Specialized Information for:

Nursing HomesAssisted Living/Board & Care Home and Community Based Services



Quality Care, No Matter Where: Successful Nursing Home Transitions Report

This report produced by the National Consumer Voice for Quality Long-Term Care examines nursing home transitions nationwide and how they can be improved from the perspective of both the individuals who had moved back into the community and the programs that assist them.  The findings from interviews and surveys with these individuals are presented, along with policy recommendations for making the transition process go more smoothly for consumers from beginning to end.

How To Guide for State and Local Advocates
This How To Guide is intended to equip state and local advocates with information and tools to advocate for improvements to nursing home transitions. The recommendations found in the Quality Care, No Matter Where: Successful Nursing Home Transitions Report are elaborated on and examples are provided within this guide. 

A Right to Person-Centered Care Planning
This report from Justice in Aging analyzes how well states are implementing the 2014 rule that creates the right to person-centered care planning for Medicaid consumers of Long-Term Services and Supports.

Charting the Long-Term Care Ombudsman Program's Role in a Modernized Long-Term Care System
This Long-Term Care Ombudsman Program Strategic Directions Work Group Meeting Report, by the National Ombudsman Resource Center (NORC), prepared by the National Association of State Units on Aging (NASUA), seeks to help long-term care ombudsmen to define their role and develop coordination efforts in a new long-term care system.

Home Care Ombudsman Programs Status Report: 2007
Ombudsman programs in twelve states are authorized or mandated under state law to provide advocacy on behalf of consumers who receive home and community based care. Over the last seven years the Long-Term Care Ombudsman Program's involvement in home care advocacy has changed little; the numbers of complaints, types of individual and systems issues, and the level of support have remained relatively stable. This paper updates and expands information previously collected on home care ombudsman programs in 2000. New information reported here was gathered in April/May 2007 through a web-based questionnaire and a teleconference.

The Role of the Long-Term Care Ombudsman in Home Care Advocacy (June 2001)
This technical assistance paper, prepared by the National Association of State Units on Aging (NASUA), includes information on the scope of Home Care Ombudsman Programs' responsibilities, the types of complaints which may be reported, program funding, access issues, training and systems advocacy activities.

Strategy Brief:  Ombudsman Program Connections to Home- and Community-Based Service (July 2004)
This document presents discussion highlights from a National Dialogue Forum convened by NASUA on the topic. The primary issues discussed by the participants included: the ombudsman program's role in providing information about home care to consumers; consumer access to home care services; advocacy for quality home care options and relationships with the home- and community-based services system.

Money Follows the Person ToolKit
Developed by the Rutgers Center for State Health Policy, National Academy for State Health Policy and the NCB Development Corporation in 2006, this toolkit compiles information from numerous sources about nurisng home transition and Money Follows the Person (MFP)  initiatives.

Money Follows the Person: Impediments to Implementation: A Fact Sheet on Program Start up, Capacity and Access
Developed by NASUAD. The Money Follows the Person Rebalancing Demonstration Program (MFP) was designed to assist states in rebalancing their long-term care systems, and to help Medicaid beneficiaries transition from institutions to the community. Since its inception, MFP has faced many barriers to implementation, most of which have resulted in the program transitioning fewer individuals than originally anticipated. In efforts to clarify the origin and impact of these early problems and ongoing capacity and access challenges, NASUAD prepared a fact sheet, outlining some of the most commonly-reported programmatic complications, such as the unanticipated consequences of statutory compliance and a lack of accessible, affordable housing for MFP participants.



Consumer to Consumer: Tips for a Successful Nursing Home Transition

Moving out of a nursing home and back into the community can be difficult.  The purpose of this Tip Sheet is to share with you suggestions for steps you can take to make your move go as smoothly as possible. These recommendations come directly from people who have already transitioned so you can learn from their experiences.
This Tip Sheet is designed to be used along with a checklist that takes you step by step through what you can do before, during and after your move in order to make your transition a success.  The checklist is included with permission of the Independent Living Research Utilization (ILRU) and IL-NET. 

HCBS Advocacy.org
HCBSadvocacy.org is a platform for the aging and disability communities to post information and resources regarding the new HCBS settings rule and steps each state is making to comply with the new rule.

ADRC Technical Resource Center 
The ADRC Grant Program, a cooperative effort of the Administration on Aging (AoA) and the Centers for Medicare & Medicaid Services (CMS), was developed to assist states in their efforts to create a single, coordinated system of information and access for all persons seeking long term support to minimize confusion, enhance individual choice, and support informed decision-making. The ADRC Technical Assistance Exchange (TAE) provides technical assistance through one-on-one support, semi-annual ADRC national meetings, weekly newsletters, monthly webcasts and a variety of other ways.

Nursing Facility Transition: A Resource Kit for Long-Term Care Ombudsman
This resource kit provides information and materials for ombudsman programs about nursing facility transition. It is designed to provide state ombudsmen with an easy to use reference point for basic information about state and federal nursing facility diversion and transition initiatives and to facilitate exploration of ombudsman program roles in helping residents who wish to leave the nursing facility.



Plenary – Advocating for Real Reform Through the New Federal HCBS Regulations (2015 Consumer Voice Annual Conference, presented by: Justice In Aging)

The Who, What, When, Where and How of Ombudsman Services for Home Care Consumers (November 2013)
This session from the 37th annual Consumer Voice conference talks about an increasing number of states are looking at options for advocacy for home care consumers. The Older Americans Act Reauthorization Act of 2013 would give ombudsman programs the authority to continue to serve residents transitioning from a long-term care facility to a home care setting, and there are opportunities to provide ombudsman services to clients of Money Follows the Person (MFP), managed care and dual integration programs. What does it take to develop a home care ombudsman program? During this session, participants will look at different options for creating a home care ombudsman program and hear about issues such as funding, scope of services, authority and oversight, staffing and more from states that have already made these decisions.

Session Materials:

NSCLC WEBINAR: Understanding and Impacting Implementation of New Medicaid Home and Community-Based Services Rules
This webinar and a new NSCLC guide to the new rules provides consumer advocates and other stakeholders with a clear explanation of the rules and share guidance for state engagement. Advocates, state policymakers, national advocates, and regulators can learn about what the rule means for residential settings, service planning, and the community-integration transition process.

Transitions and Long-Term Care: A Look at MDS 3.0 Section Q and Money Follows the Person (January 30, 2012)
The Administration on Aging hosted a webinar giving an overview of MDS 3.0 Section Q and Money Follows the Person and detailing how these programs affect the aging network.

Webinar Materials:


Information from States

I Choose Home NJ
This website provides information on New Jersey's Money Follows the Person program with information on services and eligibility. Hear two participants of I Choose Home NJ talk about their successful transitions to the community

Minnesota Home Care Bill of Rights (July 2007)

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