Michigan Program for Michigan Program for Background ChecksBackground Checks

Michigan’s Long-Term Care Michigan’s Long-Term Care

ConferenceConference

March 24, 2006March 24, 2006

Statement of the ProblemStatement of the Problem Some LTC employees with direct access Some LTC employees with direct access

undergo background checks, but not undergo background checks, but not all.all.

Process was not Process was not comprehensivecomprehensive or or systematicsystematic, no appeal process, and , no appeal process, and limited training on abuse and neglect.limited training on abuse and neglect.

There is a shortage of qualified health There is a shortage of qualified health care workers. care workers.

Proportion of elderly and disabled is Proportion of elderly and disabled is increasing.increasing.

Current MI Background Check Current MI Background Check Laws and StatusLaws and Status

Currently only Nursing Homes, Currently only Nursing Homes, County Medical Care Facilities, County Medical Care Facilities, Homes for the Aged and Adult Foster Homes for the Aged and Adult Foster Care FacilitiesCare Facilities

Primarily of a “name” check on the Primarily of a “name” check on the Internet Criminal History Tool (ICHAT)Internet Criminal History Tool (ICHAT)

Not in state for at least three years Not in state for at least three years = FBI fingerprint check = FBI fingerprint check

Current MI Background Check Current MI Background Check Laws and StatusLaws and Status

Not Included: Psychiatric Hospitals, Not Included: Psychiatric Hospitals, Hospices, Home Health Programs, Home Hospices, Home Health Programs, Home Help, Long Term Care Hospitals, and Help, Long Term Care Hospitals, and ICF/MRs, New Health ProfessionalsICF/MRs, New Health Professionals

Does not include all federally prohibited Does not include all federally prohibited offenses and substantiated findings under offenses and substantiated findings under abuse and neglectabuse and neglect

Takes too long, inefficient, to often Takes too long, inefficient, to often inaccurateinaccurate

Michigan’s Response:Michigan’s Response:

September 2004, Michigan submitted September 2004, Michigan submitted Federal Background Check Pilot Federal Background Check Pilot Project Grant under the Medicare Project Grant under the Medicare Modernization Act of 2004Modernization Act of 2004

CMS awarded $5,000,000 over thirty CMS awarded $5,000,000 over thirty months beginning in January 2005months beginning in January 2005

One of Seven States in Pilot One of Seven States in Pilot

Michigan’s Response:Michigan’s Response:

Collaborative Partnership:Collaborative Partnership:• Michigan Department of Community HealthMichigan Department of Community Health• Michigan Department of Human ServicesMichigan Department of Human Services• Michigan State PoliceMichigan State Police• Office of Services to the AgingOffice of Services to the Aging• Michigan State UniversityMichigan State University• Multiple Advocacy and Provider GroupsMultiple Advocacy and Provider Groups• Background Check and AANP AdvisorsBackground Check and AANP Advisors

Michigan’s Response:Michigan’s Response:Six Key Features of the program: Six Key Features of the program:

Expand the Scope of Michigan’s LawsExpand the Scope of Michigan’s Laws• include Psychiatric Hospitals, Hospices, Home include Psychiatric Hospitals, Hospices, Home

Health, Long Term Care Hospitals, and ICF/MRs Health, Long Term Care Hospitals, and ICF/MRs (Michigan is including Home Help.) (Michigan is including Home Help.)

Strengthen Michigan’s Criminal Background Strengthen Michigan’s Criminal Background ChecksChecks• include prohibited offenses, substantiated findings include prohibited offenses, substantiated findings

of abuse and neglect, and registry checks of abuse and neglect, and registry checks

Michigan’s Response:Michigan’s Response:

Six Key Features (Cont.):Six Key Features (Cont.): Provide Due ProcessProvide Due Process

• Create an Appeal Process Create an Appeal Process Speed up the process--enhance Speed up the process--enhance

accuracy accuracy • Fixed and Mobile Locations (MSP Fixed and Mobile Locations (MSP

/Identix)/Identix)• Electronic Fingerprint (MSP)Electronic Fingerprint (MSP)• Web-based Provider Interface (MSU)Web-based Provider Interface (MSU)

Michigan’s Response:Michigan’s Response:

Six Key Features (Cont.):Six Key Features (Cont.):

Implement AANP Training Implement AANP Training • BEAM—(OSA, MSU, MPRO) BEAM—(OSA, MSU, MPRO)

Objective and rigorous evaluation Objective and rigorous evaluation • MSU (Background Checks and AANP) MSU (Background Checks and AANP) • Federal ContractorFederal Contractor

Legislation Legislation Process / DecisionsProcess / Decisions

Broad-Based Legislative CommitteeBroad-Based Legislative Committee• Met several times, plus subcommittees Met several times, plus subcommittees • March 2005-January 2006March 2005-January 2006• Consensus-based process Consensus-based process • Legislation takes effect April 1, 2006Legislation takes effect April 1, 2006

