40%

50%

60%

2007 2008 2009 2010 2011 2012 2013 2014 2015 Q12016

Benchmark 3Percentage of Hospital Discharges to Home and

Community Care vs. Skilled Nursing Facility

Home and Community CareSkilled Nursing Facility

24%27% 28% 31% 32% 31%

38% 35% 37%37%38% 35% 37%41%

0%

10%

20%

30%

40%

50%

Benchmark 4Percent of SNF admissions returning to the community

within 6 months

* Data for 3 months

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

48% 48% 47% 46% 45%44%

42% 41% 40% 40%

30%

40%

50%

60%

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

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

Home and Community Care Institutional Care

60%

79% 77% 78%

40%

21% 23% 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

180163

193

119

220

317

159194

231

325341

327 311

372331

313

226214

604

709

352

565587

509

462503496

460438

0

100

200

300

400

500

600

700

800

Nu

mb

er

Re

ferr

ed

Quarter

Referrals to Transition Coordinatorsᵗ: Q1 2009 to Q4 2016

ᵗExcludes NH closure and Chelsea/TouchpointsManchester mass referrals 12/23/16 or later *Increase in referrals reflects the ongoing adjustment to MFP reorganization

1938

4362

6074

9883

66107

152109

114120

110166

132167

147

166121

117159

199163

215201

213209

181

207194

0 50 100 150 200 250

2009 12009 22009 32009 42010 12010 22010 32010 42011 12011 22011 32011 42012 12012 22012 32012 42013 12013 22013 32013 42014 12014 22014 32014 42015 12015 22015 32015 42016 12016 22016 32016 4

Number of Transitioned Referrals

Qu

arte

r

Number of Transitions by Quarter: 12/2008 - 12/31/2016

3

42% 38% 38% 41% 33%

21%10% 8% 7%

10%

35%47% 49% 46% 56%

3%5% 4% 6% 2%

BENCHMARK FORTRANSITIONS

Referrals (n=8302) Signed InformedConsents (n=6972)

Transitions (n=3942) Closed w/oTransitioning

(n=1851)

Target Population Summary for Referrals through Q4 2016(Demonstration Only)

Physical Disability Mental Health Elderly Developmental Disability

72.4%

13.7%

9.4%

2.4%2.0% 0.2%

Qualified Residence Type for Transitioned Referrals: 12/4/08 to 12/31/16Apartment 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

360

1503

601

880

551

57 162 148 173 81

0

500

1000

1500

2000

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% (417) of participants who transitioned by Dec 31, 2015

were in an institution 12 months after their transition.

4

258

1480

1865

228376

356 160301

66 16 10

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

41% 41% 34%

55% 55% 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 work

Not working but want to work

15% 14% 14%

84% 85% 85%

0.5% 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 work

Not working but want to work

31% 32% 28%

62% 61% 63%

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% 15% 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% 90%

26%

12% 11% 10%

0%

20%

40%

60%

80%

100%


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

happy

unhappy

32%

85% 84%80%

27%

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 12/31/2016

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

4.09

5.16 5.16 5.08

0

1

2

3

4

5

6


Average number of areas of choice and control*

43%54% 57% 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 12/31/16) Baseline interviews done prior to transition, n=4,275 6 month interviews done 6 mos after transition, n=3,090 12 month interviews done 12 mos after transition, n=2,790 24 month interviews done 24 mos after transition, n=1,879

13% 15% 13% 12%

87% 85% 87% 88%

0%

20%

40%

60%

80%

100%

baseline 6 month 12 month24 month

Healthcare unmet need*

yes

no

90% 91% 90%

35% 29% 27%

0%

50%

100%

6 month 12 month 24 month

Have or Need* Assistive Technology (AT)?

Have AT Need AT*

85%91% 93% 93%

15%9% 7% 8%

0%

20%

40%

60%

80%

100%


Personal care - unmet needs*

0 unmet needs 1 or more

2.15

2.03

2.052.21

1.00

2.00

3.00


me

an s

um

mar

y sc

ore

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

6=need assistance with all*

3.95

4.14 4.17

4.27

3.00

4.00

5.00


me

an s

um

mar

y sc

ore

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

independently; 7=need assistance with all*

7.4% 11.5% 11.4% 12.4%

49.8% 43.4% 43.3% 41.6%

35.6%34.0% 34.4% 35.3%

7.2% 11.2% 10.9% 10.7%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Rate Your Overall Health*

excellent good fair poor

7

Transition Challenges through 12/31/16

Transition coordinators (TCs) and specialized care managers (SCMs) complete a standardized challenges checklist for each consumer. There were a total of 11,709 MFP referrals to SCM Supervisors. Challenges checklists were completed for 8,036 of these referrals, representing 7,417 consumers. Excluding the referrals which indicated “no challenges,” the challenges checklist generated 45,738 separate challenges. Of these, the most frequently chosen challenge was physical health (17.0%), followed by challenges related to housing (15.7%), services and supports (14.5%), mental health (12.7%), and consumer engagement (9.8%).

