>>SLIDE 1 CIL-NET Presents… Paving the Way for Nursing Home Transition A National Teleconference & Webcast Monday, August 18, 2008 3:00 PM – 4:30 PM EDT Presenter: Judy Roy, Independent Living Resources of Greater Birmingham: 206  13th Street S. / Birmingham, AL 35233-1317; Phone: 205.251.2223 ext 102; Email: bhamilc1@bellsouth.net >>SLIDE 2 Learning Objectives * Describe strategies for locating and connecting with individuals wanting to transition out of nursing homes * Explain how to build rapport with consumers for productive and effective interactions * Describe importance of the initial assessment of the individual’s needs and the critical role of planning to ensure success * Identify strategies for building good working relationships with institutional staff, family members, and others who either support or challenge the transition >>SLIDE 3 Supreme Court Decision: Olmstead vs. L.C. * Changed landscaped for disability advocates * Provides framework to support persons to transition out of nursing homes into the community * Supports persons to remain in the community and not be placed in institutions >>SLIDE 4 Setting the Stage: ADA and Olmstead * 1990 ADA signed into law * Title II prohibits discrimination in provision of public benefits and services – Shall administer in most integrated setting appropriate to individuals’ needs * Olmstead vs. LC – went all the way to the Supreme Court >>SLIDE 5 What the Decision Says * The unnecessary segregation may constitute discrimination based on disability * ADA may require states to provide community-based services rather than institutional placements * Programs should be conducted in the most integrated settings appropriate to the needs of individuals * Unjustified isolation is considered discrimination >>SLIDE 6 What is Successful Transition? * Much more than a physical change * Increasing sense of self-direction and decision-making * Becoming a full participant in community activities * As transition facilitator, you have a critical role >>SLIDE 7 Transition Facilitators * Facilitator - someone who aids or assists in a process, especially by encouraging people to find their own solutions to problems or tasks * Partners with someone with disabilities who wishes to live in the community and requires community-based supports and services * Provides support and is a peer mentor >>SLIDE 8 Role of the Transition Facilitator To be an effective peer mentor: * Understand what brought them to the nursing home * Be a good listener who hears both words and the feelings * Acknowledge emotions of fear, anger, and anxiety >>SLIDE 9 Role of the Transition Facilitator, cont. * Be knowledgeable about community supports and services * Provide accurate information in a timely manner – don’t overpromise * Explore options – don’t just push what you think is best >>SLIDE 10 Critical Components that Contribute to Success * Developing trusting relationship * Conducting comprehensive assessment that clearly reflects needs, concerns, and priorities * Developing and implementing a Transition Plan >>SLIDE 11 Guiding Principles * Self-Determination – ability or right to make your own decisions without interference from others * Dignity of Risk – making choices about new experiences and possibilities >>SLIDE 12 Self-Determination * Nursing home environment – choices are made for the individual * For an individual, it can be challenging to suddenly be in charge * This is a PROCESS – as transition facilitator, you need to provide support >>SLIDE 13 Dignity of Risk * Overprotection can smother people emotionally, stripping them of their dignity * Many great achievements involve taking risks * There can be healthy development in prudent risk taking >>SLIDE 14 Questions? >>SLIDE 15 Locating Individuals Who Wish to Transition * CIL may already have a list of consumers who have expressed interest * Outreach to nursing home administrators and other staff * Nursing Home Ombudsman Program >>SLIDE 16 Locating Individuals cont. * Referrals from peers * Mailings to nursing homes >>SLIDE 17 Locating Individuals – examples * Utah CILs and Area Agencies on Aging partnered to identify transition candidates. * Georgia CILs collaborated with a nursing home chain to identify residents. >>SLIDE 18 Locating Individuals – examples cont. * CIL in Charlotte, North Carolina offers CEU credits to nursing home social workers who attend training on nursing home transition. * Advocates performed in a choir at a nursing home, using that event as an opportunity to meet nursing home residents. >>SLIDE 19 Locating Individuals – examples cont. * Texas and others use their state CMS assessment data (Q1a) to determine prospects for transition. >>SLIDE 20 Understand Nursing Home Residents’ Rights * Used to facilitate access and communication with nursing home residents. * May need to remind nursing home staff. >>SLIDE 21 Nursing Home Bill of Rights * associate and communicate privately and without restriction with persons and groups of the patient’s choice, on the patient’s initiative or that of the persons or groups at any reasonable hour; >>SLIDE 22 Bill of Rights cont. * send and receive mail promptly and unopened, unless the patient is unable to open and read