256B.0917 Seniors' Agenda for Independent Living (SAIL) projects for a new long-term care strategy.
Subdivision 1. Purpose, mission, goals, and objectives. (a) The purpose of implementing seniors' agenda for independent living (SAIL) projects under this section is to demonstrate a new cooperative strategy for the long-term care system in the state of Minnesota.
The projects are part of the initial plan for a 20-year strategy. The mission of the 20-year strategy is to create a new community-based care paradigm for long-term care in Minnesota in order to maximize independence of the older adult population, and to ensure cost-effective use of financial and human resources. The goals for the 20-year strategy are to:
(1) achieve a broad awareness and use of low-cost home care and other residential alternatives to nursing homes;
(2) develop a statewide system of information and assistance to enable easy access to long-term care services;
(3) develop sufficient alternatives to nursing homes to serve the increased number of people needing long-term care;
(4) maintain the moratorium on new construction of nursing home beds and to lower the percentage of elderly persons served in institutional settings; and
(5) build a community-based approach and community commitment to delivering long-term care services for elderly persons in their homes.
(b) The objective for the fiscal years 1994 and 1995 biennial plan is to continue at least four but not more than six projects in anticipation of a statewide program. These projects will continue the process of implementing:
(1) a coordinated planning and administrative process;
(2) a refocused function of the preadmission screening program;
(3) the development of additional home, community, and residential alternatives to nursing homes;
(4) a program to support the informal caregivers for elderly persons;
(5) programs to strengthen the use of volunteers; and
(6) programs to support the building of community commitment to provide long-term care for elderly persons.
The services offered through these projects are available to those who have their own funds to pay for services, as well as to persons who are eligible for medical assistance and to persons who are 180-day eligible clients to the extent authorized in this section.
Subd. 2. Design of SAIL projects; local long-term care coordinating team. (a) The commissioner of human services shall contract with SAIL projects in four to six counties or groups of counties to demonstrate the feasibility and cost-effectiveness of a local long-term care strategy that is consistent with the state's long-term care goals identified in subdivision 1. The commissioner shall publish a notice in the State Register announcing the availability of project funding and giving instructions for making an application. The instructions for the application shall identify the amount of funding available for project components.
(b) To be selected for the project, a county board or boards must establish a long-term care coordinating team consisting of county social service agencies, public health nursing service agencies, local boards of health, a representative of local nursing home providers, a representative of local home care providers, and the area agencies on aging in a geographic area which is responsible for:
(1) developing a local long-term care strategy consistent with state goals and objectives;
(2) submitting an application to be selected as a project;
(3) coordinating planning for funds to provide services to elderly persons, including funds received under Title III of the Older Americans Act, Community Social Services Act, Title XX of the Social Security Act and the Local Public Health Act; and
(4) ensuring efficient services provision and nonduplication of funding.
(c) The board or boards shall designate a public agency to serve as the lead agency. The lead agency receives and manages the project funds from the state and is responsible for the implementation of the local strategy. If selected as a project, the local long-term care coordinating team must semiannually evaluate the progress of the local long-term care strategy in meeting state measures of performance and results as established in the contract.
(d) Each member of the local coordinating team must indicate its endorsement of the local strategy. The local long-term care coordinating team may include in its membership other units of government which provide funding for services to the frail elderly. The team must cooperate with consumers and other public and private agencies, including nursing homes, in the geographic area in order to develop and offer a variety of cost-effective services to the elderly and their caregivers.
(e) The board or boards shall apply to be selected as a project. If the project is selected, the commissioner of human services shall contract with the lead agency for the project and shall provide additional administrative funds for implementing the provisions of the contract, within the appropriation available for this purpose.
(f) Projects shall be selected according to the following conditions.
No project may be selected unless it demonstrates that:
(i) the objectives of the local project will help to achieve the state's long-term care goals as defined in subdivision 1;
(ii) in the case of a project submitted jointly by several counties, all of the participating counties are contiguous;
(iii) there is a designated local lead agency that is empowered to make contracts with the state and local vendors on behalf of all participants;
(iv) the project proposal demonstrates that the local cooperating agencies have the ability to perform the project as described and that the implementation of the project has a reasonable chance of achieving its objectives;
(v) the project will serve an area that covers at least four counties or contains at least 2,500 persons who are 85 years of age or older, according to the projections of the state demographer or the census if the data is more recent; and
(vi) the local coordinating team documents efforts of cooperation with consumers and other agencies and organizations, both public and private, in planning for service delivery.
