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Nursing Home Resident Relocations
Age OdysseyJune 17th, 2013
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Objectives
• Overview of the law, history, scope and applicability
• Overview of resident relocation process• Know where to find helpful resources• Be prepared with strategies to meet
challenges that may arise
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Resident Relocation ProcessWhat is it all about ?
A thoughtful and systematic approach to the relocation of residents
in situations where a nursing facility (NF)is undergoing a partial or
complete closure
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Nursing Facility (NF) Closure History
In the MA program:Total NFs (1998) = about 434
NFs closed about 75New NFs about 14
Today = 373
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Closure Historynot counting partial closures or changes in operations
where resident relocations also occur
– 1998 3– 1999 0– 2000 13– 2001 4– 2002 6– 2003 6– 2004 10– 2005 6
– 2006 3– 2007 6– 2008 6– 2009 3– 2010 3– 2011 2– 2012 3– 2013 1 (as of 5/1/13)
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Pre-Resident Relocation Law Concerns
• Closures went very fast
• Residents often received little or no notice
• No information about where residents went
• Residents were often given no choice
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Intent of the Resident Relocation Law
• To recognize that involuntary relocations can be especially difficult for nursing home residents – to reduce transfer trauma
• Expecting that new state policies would lead to some closures – to be prepared
• To provide equity in access to available beds/services
• To provide oversight
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Development of the Law
Participants included:– Minnesota Department of Health (MDH)– Minnesota Department of Human Services (DHS)– Counties– Ombudsman– NH trade associations– Provider representatives
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Purpose of 2013 revisions
• Align with new federal regulations• Incorporate twelve years of experience,
current practice and circumstances and best practices
• Clarify and simplify the language• Reduce unnecessary burden on all parties
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Facility Costs
• Concerns over facility costs of compliance– 50% rate increase
• Accountability
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Overview of Process
• Initial notice from licensee• Coordinated planning process– facility interdisciplinary team– county of location involvement– ombudsman involvement– notice to Managed Care Organizations (MCOs)– notification to and possible involvement of
DHS/MDH
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Overview of Process
• Development of the “relocation plan”– agreement of parties on the process– identify residents, resources and timelines–what best meets needs of residents
• Facility begins reporting the week following development of relocation plan
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Overview of Process
• Notice to residents/family by closing facility– 60 day notice of closure– meetings with families/resident councils
• Preparation for resident relocation– sufficient preparation– relocation options/information– site visits– transfer or retention of medical records and forms– resident property, communication devices
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Overview of Process
• Licensee provides final discharge notice
– resident – responsible parties–managed care organization, if applicable–physician
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Overview of Process
• Physical relocation of residents– facility responsible for transport of resident– facility responsible for transport of
property & funds– facility responsible for reconnection of
communication devices– facility must provide staff escort–no disruption in meals or treatment
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Overview of Process
• County Role–participatory–helps to coordinate relocation process– serves as a resource –monitors facility compliance with plan– reports to state– conducts follow-up assessments
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Overview of Process
• Other noteworthy provisions
– refrain from public notice of closure (until 60 day notice)–no new admissions after notice (on
complete closures only)– licensee and administrator bear
responsibility
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Definitions
• change in operations/closure/reduction
• facility types
• “responsible party”
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Initial Notification Process
• allows MCOs to begin planning process
• may provide additional resources in relocation process, through MCO involvement
• allows county to begin determining the involvement of other case managers
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• allows county to conduct some advance planning for individuals with special needs
• clarifies facility responsibilities and allows county to monitor changes
Initial Notification Process
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Initial Notification Process
• facilities still face difficulty identifying specific county contacts
• challenges with multiple party involvement and the risk of public “leak” of closure
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Planning Process
• ensures that parties are working together, by instituting a deadline for developing the relocation plan
• provides for an outline of items included in the plan
• community assessment by lead agency will assist residents seeking alternative placements
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Planning Process
• difficulty in finding the right county staff contact person may result in delays or could result in the county not being in compliance with their role in process - NF follow up needed
• places responsibility of sharing information with MCOs on other parties, when MCO not involved in planning
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Responsibilities of Licensee
• outlines facility responsibilities
• outlines repercussions if out of compliance with statute
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Responsibilities of Licensee, cont.
• 60 day notice to residents and others
• census concurrent with notice
• weekly status reports
• MCO
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Placement Information
• sufficient preparation and options allow for resident placement choice
• lead agency assessors can identify relocation options other than NFs
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Placement Information
• finding community options takes time and is difficult under time pressures
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Meeting with Residents/Responsible Parties and Site Visits
• county/ombudsman should be present at each meeting to assist, answer questions and provide assurances and options
• county/ombudsman presence essential for problem-solving and successful transitions
• having facility responsibility for site visits in writing clarifies their responsibility and allows for resident choice
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Meeting with Residents/Responsible Parties and Site Visits
• if facility ill-prepared, creates difficult position for county and ombudsman
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Resident Property, Funds and Communication Devices
• Property
• Funds
• Communication devices
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Final Written Discharge Notice & Responsibilities During the Relocation
• final notice
• notification
• process of discharge
• date of discharge
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Responsibilities of County Social Service Agency
• flexibility in staff assignments
• county as a resource is especially important for potential HCBS services
• lead agency community assessment will assist residents seeking alternatives
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Responsibilities of County Social Service Agency
• required concurrent resident notice by county agency provides residents/responsible party with added assurance that process will be followed and advocacy provided
• county serves as monitor for state regulatory agencies and on behalf of MCOs (when applicable)
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Responsibilities of County Social Service Agency
• county role in this process remains unfunded
• no direction on what unit of county government should be responsible for participating in meetings and these activities
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Role of Ombudsman
• Monitor and protect resident rights• Investigate complaints• Monitor quality of care for residents• Provide technical assistance to facility staff• Participate in planning process• Resident follow-up visits
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Resident Rights• To be treated with respect, dignity, and consideration• Right to choice and individual preference• Freedom from abuse and unnecessary restraints• Freedom of association and communication• Right to not be transferred without proper notice• Right to make complaints and express grievances• Right to keep possessions
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Transfer TraumaWhat is it?
“combination of medical and psychological reactions to abrupt physical transfer
that may increase the risk of grave illness or death”
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Transfer Trauma
Characteristics:
–Depression manifesting as agitation– Increase in withdrawn behavior–Confusion–Change in eating and sleeping habits
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Transfer Trauma
Characteristics, cont.:
– Self-care deficits– Increase in falls–Diagnoses of dementia and Alzheimer's:
exaggerated symptoms, including hallucinations and delusions
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PerspectivesResident:
– “Little things all add up to important things”– “The resident council needs to be more
proactive...”– “ What will happen to my belongings, what if
things get lost or broken?”– “Can I see the new place first?”– “I want the same staff to care for me at the new
place”
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Perspectives
Family:– “I don’t want my husband to move”
– “Will this cost more money?”
– “We know what is best for our loved one”
– “Need for a strong family council…”
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Resources
• Relocation Resource Guides– Nursing Facility Resource Guide– County Resource Guide
• Local County Social Services Agency• DHS or MDH staff• Office of Ombudsman for Long-Term Care
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Q &A
Audience Questions ?
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Thank You !
• Sue Fehr, Hennepin County• Robert Held, MN Dept. of Human Services (DHS)• Cheryl Hennen, Office of Ombudsman for Long-
Term Care• Thom Johnson, Ramsey County• Louise Starr, Dakota County• Munna Yasiri, MN Dept. of Human Services (DHS)
