New Hampshire Long Term Support Systems Transformation

Individuals with disabilities and older adults have the right to live as independently as possible within their home and community. Most people want to stay in their home and community as their support needs increase. But for some individuals with disabilities and older adults the freedom to live where and with whom they choose is lost due to barriers that prevent them from being supported in their homes and communities. These barriers include lack of affordable and accessible housing, access to transportation, employment supports, an adequate workforce to provide personal care, healthcare, and funding, as well as attitudinal and public policy barriers.
In June 2001, President Bush launched the New Freedom Initiative outlining his clear intent "to help ensure that all Americans have the opportunity to live close to their families and friends, to live more independently, to engage in productive employment, and to participate in community life." As part of this initiative, the president authorized funds for Real Choice System Change Grants to help design and implement improved ways of providing community supports and services to enable children and adults of any age who have a disability or long-term illness to live and participate in their communities. Since 2001, New Hampshire has received eleven Real Choice grants to support its efforts to support all people to live full and meaningful lives in their communities. A broad cross-disability coalition of individuals with disabilities, older adults, families, professionals and others in need of long-term services and supports has been developed to guide the work of New Hampshire’s Real Choice projects.
The Real Choice Systems Transformation project is designed to create and implement improvements in community-based care systems in order to improve health and long-term care services and supports that assist people with disabilities and long-term illnesses to live in the community. This project has been structured to:

1. Support NH’s Medicaid Reform efforts to substantially expand access to community based consumer directed services and supports;
   
2. Increase the percentage of people referred to and enrolled in home and community based as opposed to institutionally based services;
   
3. Develop nationally relevant and innovative community practices that can be replicated by other states.
   

Our Mission
To create a dynamic and enduring community-based system of long-term supports, so all
New Hampshire citizens may live and age with respect, dignity, choice and control
until the end of life.

Our Vision
All New Hampshire citizens have access to the full array of long-term supports and services. This allows them to exercise personal choice and control, and affords them dignity and respect throughout their lives. To the greatest extent possible, each of us is able to make informed decisions about our aging, health, and care needs. There is a high level of quality and accountability in everything offered and in everything provided. Over time, New Hampshire truly becomes an extended community of people who care about, value and help one another.

Our Values & Commitments
These are the ideals toward which we strive for all New Hampshire citizens:

• Quality of Life • Dignity & Respect • Choice & Access
• Personal Responsibility • Ease • Service • Integration
• Responsiveness • Wellness • Quality & Outcomes

Quality of Life. First and foremost, we are steadfast in our commitment to a quality of life of one’s choosing throughout our lives. To this end, we aspire to the following:

Dignity & Respect. Each individual is valued. This includes the many differences that exist among people. Such valuing leads to increased dignity and respect of older adults and those with disabilities. In the process, the citizens of New Hampshire come to recognize that everyone is valuable and has something to contribute to the greater good. Likewise, all types of caregivers (including family members) are sufficient in number and are developed, trained, valued, and compensated appropriately.

Choice & Access. All efforts ultimately lead to maximized choice, independence, control and timely access to a full array of services and options by all individuals, regardless of age, payer source or personal ability to pay. Self-determined, individualized plans exist and are utilized. People are encouraged to make their own choices within a full range of possibilities (even as we are mindful of how others, at times, must make choices on behalf of individuals). Information, education, support and services become increasingly available on a 24/7 basis. All of these components (and the service system as a whole) are responsive to individuals as their needs arise and then change over time. All components of the health care system exist to help and support people. Thus they act in support of the people they are meant to serve.

Personal Responsibility. Personal responsibility is a lifelong ideal and commitment. It takes different forms for different people. It often varies significantly over the course of one’s lifetime. Personal responsibility encompasses the lifestyle and health care options one has, the choices one makes, and the actions one takes. Not just for oneself, but often for members of one’s extended family…even one’s friends and neighbors. Such family supports are the backbone of the care most people receive at most stages of life. These range from regular communication and personal visits to ongoing education and proactive planning…from hands-on care to responsible, long-term financing. Yet we also recognize that there are some individuals, situations, or times when personal and family efforts need to be supplemented by appropriate community and governmental supports or structures.

Ease. Not only are services accessible, but the entire system is simple to use. We strive for a seamless system, capable of smooth transitions from one phase of living to another as time passes. As people age and lose capabilities, connectedness, and so forth, we do our best to keep people connected socially and involved in how their changing needs are met. Each older or disabled adult in New Hampshire comes to have a personal guide, one single individual with whom to deal within the larger system.

Service. An integral and essential part of being a citizen – a human being! – is the commitment to help one another. This belief infuses all that we do, all that we stand for, and all that we promote. Out of this value of care and connectedness emerges our ongoing efforts to collaborate – to work together for the good of all people in our communities and state.

Integration. Everything is well integrated, from systems and processes, to services and choices. All government-funded services are available as a single, unified pool to individuals. Such components as community and non-medical services, the home, family roles, and geographic realities are taken into consideration. All efforts are mindful of individual, family, and community desires, differences, and abilities in providing services, support and care. The system supports the existing inherent resources within each individual’s life.

Responsiveness. We continually seek ways to enlarge society’s capacity to meet critical needs by providing the services and resources collectively needed and desired. Over time, we expect communities to become more comprehensively “livable,” playing a more significant role in supporting the varied needs of all their citizens. As times, needs and expectations change, the system of services will change as well. It is responsive and dynamic. The past and present influence, but do not control the future. Our culture, our attitudes, our communities, our neighborhoods, and our systems are all reinvented as needed. Nothing can stagnate, when change and responsiveness are required. We are continually alert to unintended consequences to actions and decisions – and we respond accordingly, so we are able to create what we truly desire.

Wellness. In the inevitable face of aging – with or without disabilities – we promote wellness. It is the foundation for everything we do. Out of wellness emerges the ability for all men and women to live to the maximum.

Quality & Outcomes. Quality infuses everything that is done, everything that is offered, everything that is provided. We pay attention to what does and does not happen. We measure and assess outcomes, and utilize that data in our ongoing informed decision-making and the modifications to our efforts that result. Thus, as we achieve quality – or fall short of it – we know it. We act accordingly.

Real Choice Systems Transformation is a project of the
Institute on Disability at the University of New Hampshire.