Real Choice Systems Change
Identified Problems with the State's Long-Term Care System
- Institutions are utilized more than community services.
- Lack of community housing alternatives.
- Uncoordinated access across LTC programs.
- Difficulties recruiting and retaining personal assistants.
- Insufficient funding for current waiver programs.
- Lack of consumer direction of caregivers.
- Creation of a Disability Services and Supports System Planning Group (DSSSPG) and a Consumer Task Force (CTF) to design and implement effective and enduring change in community long-term supports systems. The CTF functions as the steering committee for the larger DSSSPG. The activities of these groups will be largely funded with Real Choice grant funding but are also supported by in-kind from participating state agencies.
- Louisiana has very involved and active stakeholders from all perspectivesconsumers, providers, state agencies, legislators, community leaderswho are committed to improving the long-term care system of services and supports.
- The Department of Health and Hospital's vision is to move towards a continuum of long term care services, which will increase the availability of community-based services for the elderly and individuals living with disabilities. Support of this vision has been demonstrated by increased funding from the legislature for home and community-based waiver servicesan average annual expenditure growth rate of about 29 percent from FY9596 to FY0203.
- Dedication of a portion of interest earnings on a trust fund to increasing community-based, long-term care services and supports.
Primary Focus of Grant Activities
- Support the planning process of the CTF and DSSSPG.
- Develop and implement consumer-direction in HCBS waivers.
- Develop and implement a Workforce Development Project.
- Develop and implement Housing Pilot Projects.
Goals, Objectives, and Activities
Overall Goal. Identify and implement enhancements to the LTC infrastructure that will dramatically move the state away from a reliance on institutional care, by demonstrating cost efficiencies, improved consumer satisfaction and outcomes, and increased integration of a full continuum of long-term care services.
Goal. Support the planning process of the CTF and DSSSPG.
- Provide CTF and collaborators with information regarding Louisiana's long-term care services and supports and community-based, long-term care initiatives in other states that may be applicable in Louisiana for planning purposes. This information will be obtained from CMS, other states, conferences, Real Choice technical assistance grantees and other sources.
- Conduct public forums to both inform consumers about the options for long-term care systems change and to obtain their input into the planning process.
- Develop an annual report of recommendations to be submitted to the Secretary of the Department of Health and Hospitals (DHH) and other applicable entities to improve the long-term services and supports system. Evaluate recommendations annually and update as needed to reflect objectives achieved or modified.
Goal. Develop and implement Consumer Direction in HCBS waivers.
- Develop and implement training materials to enhance consumer self-determination (e.g., hiring, firing, supervising) in employing frontline workers.
- Develop and implement project evaluation materials to enable implementation of consumer direction in HCBS waivers.
- Adapt HCBS waiver administrative processes to allow use of fiscal agents.
Goal. Develop and implement a Workforce Development Project.
- Establish methods for assessing the impact of the proposed project on professionalization of the Direct Support Specialist (DSS) workforce.
- Develop a competency-based DSS curriculum reflecting stakeholder input.
- Recommend a "career ladder" framework that ties demonstrated competency to wage and benefit increases based on a proposed system of credentialing.
- Conduct outreach and training to raise consumer/family awareness of proposed DSS credentialing system and enhance their self-determination, knowledge, and responsibilities (e.g., selecting, training, supervising) related to DSS.
- Host a DSS "Summit" to share information and establish consensus on key issues among stakeholders.
Goal. Develop and implement Housing Pilot Projects.
- Establish partnerships between housing stakeholder groups in three regions.
- Conduct housing needs assessments.
- Develop how-to procedures for publication describing best practices.
- Ensure consumers are aware of, and have access to, housing options.
- Conduct a Statewide Housing Summit in collaboration with and funded by the Medicaid Infrastructure grant.
- Establish a housing network in three regions of the state and develop collaborative partnerships to identify and implement strategies to overcome housing barriers.
- Establish a Statewide Housing Network to identify and overcome housing barriers in Louisiana's rural communities, whose activities will be similar to those of the Regional Housing Networks.
