MissionCare Health

iCare Health Network’s MissionCare Health is the Leading Provider and Operator of Long Term Care for the Justice Involved and Difficult to Place Population

Since 2013, iCare Health Network has operated the first long term care nursing center for the justice involved population and individuals that are otherwise challenging to transition and place in an appropriate site of care. 

Now, in 2024, when budget and policy experts search for a provider and operator with experience, accomplishments and successes in working with a justice-involved population in a Medicare/Medicaid certified and state licensed Long Term Care Facility, iCare Health Network stands out as the gold standard. As such, we have created a new brand, MissionCare Health, that incorporates both 60 West and MissionCare at Holyoke as well as future, similar endeavors.  

What follows is a description the current programs at MissionCare locations, the MissionCare philosophy and best practices for such a program and facility. 60 West is the flagship project and location for this program and is heavily highlighted. 

PBS NewsHour Segment

Keys to Success in Long Term Care for the Justice Involved and Complex to Place Population

1. Policies, procedures and interventions compliant with state and federal nursing facility regulations, including 2017 revisions to CMS Guidelines addressing justice-involved residents.
2. Development of innovative and unique programming in a person-centered facility environment and culture guided by the social and cultural backgrounds and interests of the individuals who contribute to the community’s composition.
3. Procedures to assess and treat PTSD and undiagnosed traumatic reactions and symptoms of residents. 
4. “Stigma-free” campaign and initiative in which all employees pledged to adopt a broadened philosophy of caregiving, including a commitment to welcome and respect those of differing cultures and backgrounds.
5. Extensive pre-admission screening (CCR 2505-10 8.400) and risk mitigation strategies and protocols.
6. Knowledge, skills and experience in legal, government and community relations, clinical operations and healthcare regulations.
7. Recruitment, screening, hiring and training of the staff as building blocks for the development and maintenance of an environment and person-centered programming that promotes resident quality of life.
8. A physical environment designed with a focus on safety and comfort, with removal or mitigation of potentially dangerous, hazardous or antagonistic spaces, equipment or systems prior to occupancy with particular attention to creating an atmosphere or milieu conducive to healing.
9. Specialized visitation policy and procedures that ensure resident rights to visitation are protected
10. Screening and access control supervision techniques that have proven effective in providing a safe environment.
11. Empower and inform residents in addressing their court-ordered restrictions or conditions of parole or probation, while ensuring they preserve their rights as a nursing home resident.
12. Facility policies, practices and care planning that assist residents with their legal responsibilities through awareness of the resident’s restrictions, education on consequences, and counseling regarding a resident’s choices and actions. 
13. Training in Avoiding Crisis and Escalation (ACE), a proprietary behavioral management training curriculum that places great emphasis on safe and effective de-escalation and management of potentially harmful resident care situations.

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Resident Profile and Referral Review

MissionCare Health care centers are committed to providing long term care and services for physically, mentally and cognitively impaired individuals who are difficult to place in a standard nursing home or long-term care setting. 

MissionCare uses a comprehensive and compassionate approach to meeting the physical, emotional, social and spiritual needs of this special patient population. This approach enables residents to thrive in the most attentive – yet least restrictive – environment possible.

Common referral sources for MissionCare Health:

• Acute Care Hospitals.
• Correctional and Forensic Institutions.
• Mental Health Hospitals.
• Community settings such as group homes, congregate housing or other nursing homes.
• Other categories such as through community case managers, population health programs/payers, the office of the ombudsman, state officials, etc. 

MissionCare serves adults in need of Long Term Care or hospice (short term rehabilitation services in rare circumstances) and qualify for a nursing home level of care as determined by the federal Preadmission Screening and Resident Review (PASRR) process. In addition, resident must be –

A. Demonstrated to be Difficult to Place (by fitting one or more of the following categories) –

• Major, chronic medical condition coupled with a diagnosed mental illnesses/behavioral disorder, and/or;
• Discharging directly from a correctional or other justice-involved setting with or without the presence of a mental illness, and/or;
• Are otherwise deemed by evidence to be difficult to place in a traditional long term care or other site of care due to a stigmatizing event or background including presence on the sex offender registry.