Subd. 3. Local long-term care strategy. The local long-term care strategy must list performance outcomes and indicators which meet the state's objectives. The local strategy must provide for:
(1) accessible information, assessment, and preadmission screening activities as described in subdivision 4;
(2) an increase in numbers of alternative care clients served under section 256B.0913, including those who are relocated from nursing homes, which results in a reduction of the medical assistance nursing home caseload; and
(3) the development of additional services such as adult family foster care homes; family adult day care; assisted living projects and congregate housing service projects in apartment buildings; expanded home care services for evenings and weekends; expanded volunteer services; and caregiver support and respite care projects.
The county or groups of counties selected for the projects shall be required to comply with federal regulations, alternative care funding policies in section 256B.0913, and the federal waiver programs' policies in section 256B.0915. The requirements for preadmission screening are defined in section 256B.0911, subdivisions 1 to 6. Requirements for an access, screening, and assessment function are defined in subdivision 4. Requirements for the service development and service provision are defined in subdivision 5.
Subd. 4. Accessible information, screening, and assessment function. (a) The projects selected by and under contract with the commissioner shall establish an accessible information, screening, and assessment function for persons who need assistance and information regarding long-term care. This accessible information, screening, and assessment activity shall include information and referral, early intervention, follow-up contacts, telephone screening, home visits, assessments, preadmission screening, and relocation case management for the frail elderly and their caregivers in the area served by the county or counties. The purpose is to ensure that information and help is provided to elderly persons and their families in a timely fashion, when they are making decisions about long-term care. These functions may be split among various agencies, but must be coordinated by the local long-term care coordinating team.
(b) Accessible information, screening, and assessment functions shall be reimbursed as follows:
(1) The screenings of all persons entering nursing homes shall be reimbursed as defined in section 256B.0911, subdivision 6; and
(2) Additional state administrative funds shall be available for the access, screening, and assessment activities that are not reimbursed under clause (1). This amount shall not exceed the amount authorized in the guidelines and in instructions for the application and must be within the amount appropriated for this activity.
(c) Any information and referral functions funded by other sources, such as Title III of the Older Americans Act and Title XX of the Social Security Act and the Community Social Services Act, shall be considered by the local long-term care coordinating team in establishing this function to avoid duplication and to ensure access to information for persons needing help and information regarding long-term care.
(d) The lead agency or the agencies under contract with the lead agency which are responsible for the accessible information, screening, and assessment function must complete the forms and reports required by the commissioner as specified in the contract.
Subd. 5. Service development and service delivery. (a) In addition to the access, screening, and assessment activity, each local strategy may include provisions for the following:
(1) the addition of a full-time staff person who is responsible to develop the following services and recruit providers as established in the contract:
(i) additional adult family foster care homes;
(ii) family adult day care providers as defined in section 256B.0919, subdivision 2;
(iii) an assisted living program in an apartment;
(iv) a congregate housing service project in a subsidized housing project; and
(v) the expansion of evening and weekend coverage of home care services as deemed necessary by the local strategic plan;
(2) small incentive grants to new adult family care providers for renovations needed to meet licensure requirements;
(3) a plan to apply for a congregate housing service project as identified in section 256.9731, authorized by the Minnesota Board on Aging, to the extent that funds are available;
(4) a plan to divert new applicants to nursing homes and to relocate a targeted population from nursing homes, using the individual's own resources or the funding available for services;
(5) one or more caregiver support and respite care projects, as described in subdivision 6; and
(6) one or more living-at-home/block nurse projects, as described in subdivisions 7 to 10.
(b) The expansion of alternative care clients under paragraph (a) shall be accomplished with the funds provided under section 256B.0913, and includes the allocation of targeted funds. The funding for all participating counties must be coordinated by the local long-term care coordinating team and must be part of the local long-term care strategy. Alternative care funds may be transferred from one SAIL county to another within a designated SAIL project area during a fiscal year as authorized by the local long-term care coordinating team and approved by the commissioner. The base allocation used for a future year shall reflect the final transfer. Each county retains responsibility for reimbursement as defined in section 256B.0913, subdivision 12. All other requirements for the alternative care program must be met unless an exception is provided in this section. The commissioner may establish by contract a reimbursement mechanism for alternative care that does not require invoice processing through the Medical Assistance Management Information System (MMIS). The commissioner and local agencies must assure that the same client and reimbursement data is obtained as is available under MMIS.
