From:  (Justice For All Moderator)
"Getting People out of Nursing Homes"

Steve Gold writes:

Who and How to Get Persons Out - Information Bulletin # 59

As of September 30, 2003, CMS listed by State (at  click on "Q1a),
the number of persons with disabilities who are in nursing
homes who have said or indicated an interest/preference to
get out and live in the community.

There are AT LEAST 267,691disabled people, old and young,
nationally who want out of nursing homes. They have said in
their own way: "YES, I want my freedom." (Your state
numbers are listed below).

Two main reasons people stay in nursing homes are:
1. "our failure to identify them" and
2. "our failure to find funding for the service
coordination necessary to get these folks the support
services they need to get out."


Your State's Medicaid office collects the names and nursing
home addresses where disabled persons are
institutionalized. In Information Bulletin #58, we
explained about the Minimum Data Set (MDS). This is the
federally mandated information kept on each
Medicaid/Medicare nursing home resident. Your State need
only ask the federal CMS for a "Data Use Agreement" to use
this information. (We've been told this is very simple
process and some States have used this data to identify
persons in the MDS).

Your State could at least initially focus on those people
who have indicated on the MDS they want out. Your State
now knows WHO are disabled persons in which specific
nursing homes who want to live in the community.


Your State can receive federal Medicaid funds as "Targeted
Case Management" to transition these people out of the
nursing home. "Targeted Case management services" are
those "services which will assist individuals... in gaining
access to needed medical, social, educational, and other
services." They can include, for example, talking to
residents, helping them find a place to live, assessing
accessibility, making environmental modifications to make a
home accessible.

Specifically, "Targeted Case Management" federal funds are
available "up to 180 consecutive days of a Medicaid
eligible person's institutional stay, if provided for the
purpose of community transition." (See the federal "Dear
State Medicaid Director" letter, July 25,2000. Olmstead
Update No. 3 ( ). Even if a
disabled person in a nursing home changes his/her mind or
dies, your State will still be reimbursed under
"Administrative Case Management."

Advocate for your State to develop "Money Follows the
Person" process using these disabled persons as the
priority population for identification and for moving out
of nursing homes. (Use your Olmstead Plan as a political
tool.) This is a great opportunity to tie this process
into real folks. It is also a great opportunity to
advocate for an increase in the number of people to be
served in your Home and Community Waivers.


1. Your State could use its own workers to identify those
disabled persons on the MDS who have stated they want
to live in the community.

2. Independent Living Centers, could provide the
Targeted Case Management services to identify folks who
want out and provide the service coordination to assist
them in getting out.


1. We know the number of disabled persons, old and young,
who want their freedom. (MDS #'s)

2. We know the funds to pay for transitioning exists.
(Targeted Case Management funds)


1. Get the MDS #'s for your state.
2. Contact your state for specifics on where these (folks
are located (city, nursing home etc)
3. Advocate for Targeted Case Management Services included
in your Medicaid state Plan.
4. Advocate for a Money Follow the Person concept to be
instituted in your state.
5. If your State refuses contact me or your local
Protection and Advocacy (P&A) agency for possible legal
6. Go into those nursing homes and identify real people
who want out.

We will reform the system one person at a time.

The pieces of the puzzle are out there. We must be the
"puzzle masters" and pull the pieces together. When
together they spell "LIBERATION."


The following data is for your State as of September 30,
2003. We provide for each State both the percentage of
and actual number of recipients who answered "YES" to
freedom, as recorded on the CMS "MDS Active Resident
Information Report: 9/30/03, "Q1a: Resident
Expresses/Indicates Preference to Return to the Community."

These percentages and numbers are absolutely consistent
with the data in Information Bulletin #58 which reviewed
data as of June 30, 2003.

In Alabama 14% of the total residents in the nursing homes,
or 3,255 people, wanted to live in the community; in Alaska
27% of the total residents in the nursing homes, or 160
people, wanted to live in the community; Arizona 25%
or 3,083 people; Arkansas 15%or 2,733; California 22% or
22,556; Colorado 21% or 3,356; Connecticut 20% or 5,523;
Delaware 23% or 882; D.C. 17% or 460; Florida 24% or
16,886; Georgia 14% or 4,901; Hawaii 15% or 572; Idaho 24%
or 1,128; Illinois 20% or 15,286; Indiana 18% or 7,062;
Iowa 17% or 4,536; Kansas 16% or 3,361; Kentucky 17% or
3,757; Louisiana 10% or 2,917; Maine 21% or 1,376; Maryland
22% or 5,376; Massachusetts 18% or 8,110; Michigan 23% or
9,618 ; Minnesota 19% or 6,518; Mississippi 10% or 1,547;
Missouri 20% or 7,564; Montana 21% or 1,188; Nebraska 18%
or 2,308; Nevada 21% or 848; New Hampshire 15% or 1,078;
New Jersey 19% or 8,163; New Mexico 22% or 1,324; New York
18% or 19,992; North Carolina 18% or 6,739; North Dakota
14% or 825; Ohio 22% or 16,856; Oklahoma 16% or 3,328;
Oregon 26% or 2,196; Pennsylvania 16% or 12,627; Rhode
Island 17% or 1,458; South Carolina 16% or 2,609; South
Dakota 15% or 1,002; Tennessee 19% or 6,257; Texas 15% or
13,429; Utah 28% or 1,466; Vermont 20% or 638; Virginia 21%
or 5,679; Washington 24% or 4,735; West Virginia 21% or
2,129; Wisconsin 20% or 7,018; Wyoming 22% or 532.

Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available
online at with a searchable
Archive at this site.

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