Nursing Facility Transition Grant - Project Abstract
The State of Indiana is submitting this project to facilitate the movement of nursing home residents into the community setting of their choice. The proposal focuses on transitioning nursing facility residents for reintegration into their communities. The project also targets individuals who are at risk of entering a nursing facility. The Indiana Family & Social Services Administration (FSSA) will serve as the lead agency, with $1,147,500 in federal funds being used to implement the following changes:
- Identification of current or potential nursing facility residents. Persons will be identified using Pre-Admission Screening processes, minimum data set (MDS) assessment data, Area Agency on Aging case management and ombudsman outreach.
- Collaborators and partnerships. Collaborators including the Office of Medicaid Policy and Planning, Long-Term Care Ombudsman, Area Agencies on Aging, Independent Living Centers, consumers, advocates, Assisted Living facilities, and the nursing home industry will work together to facilitate the transition of individuals into the community by securing the necessary services and residential supports.
- Quality assurance and monitoring. Case management functions will be extended to include more immediate and frequent communication as well as on-site monitoring and contacts with service providers.
- System Change. The efficacy of local coalitions to transition and divert nursing facility residents will be evaluated. Strategies for early consumer assessment and service coordination will also be implemented.
