Steve Gold, The Disability Odyssey continues

On July 18, 2007, we presented data showing that nationally nearly 12% of nursing facility residents went into nursing facilities directly from their homes, without having received any health services or attendant care supports BEFORE they were admitted into the nursing facility. There was also another 5% of nursing facility residents who also went directly from their homes but who had been receiving some health services.

These two percentages total 213,988 current residents who might still be residing in their own homes and apartments, if your State had an effective mechanism to determine what and how much health services and attendant care services were needed PRIOR to their institutionalization in nursing facilities. With community-based services, many of these nursing facility residents might have decided to stay in their homes.

In addition, we know that nearly 56% of nursing facility residents lived with someone else prior to admission to the nursing facility. We do not know if the persons with whom they lived were willing or able to provide assistance, nor do we know if they were even aware that community-based services might have been available. But again, did anyone from your State tell them about community-based services and ask them PRIOR to institutionalization if they wanted such services?

If, as is likely, some of the 213,988 persons overlap with the 56% of the residents who lived with another person prior to admission, it's unfortunate that effective "diversion" mechanisms did not exist to work with these people to prevent unnecessary institutionalization.

We also know that 18% of current nursing home residents have a current "support person" who wants the resident to return home. Again, does your State ask these "support persons" what health services and attendant care services might be needed to provide appropriate and safe services in the residents' home or apartment?

Your State's can be found on the CMS website for the Minimum Data Set.

We return to these statistics because a number of people responded to the original "One Simple Solution"(See July 18, 2007, Information Bulletin #218) by citing their State's "preadmission" screening process.

States "screen" persons, but only to determine if they meet the requirements for nursing level of care and for Medicaid financial eligibility.

But advocates for Older Americans and persons with disabilities should ask for more. If a State really wants to save Medicaid funds and also comply with the ADA to avoid unnecessary institutionalization, then BEFORE a person goes into a nursing facility (or ICF or Mental Institution), they (and their "support person") should be talked with as part of the eligibility screening for what services they might need to continue living in the community.

More than "screening" is necessary. People should be told exactly what services could be provided for them in the community. They should be told the State will assist in arranging for those services immediately b not telling the person there is a waiting list for community-based services.

It's more than just screening. It's actually offering and providing all the services a person needs to stay in the community. Without this, screening is a sham.