CRITICAL ANALYSIS REPORT 1

COSAs Critical Analysis Report

Rahmah Allen
Wilmington University














CRITICAL ANALYSIS REPORT 2

Many seniors want to live independently in their home for as long as possible. When
caring for a senior becomes too much for the caregiver, the senior is usually placed in a nursing
home. According to Fox-Grage, Houser, Ujvari (2013), The typical cost for Home and
Community Based Services is about one-third the cost of institutional care. However, 64 percent
of Medicaid LTSS dollars for older people and adults with physical disabilities went to nursing
facility care, even though most people prefer to live at home. Education is needed to caregivers,
seniors, and the community about certain Medicaid funded programs to help seniors live in the
community opposed to being placed in a nursing home.
The Nursing Home Transition Program (NHT) is a service through Delaware County Office
of Services for the Aging (COSA). COSA is the Department of County Government responsible
for planning, coordinating and administering programs and services for the seniors in Delaware
County, Pa. (www.delcosa.org). The NHT program assist individuals age sixty and over with
moving out of a nursing facility. The program helps with eliminating barriers, so that individuals
receive services and supports in settings of their choice.
The Assessment Unit Director is responsible for running the NHT program and the
Assessment Unit at COSA. However, each county in the state runs the program differently. The
program is managed as followed. The program has one supervisor and one coordinator which
limits the amount of transitions. The NHT Supervisor is also the Assessment Supervisor. The
supervisor oversee all activities, monitor billing reports, networks with nursing home Social
Workers, review referrals, and supports and educates the NHT Coordinator. The Supervisor
reports to the Assessment unit Director. However, changes in rules or policy are implemented
from the Office of Long Term Living. If the consumer requires special nursing home transition
CRITICAL ANALYSIS REPORT 3

funding, a request must be sent to the Office of Long Term Living. The NHT program is funded
by the Center for Medicaid and Medicare Services.
If a resident living in the nursing facility wants to leave the nursing facility, but cannot
without community supports. A referral is made to COSAs NHT unit. Depending on the
residents medical and financial status, they will be connected to certain programs to help them
live independently in the community. The NHT Coordinators or counselor's first step is to assess
the resident's long-term support needs. During the assessment, the counselor reviews the
resident's chart and pre-admission screening report, interviews nursing home staff. The
counselor will give the resident a business card, and, interview the person's family or informal
supports. The Nursing Home Transition Counselor will call or visit the consumer twenty four to
forty eight hours after discharge. Then a three, six, and twelve month call or visit is required.
If I was COSAs director, I would not change much about the NHT program. I think the flow
process for the NHT program is very effective. However, I would change the Agency
Organizational Chart. I would not have the NHT program under the Assessment unit. The NHT
program will function independently. By doing this, the director of the NHT program would
focus strictly on the administrative task such as, billable reports, updating policies and
procedures, and networking with the Office of Long Term living. This NHT Supervisor would be
able focus on supervising the NHT Coordinator. The NHT Director and NHT Supervisor could
focus more on promoting the NHT program and increase the amount of residents transitioning
out of the nursing facilities.
If I was COSAs director I would hire an additional NHT coordinator. By bringing on
additional staff, I could increase the amount of revenue the agency receives. This could double
the funding. Funding for the programs is available from the Center for Medicaid and Medicare
CRITICAL ANALYSIS REPORT 4

services. COSA receives money for each transition completed, and each three, six, and twelve
month follow up completed. The more transitions completed, the more money COSA receives.
I would look for staff or interns that are self-sufficient, friendly and provides excellent
customer service skills, caring towards other, and have a history of helping others. It is important
to care for the people you serve. Empathy is needed to show compassion. Many seniors dream of
living independently. They are searching for a feeling of safety and security. They want a NHT
Coordinator, who will solve the problems that they cannot solve independently. According to
The Gerontologist (2007), research shows that prominence of individuals who were discharged
from a nursing home through Nursing Home Transition remained living in the community for
one year or more.















CRITICAL ANALYSIS REPORT 5


Reference
(2014). Information retrieved June 30, 2014, from www.delcosa.org.
Houser, a, Fox-Grage, W, Ujvari, K. (2012). Across the States 2012: Profiles of Long-Term
Services. Retrieved from http://www.hcbs.org/files/218/10855/across-the-states-2012-brief.pdf
Howell, S., Silberberg, M., Quinn, W., Lucas, J., (2007). Determinants of Remaining in the
Community After Discharge: Results From New Jersey's Nursing Home Transition Program.
The Gerontologist Vol. 47, No. 4, 535-547.