Nursing Home Diversion and Modernization Program Grant:
Overview: The New York State Office for the Aging (NYSOFA) received a 2008 Nursing Home Diversion Modernization (NHDM) grant from the U.S. Administration on Aging (AoA). This AoA funding was targeted at reaching individuals not eligible for Medicaid, but who were at high risk of nursing home placement and of spending down their income and assets to the Medicaid level. The project provided opportunities for eligible individuals to receive long term services and supports through traditional and/or consumer directed models. The program was developed in three counties (Broome, Oneida and Onondaga) where the local NY Connects was responsible for screening and referring potentially eligible participants to the Area Agency on Aging (AAA). The three counties served 133 individuals through the program. The outcomes data below was generated from monitoring 93 of these 133 individuals enrolled in the program for a minimum of 90 days and at an average of 8.34 months.
Outcomes: The Center for Excellence in Aging & Community Wellness (CEACW) at the University at Albany conducted a final evaluation to gain a better understanding of program utilization and accomplishments towards the main objectives; prevent Medicaid spend-down and divert nursing home placement.
- 81% of participants did NOT enter a nursing home and for the same group
- 83% did not spend down to Medicaid.
- NHDMP at minimum saved the public $89,157 per month (Medicaid-supported home care costs of approximately $321,626 for the 93 individuals tracked minus NHDMP costs of approximately $232,469)
- NHDMP maximum savings were $410,780 per month (Medicaid nursing home costs of approximately $643,249 for the 93 individuals tracked minus NHDMP costs of approximately $232,469).
Participant Profile: The 'typical' consumer participating in the NHDM grant was aged 80 and over, had three or more ADL needs and five or more IADL needs. Of the participants in the program, 32% chose to direct their services themselves, and all others appointed a consumer representative. 68% of participants accessed assistive technology and home renovations and purchased goods and services; 26% hired and supervised their own in-home services worker and most also accessed traditional Older Americans Act (OAA) and state funded services administered by the AAA, such as home delivered meals, transportation and agency provided personal care to address ADL needs such as bathing and dressing.
Community Living Program:
Overview: NYSOFA received a 2009 Community Living Program (CLP) grant, the successor to the 2008 NHDM grant. The CLP grant allows NYSOFA to expand the NHDM program to seven additional AAAs (Orange, Dutchess, Albany, Otsego, Washington, Tompkins and Cayuga). The goal is to have local NY Connects programs pre-screen and refer 200 enrollees (19% of the eligible population at risk of nursing home placement and/or Medicaid spend-down) into services and supports through traditional and/or consumer directed models. Functional and financial eligibility criteria are consistent with the NHDM grant and enable evaluators to assess the program's ability to divert Medicaid spend down and nursing home placement. In September 2011, a one year, no cost extension was obtained from AoA.
The CLP grant also allows NYSOFA to utilize the three AAAs that participated in the NHDM grant (Oneida, Onondaga, and Broome) as peer mentors. During the past year, the mentor program was recognized nationally as Broome, Oneida, and Onondaga were selected as the recipients of the Outstanding Achievement in Changing Systems by a Regional or Local Program award category. The mentor program was chosen for its exceptional commitment, creativity, leadership and success related improving conditions for individuals through systems change. to the seven new AAAs and serve approximately 200 seniors (19% of the eligible population) in these counties.
The CLP grant also allows NYSOFA to utilize the three AAAs that participated in the NHDM grant (Oneida, Onondaga, and Broome) as peer mentors. The mentor program was recognized nationally when New York State was selected as the recipient of the Outstanding Achievement in Changing Systems award.. The mentor program was chosen for its exceptional commitment, creativity, leadership and success in improving conditions for individuals through systems change.
Case example: Mr. S is committed to keeping his wife, who has mid to late stage dementia and scores 178 on DMS1, at home. The S's had previously received traditional services, but had stopped due to difficulty with aide availability given their geographic isolation. Because of her dementia it can be difficult to communicate with Mrs. S. It is important to the family that her aide provide assistance in the manner that Mrs. S and the family determined works best for her and also allows Mr. S the time and confidence to be outside and engage in activities that are important to him. Mr. and Mrs. S have found a consumer directed aide who communicates well with Mrs. S. and has turned into a reliable caregiver.
Outcomes: A final report will be prepared by The Center for Excellence in Aging & Community Wellness (CEACW) at the University at Albany to further demonstrate CLP's impact on a consumer's ability to remain living safely in his/her home and on the occurrence of Medicaid spend-down. The report will be completed by December 31, 2012.
Systems Change: In order to develop a program that counties could financially sustain once grant funds were discontinued, NYSOFA needed to identify ways that existing funding streams could be made more flexible, as well as, encourage the use of private funds when possible. This resulted in reforming Expanded In-home Services for the Elderly Program (EISEP) regulations and increasing opportunities for cost sharing through appropriate (Older American's Act) OAA funds.
- EISEP: NYSOFA expanded EISEP to increase opportunities for consumer direction. NYSOFA published a Notice of Adoption in the New York State Register which allows Consumer Directed In-home Services to be implemented statewide. NYSOFA is in the process of developing guidance documents for the purpose of directing and assisting local AAAs with the implementation of Consumer Directed In-home Services.
- Increasing cost sharing opportunities: Per New York State's grant application to AoA, the NHDM and CLP included the use of Titles III-B, III-C-2 and/or III-E funds in the demonstration in addition to State funds for programs that provided similar or the same services. Following guidance from AoA, cost sharing under these federal funding streams is allowable.
- Further expansion of CLP: NYSOFA is exploring ways to expand AAAs ability to target older adults most at risk of nursing home placement and Medicaid spend-down. Additional funds dedicated towards the provision of services for this cohort will have significant impact on the consumer's quality of life as well as provide fiscal relief in the case of providing long term services and supports.