The governor appointed the 15-member Wisconsin Council on Long-Term Care in July 2000. The Wisconsin Department of Health and Family Services, with the Governor's Office, the Legislature, the counties, advocacy organizations, and consumers, in cooperation with the appropriate federal, state and local entities, coordinated Wisconsin's activities. The council is studying the state's various long-term care systems and identifying strategies for improving service delivery.
Phase 1 of the state plan was released in January 2002 and is available online at http://www.wcltc.state.wi.us/PDF/ADAPlan1-02.pdf. More information about the Olmstead activities can be found at http://www.wcltc.state.wi.us. The plan contains a rough outline of resources provided in the FY 2001-2003 biennial budget, additional resources needed and cost estimates. A set of recommendations concerning long-term care, issued in November 2002 is available online at http://www.wcltc.state.wi.us/PDF/Council%20recs%20-%20Nov%2002.pdf
Wisconsin's ADA Title II Plan is divided into two phases: Phase 1 and Phase 2. During Phase 1, which occurred in 2001, the ADA Committee focused on consumers of all ages who currently are living in institutions. Phase I also responds to the recommendations from a recent special legislative study committee that looked at the Olmstead decision in its report, Report of the Wisconsin Joint Legislative Council's Special Committee on Developmental Disabilities (May 1, 2001).
Phase 2, which began in 2002, focuses on consumers who are at risk of institutionalization, those on waiting lists, repeat admissions (revolving door), and prevention strategies that allow consumers to live in their own homes or in other community settings. The authority and oversight of the Council on Long-Term Care will continue during review and implementation of the final development of ADA Title II recommendations as contained in this plan and in Phase 2 of the plan development.
ADA Title II Plan Objectives:
- Informed Choice: Ensure that long-term care (LTC) consumers, and their families and guardians are informed of their rights under Title II of the ADA and are empowered to make informed choices about whether to live in the community or in an institution. In Phase 1, the term "consumer" refers primarily to people who currently are in institutions.
- Assessment and Decision Making: Develop, systematically apply, and periodically evaluate consistent criteria and the assessment and decision-making processes (with clear delineation of the role of consumers, families, guardians, case managers, and other professionals) for institutional admissions, discharges from institutions and acute settings, reviews of "appropriateness" of existing institutional placements, and evaluations of consumers in the individual planning process.
- Range of Services: Develop and implement strategies to achieve the full range of LTC services, balancing consumer choice for independent living, in-home support services, and new community-based facilities. The housing capacity and workforce must be adequate to serve diverse consumer choices, including all persons with LTC needs throughout Wisconsin.
- Funding: Provide sufficient funding to relocate appropriate individuals in institutions by moving institutional capacity and resources to community care, to expand capacity to eliminate waiting lists for community service, and to strengthen existing community care capacity for current consumers. This should be accomplished no later than July 1, 2007, for all institutionalized people who a) have not made an informed choice to stay in the institutions, and b) could be served appropriately and cost effectively in the community. Incremental progress will be made in each year of the biennium to achieve these goals. Priority will be given to relocating those individuals who are in institutions or are at clear risk of institutionalization, and are interested in and determined appropriate for community living.
- Safeguards: Develop more effective safeguards to ensure that the ADA Title II rights, wishes and preferences of consumers are taken into account as much as possible in every phase of service delivery, regardless of whether the person has a guardian or other legally designated decision maker in his or her life.
- Oversight: Wisconsin will incorporate criteria derived from the Supreme Court's Olmstead decision and President George Bush's Executive Order on the Olmstead decision to carry out its oversight, monitoring, plan review mandates related to the effectiveness, and coordination of long-term care to meet the individual outcomes of people with disabilities.
No legislation regarding Olmstead was reported in 2002.
- All resource centers have made great strides in implementing the vision of increasing access to long-term care information.
- The federal government has approved the new long-term care functional screening. This screening device is designed to standardize the nursing facility level of care determination process.
- The resource centers report diversions from institutional services. The centers are offering pre admission consultation and options counseling services to individuals who want r long-term placements in residential settings.
- Resource center resources are stretched and are not adequate at times to fulfill all the functions.
- Challenges in establishing eligibility criteria and streamlining the eligibility process.
- Pre admission consultation is not being executed properly. They were not screening out those who did not have long-term care needs, resulting in a deluge of referrals to the resource centers with a large number of people who were not appropriate for long-term care.
- Due to lack of visibility and knowledge, certain areas of the state do not receive adequate support from and outreach by the resource centers.
- Conflicts of interest exist between entities that provide functional eligibility support and the enrollment counseling agencies.
State officials report that people with developmental disabilities and people with physical disabilities have filed some complaints with the Office of Civil Rights. The complaints generally are from people on the waiver waiting lists.
The state of Wisconsin received a $450,000 Nursing Facility Transitions, State Program Grant. The money is being used to develop and implement relocation plans for consumers who reside in nursing facilities and who want to move to the community and to train and support transition specialists and peer support volunteers. The state plans to set up a Web-based chat group to connect independent living center (ILC) transition specialists with the Department of Health and Family Services (DHFS) and to conduct statewide outreach to individuals in nursing facilities and the agencies with which they may come into contact.