B. Meet Clinical Criteria and be Appropriate for the Milieu –

• Be evaluated clinically, including chart review and via an in-person, on-site evaluation, comprehensive assessment, interview and risk assessment by MissionCare Health’s Clinical Liaison who specializes in this population, and;   
• Be considered clinically, socially and behaviorally appropriate and stable. Determining appropriateness and stability is an in-depth, patient-specific process.
• Each potential resident is thoroughly evaluated for the presence of a significant cognitive, physical or other impairment, disorder or disability that meet the federal guidelines and establish their appropriateness for a long term care setting. These impairments also serve to mitigate risk and determine a resident-specific, patient specific plan of care.  

C. Have an appropriate and acceptable long-term payer. – This varies by MissionCare location but acceptable payment sources are typically Medicare for any short term stay, Medicaid, private pay, a limited list of other contracted payers or via single case agreement. 

In addition to the PASRR process and the above, potential admissions are most often reviewed by a utilization management committee comprised of Mental Health, Aging and Addiction Services, Corrections, other State government and staff and/or are approved for admission by a representative of the State who deems them appropriate for the setting.  

As noted, candidates for admission often have a degenerative medical condition, such as dementia, Parkinson’s, MS, Huntington’s disease, a terminal or hospice-level type diagnosis requiring skilled nursing, level of care services and is the most appropriate, least restrictive setting for that person. 

Services

Services vary by location but may include:

• 24 hour Skilled Nursing Care
• 24 hour Assistance with Activities of Daily Living
• On-site Physician Services
• Mental Health Services, Psychiatric Care and Behavior Management
• Secured, Dementia Care in Certain Locations
• Individual and Group Therapy
• Hospice and Palliative Care
• Rehabilitative and Restorative Services - Physical Therapy, Occupational Therapy, Speech Therapy
• Social Work
• Therapeutic Recreation and Structured Activities. 
• Pastoral Services
• Dietary and Meal Services

Timeline and Background for the Flagship Project: 60 West

In 2012, in response to a State of Connecticut Request for Proposal (Titled “Nursing Home For Individuals In State Care Who Are Difficult To Place”), iCare Health Network submitted a response which resulted in a engagement with the State of Connecticut to establish nursing home care for individuals in state care.

60 West Project Timeline

Check out news, stories, and updates from 60 West

The basic resident profile was individuals that were: (1) difficult to place at a site of appropriate care as a result of their judicial, social or other history; and (2) they met federal requirements for long term care in a nursing home setting; and, (3) would be transitioning from a correctional facility, have criminal justice involvement and/or be individuals transitioning from a higher level of care provided by the Department of Mental Health and Addiction Services (DMHAS).

After being  the selected bidder and contracting with the State of Connecticut, iCare opened “60 West”, a 95 bed skilled nursing center operated by an iCare entity known as SecureCare Options in 2013, in Rocky Hill, CT. iCare continues to manage and operate this nursing facility.   

60 West’s Mission

60 West’s mission is to provide enrichment to the lives of our patients through specialized care, dignity and acceptance.

The mission is achieved through an inclusive, compassionate and stigma-free approach to caring for an aging population of residents that are difficult to place.

Vital Stats for 60 West After Ten Years in Operation

• Consistently achieved an overall 5-Star Rating from the Center for Medicare and Medicaid Services (CMS) - One of only nine nursing homes in CT with 5-Star Ratings in all four categories (98^th percentile – 320 out of 15,600 nationally).
• Over 100 resident admissions from correctional facilities since opening.
• Over 200 total admissions from a state facility since opening.
• Coordinated care and supervision for residents needing SNF level of care under the Psychiatric Security Review Board (PSRB) who were found not guilty of a crime by reason of mental disease or defect.
• Care and supervision for residents who are listed on the Connecticut Sex Offender Registry.
• Acquired Brain Injury - Traumatic Brain Injury Program.
• US News and World Report – Best Nursing Homes – 2018-2019 and 2019-2020 in the Long Term Care category. 
• Zero Employee-Related Lost Time Injuries since opening in 2013
• 2020 American Health Care Association (AHCA) ‘Silver Quality Award’ Recipient
• Director of Nursing Recognized with 2022 Nightingale Excellence in Nursing Award
• Mission Statement: “Provide Enrichment Through Specialized Care, Dignity and Acceptance.” 

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  MissionCare at Holyoke Overview

In 2018, the iCare Health Network team consulted at a facility known as Farren Care Center which was the only one of its kind in Massachusetts, serving a population with dual diagnoses of major medical condition coupled with mental illness. By their diagnoses, behaviors and stigma, these residents were hard to place in classic nursing home settings. iCare reduced the use of off label anti-psychotics, restraints, falls and improved the overall quality of care.

