CT Money Follows the Person Report - UConn Health · CT Money Follows the Person Report February 2020 UConn Health, Center on Aging Operating Agency: ... q4 2016 q1 2017 q2 2017 q3

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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 Report

February 2020 UConn Health, Center on Aging

Operating Agency: CT Department of Social Services Funder: Centers for Medicare and Medicaid Services

Benchmark 1: Total Transitions = 5,964 Demonstration = 5,576 (94%)

Non-demonstration = 388 (6%)

33%33% 35% 38%40% 41% 43% 45% 45% 49% 50%

53% 52%

67% 67% 65% 62% 60% 59% 57% 55% 55% 51% 50%

47% 48%

0%

20%

40%

60%

80%

Benchmark 2CT Medicaid Long-Term Care Expenditures

Home & Community Care Institutional Care

47%47% 49% 50%

51% 52% 52% 52% 54% 56% 57% 58%53% 53% 51% 50%

49% 48% 48% 48% 46% 44% 43% 42%

0%10%20%30%40%50%60%70%

Benchmark 3Percentage of Hospital Discharges to Home and

Community Care vs. Skilled Nursing Facility

Home & Community Care Skilled Nursing Facility

25%30% 32%

37% 36% 37% 36% 39% 40% 37%

0%

10%

20%

30%

40%

50%

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Benchmark 4Percent of SNF admissions returning to the

community within 6 months

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

60% 60% 61% 64%64%

48%48% 47% 46% 45%44% 42% 41% 40%40% 39% 36% 36%

0%10%20%30%40%50%60%70%

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

Home & Community Care Institutional Care

85% 80%

15%20%

0%

20%

40%

60%

80%

100%

1 month 12 month

Happy or unhappy with the way you live your life

happy unhappy

2

748 707908

1296 1242

18782186

1893 1886 1719 1818

0

500

1000

1500

2000

2500

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

Co

un

t

Year of Referral

Total Number of Referrals Assigned to the Field by Year

158315

434510

612 596

792 792636 577 535

0

200

400

600

800

1000

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

Co

un

t

Year of Transition

Total Number of Transitions by Year

549 581509

462 501 497 460 435482 473

523

408 390

515

372443

400491 475 452

0100200300400500600

q12015

q22015

q32015

q42015

q12016

q22016

q32016

q42016

q12017

q22017

q32017

q42017

q12018

q22018

q32018

q42018

q12019

q22019

q32019

q42019

Co

un

t

Quarter

Referrals Assigned to the Field by Quarter

163

216 201 214 209181

207 195170 169

143 154 141 143 146 148119 123 134

159

0

50

100

150

200

250

q12015

q22015

q32015

q42015

q12016

q22016

q32016

q42016

q12017

q22017

q32017

q42017

q12018

q22018

q32018

q42018

q12019

q22019

q32019

q42019

Co

un

t

Quarter

Number of Transitions by Quarter

Note: Excludes nursing home closures

Note: Excludes nursing home closures

3

42% 40%47%

44%37% 34% 32% 35% 35%

40%36% 37%35%

42%

32%44%

50%54% 51% 45% 44%

44%39%

43%

21%17% 19%

8% 9% 7% 8%

15% 13% 12%20%

15%

3% 2% 2% 4% 4% 5%9%

5%9%

5%6% 5%

Target Population for Transitions by Year of Transition (Demonstration Only)

Physical Dis Older Adult Mental Health Developmental Dis

11.2% 12.1% 11.2%12.9%

10.4% 10.0%

0%

5%

10%

15%

2013 2014 2015 2016 2017 2018

Per

cen

t

Year of Transition

Participants Who Were in an Institution 12 Months after Transition Regardless of Length of Stay

