Even minimal policy changes, such as redefining funding for home modifications and adaptive equipment, can mean the difference between remaining at home or moving to an institution. To insure effective prevention of unnecessary institutionalization, center boards, staff, and consumers should become knowledgeable about the nursing home reform amendments of OBRA '87 as well as how Medicaid waiver programs are being implemented in their state. Centers should insure that a higher proportion of minorities are served in nursing home transition programs than is reflected in the general population, since people of color are disproportionately represented among nursing home residents. While no conclusion can be drawn about whether or not distinct services for multicultural populations are needed, it is clear that center board and staff composition should reflect the racial and ethnic mix of the consumer population. Most important multicultural issues should be considered at the program design stage, not as an afterthought.
Additional information is needed about how various populations can be served effectively.
Board members, staff, and volunteers who have been institutionalized and have made a successful transition to independence can have a powerful impact on convincing nursing home residents, medical professionals, and others of the viability of independent living. These formerly interred individuals should be used at all levels of program design and implementation, especially in the provision of direct services and advocacy. A consumer group of nursing home residents can also be an important vehicle for obtaining consumer participation and involvement. A common problem observed during the research for this monograph was that centers did not keep accurate statistics on how many consumers left nursing homes or remained in the community as a result of center programs. Centers commonly stake claims for additional funding upon cost savings of community versus institutional living and should bolster these claims with accurate documentation.