Dear list members,
This has been a thought provoking discussion - started in response to
Ivan's situation, but realizing that any of us could be facing the same
problems down the road.  Or already are. While I don't know all the
details of Ivan's case or the Medicaid rules in Maine,  I do know Ivan
and I are exactly the same age (almost 51). I also know I would not
willingly go into a nursing home in NewYork State at this point in my
life. (at least not without a fight)

First to clarify from my last posting  -- I believe  the federal grants
mentioned are for planning implementation of community based care --
similar to what Missouri has done -- not to pay for the services
themselves. (SEE BELOW)  Sorry, this wasn't stated clearly.

I think Camilla is right that the proposals for commuity based care will
be comprised of different levels of sevices, based on individual needs.
And creative planning is needed to devise new options and ways of
delivering cost-effective, coordinated services in the community.

Also as HIlary said -- each state is different in terms of  the type of
services available and the amount of payments. Some states have a greater
percentage of disabled people in nursing homes than others. Some offer
more comprehensive services that allow more disabled people to remain in
their communities. According to the workshop speakers, the way Medicaid
is structured now -- it generally favors institutional caare over
community care. By offering states more flexibility, the goal is to turn
this around.

Another issue brought up was improving nursing home services and making
them more accountable -- Nancy posted a great list of recommendations.

The web sites listed in my previous post contain alot of good
information.
I just also found that the Missouri  Home and Community Based Services
and Consumer Directed Care Commission has their report online.
PLEASE READ THIS -- I thinkk it is a model of what is meant by Olmstead
Planning, and provides possible answers to many of the good questions
raised.

****Working Plan of the Home and Community-Based Services and
Consumer-Directed Care Commission
http://www.dolir.state.mo.us/gcd/Olmstead/OlmReport/CoverPage.htm
(Note: from the introduction page you have to click on Tables 18-21 -->
to get into the body of the report)

Index to other Missouri Olmstead documents
http://www.dolir.state.mo.us/gcd/Olmsteadindex.html

fact sheet -- with costs and funding info.
http://www.dolir.state.mo.us/gcd/Olmstead/hfsheet.htm

To briefly summarize what  the planning commission did:
        * Identify the current number of and current level of funding for
home
     and community-based services and consumer-directed care programs for
     individuals with disabilities in the State of Missouri
   * Develop a tool or mechanism for assessing the effectiveness of these
     services and programs in addressing the needs of individuals with
     disabilities
   * Identify the number of individuals with disabilities in the State of
     Missouri that are institutionalized
   * Identify the number of waiting lists for home and community-based
     services or consumer-directed care programs and evaluate the pace at
     which individuals move from these lists;
   * Examine whether existing programs and services provide individuals
     with disabilities who may be eligible for community-based treatment
     with information regarding this option.
   * Recommend any modifications or changes that may be needed to improve
     existing home and community-based services and consumer-directed
care
     programs
   * Recommend any potential means of expanding home and community-based
     services or consumer-directed care programs; and
   * Develop a process for transitioning individuals with disabilities
who
     are institutionalized and who are eligible for community-based
     treatment into community-based treatment settings.

To obtain the view of the general public, local public hearings were held
in six locations throughout the state of Missouri.  Also involved were
representatives of state government, agencies, legislature, advocacy
organizations AND the disabled and their families.

Some findings
FACT SHEET ON LONG TERM CARE SYSTEM IN MISSOURI

1. SPENDING ON LONG TERM CARE

               · In 1998 Missouri spent 73% of Medicaid long term care
               dollars on institutional services. This includes nursing
               homes, institutional care facilities for the mentally
               retarded (ICR/MR) and residential care facilities.
(figures
               from Health Care Financing Administration reports)

               · In 1998, Missouri spent only 27% of Medicaid long term
               care dollars on home and community-based services. This
               includes personal assistance services and services through
               the MR/DD waiver (personal assistance, assistive
technology,
               habilitation, respite). (figures from Health Care
Financing
               Administration reports)

               · In FY98, the average annual cost per person in a nursing
               facility was $31,765. The average annual cost per
recipient
               of home and community services was $3,731. (Missouri
               Division of Aging Missouri Care Options Annual Report,
               Fiscal Year 1998).

These Missouri commission web sites actually have much more info than the
handouts I offered to send. But if anyone can't access them, or would
like a print copy of the Executive Summary  - send me you snail mail
address (off list).
I hope this discussion will continue -- who knows what new ideas or
solutions could result.
Linda
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