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 [log in to unmask]