(c) The administration of these components is the responsibility of the agencies selected by the local coordinating team and under contract with the local lead agency. However, administrative funds for paragraph (a), clauses (2) to (5), and grant funds for paragraph (a), clauses (6) and (7), shall be granted to the local lead agency. The funding available for each component is based on the plan submitted and the amount negotiated in the contract.
Subd. 6. Caregiver support and respite care projects. (a) The commissioner shall establish up to 36 projects to expand the respite care network in the state and to support caregivers in their responsibilities for care. The purpose of each project shall be to:
(1) establish a local coordinated network of volunteer and paid respite workers;
(2) coordinate assignment of respite workers to clients and care receivers and assure the health and safety of the client; and
(3) provide training for caregivers and ensure that support groups are available in the community.
(b) The caregiver support and respite care funds shall be available to the four to six local long-term care strategy projects designated in subdivisions 1 to 5.
(c) The commissioner shall publish a notice in the State Register to solicit proposals from public or private nonprofit agencies for the projects not included in the four to six local long-term care strategy projects defined in subdivision 2. A county agency may, alone or in combination with other county agencies, apply for caregiver support and respite care project funds. A public or nonprofit agency within a designated SAIL project area may apply for project funds if the agency has a letter of agreement with the county or counties in which services will be developed, stating the intention of the county or counties to coordinate their activities with the agency requesting a grant.
(d) The commissioner shall select grantees based on the following criteria:
(1) the ability of the proposal to demonstrate need in the area served, as evidenced by a community needs assessment or other demographic data;
(2) the ability of the proposal to clearly describe how the project will achieve the purpose defined in paragraph (b);
(3) the ability of the proposal to reach underserved populations;
(4) the ability of the proposal to demonstrate community commitment to the project, as evidenced by letters of support and cooperation as well as formation of a community task force;
(5) the ability of the proposal to clearly describe the process for recruiting, training, and retraining volunteers; and
(6) the inclusion in the proposal of the plan to promote the project in the community, including outreach to persons needing the services.
(e) Funds for all projects under this subdivision may be used to:
(1) hire a coordinator to develop a coordinated network of volunteer and paid respite care services and assign workers to clients;
(2) recruit and train volunteer providers;
(3) train caregivers;
(4) ensure the development of support groups for caregivers;
(5) advertise the availability of the caregiver support and respite care project; and
(6) purchase equipment to maintain a system of assigning workers to clients.
(f) Project funds may not be used to supplant existing funding sources.
Subd. 7. Contract. (a) The commissioner of human services shall execute a contract with Living at Home/Block Nurse Program, Inc. (LAH/BN, Inc.). The contract shall require LAH/BN, Inc. to:
(1) develop criteria for and award grants to establish community-based organizations that will implement living-at-home/block nurse programs throughout the state;
(2) award grants to enable living-at-home/block nurse programs to continue to implement the combined living-at-home/block nurse program model;
(3) serve as a state technical assistance center to assist and coordinate the living-at-home/block nurse programs established; and
(4) manage contracts with individual living-at-home/block nurse programs.
(b) The contract shall be effective July 1, 1997, and section 16B.17 shall not apply.
Subd. 8. Living-at-home/block nurse program grant. (a) The organization awarded the contract under subdivision 7, shall develop and administer a grant program to establish or expand up to 33 community-based organizations that will implement living-at-home/block nurse programs that are designed to enable senior citizens to live as independently as possible in their homes and in their communities. At least one-half of the programs must be in counties outside the seven-county metropolitan area. Nonprofit organizations and units of local government are eligible to apply for grants to establish the community organizations that will implement living-at-home/block nurse programs. In awarding grants, the organization awarded the contract under subdivision 7 shall give preference to nonprofit organizations and units of local government from communities that:
(1) have high nursing home occupancy rates;
(2) have a shortage of health care professionals;
(3) are located in counties adjacent to, or are located in, counties with existing living-at-home/block nurse programs; and
(4) meet other criteria established by LAH/BN, Inc., in consultation with the commissioner.
(b) Grant applicants must also meet the following criteria:
(1) the local community demonstrates a readiness to establish a community model of care, including the formation of a board of directors, advisory committee, or similar group, of which at least two-thirds is comprised of community citizens interested in community-based care for older persons;
(2) the program has sponsorship by a credible, representative organization within the community;
(3) the program has defined specific geographic boundaries and defined its organization, staffing and coordination/delivery of services;
(4) the program demonstrates a team approach to coordination and care, ensuring that the older adult participants, their families, the formal and informal providers are all part of the effort to plan and provide services; and
(5) the program provides assurances that all community resources and funding will be coordinated and that other funding sources will be maximized, including a person's own resources.
