Title: On the Edge of Crisis
1On the Edge of Crisis
- Florida Assisted Living Facilities a Critical
Link to Recovery
2Floridas Limited Mental Health ALF Program -
Overview
- Over 90 of residents have a diagnosis of
schizophrenia - 5379 Mental Health residents who also received
Optional State Supplementation (OSS)
3Overview - continued
- Florida has lost 980 LMH-ALF beds over the last
four years. - Medicaid Assistive Care Services Program pay
9.28/day for care. - The number of people served has declined from
15,913 in 2004 to 11,675 in 2007
4Limited Mental Health ALF - facts
- The OSS budget has been reduced over the last 2
yrs by 48 from 25 million to 15 million - The Medicaid ACS Program was reduced from 32
million to 25 million.
5Limited Mental Health ALFs - facts
- The average funds paid to the ALF was 5.67/day
as opposed to the 9.28/day. - This is the actual funds being invested in the
care at the facility. - There has been no rate adjust since 2001.
6Limited Mental Health ALF - facts
- The rise of admissions to forensic mental health
facilities has increased from 1206 in 2004 to
1530 in 2008. - This change in rates of admission has coincided
with the loss of ALF bed capacity. - The numbers of mentally ill in Florida prisons
has doubled during same period from 9 to 17 of
total inmate population.
7Optional State Supplementation (OSS)
- Florida OSS is provided to individual who also
receive Medicaid - In 2001 there were 10,645 in 2008 only 8221.
This is a loss of 2424 state funded ALF beds - This number includes the beds for low income
elders and disabled adults.
8OSS what is this?
- OSS funds are transferred to AHCA to pay for the
state match to leverage federal Medicaid funds. - Residents receive a personal needs allowance of
54/month. - ALF receives 20 towards room and board each
month.
9OSS How does Florida compare to other states?
- In New York residents receive 179 in the PNA.
- In South Carolina the resident receives
71/month. - In New Jersey the PNA is 67.50/month
- In Florida it is 54/month
10Limited Mental Health ALF residents
- Over 90 have a diagnosis of schizophrenia
- Individuals with schizo affective disorders move
in and out frequently. - GAF scores on average are 45 non ALF residents
are 55 on average
11Limited Mental Health ALF - residents
- In 2005 over 750 individuals migrated from the
LMH-ALF setting to the nursing home setting. - The cost of this migration was 9.8 million
- The cost of care in the ALF was 800,000.
- The average age of these residents was 75 yrs old.
12Limited Mental Health ALF answers to care
- Of 5379 residents on average 26 per year go to a
forensic mental facility. - Residents spend 70 of their time at the ALF.
- Medication compliance is better in a supervised
living arrangement.
13Why do we have a CRISIS?
- Due to low rates of reimbursement the business
model is now under water. - It is more profitable to operate an unlicensed
facility. - Operation spot check and aggressive action by
municipal governments to close down housing for
these individuals. (S. Florida)
14What is the IMPACT of the Crisis?
- Increased numbers headed to jails and state
prisons. - Increased migration of the mentally ill to the
nursing home setting. - Increased numbers among the homeless.
- Increased utilization of crisis services like the
Baker Act.
15Who is affected by the ALF Crisis?
- The non Medicaid eligible increasingly cannot get
access. - The loss of beds is impacting the emergency rooms
psychosis is now the 3 dx seen. - The need for law enforcement involvement has
grown because the system is now being driven by
crisis. - Residents with emerging medical needs must seek
care in unlicensed facilities until they can
access a nursing home bed.
16How will this CRISIS affect Florida?
- The AARP agreement with AHCA contemplates a
transition plan to less restrictive settings.
Many of the people who would eligible for
alternative placement are adults with mental
illness in the nursing home. The loss of bed
capacity eliminates this as an option and leaves
these people in a nursing home in violation of
Olmstead.
17New Threats on the Horizon
- Elimination of the meds AD waiver program.
- Federal health reform mandated expansion of
Medicaid would adversely affect optional services
that help these people remain in the community. - Reduction in access to care via managed care
plans Medicaid reform and pre paid mental
health plans. Problems with compliance FS
394.4574. - Over regulation by state agencies growth in
regulation has divert dollars from care to
regulatory management. - Further raid on the budget for residential care
will continue to erode capacity. - Medicare part D co-payments adults with
disabilities will not receive relief under the
proposed federal plan.
18What Steps are needed NOW?
- We need an OPPAGA study to follow up on 2/17/97
report. - We need a FMHI follow up report to examine access
to care. - We need to examine new ideas to help address the
funding crisis and improve the quality of care
19The Solutions
- Advocate for an increase in the Medicaid
Assistive Care Services rate with an index to
cost of living. A 2 rate increase would cost 3
million. - Create a residential care trust fund to protect
the funding streams. This would not create a
fiscal impact. - Improve review and enforcement of the district
planning provision under FS 394.4574 to ensure
improved access to care. - Improve compliance review of managed care plans
for compliance with requirements that relate to
access to services detailed in the community
living support plans.
20Solutions
- Maintain the meds AD waiver for residents of
LMH-ALF facilities over 2000 people could be
displaced. - Allow the LMH-ALF to recycle the medications that
are unused through the pharmacy to be used for
the non Medicaid eligible.
21Solutions
- Increase the resident personal needs allowance
from 54 to 80 - 6 million. - Ask not for profit mental health agencies to
provide greater levels of staff training to help
improve the soft skills of the ALF team. - Ask AHCA to consider a three tier reimbursement
model for ACS Medicaid based on level of need. - Ask the TD Commission to consider changes to the
transportation disadvantaged service plan to
require a plan on how residents of ALF will
access non emergency transportation. - Ask AHCA to consider a a different rate of
reimbursement for limited mental health ALF for
the stepped up supervision being provided.
22Answers to forensic needs?
- ALFs can be effective partners in transitioning
people from 916 facilities into the community. - The ALF setting with proper support can help
address the rising number of people charged with
misdemeanors and need supervised residential
placement options. - The ALF setting can offer Solutions at a lower
rate and allow more people to be served with the
same funding.
23Why is the ALF setting important?
- We need a full continuum of housing.
- Residents in ALFs have protections under a
resident bill of rights which can be enforced
with lawsuits. - The ALF is a capitated residential setting that
can help reduce the need for institutional care.
24ALFs save taxpayers money
- 50 of the nursing home diversion patients are
referred to ALFs. - For one fee each month the ALF accepts the risk
associated with each case. - The ALF provides access to schedule care which
reduces the need for crisis care. - The improved level of supervision of medications
reduce the need for institutional care. - ALFs care for people who have greater needs that
what can be cared for in other settings.
25Steps today will pave the future
- OPPAGA study of the ALF crisis.
- FMHI data review and examination of access and
barrier issues associated with managed care. - Changes to the ALF funding model Housing Trust
Fund and a three tiered model for reimbursement.
26Questions/ Answers
- Douglas D. Adkins
- Executive Director
- Dayspring Village, Inc.
- Hilliard, Florida
- www.dayspringvillage.org