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Nursing Home Resident Relocations

Nursing Home Resident Relocations. Age Odyssey June 17 th , 2013. Objectives. Overview of the law, history, scope and applicability Overview of resident relocation process Know where to find helpful resources Be prepared with strategies to meet challenges that may arise .
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Nursing Home Resident RelocationsAge OdysseyJune 17th, 2013Objectives
  • Overview of the law, history, scope and applicability
  • Overview of resident relocation process
  • Know where to find helpful resources
  • Be prepared with strategies to meet challenges that may arise
  • Resident Relocation ProcessWhat is it all about ?A thoughtful and systematic approach to the relocation of residents in situations where a nursing facility (NF)is undergoing a partial or complete closureNursing Facility (NF) Closure HistoryIn the MA program:Total NFs (1998) = about 434NFs closed about 75New NFs about 14Today = 373Closure Historynot counting partial closures or changes in operations where resident relocations also occur
  • 1998 3
  • 1999 0
  • 2000 13
  • 2001 4
  • 2002 6
  • 2003 6
  • 2004 10
  • 2005 6
  • 2006 3
  • 2007 6
  • 2008 6
  • 2009 3
  • 2010 3
  • 2011 2
  • 2012 3
  • 2013 1 (as of 5/1/13)
  • Pre-Resident Relocation Law Concerns
  • Closures went very fast
  • Residents often received little or no notice
  • No information about where residents went
  • Residents were often given no choice
  • Intent of the Resident Relocation Law
  • To recognize that involuntary relocations can be especially difficult for nursing home residents – to reduce transfer trauma
  • Expecting that new state policies would lead to some closures – to be prepared
  • To provide equity in access to available beds/services
  • To provide oversight
  • Development of the LawParticipants included:
  • Minnesota Department of Health (MDH)
  • Minnesota Department of Human Services (DHS)
  • Counties
  • Ombudsman
  • NH trade associations
  • Provider representatives
  • Purpose of 2013 revisions
  • Align with new federal regulations
  • Incorporate twelve years of experience, current practice and circumstances and best practices
  • Clarify and simplify the language
  • Reduce unnecessary burden on all parties
  • Facility Costs
  • Concerns over facility costs of compliance
  • 50% rate increase
  • Accountability
  • Overview of Process
  • Initial notice from licensee
  • Coordinated planning process
  • facility interdisciplinary team
  • county of location involvement
  • ombudsman involvement
  • notice to Managed Care Organizations (MCOs)
  • notification to and possible involvement of DHS/MDH
  • Overview of Process
  • Development of the “relocation plan”
  • agreement of parties on the process
  • identify residents, resources and timelines
  • what best meets needs of residents
  • Facility begins reporting the week following development of relocation plan
  • Overview of Process
  • Notice to residents/family by closing facility
  • 60 day notice of closure
  • meetings with families/resident councils
  • Preparation for resident relocation
  • sufficient preparation
  • relocation options/information
  • site visits
  • transfer or retention of medical records and forms
  • resident property, communication devices
  • Overview of Process
  • Licensee provides final discharge notice
  • resident
  • responsible parties
  • managed care organization, if applicable
  • physician
  • Overview of Process
  • Physical relocation of residents
  • facility responsible for transport of resident
  • facility responsible for transport of property & funds
  • facility responsible for reconnection of communication devices
  • facility must provide staff escort
  • no disruption in meals or treatment
  • Overview of Process
  • County Role
  • participatory
  • helps to coordinate relocation process
  • serves as a resource
  • monitors facility compliance with plan
  • reports to state
  • conducts follow-up assessments
  • Overview of Process
  • Other noteworthy provisions
  • refrain from public notice of closure (until 60 day notice)
  • no new admissions after notice (on complete closures only)
  • licensee and administrator bear responsibility
  • Definitions
  • change in operations/closure/reduction
  • facility types
  • “responsible party”
  • Initial Notification Process
  • allows MCOs to begin planning process
  • may provide additional resources in relocation process, through MCO involvement
  • allows county to begin determining the involvement of other case managers
  • Initial Notification Process
  • allows county to conduct some advance planning for individuals with special needs
  • clarifies facility responsibilities and allows county to monitor changes
  • Initial Notification Process
  • facilities still face difficulty identifying specific county contacts
  • challenges with multiple party involvement and the risk of public “leak” of closure
  • Planning Process
  • ensures that parties are working together, by instituting a deadline for developing the relocation plan
  • provides for an outline of items included in the plan
  • community assessment by lead agency will assist residents seeking alternative placements
  • Planning Process
  • difficulty in finding the right county staff contact person may result in delays or could result in the county not being in compliance with their role in process - NF follow up needed
  • places responsibility of sharing information with MCOs on other parties, when MCO not involved in planning
  • Responsibilities of Licensee
  • outlines facility responsibilities
  • outlines repercussions if out of compliance with statute
  • Responsibilities of Licensee, cont.
