In December 2006, NASUA and the National Ombudsman Resource Center emailed a questionnaire to all state ombudsmen for the purpose of identifying current ombudsman practices related to home and community based services, involvement in nursing facility transition initiatives and proposed involvement in
the federal Money Follows the Person grant programs. Forty-six (46)
ombudsman programs responded. This Information Bulletin presents a summary of the data collected from December, 2006 through February, 2007.

The results are organized and presented under three topic areas:

Home and community based services
Involvement in nursing facility transition initiatives
Planned involvement in the federal Money Follows the Person Demonstration Grant

• 40 (87%) of the 46 ombudsman programs provide training about HCBS options for staff and volunteers.
• 61% of the responding ombudsman programs include issues related to
  HCBS, such as additional home and community based services and affordable housing on their program's advocacy agenda.
• 36 (78%) of the 46 ombudsman programs make referrals to HCBS when residents express a desire to leave the nursing home.
• 100% of the 46 ombudsman programs have helped nursing home
  residents to transition back to the community.

Responses revealed that training provided to ombudsmen on home and
community based services (HCBS) is typically general in nature and commonly includes information about the types of HCBS that may be available, including Waiver services, eligibility criteria and how to make referrals.

• 36 (78%) of the 46 ombudsman programs reported the existence of a
  nursing facility transition (NFT) initiative in their states.
• 31 (91%) of 34 programs rated local ombudsman program knowledge of nursing facility transition programs and how to link residents to those programs as "good" or "fair".
• 27 (75%) of 36 ombudsman programs reported that local ombudsman programs have received training on nursing facility transition.
• 28 (88%) of 32 ombudsman programs reported making referrals to the NFT initiative in their state.
• 25 (69%) of 36 ombudsman programs reported having a role in their states' NFT initiative. The most common roles played by the LTCO program are:
  • informing and educating individual residents and families about the
    NFT initiative (96%)
  • identifying residents who are potential candidates for NFT services (80%)
  • training NFT program staff about the ombudsman program and
    residents' rights (72%)
  • informing and educating nursing home staff about transition programs (72%)
  • serving on a committee or work group responsible for implementing a NFT grant or initiative (68%)
  • coordinating with the NFT initiative at the state/local level to help residents move back to the community (68%).

  Other ombudsman program activities in NFT initiatives include:

  • informing and educating resident and family councils and community groups about nursing facility transition
  • following up on persons who are transitioned out of nursing facilities.

• 24 (67%) of 36 ombudsman programs in states with NFT initiatives reported having had concerns about the program in their states, most commonly:
  • a lack of support by nursing homes
  • inadequate supply of affordable housing and services to meet transitioned residents' needs
  • inconsistency in transition services from one part of the state to another.

Ombudsmen were asked about what they have learned from their experiences with helping residents transition back to the community. Several themes emerged through their responses.

• Coordination is key. Coordination and planning between transition coordinators, case managers, HCBS providers and the nursing facility is critical to a successful transition process.
   
• Be patient. The transition process takes time and residents and families need to be kept informed and reassured throughout the process.
   
• Be aware of potential barriers. Certain challenges to the transition process may be encountered, including: resistance from family members, guardians and residents' physicians and a lack of service and housing options.

• 30 (65%) of 46 ombudsman programs reported that their states applied for
  a federal Money Follows the Person (MFP) Grant.
• 17 (57%) of these 30 programs provided input into the MFP grant proposal and 14 reported that a specific role(s) was identified for the LTCO program
  in the proposed project. The most common roles proposed for the ombudsman program include:
  • Identifying residents who are potential candidates for MFP transition services (64%)
  • Informing and educating individual residents and families about the MFP transition program (64%)
  • Informing and educating resident and family councils about the MFP transition program (50%)
  • Coordinating at the state and/or local level with the MFP transition program to help residents transition back to the community (43%)
  • Serving on a committee or work group responsible for implementing the MFP grant (43%)

  Other planned ombudsman program activities in MFP grants include:

  • Training MFP transition staff about the ombudsman program and residents' rights
  • Following up on persons transitioned back to the community
  • Informing and educating nursing home staff and community groups about the MFP transition program.

Special Note: Since January 2007, the Centers for Medicare & Medicaid
Services (CMS) has awarded MFP grants to 30 states and the District of Columbia. These awards include 11 states whose proposals identified a role
for the Long-term Care Ombudsman Program: Arkansas, Connecticut, Indiana, Georgia, Louisiana, Missouri, North Carolina, Ohio, Texas, Virginia and Wisconsin.

Ombudsman Program Involvement in Nursing Facility Transition Initiatives
Money Follows the Person - The Texas Experience
Money Follows the Person - The Texas Experience (PowerPoint)
Resources on Nursing Facility Transition
PowerPoint Presentations
2007 Money Follows the Person Grant Awardees
Relocation Materials