Aging and Disability Resource Centers (ADRC) have expertise in providing resource information to their community about long term options available for all aspects of life related to aging or living with a disability. The ADRC provides information on a broad range of programs and services, to help people understand the various long term care options available to them.
ADRCs are expected to provide outreach to nursing home residents, providers, stakeholders and the community regarding opportunities for community living. Information and assistance staff will meet in person with nursing home residents and their families to ensure that individuals living in nursing homes across the state are aware of options to live in less restrictive community settings, as well as the availability of services, which in turn may increase relocations and reduce Medicaid expenditures. Topics covered during these meetings include, but are not limited to, the following:
- The range of care settings and options available to meet the person's long term care needs;
- Financial implications of the various options;
- Ways to evaluate facility quality and appropriateness; and
- Publicly funded long term care programs which may be available to help pay for the person's care, and the eligibility requirements and procedures.
As the "Local Contact Agency" (LCA), ADRCs will receive referrals from nursing homes through the Program Participation System (PPS). These referrals are prompted by the completion of the Minimum Data Set (MDS) comprehensive assessment tool by the nursing home. The MDS is completed upon admission and periodically thereafter to assess residents in Medicare or Medicaid certified facilities. The MDS identifies potential resident strengths, difficulties and preferences. When a resident indicates they wish to talk to someone about returning to the community through the MDS process, nursing home staff make a referral to the LCA through the Referral Management Module within PPS.
Some counties have been identified as areas with large numbers of Medicaid funded nursing home residents (PDF 46 KB). In those areas the state will assign Community Living Specialists (CLS) to assist the ADRC with outreach and information to nursing home residents and nursing homes staff.
Links to helpful resources:
- Connections to Community Living Brochure (P-00420) (PDF 808 KB)
- Connections to Community Living Sustainability Initiative Operational Guide Series
- Operational Guide #1, Topic: Funding for ADRC Relocation Activity (August, 2012) (PDF, 68 KB)
- Operational Guide Series #2, Topic: Best Practices for Outreach to Residents of Nursing Homes (August, 2012) (PDF, 134 KB); and
- Operational Guide Series #3, Topic: ADRC Role with the Money Follows the Person (MFP) Demonstration Grant (August, 2012) (PDF, 172 KB).
- Wisconsin MDS Section Q Referral Process
- Money Follows the Person Demonstration Grant
- CMS Section Q Brochure (Exit DHS)
- MFP Brochure (P-00448) (PDF 302 KB)
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