Key Activities and Products
- Provide staff, meeting space, educational opportunities, and consultants to support and inform the CTF and DSSSPG as they continue to recommend programmatic direction.
- Hold a series of public forums in all regions of the state to both inform consumers about the options for long-term care systems change and to obtain their input into the planning process.
- Develop and implement administrative processes including systems programming, training materials, and project evaluation materials to enable implementation of consumer direction in HCBS waivers.
- Develop competency training curriculum and career ladder recommendations aimed toward professionalizing personal assistance workers.
- Develop guidelines for establishing local coalitions to address housing issues.
- Establish three regional housing networks, as well as a statewide housing network for rural communities, and develop collaborative partnerships to identify and implement strategies to overcome housing barriers.
- The Consumer Task Force (CTF) comprises 22 members, including six consumer representatives (for the elderly and each disability groupdevelopmental disabilities, mental illness, physical disabilities) as well as numerous advocacy groups, three state agencies, two legislators and providers.
- DSSSPG is the larger group for which the CTF serves as steering committee. This larger group consists of consumers, family members, advocates, interested citizens, state staff, providers, facility administrators, etc. The participants vary from meeting to meeting, but generally include more than 40 individuals.
- Consumer Direction Workgroup includes several waiver consumers, advocates and state agency staff as well as DHH contractors.
Consumer Partners and Consumer Involvement in Planning Activities
- The DHH sponsored several public forums for consumers, providers, and other stakeholders to solicit information on current needs, perceptions of gaps in the system, and response to DHH's vision for improving Louisiana's LTC system. This information was then incorporated into DHH's vision for a community-based, LTC system to reduce the reliance on institutions.
- The Louisiana People's Olmstead Planning Group (LaPOP) and its subcommittees convened a series of meetings to identify consumer concerns about Louisiana's LTC system and consumer-preferred options for LTC reform. Consumer input was reflected in prioritizing which goals would be pursued under the grant.
- Some members of the Consumer Direction Workgroup assisted in developing the CD component of the grant application.
- Consumers also helped draft the grant and reviewed the application.
- The original grant was reworked for the second round opportunity with direction, review and approval from the CTF/DSSSPG.
Consumer Partners and Consumer Involvement in Implementation Activities
- A consumer-driven process will guide all planning activities of the project. This process will utilize the DSSSPG, under the direction of the CTF, which includes individuals with disabilities and/ or chronic illness who rely on long-term services and supports, as well as other stakeholders. These groups' activities will be identifying opportunities for improving the LTC system as well as continuing to participate in and monitor grant activities.
- Consumers will be actively involved in the design, implementation, evaluation, and reporting of project activities through their involvement in demonstration projects and with the public forums that will be conducted under this grant.
- The Consumer Direction workgroup is now assisting DHH in developing criteria and processes for Consumer Direction and will monitor the pilots in the three regions. It is also anticipated that the consumer members of the group may be participants in the pilot and that the advocates and other state agencies will assist in recruiting other participants for the pilots.
- Disability Services and Supports System (DSSS) Planning Group.
- Governor's Office of Disability Affairs (GODA).
- Governor's Office of Elderly Affairs (GOEA).
- LSU Health Sciences CenterHuman Development Center (LSU HDC).
- Department of Social ServicesLouisiana Rehabilitative Services (LRS).
- Department of Transportation and DevelopmentElderly and Disabled Program.
- Department of Labor.
- Department of EducationSpecial Populations.
- Public Housing Authorities.
- Vocational-Technical Schools.
- State Planning Developmental Disabilities Council.
- Louisiana Technical Assistance Network (LaTAN).
Private Partners and Subcontractors
- The ARC of Louisiana and local ARCs.
- Supervised Independent Living Center.
- Mental Health Association of Louisiana.
- National Alliance for the Mentally Ill.
- Center for Independent Living.
- Louisiana Citizens for Action Now (LaCAN).
- Brain Injury Association of Louisiana.
- Alliance of Louisiana Schools for the Mentally Retarded.
- Citizens Care.
- Louisiana Nursing Home Association.
- Families Helping Families.