personal mail; * have access at any reasonable hour to a telephone where the patient may speak privately; and * have access to writing instruments, stationery, and postage. >>SLIDE 23 Residents’ Rights of Access * Have the right to allow or refuse any visitor entry to their room. * Have the right to immediate access to family and reasonable access to others. * Visiting hours must be at least 8 hours a day and must be posted. >>SLIDE 24 Residents’ Rights of Access cont. * Members of any community organization may visit any nursing home during posted visiting hours. * Communication between visitors and residents is confidential. * Resident has right to private meeting with a CIL staff member. * CIL staff is under no obligation to divulge the nature of conversation with any resident, to nursing home staff. >>SLIDE 25 Residents Have the Right to: * be treated with dignity, respect, courtesy and consideration without regard to race, religion, national origin, sex, age, disability, marital statues or source of payment. * make their own choices regarding personal affairs, care, benefits and services. * be free from abuse, neglect and exploitation. >>SLIDE 26 Rights continued * live in safe, decent and clean conditions. * participate in planning treatment and care. * be transferred or discharged only for medical reasons. * voice grievances without retaliation. >>SLIDE 27 A Word about Guardianship * What it is * How it works * When to seek legal advice >>SLIDE 28 Questions? >>SLIDE 29 Importance of Comprehensive Assessment * One of the first steps is conducting the assessment * Series of meetings to develop trust in facilitator and process * Purpose – identify individual’s strengths, abilities and wishes, and additional issues >>SLIDE 30 Key Factor in Successful Community Integration * The level of community supports available to the individual, not the type or severity of disability * Goal is not matter of readiness, it’s the assumption that individuals can achieve success with supports and services >>SLIDE 31 Assessment: Getting Started * Requires significant commitment of time and energy * Planning is critical * Initial interview – do not rush process; may take more than one appointment >>SLIDE 32 Conducting Interview * Let the individual be the “leader” in the process * Listen and assist with expressing desires * Take time – don’t rush, even if you don’t get all needed information on first visit >>SLIDE 33 Items to Accomplish * Get acquainted to work comfortably together * Explain and discuss overall strategy * Support individual in taking the lead; review all information together * Discuss transition process and overall schedule * Explain confidentiality and obtain verbal and written consent >>SLIDE 34 Health Insurance Portability and Accountability Act (HIPAA) * Goal: to ensure confidentiality and security of personally identifiable healthcare information * “Personal information” – name, age, address, SSN, Medicaid/CHIP number, income or other financial information, including health care and treatment >>SLIDE 35 Health Insurance Portability and Accountability Act (HIPAA), cont. * Privacy rights must be guaranteed – Obtain written authorization before accessing any health care or other identifiable information – Give individuals clear, written explanations of how this information will be used – Respect individual’s request to restrict the uses and disclosures of information >>SLIDE 36 Ensure Privacy Safeguards * Avoid using names in offices, hallways and elevators; post signs to remind employees to protect confidentiality * Isolate or lock file cabinets or records rooms * Provide additional security, such as passwords, on computers maintaining personal information * Fax information only to secure fax machine with authorized receiver standing by * Limit how much protected personal information is used, disclosed, and requested for certain purposes >>SLIDE 37 Successful Interviewing Steps – Keys to Effective Interactions * Always be on time * Dress casually * Choose appropriate location * Position yourself at eye level contact * Take only essential notes * Respect personal space and equipment * Interview the person alone >>SLIDE 38 Successful Interviewing Steps – Keys to Effective Interactions, cont. * Listen; don’t interrupt * Do not make promises you can’t keep * Ask about activities in the facility * Ask about previous favorite community and social connections and future desires * Schedule next appointment >>SLIDE 39 Building Relationships with Nursing Homes, Family, and other Supports * Involve nursing home staff from beginning * This can significantly reduce workload * Offer training from the local CIL to establish a positive relationship * Involve Ombudsperson, especially if staff are not receptive to your visits >>SLIDE 40 Working with Family Members and Other Support People * Good support system increases likelihood of successful transition * Get families and friends involved in the transition process as early as possible * Be aware that some families may oppose the move; with consumer’s consent: – keep them informed – have them attend planning meetings – encourage them to visit the housing >>Slide 41 Questions? >>SLIDE 42 Wrap up and Evaluation