using core ndicators in federal hcbs reviews jon fortune, ed.d david heath, mpa

Using CORE NDICATORSin Federal HCBS Reviews

Jon Fortune, Ed.DDavid Heath, MPA

Wyoming Developmental Disabilities Division& the Wyoming INstitute for Disabilities

(WIND-UCE)

HCBS Quality Framework ProtocolRed - Indicates that information gathered by Core Indicators

provides data that can be reviewed by CMS

Domain Sub-Domain

I. Participant Access A. Information/referralB. Enrollment

II. Participant-centered A. Participant-centered service planningService planning and B. Service DeliveryDelivery

III. Provider Capabilities A. Provider Networks & AvailabilityB. Provider QualificationsC. Ongoing Monitoring

HCBS Protocol (cont.)

Domain Sub-Domain

IV. Participant safeguards A. Abuse, neglect, exploitationB. Major & unusual IncidentsC. Housing & environmentD. Behavior interventionsE. Medication management F. Personal safety & securityG. Natural disasters

V. Participant rights & A. Grievances Responsibilities B. Due process

C. Fundamental Rights

HCBS Protocol (cont.)

Domain Sub-Domain

VI. Participant outcomes & A. Participant satisfaction Satisfaction B. Participant outcomes

VII. System performance A. System performance appraisalB. Continuous quality improvement

C. Cultural competencyD. Participant & stakeholder involvementE. Financial integrity

Several other features in addition to 150 core indicators helped:

• Use CARF…The Rehabilitation Accreditation Commission’s national standards for 3 waivers

• Individual waiver budget technology (DOORS)with good system architecture

* Extensive rules/training • RN, CDDN consultation • Published service provider site survey

reports http://ddd.state.wy.us

‘02 & ‘03 Results – Wyoming(Consumer Survey)

Wyoming’s performance was strong along four principal scales – community inclusion, support-related choices, personal choices, and service coordination

Satisfaction with Work/Day Satisfaction with Work/Day Program Program (Consumer Survey)(Consumer Survey)

20012001 20022002

89.1% (n=264)89.1% (n=264) -YES --YES - 94.2% (n=260)94.2% (n=260)

5.7% (n=17) 5.7% (n=17) -In between--In between- 4.3% (n=12) 4.3% (n=12)

5.0% (n=15) 5.0% (n=15) -NO--NO- 1.4% (n=4) 1.4% (n=4)

Satisfaction with ResidentialSatisfaction with Residential(Consumer Survey)(Consumer Survey)

20012001 20022002

89.4% (n=288) 89.4% (n=288) -YES--YES- 89.7% (n=272) 89.7% (n=272)

3.4% (n=11) 3.4% (n=11) -In Between--In Between- 5.6% (n=17) 5.6% (n=17)

7.1% (n=23) 7.1% (n=23) -NO--NO- 4.6% (n=14) 4.6% (n=14)

Case Management - 2002 Case Management - 2002 (Individually-Selected Service Coordination)(Individually-Selected Service Coordination)

(Consumer Survey)(Consumer Survey)

94.7% know their case manager94.7% know their case manager

93% say their case manager helps them 93% say their case manager helps them get things that they need if they askget things that they need if they ask

89.6% say that their case manager asks 89.6% say that their case manager asks them what they wantthem what they want

Case Management Case Management (Family Surveys)(Family Surveys)

80.9% (combined total)80.9% (combined total)

Satisfied With Services Provided by Case ManagerSatisfied With Services Provided by Case Manager

71.3% Adult/Family71.3% Adult/Family

89.1% Child/Family89.1% Child/Family

78.2% Family/Guardian78.2% Family/Guardian

(Thanks Washington State and Lisa Weber!!!)(Thanks Washington State and Lisa Weber!!!)

General InformationGeneral Information

91.6% (n=372) get the services that they need 91.6% (n=372) get the services that they need (66% of those answering were consumers)(66% of those answering were consumers)

3.1% of agency boards are consumers3.1% of agency boards are consumers

19.8% of boards are family members19.8% of boards are family members

Community Inclusion is high Community Inclusion is high (often @ 90%)(often @ 90%)

Choice and decision making was high Choice and decision making was high (most had input)(most had input)

Range of annual per person expenditure by living arrangement (2002)

Minimum Maximum Average Living Arrangement

$1,800 $187,270 $31,657 1 With parents or relatives

$32,700 $73,447 $58,745 2 Foster Home

$1,800 $109,187 $21,009 3 Independent in own home or rental unit

$1,800 $135,760 $36,361 4 Independent with regular home-based services or monitoring

$21,528 $185,432 $59,897 6 Semi-independent unit with supervisory staff in bldg.

$9,864 $299,134 $82,648 7 Group residence with staff providing care, supervision and training

$26,500 $173,130 $75,570 8 Personal care facility with staff providing care, but no training or nursing services

Mortality, Serious Injury and Mortality, Serious Injury and Abuse/Neglect (2002)Abuse/Neglect (2002)

CMS reviewers liked: CMS reviewers liked:

NCI definitions of abuse/neglect NCI definitions of abuse/neglect (and that (and that information was broken down in respect to restraints, injuries, and information was broken down in respect to restraints, injuries, and “substantiation”)“substantiation”)

NCI breakdown of mortality NCI breakdown of mortality (by age and total (by age and total number in each population bracket)number in each population bracket)

NCI breakdown and definition of crimes NCI breakdown and definition of crimes (forcible rape, aggravated assault, larceny theft)(forcible rape, aggravated assault, larceny theft)

673 Workers Needed Today

Direct service staff members $5.66 Need $10.23(Core Indicator: staff pay and turnover)

Funded July 1, 2002 Wyoming Legislature

Turnover rate: 50%

HELP WANTED

Contact Informationhttp://www.hsri.org/cip/core.html

National Core Indicators Web Site

Jon Fortune, Ed.Djfortu@state.wy.us

307-777-7115

David Heath, MPAdaheath@uwyo.edu

307-766-2609

DDD Wyoming Web Sitehttp://ddd.state.wy.us

http://wind.uwyo.edu/wycip/Wyoming Core Indicators Web Site