Long-term Care Consultation Expansion – Results to Date

Krista Boston, Director-Consumer Assistance Programs

Minnesota Board on Aging

Elissa Schley, MinnesotaHelpNetwork™ ConsultantMinnesota Board on Aging

Background

• 2007– Legislature amended Minnesota Statutes, Section

256B.0911 governing Long Term Care Consultation Services to include a new service called transitional consultation service for people entering assisted living.

Background

• During the 2009 and 2010 sessions Senators and Representatives requested a revised proposal from DHS to implement this service as a requirement for consumers.

• DHS presented these proposals – there was testimony in committees

• These were called “mandatory transitional consultation. The proposals had a variety of level of interest by the committees.

• A revised proposal was requested during the 2011 special session and was adopted as Long Term Care Consultation Expansion.

Background

• 2011– Legislature amended the same statute to require all registered

housing with services to give the information with some exceptions.• Deadline for implementation was October 1, 2011 (a Saturday)• Consumers are required to call for long term care options

counseling and seek verification. Providers are required to put a verification code in their file.

LTCC Consultation Expansion

• LTC Optlons Counseling (LTCOC) provided by the SLL– estimated to reach 30,000 annually

– Increase phone based LTCOC provided by the Senior LinkAge Line®

• Increase face-to-face LTCC services (1800 annually) delivered by counties, health plans and tribes

• Results in savings to the Medicaid Elderly Waiver program

Involvement of Stakeholders

• Stakeholders include:– Representatives from Aging Services of MN, – Care Providers, – Counties, – Health Plans,– Ombudsman Office, – Area Agencies on Aging and Senior LinkAge Line® staff, – DHS (Health, Aging and Disability Services) and MDH staff, and– Recently added - AARP.

Stakeholder Input• Processes have had significant influence through ongoing stakeholder

input via meetings, emails and phone calls– Service definitions

• After hours form• Ability to opt out• Subsidized housing exemption (lease only arrangements)

– All the materials• Brochures and Aging in place packet• Step by Steps for various audiences• Web page content• Linkage Line Client Tracking• Dashboard production requirements

LTCC Expansion Service Requirements under State Law

• Information has to be made available to prospective Housing with Services residents. There are exemptions.

• When the call comes in, the SLL must provide Transitional Housing with Services Consultation within five working days of the request of the prospective resident.

• A face-to-face LTCC visit may be requested by the client or caregiver, without regard to resource level, as a result of participating in the Transition to Housing with Services Consultation

• The AAAs have implemented a follow-up strategy, the follow-up occurs 10 days after initial call to the SLL.

Senior LinkAge Line® and Counties• Take the calls• Perform the rapid screen – identify the risks for the caller• For high risk callers – refer them to LTCC at county for more in depth

assessment and counties schedule face to face based on caller’s preference and needs.

• For low and medium risk callers – identify ways to age well and live well.• All callers will be offered an age in place packet.• Verification of counseling through a random numeric code will be

generated and provided to the prospective resident by Senior LinkAge Line® upon completion of the telephone-based counseling.

The Rapid Screen

SLL asks consumer about any challenges with the following:• Walking

• Going to the bathroom

• Dressing

• Injurious fall or 3 or more falls in last 6 months

• Considered housing move to nursing home or housing with services

• Memory – very concerned

• Getting out of bed/chair

• Bathing

• Eating

• Caregiver not available

• Stressed caregiver

• Live alone

• Memory – somewhat concerned

The ProtocolSLL actions based on Risk Level results• High Risk

– SLL connects consumer, with their consent, via a 3 way call to the county Long-term Care Consultant for a face-to-face assessment and schedules appointment

– SLL follows up with consumer in 10 days to check in to see what the consumer decided

• Moderate Risk– SLL provides risk management

assistance

– SLL uses LTC Navigator for a “light support plan” if consumer wants help seeking and setting up HCBS

SLL actions based on Risk Level results• Low Risk

– SLL uses LTC Navigator for a “light support plan” if consumer wants help seeking and setting up HCBS

All callers are offered an Age in Place Packet.

IMPORTANTWithout regard to Risk level, SLL provides

Long-term Care Options Counseling and information about the LTCC based on the consumer’s request.

