Community Integration and Employment: Innovations in LTC

and MFP Doug Stone, Technical Consultant,

Center for Workers with Disabilities

Americans With Disabilities Act

“Integration of individuals with disabilities into the mainstream of society is fundamental to the purposes of the Americans with Disabilities Act.”

U.S. Department of JusticeCivil Rights DivisionDisability Rights Section

Rebalancing Long-Term Care System

• CMS Definition: reaching more equitable balance between the proportion of total Medicaid long-term support expenditures used for institutional services (i.e. Nursing Facilities and Intermediate Care Facilities for the Mentally Retarded) and those used for community-based supports under its state plan and waiver options. Additionally, a balanced long-term care system offers individuals a reasonable array of balanced options, particularly adequate choices of community and institutional options.

National Medicaid Nursing Home vs. HCBS Expenditures

• In 2008 for Aged and Disabled– Nursing Homes $49 Billion 68%– HCBS $22 Billion 32%

Data From the Minimum Data Set

• The MDS Q1a report summarizes, by state and county, percentages of residents that answered "yes" to Q1a: Residents expresses/indicates preference to return to the community. For the 2nd Quarter 2010:– 313,800 persons in nursing homes indicated

they would like to return the community– 60,000 of those are under the age of 65

-6-

One major predictor of a successful placement in the community, instead of a NF, is the resident’s

length of stay.

0%

10%

20%

30%

40%

50%

60%

70%

80%

Community Deceased Other Institution

Hilltop Refined MDS data for Maryland, Extended Stays w/Discharge 1999-2008,

limited to the stays that convert to Medicaid

Days

-7-

Yet by the time many residents convert to Medicaid, the odds of community integration

are low.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

30 60 90 120 150 180 210 240 270 300 330 360 390 420 420+

Discharge to Community Transition to Medicaid

Hilltop Refined MDS data for Maryland, Extended Stays w/Discharge 1999-2008,limited to the stays that convert to Medicaid

Days

Major Influences on the Development of Community

Integration• Olmstead

• New Freedom Initiative

• Money Follows the Person

• Consumer Directed Care

• Health Care Reform

Integration into the Community

• The goal is to provide living arrangements that include the necessary services and supports to assist an individual to meet the basic activities of daily living.

• For some persons with disabilities, however, community integration includes more complex life activities such as employment and the enhanced social interaction that comes from being employed.

A Least Restrictive Environment Continuum

Nursing Home-----------------------------HCBS*

*Home and Community Based Services

An Community Integration Continuum

Nursing Home-------HCBS*-------Employment

*Home and Community Based Services