5%

17%20%

13%14%

31%

42%

57%

30% 28%

39%

59%

6%

19% 20% 24%

13%

26%

41%

56%

40%46%

53%

69%

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, 69 percent had a physical health challenge. Conversely, 59 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, 1.2%

Facility related, 2.8%

Other involved individuals, 3.5%

Legal issues, 4.3%

MFP office /TC, 4.3%

Waiver/HCBS, 7.0%

Financial issues, 7.6%

Consumer engagement, 9.8%

Mental health, 12.7%

Services and supports, 14.5%

Housing, 15.7%Physical health,

17.0%

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 12/31/2016

Shown below are the six most common challenge types

56%30%

5%

2%7%

Physical health Current, new or undisclosedphysical health problem

Inability to manage physicaldisability or physical illness incommunity

Medical testing issues or delays

Missing or waiting for physicalhealth documents

Other physical health issues

18%

35%28%

16%

4%

Mental healthCurrent or history ofsubstance/alcohol abuse w/ risk ofrelapse

Current, new, or undisclosedmental health problem

Dementia or cognitive issues

Inability to manage mental healthin community

Other mental health issues

6%3%

16%

7%49%

4% 16%

Housing Delays related to housing authority,agency or housing coordinator

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

Needs housing modifications beforetransition

Ineligible or waiting for approval fromRAP or other housing programs

Lacks affordable, accessible communityhousing

Housing related legal, criminal or creditissues, including evictions or unpaidrent

Other housing related issues

13%

32%

17%

17%

21%

Financial

Consumer credit or unpaidbills

Lack of or insufficientfinancial resources

SSDI, SSI, SAGA, SSA, VA orother cash benefits

Medicaid eligibility orinsurance issues

Other financial issues

6%

12%

9%

37%

19%

6%

8%4%

Services and supports

Lack of alcohol, substance abuse,or addiction services

Lack of AT or DME

Lack of mental health services orsupports

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 services orsupports

For the full report on transition challenges through 12/31/2016, use the link on page 7 to

get to the Center on Aging website.

12%

36%36%

10%7%

Consumer engagement

Disengagement orlack/loss of motivation

Lack of awareness orunrealistic expectations

Lack of independent livingskills

Language orcommunication skills

Other consumer relatedissues

9

23%

23%

17%

16%

6%

5%

4%4%

2% 0.3%

Percentage of Closed Cases by Closure Reason: Oct- Dec 2016*Participant would not cooperate with care planning processParticipant changed their mind and would like to remain in the facilityTransitioned to community before informed consent signedCOP/Guardian refused participation

Exceeds physical health needs

Participant not aware of referral & does not wish to participateOther

Reinstitutionalized for 90 days or more

Exceeds mental health needs

Participant moved out of state

* Excludes NH closure and Chelsea/TouchpointsManchester mass referrals 12/23/16 or later

284

156 168

109119

362

171

287

202

303

709

352

566587

508

462503 505

461438

159199

163

214 201 206 208181

207 194

40

4430

19 23

78

34

57 4469

22

57

29

36 40

45

41

36 45 440

100

200

300

400

500

600

700

800

Jul-Sep 14 Oct-Dec 14 Jan-Mar 15 April-Jun15 Jul-Sep15 Oct-Dec 15* Jan-Mar 16 April-Jun 16 Jul-Sep16 Oct-Dec 16

Nu

mb

er

Quarter

Comparison of Closures, Referrals and Transitions per Quarter

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

New referrals excluding nursing home closures

Total cases transitioned

Closures per 100 new referrals

Transitions per 100 new referrals

10

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.

Meet Gregory Johnson

“Godsend” As a native of New York, Gregory Johnson made a living in real estate. When he came to Connecticut, he had the opportunity to change careers. Greg was required to complete a physical examination for a new job and when he saw the results of the health screening, he was stunned. He had multiple conditions that forced him to go directly to an emergency room. This led to a hospital stay which led to a nursing home admission where Greg stayed for over a year. He reflects, “You get better in places like nursing homes and that is why I went. It took longer than I thought, but I got better. From not walking—all the rehab—to the walker and the wheelchair—to the canes.” He had heard other residents were moving out through the Money Follows the Person (MFP) program and when he was approached, he took the chance. Greg recognizes, “It is a wonderful program.” Greg worked with a transition coordinator and housing coordinator to find his one bedroom apartment. Greg reflects on these times fondly, “I have been very fortunate [with] the people I had to deal with. The people that I have met in the program have been incredible…I got a lot of help with paperwork. [MFP] took the extra steps.” Greg has strong family ties and appreciates the support system he has. He recalls, “My son said, ‘Seeing you in that [hospital] bed, made me feel that we were all vulnerable.’” At one time Greg was afraid his family would have to care for him, but those days are gone. He is active in the community, using mass transportation in his city as a way to do his favorite activities. He shops independently and visits with family and friends. He says, “I’d like to get a bike eventually. I’d like to ride, I don't feel comfortable with that right now. Walking around… I do that and that is enjoyable.” Greg has lived in his apartment for a year and has decided to make another transition. Greg’s transition coordinator is helping him find a better apartment setting, one with more personal space and better amenities, like a fully accessible bathroom. He is thankful for the help he has gotten from MFP, especially his workers. He has an optimistic outlook on life, “when your intentions are good […] people come into your life. It’s a positive light.” He states, “I have been fortunate, it is like a Godsend. My end of the bargain is to do what I am supposed to do, I am responsible.”

Photo credit: Kaleigh Ligus

CT Money Follows the Person Quarterly Report - UConn Health · Quarterly Report Quarter 4 , 2016: ... Target Population Summary for Referrals through Q4 2016 (Demonstration Only)

Documents