  • 60 day notice to residents and others
  • census concurrent with notice
  • weekly status reports
  • MCO
  • Placement Information
  • sufficient preparation and options allow for resident placement choice
  • lead agency assessors can identify relocation options other than NFs
  • Placement Information
  • finding community options takes time and is difficult under time pressures
  • Meeting withResidents/Responsible Parties and Site Visits
  • county/ombudsman should be present at each meeting to assist, answer questions and provide assurances and options
  • county/ombudsman presence essential for problem-solving and successful transitions
  • having facility responsibility for site visits in writing clarifies their responsibility and allows for resident choice
  • Meeting with Residents/Responsible Parties and Site Visits
  • if facility ill-prepared, creates difficult position for county and ombudsman
  • Resident Property, Funds and Communication Devices
  • Property
  • Funds
  • Communication devices
  • Final Written Discharge Notice & Responsibilities During the Relocation
  • final notice
  • notification
  • process of discharge
  • date of discharge
  • Responsibilities of County Social Service Agency
  • flexibility in staff assignments
  • county as a resource is especially important for potential HCBS services
  • lead agency community assessment will assist residents seeking alternatives
  • Responsibilities of County Social Service Agency
  • required concurrent resident notice by county agency provides residents/responsible party with added assurance that process will be followed and advocacy provided
  • county serves as monitor for state regulatory agencies and on behalf of MCOs (when applicable)
  • Responsibilities of County Social Service Agency
  • county role in this process remains unfunded
  • no direction on what unit of county government should be responsible for participating in meetings and these activities
  • Role of Ombudsman
  • Monitor and protect resident rights
  • Investigate complaints
  • Monitor quality of care for residents
  • Provide technical assistance to facility staff
  • Participate in planning process
  • Resident follow-up visits
  • Resident Rights
  • To be treated with respect, dignity, and consideration
  • Right to choice and individual preference
  • Freedom from abuse and unnecessary restraints
  • Freedom of association and communication
  • Right to not be transferred without proper notice
  • Right to make complaints and express grievances
  • Right to keep possessions
  • Transfer TraumaWhat is it?“combination of medical and psychological reactions to abrupt physical transfer that may increase the risk of grave illness or death”Transfer TraumaCharacteristics:
  • Depression manifesting as agitation
  • Increase in withdrawn behavior
  • Confusion
  • Change in eating and sleeping habits
  • Transfer TraumaCharacteristics, cont.:
  • Self-care deficits
  • Increase in falls
  • Diagnoses of dementia and Alzheimer's: exaggerated symptoms, including hallucinations and delusions
  • PerspectivesResident:
  • “Little things all add up to important things”
  • “The resident council needs to be more proactive...”
  • “ What will happen to my belongings, what if things get lost or broken?”
  • “Can I see the new place first?”
  • “I want the same staff to care for me at the new place”
  • PerspectivesFamily:
  • “I don’t want my husband to move”
  • “Will this cost more money?”
  • “We know what is best for our loved one”
  • “Need for a strong family council…”
  • Resources
  • Relocation Resource Guides
  • Nursing Facility Resource Guide
  • County Resource Guide
  • Local County Social Services Agency
  • DHS or MDH staff
  • Office of Ombudsman for Long-Term Care
  • Q &AAudience Questions ?Thank You !
  • Sue Fehr, Hennepin County
  • Robert Held, MN Dept. of Human Services (DHS)
  • Cheryl Hennen, Office of Ombudsman for Long-Term Care
  • Thom Johnson, Ramsey County
  • Louise Starr, Dakota County
  • Munna Yasiri, MN Dept. of Human Services (DHS)
  • Questions ?Contact:Munna Yasirimunna.yasiri@state.mn.us(651) 431-2264
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