By 2021, iCare had taken over the operation, purchased an alternative location for the program in the City of Holyoke, merged the two resident populations and facilitated a partnership with MassHealth to care for difficult to place residents in a humane and stigma-free setting statewide. The new, merged and relocated program and facility became known as MissionCare at Holyoke, with MissionCare Health emerging as iCare’s name for the difficult to place and justice involved programs and locations.

MissionCare at Bennington Overview

In 2022, the State of Vermont issued a Request for Proposals for “Specialty Care in Licensed Long-Term Care Facilities”. The RFP sought a licensed and experienced provider to establish a nursing home to care for individuals who may have complex needs, be involved historically or currently with the justice system or be otherwise challenging to place in existing nursing homes despite their need for nursing home level of care. 

In early 2023, iCare Health Network was identified as the provider of choice for Vermont and entered into an agreement to secure a functioning and licensed long term care center in which to operate the program. An ideal location in Bennington, Vermont was located and purchased by an entity affiliated with iCare and created for this purpose. A final contract for services was completed iCare assumed operation of the care center on September12, 2024. 

The population care for in Vermont is the same as other MissionCare Health locations and the process for consideration and admissions is jointly managed by iCare and the Vermont Department of Aging, Disability and Independent Living (DAIL) in concert with the Department of Mental Health and the Department of Corrections. 

Resources, Links and News

1. Vermont hospitals stuck caring for patients who can’t get into nursing homes, costing millions.

2. Building an Edge: SNF Operators Innovate Through Establishing Specialty Services, Public-Private Partnerships

3. Frank Smith was locked up for eight decades. At 98, what would it mean to be free?

4. The Never-Ending Murder Case: How Mental Competency Laws Can Trap People With Dementia

5. Connecticut SNF Provides Behavioral Health Blueprint as CMS Places Emphasis on Service Line

6. WHY ELDERLY INCARCERATED PEOPLE STRUGGLE TO FIND CARE AFTER PRISON
7. 60 West’s Michele Clemens Wins 2022 Nightingale Award for Excellence in Nursing 
8. For Aging Inmates, Care Outside Prison Walls” by Christine Vestal, the PEW Charitable Trusts, 8/12/2014
9. Evaluation of Outcomes for a Skilled Nursing Facility for Persons Who are Difficult to Place
10. 60 West Project Timeline
11. Greenwich Times Article on Longest Serving Prisoner, Now Residing at 60 West After 72 Years in Prison
12. UCONN Center on Aging Study – “A Community-Based Skilled Nursing Facility for Difficult-to-Place Patients”

13. “When Prisons Need to Be More Like Nursing Homes” The Marshall Project

14. AHCA Silver Award New Release
15. iCare Behavioral, Cognitive, SUD Brochure
16. iCare Mental Disorders Brochure
17. iCare Health Network Clinical Capabilities Grid
18. Governing Magazine Article: States Look so Nursing Homes to Lower Prison Healthcare Costs 
19. Hartford Courant - Rocky Hill’s 60 West nursing home named one of best by U.S. News and World Report
20. 60 West - Facility News, Discussion and Updates
21. Admission Criteria for the Justice Involved Population
22. PASRR Level of Care Criteria Worksheet

If you represent a State agency or other public or justice-involved organization or entity and you are interested in learning more about 60 West, MissionCare Health and/or skilled nursing programs for individuals that are difficult to place or in state care, please contact:

David Skoczulek, Vice President of Business Development and Communications, at (860) 250-3075 or email at MOC.NHERACI@OFNI.

iCare Health Network’s Qualifications for Special Population Care

• Care of Justice-Involved and Difficult to Place Individuals (both in Connecticut and Massachusetts)
• Seven (7) Secured Behavioral Health Programs
• Six (6) Secured Memory Care Programs
• iRecovery Substance Use Disorder (SUD) Program
• Huntington’s Disease Program (part of Movement Disorder Program) – Unique to only one nursing facility in CT.
• HIV/AIDS Program – One of only two programs in CT nursing facilities.
• Veterans Program
• Advanced CHF and COPD Programs
• On average, over 90% of residents payor State Medicaid
• Both unionized and non-unionized workforce (around 1900 employees)
• Eleven (11) American Health Care Association (AHCA) Bronze Quality Award Recipients
• Six (6) American Health Care Association (AHCA) Silver Quality Award Recipients