Resources for Older Adults with Mental Illness

What does the Department of Mental Health and Addiction Services offer for CT’s Aging Population?

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LTSS Programs

• Acquired Brain Injury
• Mental Health Waiver
• Nursing Home Diversion and Transition Program
• 60 West
• Senior Outreach and Engagement

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Nursing Home Diversion and Transition Program (NHDTP)

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• Program Goals:
• Diverting individuals from institutional levels of care
• Ensuring that nursing home placements for DMHAS clients are necessary, appropriate, and safe   
• Transitioning nursing home residents, with a serious mental illness, back to the community
• Diverting individuals from ED’s & avoiding unnecessary acute care hospitalizations
• Consultations with CVH, community providers, medical personnel, state partner staff

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Nursing Home Diversion and Transition Program (NHDTP)

• 8 nurses & 3 case managers cover the 5 DMHAS regions
• Provide consultation to nursing home discharge staff regarding behavioral health options in the community
• Consult with community providers regarding:
• medical issues such as diabetes education, healthy lifestyle choices
• mental health service linkage
• substance use treatment & linkages including MAT & MOUD
• RCH placement 
• Ongoing collaboration with Money Follows the Person & Mental Health Waiver
• Assessment for level of care to determine the most appropriate community based residential option

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Nursing Home Diversion and Transition Program (NHDTP)

• The NHDTP program collaborates with the CT Association for Residential Care Homes (CARCH) :
• Develop curricula for the training of RCH direct care staff to better serve residents. Trainings topics: Mental illness 101 , Establishing Professional Boundaries and Avoiding Power Struggles, Crisis Stabilization and De-escalation Bullying in Congregate Care Settings, Substance Use and Addictions, The Mind, Body, Spirit Connection (Self Care), Working with People with Intellectual Challenges, Working with People with Alzheimer’s Disease and Dementia, Diabetes 101, Fall Risk and Prevention, and Recovery Transformation Topics
• Assist with residents who are in crisis by assessing clients for the most appropriate level of care; act as liaison between the residential care home and the hospital emergency department
• Assist in the emergency placement of RCH residents and coordinate with DPH, DSS, and the State Long Term Care Ombudsman program in securing alternative housing.

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Senior Outreach & Engagement

• Mission: To outreach and engage at-risk older adults with behavioral health and substance use disorder treatment needs 
• Program capacity covering all 5 DMHAS regions; expansion in March 2023
• Provides outreach through visits to residences, nursing homes, senior centers and other community locations
• Assist people in navigating mental health and substance disorder treatment system
• Assist with linkages to all levels of treatment services to help older adults “age in place” and avoid unnecessary institutionalization

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Mental Health Waiver

• Assist clients with Severe Mental Illness (SMI) who are in, or at risk of entering a nursing home to live independently in the community
• The MHW is not a DMHAS program. It is a DSS/Medicaid program that is operated by DMHAS
• The MHW’s recovery orientation encompasses:
• Intensive psychiatric rehabilitation provided in the participant’s home, and in other community settings;
• Attention to both psychiatric and medical needs;
• Emphasis on wellness and recovery;
• Person-Centered Planning leading to development of an individualized Recovery Plan; and
• Use of peer supports provided by people trained and certified in rehabilitative care, who know from first-hand lived experience about recovery from mental illness.

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Client Eligibility

• Community Support Clinician (CSC) deems client eligible for the Mental Health Waiver program if the following criteria are met:
• 22 years or older
• Medicaid eligible (Husky C only)
• Meets nursing home LOC
• SMI diagnosis
• Voluntarily agrees to be in the program
• Can be managed safely in the community

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• The CSC completes a psycho-social and skills assessment to determine level of functioning.

MHW Eligibility

What does “nursing home level of care” mean?

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The individual must have at least 3 Critical Needs…

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OR 2 critical needs AND 4 or more Cognitive Deficits

Additional Considerations

• Health and safety needs must be reasonably assured
• Cost of waiver services must remain within the cost limit established by the state

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What does “serious mental illness” mean?

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• Schizophrenia
• Bipolar Disorder
• Major Depression
• Delusional/Paranoid Disorder
• Psychotic Disorders, NOS (Brief Reactive Psychosis, Schizoaffective Disorder, and Psychotic Disorders NOS)

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-OR-

Another mental illness that may lead to a chronic disability, requires assistance or supervision, and have limitations in at least one area of functioning due to the mental illness

Are these 5 criteria met?

