Wyoming

Task Force

Following the Olmstead decision, Wyoming's governor designated the state Department of Health (DOH) as the lead agency for developing a comprehensive plan to address home and community-based care for the state's disabled population. Draft documents were reviewed by the Office of Civil Rights and sent for public comment in April 2001. The plan was approved by the DOH director in July 2002 and released. In addition, the DOH has conducted 23 county visits in preparation for implementing the plan. The Olmstead Plans can be viewed at http://wdhfs.state.wy.us/OLMSTEAD/index.htm

The Plan

The plan consists of four sections: Aging, Developmental Disabilities, Acquired Brain Injury, and Mental Health. Each section includes nine elements: 1) Participation of key stakeholders in the development of the plan; 2) Needs assessment process; 3) Development of new community services and support infrastructure; 4) Transition services to prepare individuals for a change in placement; 5) Data collection which is individualized and tied to individual program plans; 6) Outcomes measurement and target dates; 7) Quality assurance; 8) Resource development; and 9) Revision guidelines/timelines. The plan will be reviewed, revised and updated at least every two years beginning in July 2004. Examples of plan content drawn from the aging portion of the plan follow.

• The Aging Division would like to include the stakeholders in discussions of future service improvements.


• Stakeholders are organized into four subcommittees (representing regions of the state) and serve as an advisory committee to the Aging Division.

• Current assessment procedures may be modified to create a new assessment tool that will guide the development of individualized service care plans.


• Within one year of the implementation of the plan, all clients will be reviewed for potential community placement.


• The Aging Division has created a resource directory listing services and supports available to assist those who desire to reside in an integrated community setting.

• The Aging Division notes the following areas that need to be addressed: Medicaid subsidized assisted living, adult chronic mental illness residential homes, increased senior housing options or group homes for seniors, training health professionals (promoting person-centered planning), training for service providers, and senior center participation.


• The division has adopted the Olmstead philosophy in modified rules for assisted living facilities (ALF). The rules speak to Medicaid subsidized assisted living, allowing clients to choose the ALF as their "home," and receiving nursing services or skilled nursing services in the ALF as long as they are provided by an outside entity.


• To enhance community infrastructure, the Aging Division may address the following areas:


• Strengthening adult protective services.


• Chronic mental illness residential homes for the elderly (group home).


• Housing recommendations may include increasing home modification allowance up to $300, utility deposits, allowances for furniture and household needs, first and last months' rent.


• Increase number of HCBS waiver slots.


• Train health professional in person-centered planning.


• Train senior centers as service providers.


• Train service providers to help clients make the transition to the community.

• The Aging Division will develop a "transition profile" of each client, based on client choice and assessment results. The form will standardize transition information.


• Transitioning will be eased with day or partial day visits to the new setting by the client.


• Subsequent assessments will be conducted annually.


• The division has recommended a "bed hold" policy, whereby a client on a waiting list who has left the facility but needs to return within 90 days of making a transition is given preference.


• Allowable pre-placement home visits and overnight stays coordinated with current service providers.


• Choice of alternative placements.


• Develop procedures for institutionalized people who are seeking Section 8 vouchers for housing (subsidizes low-income individuals' monthly rent).

• Necessary data include, but are not limited to, tracking of assessment time, length of time on waiting list, monitoring of services and his/her healthcare status at current placement site, client satisfaction levels on each service, and tracking complaints and grievances.

• Aging Division is developing an automated database system to identify individuals who are institutionalized and ready to make the transition to a more integrated setting.


• Outcome data could include, number of clients reviewed for community placement, anticipated date of transition, number of clients transitioned into the community and the resulting outcome, number of clients returning to their original care provider, frequency of assessments of clients for future placement consideration.

• Monitoring will be done by teams who will conduct site visits.


• Key elements of monitoring will include regular review of individualized plans of care; training for monitors; meaningful self-assessment process; confidentiality of personal information; ensuring client access to the ombudsman; self-advocacy training; service provider standards, rights and expectations; and appeals and grievances procedures.

• The Aging Division has not identified a specific focus for resource development.

• This plan will be evaluated, revised and updated annually. These efforts will coincide with the state budget cycle for funding purposes.

Implementation

There is no legislation currently under consideration for the 2003 legislative session.

Obtaining approval of the Olmstead Plan is a major success. In addition, the Department of Health currently has an assessment tool for determining nursing home medical and financial necessity and will develop assessment tools for other health care facilities, including assisted living facilities.

Although work on the plan is occurring, the barriers of lack of adequate finances, divergent views among the various advocacy groups, a shortage of primary care physicians and mental health professionals, and the rural nature of the state make it difficult to develop a community-based infrastructure.

There are no Olmstead-related lawsuits.

The Wyoming Department of Health, Aging Division, received a $500,000 Systems Change Starter Grant for December 2001 through December 2002. The department is awaiting a notification of a $600,000 grant award from CMS for Systems Change Nursing Facility Transitions Grant for Sept. 30, 2002, through Sept. 29, 2005.

The Systems Change Starter Grant funds have been used to educate consumers, professionals and advocates of the Olmstead Supreme Court decision and Wyoming's plan to address it. Community meetings have been held throughout the state to gather input from stakeholders regarding the strengths, barriers and solutions for their local community. This information will provide valuable insight regarding the infrastructure, supports and services available. Also, a Wyoming Resource Guide for Older Citizens has been developed and distributed throughout the state to help link individuals with the services and supports needed to maintain a higher quality of life and to avoid premature institutionalization.

Wyoming will use funds from Nursing Facility Transitions Grant to transition nursing home residents into the community if they so desire, are capable, and supports and services are available. The state's goal is to move 85 residents back into the community. The money also will be used to educate people about and promote the program, entitled Project OUT; provide transportation vouchers; and provide housing start-up assistance such as first and last months' rent, utility hook-ups and move-in expenses.