6 8 9 13 10 7 612

19 1529

2216 2213

15 19

2720

18 171111

29

35

2622 23

46

16

18

138 16

2013 2014 2015 2016 2017 2018 2019

Eastern North Central Northwest South Central Southwest

69 8

1210

4

13 1214

33

9 810

547

1012

33

7 6

14

9

3

15

119

7

0

5

10

15

20

Eastern North Central Northwest South Central Southwest

Jan-Jun 2017 Jul-Dec 2017 Jan-Jun 2018 Jul-Dec 2018 Jan-Jun 2019 Jul-Dec 2019

4

56% 58%

43% 40%

2% 3%

0%

20%

40%

60%

80%

100%

1 month 12 month

Participants under age 65 who are working and those who would like to work

Working

Want to work

Don't want to work

68% 71%

29% 24%

4% 6%

0%

20%

40%

60%

80%

100%

1 month 12 month

Participants under age 65 who are volunteering and those who

would like to volunteer

Volunteering

Want to volunteer

Don't want to volunteer

82% 81%

17% 18%

1% 1%

0%

20%

40%

60%

80%

100%

1 month 12 month

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

Working

Want to work

Don't want to work

76% 74%

23% 20%

1% 7%

0%

20%

40%

60%

80%

100%

1 month 12 month

Participants 65 years and older who are volunteering and those who

would like to volunteer

Volunteering

Want to volunteer

Don't want to volunteer

72%

14%

10%

2% 2%

Qualified Residence Type for Transitioned Referrals: 12/4/08 to 12/31/19

Apartment Leased By Participant, Not Assisted Living

Home Owned By Family Member

Home Owned By Participant

Group Home No More Than 4 People

Apartment Leased By Participant, Assisted Living

Participants who are Working and/or Volunteering (data 1/1/19-12/31/19)

5

55% 53%45% 47%

0%

20%

40%

60%

80%

100%

1 month 12 month

Did any unpaid family members or friends help you with things around the house?

yes no

37%50%

63%

50%

0%

20%

40%

60%

80%

100%

1 month 12 month

Depressive Symptoms*

yes no

*Questions are different at 1m vs 12m

99% 96%

38%22%

0%

20%

40%

60%

80%

100%

1 month 12 month

Have or Need Assistive Technology (AT)?

Have AT Need AT

87%80%

5% 6%9%13%

0%

20%

40%

60%

80%

100%

1 month 12 month

Do you like where you live?

yes sometimes no

61%

70%

72%

82%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

Planning your time and activities

Staff listen and communicate well

Choosing the services that matter to you

Staff are reliable and helpful

HCBS CAHPS Composite Measures: Percent with Highest Score (e.g. always, yes)

* Data for 1 month survey

MFP Quality of Life Dashboard

Number of Quality of Life Interviews Completed from 1/1/19 - 12/31/19: 1 month interviews done 1 month after transition, n=347 12 month interviews done 12 months after transition, n=377

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Physical health, 17.5%

Mental health, 14.8%

Financial issues, 8.6%

Consumer engagement, 10.7%

Services/supports, 19.3%

Waiver/HCBS, 2.9% Housing, 13.9% Legal issues, 5.6%

Facility related,

2.8%

Other involved individuals, 2.0%

MFP office /TC, 1.7%

Other challenges, 0.2%

Transition Challenges for Participants Referred in 2019

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

Frequency of Transition Challenges by Year of Referral

Physical health Mental health Financial issues Consumer engagement

Services/supports Waiver/HCBS Housing Legal issues

Facility related Other involved individuals MFP office /TC Other challenges

Challenges to Transition as Recorded by TCs and SCMs

7

1%

27%20% 16%

28%

49%

68% 70%

15%

49% 58%

78%

1%

23% 22% 17%

32%46%

73%59%

20%

43%

60%

78%

2%

21% 22%

4%17%

46%

66%55%

19%

47%58%

76%

0%

20%

40%

60%

80%

100%

Participants with Each Challenge who Transitioned by Referral Year

2017 2018 2019

5%

17%

10%

39%

13%

3% 12%

1%

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 servicesor supports

58%31%

7%2% 2%

Physical health Current, new or undisclosedphysical health problem

Inability to manage physicaldisability or physical illnessin community

Medical testing issues ordelays

Missing or waiting forphysical health documents

Other physical health issues

15%

38%26%

20%

1%

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

Current, new, or undisclosed mentalhealth problem

Dementia or cognitive issues

Inability to manage mental health incommunity

Other mental health issues

1%

1%

15%

13%60%

7%

2%

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, accessiblecommunity housing