• ) 22 years of age or older;

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2) Has a diagnosis of serious mental illness

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3) Medicaid Eligible (“Husky C”);

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4) Meets criteria for nursing home level of care

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5) Voluntarily chooses to participate in the waiver

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MH Waiver Services

Acquired Brain Injury Program

• ELIGIBILITY CRITERIA FOR ABI SERVICES
• Accepted For DMHAS services and currently receiving qualifying services
• Has a qualifying Acquired Brain Injury (ABI) as determined through appropriate testing and documentation
• Is 18 years of age or older
• Voluntarily accepts services offered
• Does not have a primary diagnosis of a degenerative cognitive disorder
• The dysfunction of the central nervous system is not congenital or developmental

Acquired Brain Injury Program

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• PROGRAM SERVICES
• Consultation Services
• ABI Substance Use Services
• Community Residence and Transition Services
• Housing and Living Subsidies
• Training and Education
• Advocacy Supports

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Community Integration Specialist (CIS)

• CIS duties include:
• Acting as the primary point of contact regarding qualification for services
• Providing and monitoring services to persons with brain injury through the LMHA network
• Processing all referrals to the ABI Community Services Program within their region
• Serving as a link for clients to inpatient services
• Arranging for clinical consultations
• Coordinating with all community services and serving as liaison with partner agencies

ABI Community Residences

• Six residential level of care homes – capacity of 23 statewide:
• BH Care Benz Street Residence, Ansonia, : Capacity: 3 male
• Ability Beyond Woodland Residence, Bristol: Capacity: 4 female
• Goodwill Cheshire Residence: Capacity: 5
• Goodwill Manchester Residence: Capacity: 2
• Ability Beyond Beecher Residence, Wolcott: Capacity: 5
• Ability Beyond Unionville Residence: Capacity: 4
• The Community Residences are a specialized 24/7 residential setting that addresses specific needs of individuals with cognitive and behavioral challenges attributed to an ABI and mental health diagnosis
• Specialized supports/services assist clients to live successfully in the community & result in diversion from institutionalization.
• Clients must have a qualifying brain injury; accepted for DMHAS ABI Services; be willing to enter the program on a voluntary basis; and be Medicaid eligible

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DMHAS �Waiver Housing & Living Support Services

• Assistance with housing search through DMHAS Housing Coordinators
• Monthly Subsidy for Community clients (this is a payer of last resort)
• Application and hold fees
• First/Last month rent and Security deposits
• Furnishings and household items for a 1 bedroom starter apartment (Clients may participate in this process to the extent practical and clinically appropriate)
• Assistance with moving expenses
• Negotiate and finalize lease with client and landlord
• Environmental modifications/assistive technology up to $10,000 maximum (request must include clinical/medical justification)
• Assistance with one-time re-location after the initial move (with appropriate clinical justification)

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60 West Nursing Home

• Mission: to serve difficult to place residents who would be denied proper nursing home services due to mental health needs or criminal histories
• Privately owned facility – two (2) units:  a secured dementia unit and open long term care unit 
• Referrals for admission originate from the community; inpatient psychiatric facilities and state correctional institutions
• Individual must meet nursing home level of care/PASRR process 
• Referrals assigned to assessment clinician for review and scheduling of face to face assessment

Referral Process

• Referral submitted to assessment clinician for review
• Assessment clinician contacts referral source for additional information/discharge packet
• Assessment Clinician to inform referral source & client of virtual tour video on DMHAS web site
• DMHAS and 60 West assessment clinicians complete on-site review/interview
• Referral discussed in monthly DMHAS/60 West UM meetings for review and determination

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Questions ?

Comments……

Contacts:

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Erin Leavitt-Smith, Director

Long Term services and supports

Statewide services division�DMHAS, Office of the Commissioner

erin.leavitt-smith@ct.gov��Amy Dumont, LCSW, Behavioral Health Clinical Manager

Nursing Home Diversion & Transition Program, Sr. Outreach & Engagement Program�Statewide services division�DMHAS, Office of the Commissioner

amy.dumont@ct.gov