Federal CMS Compliance ReviewFederal CMS Compliance Review

Legislation Legislation Process / DecisionsProcess / Decisions

Decision Rules / Priorities Decision Rules / Priorities • Medicaid / Medicare FundingMedicaid / Medicare Funding• Quick Turn Around Quick Turn Around • Readily AvailableReadily Available• Full Federal Compliance Full Federal Compliance

Michigan Program for Michigan Program for Background ChecksBackground Checks

Fingerprinting Process Fingerprinting Process • Timothy Bolles, MSPTimothy Bolles, MSP

Research and Evaluation Research and Evaluation • Lori Post, MSULori Post, MSU

IT Interface IT Interface • Robert Fulk MSU Robert Fulk MSU

FINGERPRINTING PROCESSFINGERPRINTING PROCESS• TechnologyTechnology• Collection AgencyCollection Agency• Fingerprint Collection LocationsFingerprint Collection Locations• Fingerprint Collection Requirements Fingerprint Collection Requirements • Fingerprint Transmittal MethodsFingerprint Transmittal Methods

Michigan Program for Michigan Program for Background ChecksBackground Checks

Fingerprinting Process Fingerprinting Process • Timothy Bolles, MSPTimothy Bolles, MSP

Research and Evaluation Research and Evaluation • Lori Post, MSULori Post, MSU

IT Interface IT Interface • Robert Fulk MSU Robert Fulk MSU

RESEARCHRESEARCH&&

EVALUATIONEVALUATION

ResearchResearch

Michigan Survey of Households with Michigan Survey of Households with Family Members Receiving Long-Family Members Receiving Long-

Term Care ServicesTerm Care Services

Random Sample of Michigan HouseholdsRandom Sample of Michigan Households N=1002N=1002 Stratified by AANP TrainingStratified by AANP Training Provides baseline data of abuse, neglect, Provides baseline data of abuse, neglect,

and exploitation.and exploitation.

Total Abuse Incidents Last Year by Total Abuse Incidents Last Year by MarketMarket

Descriptives

Total abuse incidents last year

483 2.7650 7.59730 .34569 2.0858 3.4443 .00 66.00

488 2.9283 7.57170 .34275 2.2548 3.6017 .00 49.50

971 2.8471 7.58097 .24329 2.3696 3.3245 .00 66.00

1

2

Total

N Mean Std. Deviation Std. Error Lower Bound Upper Bound

95% Confidence Interval forMean

Minimum Maximum

ANOVA

Total abuse incidents last year

6.471 1 6.471 .112 .737

55740.568 969 57.524

55747.039 970

Between Groups

Within Groups

Total

Sum ofSquares df Mean Square F Sig.

ResearchResearch

Impact of Aging on Michigan’s Impact of Aging on Michigan’s PopulationPopulation

Labor Force IssuesLabor Force Issues

Aging Michigan PopulationAging Michigan Population

1970 to 20301970 to 2030 Population Estimates and Population Estimates and

Projections.Projections. Median age will increase by 5 Median age will increase by 5

years.years. Number of persons > 65 will double Number of persons > 65 will double Causation and correlates of abuse, Causation and correlates of abuse,

neglect, and exploitationneglect, and exploitation

EvaluationEvaluation

ProcessProcess

Impact Impact

OutcomeOutcome

Process EvaluationProcess Evaluation

Document the steps to implement the Document the steps to implement the legislation and new background legislation and new background check systemcheck system

Barriers and Obstacles for duplication Barriers and Obstacles for duplication in other statesin other states

Did we accomplish what we set out to Did we accomplish what we set out to do.do.

Impact EvaluationImpact Evaluation Impact of Background Check Impact of Background Check

System and legislation on System and legislation on reducing abuse, neglect and reducing abuse, neglect and exploitation.exploitation.

Compare before and after Compare before and after measures of abuse, neglect, and measures of abuse, neglect, and exploitationexploitation..

ADULT ABUSE & ADULT ABUSE & NEGLECTNEGLECT

PREVENTIONPREVENTION

DefinitionDefinition

The Adult Abuse & Neglect Prevention grant is a The Adult Abuse & Neglect Prevention grant is a program for direct access staff employees and program for direct access staff employees and managers of long-term care facilities and managers of long-term care facilities and providers of service to adults that addresses the providers of service to adults that addresses the issues that precipitate abusive behavior and issues that precipitate abusive behavior and provides preventive solutions for reducing provides preventive solutions for reducing incidents of abuse and neglect and for improving incidents of abuse and neglect and for improving the quality of care for patients with long term the quality of care for patients with long term illnesses or disabilities.illnesses or disabilities.