Housing related legal, criminal orcredit issues, including evictions orunpaid rent

Other housing related issues

Types of Challenges for Referrals: 1/1/2019 - 12/31/2019 Below are the four most common challenge types for 2019

8

0% 5% 10% 15% 20% 25% 30%

Participant changed mind

Wouldn't cooperate w/ care planning

Transitioned before informed consent signed

COP/Guardian refused participation

Exceeds physical health needs

Reinstitionalized for 90+ days

Exceeds mental health needs

Not aware of referral

Moved out of state

Other

Frequency of Closure Reason by Year of Closure

2017 (n=992) 2018 (n=990) 2019 (n=1440)

204234

325

223201

321

425

283

411410 389

522

371

443

400

491475

452

154139 141 147 146

119 123 134159

50 60 62 6045

80 8760

91

38 36 27 40 33 30 25 2835

0

100

200

300

400

500

600

Oct-Dec 17 Jan-Mar 18 Apr-Jun 18 Jul-Sep 18 Oct-Dec 18 Jan-Mar 19 Apr-Jun 19 Jul-Sep 19 Oct-Dec 19

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

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Betty Lichtenstein’s Story

Betty describes herself as an active, “never been a sitting around” type of person. After graduating from Western Connecticut State University, having a career in human resources, creating a home for her family and enjoying her hobbies, life took a downward turn. Complications from diabetes led to a stroke and a single leg amputation 8 years ago followed by two years living in a skilled nursing facility. While in the nursing facility, Betty experienced more than physical losses. Her mother and brother died and she could not attend the funerals due to lack of suitable transportation.

The rehabilitation department at the nursing facility suggested Money Follows the Person (MFP) to assist her in transitioning back into the community. Although excited, Betty was fearful and anxious, having to begin again. Betty just wanted a place that felt like home and had two requests when it came to finding housing: a place where she could garden and a place where her grandsons, “the light of her life,” could visit freely. Since 2014, Betty’s MFP transition team (the housing coordinator, the transition coordinator and care manager) continues to work with her. The MFP housing coordinator was able to find Betty an end unit,

which provided her with a bigger yard. Now, she looks out her bedroom window to a lovely bird feeder and raised garden beds, where she grows carrots and tomatoes. She enlists her grandsons to help and now they can visit her in an environment where they can play outside. The apartment is not only wheelchair accessible with wider doorways, and a roll-in shower, but the MFP

team were instrumental in finding special medical equipment, like a Rifton transfer lift, assistive technology for her vision loss and environmental controls for greater independence to control the lights and fan.

Betty has adjusted well to “the new normal.” She continues to stay active and involved in her community. Utilizing transportation provided by Ability Beyond, she is able to attend her grandsons’ basketball and football games, concerts in town, and nearby shopping centers. Due to her central location and level of independence, she is also able to take herself downtown and to her alma mater, WCSU’s campus to get some fresh air. Betty enjoys giving back to her community, crocheting for charities. Every year she donates 25-30 hats to homeless shelters and 10-20 infant hat and blanket sets to Birthright, an organization that helps single mothers. Betty continues on a path of self-improvement and staying positive in her life. She enjoys attending a free all-day retreat at a Buddhist Monastery in New York, which brings her comfort and strength. She also visited the family plots at the cemetery to find closure with her losses.

Both Betty and the MFP team admit to having a rocky start, with lots of staff turnover. Betty’s advice to others who have to hire their own Personal Care Assistants (PCAs) is to go by word of mouth and know someone who has worked with an aide and trusts them. Betty self manages PCAs for over 80 hours a week and has learned to juggle PCA and Independent Living Skills Training (ILST) worker hours within her budget. Over the past four months, Betty has undergone 4 surgeries, including a second leg amputation. “MFP has changed my life!” Having the aides in place after her surgeries allowed her to go back home where she received in-home and then outpatient services. “I don’t see any reason I should ever have to go to a nursing home again.”

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: Christine Bailey

Photo credit: Betty Lichtenstein

Photo credit: Betty Lichtenstein

Photo credit: Betty Lichtenstein