The Verification Number

• Eleven digit: Alphanumeric• Provided by the consumer to the Registered Housing with

Services provider• Provider maintains the verification number in the consumer’s file• Verification number will be stored in

– MMIS

– SLL Tracking system

Exceptions and exemptions from the Process

• The following people will not have to go through Long Term Care Options Counseling (may still need a code):

– signed a lease or contract prior to October 1, 2011

– had a face-to-face Long Term Care Consultation assessment for eligibility determination purposes prior to October 1, 2011, i.e., consumers who are on waivers (LTCC will facilitate getting the code)

– went into a nursing facility and as a result of statutory requirements, received a face-to-face Long Term Care Consultation

– did not call for these purposes, but the Senior LinkAge Line® felt that they needed a risk screen, conducted it, and the results was a referral to the county (a code will be issued automatically)

– Those who have a lease-only arrangement in a subsidized housing setting (see definition on www.mnaging.org)

Prospective Residents:

• Are not: – people who live in the setting now.

– And are renewing a lease.

• But are:– People coming for a short term respite stay

– Are coming into a setting from a health care provider (include SNF, hospital or emergency room) and did not get a LTCC face to face.

– A spouse and a partner (each get a code)

Accomplishments• July 21st. State Staff return to work.• August 10th. Business Process Modeling with stakeholders• August 18 – September 8th Ten Road Shows conducted throughout Minnesota• September 22th - Two videoconferences held for all participants• September 23th - Letter and brochures mailed to providers (8,831) • September 26th - all changes to Senior LinkAge Line Tracking tools and Phone

(VOIP) system completed, tested and launched• September 27th – Senior LinkAge Line Contact Center Coordinators Trained• September 28th - Aging in place materials and packets finalized and sent to print

September 30th – Bulletin Issued, Step by Step Protocols completed and final FAQ updated after videoconferences and posted to web site

• September 30th – After hours form and database completed, tested and posted online

• September 30th – Calls start coming in….

• Senior LinkAge Line® received calls from some consumers based on literature handed out by the HWS and referrals by others.

Data Prior to October 1, 2011

SLL Data Results…10/1/08 to 7/31/11

Long-term Care Consultation Results…10/1/08 to 7/31/11

Service Delivery Challenges and Results to Date

• initially (Oct 3 – 6) the hold times were up to 30 minutes for (sufficient staffing, messaging on the line, hold time compounds)

– eventually went down to 30 seconds on average• LL Staff are getting better and more comfortable with the calls

(callers have all been responded to on same day)• About a 110 callers a day (50% declining) and of the rest 65%

of those that get the LTCOC screen out at high risk• 46% of people who are a resident representative are adult

children• Of those that decline 65% have already made a decision about

making a move

Dashboard Metrics• Number of Contacts Requesting Long Term Care Options Counseling for Registered

Housing with Services

• Reason for Move at Initial Call - High Risk Callers Only

• Percent of People Indicating Received a Uniform Consumer Information Guide (UCIG)

• Percent of Callers by Risk Category

• Number of Consumers Indicating No Move at 6 Months

• Average handle time for callers who press "1" to enter the RHWS/Sec. Q/NH queue.

• ASA (average speed of answer) for callers into RHWS/Sec. Q/NH queue.

• Median of Average Speed of Answer (Hold time)

• Customer Satisfaction for callers who completed LTCOC

• Number of Callers for RHWS that were referred to Lead Agency for an LTCC

• Summary of Reasons for After Hours Move

• Reasons For Declining LTCOC

• At Ten Day Follow Up - Received LTCC

• Reason Not Received (LTCC)

• Decision Made (to move)

• Decision Factors

• Number of Long Term Choices Navigator Sessions

• Persons Receiving Verification codes

• Age of People that Declined

• Age of People that accepted LTCOC

• Age of people screening out at High Risk

• Median and Average of People who called for a code

• Median and Average Handle Time

• Session length of callers who decline

• Session length of callers who got LTCOC

• Wait time on LTCC At counties

• Number of After Hours Forms Submitted

Dashboard Metrics

Thank you