(c) Grant applicants must provide a minimum of five percent of total estimated development costs from local community funding. Grants shall be awarded for four-year periods, and the base amount shall not exceed $80,000 per applicant for the grant period. The organization under contract may increase the grant amount for applicants from communities that have socioeconomic characteristics that indicate a higher level of need for assistance. Subject to the availability of funding, grants and grant renewals awarded or entered into on or after July 1, 1997, shall be renewed by LAH/BN, Inc. every four years, unless LAH/BN, Inc. determines that the grant recipient has not satisfactorily operated the living-at-home/block nurse program in compliance with the requirements of paragraphs (b) and (d). Grants provided to living-at-home/block nurse programs under this paragraph may be used for both program development and the delivery of services.
(d) Each living-at-home/block nurse program shall be designed by representatives of the communities being served to ensure that the program addresses the specific needs of the community residents. The programs must be designed to:
(1) incorporate the basic community, organizational, and service delivery principles of the living-at-home/block nurse program model;
(2) provide senior citizens with registered nurse directed assessment, provision and coordination of health and personal care services on a sliding fee basis as an alternative to expensive nursing home care;
(3) provide information, support services, homemaking services, counseling, and training for the client and family caregivers;
(4) encourage the development and use of respite care, caregiver support, and in-home support programs, such as adult foster care and in-home adult day care;
(5) encourage neighborhood residents and local organizations to collaborate in meeting the needs of senior citizens in their communities;
(6) recruit, train, and direct the use of volunteers to provide informal services and other appropriate support to senior citizens and their caregivers; and
(7) provide coordination and management of formal and informal services to senior citizens and their families using less expensive alternatives.
Subd. 9. State technical assistance center. The organization under contract shall be the state technical assistance center to provide orientation and technical assistance, and to coordinate the living-at-home/block nurse programs established. The state resource center shall:
(1) provide communities with criteria in planning and designing their living-at-home/block nurse programs;
(2) provide general orientation and technical assistance to communities who desire to establish living-at-home/block nurse programs;
(3) provide ongoing analysis and data collection of existing and newly established living-at-home/block nurse programs and provide data to the organization performing the independent assessment; and
(4) serve as the living-at-home/block nurse programs' liaison to the legislature and other state agencies.
Subd. 10. Implementation plan. The organization under contract shall develop a plan that specifies a strategy for implementing living-at-home/block nurse programs statewide. The plan must also analyze the data collected by the state technical assistance center and describe the effectiveness of services provided by living-at-home/block nurse programs, including the program's impact on acute care costs. The organization shall report to the commissioner of human services and to the legislature by January 1, 1993.
Subd. 11. SAIL evaluation and expansion. The commissioner shall evaluate the success of the SAIL projects against the objective stated in subdivision 1, paragraph (b), and recommend to the legislature the continuation or expansion of the long-term care strategy by February 15, 1995.
Subd. 12. Public awareness campaign. The commissioner, with assistance from the commissioner of health and with the advice of the long-term care planning committee, shall contract for a public awareness campaign to educate the general public, seniors, consumers, caregivers, and professionals about the aging process, the long-term care system, and alternatives available including alternative care and residential alternatives. Particular emphasis will be given to informing consumers on how to access the alternatives and obtain information on the long-term care system. The commissioner shall pursue the development of new names for preadmission screening, alternative care, foster care, and other services as deemed necessary for the public awareness campaign.
Subd. 13. Community service grants. The commissioner shall award contracts for grants to public and private nonprofit agencies to establish services that strengthen a community's ability to provide a system of home and community-based services for elderly persons. The commissioner shall use a request for proposal process. The commissioner shall give preference when awarding grants under this section to areas where nursing facility closures have occurred or are occurring. The commissioner shall consider grants for:
(1) caregiver support and respite care projects under subdivision 6;
(2) on-site coordination under section 256.9731;
(3) the living-at-home/block nurse grant under subdivisions 7 to 10; and
(4) services identified as needed for community transition.
HIST: 1991 c 292 art 7 s 17; 1992 c 513 art 7 s 65-72; 1Sp1993 c 1 art 5 s 73-79; 1994 c 625 art 8 s 63; 1997 c 203 art 4 s 44,45; 1999 c 245 art 4 s 62; 2000 c 488 art 9 s 36; 2001 c 161 s 46,47; 1Sp2001 c 9 art 4 s 31,32; 2002 c 379 art 1 s 113