Facilities & ProvidersFacilities & Providers

Skilled Nursing Facilities/Nursing HomesSkilled Nursing Facilities/Nursing Homes Long Term Care Hospitals, Swing BedsLong Term Care Hospitals, Swing Beds Intermediate Care Facilities (ICFs/MRs)Intermediate Care Facilities (ICFs/MRs) Psychiatric HospitalsPsychiatric Hospitals HospicesHospices

Facilities & Providers (cont’d)Facilities & Providers (cont’d)

Assisted Living Facilities Assisted Living Facilities • including Adult Foster Care Homes & including Adult Foster Care Homes &

Homes for the AgedHomes for the Aged Home Health AgenciesHome Health Agencies Adult Services Home Help WorkersAdult Services Home Help Workers Individual personal care providers Individual personal care providers

not associated with personal care not associated with personal care agenciesagencies

Geographic RegionsGeographic Regions

Upper PeninsulaUpper Peninsula Midland/Saginaw/Midland/Saginaw/

Bay City/FlintBay City/Flint Southeast Michigan Southeast Michigan

including Detroitincluding Detroit Southwest Southwest

Michigan including Michigan including KalamazooKalamazoo

GoalsGoals

Create an expanded adult abuse and Create an expanded adult abuse and neglect prevention curricula neglect prevention curricula incorporating methods of staff incorporating methods of staff empowerment, culture change, and empowerment, culture change, and person-centered care.person-centered care.

Thus, leading to…Thus, leading to…

Increased staff awarenessIncreased staff awareness

Reduced abuse and neglect incidents Reduced abuse and neglect incidents by employeesby employees

Reduced abuse and neglect incidents Reduced abuse and neglect incidents by residents or patientsby residents or patients

Improved organizational cultureImproved organizational culture

Evaluate the impact of the Evaluate the impact of the background check information and background check information and the AANP training on recognition and the AANP training on recognition and reporting of suspected abuse and reporting of suspected abuse and neglect.neglect.

Establish a process to ensure AANP is Establish a process to ensure AANP is implemented on a regular basis after implemented on a regular basis after 2007.2007.

CurriculaCurricula

Definitions:Definitions:• ““What is abuse?”What is abuse?”

Reporting:Reporting:• Procedures for each Procedures for each

group of providersgroup of providers

Prevention:Prevention:• Conflict ResolutionConflict Resolution• Stress ManagementStress Management• De-escalation De-escalation

TechniquesTechniques• Person Centered Person Centered

Care PrinciplesCare Principles

Timeline…2005Timeline…2005

Establish collaborations Establish collaborations • (MDCH, OSA, MSU, PHI, CBC, WSU)(MDCH, OSA, MSU, PHI, CBC, WSU)

Convene Advisory CommitteeConvene Advisory Committee Develop curriculaDevelop curricula Identify & recruit trainersIdentify & recruit trainers

• 11 Primary Trainers11 Primary Trainers• 75-80 Specialized Trainers75-80 Specialized Trainers

Offer Orientations in each regionOffer Orientations in each region Identify and begin surveying participantsIdentify and begin surveying participants

Timeline…2006Timeline…2006

Ongoing communication with Ongoing communication with Advisory CommitteeAdvisory Committee

Trainers in placeTrainers in place Begin training of 11,000 DASBegin training of 11,000 DAS Review and modify curricula as Review and modify curricula as

neededneeded TeleSage Survey with MSUTeleSage Survey with MSU Compile DataCompile Data

Timeline…2007Timeline…2007

Ongoing communication with Advisory Ongoing communication with Advisory CommitteeCommittee

Complete training of 11,000 DASComplete training of 11,000 DAS Complete surveysComplete surveys Compile dataCompile data Draft proposed policy recommendationsDraft proposed policy recommendations Develop steps to implement AANP Develop steps to implement AANP

statewidestatewide

End ResultEnd Result

A statewide, tested, training program A statewide, tested, training program (including manuals) for all direct (including manuals) for all direct access staff in the long term care access staff in the long term care continuum that offers cognitive ways continuum that offers cognitive ways to prevent abuse.to prevent abuse.

Michigan’s Adult Abuse & Neglect Michigan’s Adult Abuse & Neglect Prevention Program is the pilot Prevention Program is the pilot selected by the Centers for Medicare selected by the Centers for Medicare & Medicaid Services to be offered & Medicaid Services to be offered nationwide to ensure the care, safety, nationwide to ensure the care, safety, and comfort of our vulnerable adults and comfort of our vulnerable adults in the long term care continuum.in the long term care continuum.

CONTACT INFORMATIONCONTACT INFORMATION

Gloria Lanum, MDCH--Background Gloria Lanum, MDCH--Background Check Grant Manager—Check Grant Manager—lanumg@michigan.govlanumg@michigan.gov

Lauren Swanson, OSA—AANP Grant Lauren Swanson, OSA—AANP Grant Manager—swansonla@michigan.govManager—swansonla@michigan.gov

Ellen Hayes, MSU—Background Ellen Hayes, MSU—Background Check Project Manager—Check Project Manager—hayse@msu.eduhayse@msu.edu