- Local Councils on Aging.
- Case Managers Association.
- Ramps, Rails and Renovations.
- St. Francis House (ADHC).
- Independent Living, Inc.
- Community and Residential Services Association (CARSA).
- Home Health agencies.
- Mental Health Advocacy Service.
- Advocacy Center.
- Louisiana Assisted Living Association.
- PACE of Louisiana.
- Multiple Sclerosis Society.
- Alzheimer's Association.
Public and Private Partnership Development/Involvement in the Planning Phase
Lead agency staff as well as staff of the Governor's Office of Disability Affairs, the State Planning Council on Disability Affairs and the LSU HSC Human Development Center utilized information obtained in the public forums noted above and developed original drafts for the grant projects and the application.
A small group of stakeholders, including LaCAN, the ARC of Louisiana, the Advocacy Center, AARP and Citizens Care, collaborated with the public partners in developing the concept of the grant and identifying and prioritizing goals and objectives. A series of meetings were held to review and discuss the drafts among the stakeholders.
Public and Private Partnership Development/Involvement in Implementation
- Public partners will participate in the CTF/DSSSPG by providing information, discussing ideas from other states and identifying opportunities for improvements in their own agency's operations.
- Governor's Office of Disability Affairs will support the operation of the CTF/DSSSPG.
- LSU HSC Human Development Center will conduct the workforce development pilot and the housing network pilots.
- Private partners will participate in the CTF/DSSSPG by providing information, discussing ideas from other states and identifying opportunities for improvements in the long-term care system in Louisiana.
- Private partners will be involved in the Workforce Development Pilot and in assessing all other grant activities.
- The contractors will provide necessary support to the Consumer Direction project, including the financial aspects related to being an employer.
Existing Partnerships That Will Be Utilized to Leverage or Support Project Activities
- Some existing housing networks for the mentally ill will be used as a base for the regional housing networks.
- Existing partnerships with vocational/technical schools will be used as a base for the workforce development pilot.
- Existing partnerships among state agencies and stakeholders will be utilized and expanded to support the activities of the CTF/DSSSPG.
- DHH is the grantee for both the Medicaid Infrastructure Grant and for the Real Choice Systems Change Grant. One of the Real Choice activities will be to conduct a statewide Housing Summit in collaboration with and funded by the Medicaid Infrastructure Grant.
The CTF comprises individuals representing elderly persons, adults with disabilities, persons with developmental disabilities or mental health diagnoses, state agencies, legislators, advocacy organizations, provider organizations and other stakeholders.
- The CTF will participate in pilots included in grant activities and will have opportunities to make further recommendations relating to the pilots.
- Periodic reports on grant activities and reports of grant expenditures will also be presented to the CTF.
Formative Learning and Evaluation Activities
Each demonstration will include data collection activities. Analysis of the data collected, as well as feedback from pilots and public meetings, shall be utilized to evaluate project activities and shape future planning and further implementation of the pilots, or to identify needed modifications.
Evidence of Enduring Change/Sustainability
- Consumer direction will be incorporated into existing waivers. Consumer direction pilot activities are intended to put the necessary systems in place to permit consumer direction options in all of the waivers. This includes system changes as well as creation of fiscal agents and administrative processes to support individuals opting for consumer direction in the provision of community-based long term care services. Fiscal agent costs will be borne out of the costs currently paid as part of providers' overhead costs.
- The Workforce Development initiative will be incorporated into vocational/technical training programs and provider training programs via the curriculum developed.
- Housing networks will be sustained through the involvement and education of local housing authorities, consumers and community leaders.
- The CTF and demonstration projects will utilize continuous quality improvement systems to ensure an on-going assessment, planning and evaluation of long-term care services.
- Because the CTF and DSSSPG are legislatively authorized through June 30, 2005, it is anticipated that the recommendations developed annually and potentially implemented by the affected agencies will continue beyond grant funding.
- Statewide for CTF/DSSSPG and the Workforce Development initiatives.
- Three regions for the Consumer Direction pilots and three regions for the housing coalitions (one region per year).