California Department of Health Services: Real Choice Systems Change Grant for Community Living

Goal: To develop and field test a model for a uniform assessment and transition protocol that would enable nursing facility residents to exercise informed choice of home and community-based services and to provide case encounter and cost data that provide the basis for policy recommendations for Money Follows the Person initiatives in California.

Budget: $750,000 federal funding over three years.

Grant Description: The Department of Health Services proposes to:

Contract with a lead organization to develop a pilot project called California Pathways in one location in California. A pilot project community will be chosen based on its potential for successful transitions to community living; for example, the availability of an array of housing and service options.

The lead contractor would produce the following outcomes by the end of the three-year grant period:

· Development or selection of a uniform assessment tool that can be used in various nursing facilities and by a variety of care planners throughout the state.

· Cost and encounter data that supports one or more financing model(s) that demonstrates that the money follows the person;

· A uniform transition care planning protocol that enables nursing facility residents to exercise interest and informed choice of care options and services in a community setting.

· A successful care-planning protocol that enables consumer preferences of service providers and service types.

· Cost and other information on ongoing or one-time services needed by nursing facility residents in order to transition to community living.

Utilize public/private partnerships to develop and implement the pilot project.

Utilize the Long-Term Care Council, Olmstead Advisory Committee as a mechanism to obtain stakeholder input in addition to input from local stakeholders and potential consumers in pilot project location(s).

Coordinate with other long-term care programs statewide that can benefit from the pilot project formative learning and outcomes.

Develop recommendations to build on the successes of the pilot project; including care planning models, service costs associated with chronic conditions, and initiatives that enable the Money to Follow the Person.

How many current SNF residents would like to transfer from skilled nursing facilities?

See the Money Follows the Person Preference Interview Draft Report (January, 2005)

See the original grant at California Pathways