Post on 24-Jul-2020
transcript
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PERSON CENTERED PLANNING FOR CONSUMER-DIRECTED CARE
Supporting Consumers in the 21st Century Conference
Mark Sciegaj Associate Professor of Health Policy and Administration
Penn State University Senior Consultant for Research and Training
National Resource Center for Participant-Directed Services
Goals for Today’s Training
Develop a shared understanding of “person centered planning”.
Discuss the growth of consumer-directed programs Discuss the differences between person-centered
and traditional service planning. Become familiar with several person-centered
planning tools and their applications. Become aware of additional resources on person-
centered planning and consumer direction Resource guide available
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What is Person-Centered Planning?
A process to develop an individual support plan Identifying participant preferences, strengths, capacities,
needs, supports, and desired outcomes or goals.
Planned series of conversations, learning experiences and/or activities that are purposefully sequenced.
A structure for expanding the focus from program menus to the broader perspective of individual’s life.
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Why is Person-Centered Planning Important? Rebalancing of long-term care dollars
Increase in home and community based services
The growth of consumer-directed long-term care
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WA AK
Hawaii
OR
CA
NV
ID
MT
WY
UT
AZ
CO
NM
TX
OK
KS
NE
SD
ND MN
IA
MO
AR
LA
MS
TN
KY
IL
WI
MI
IN WV
AL GA
FL
SC
NC
VA
PA
NY
DC
MD
DE
NJ
RI
MA
NH
VT
ME
OH
CT
Prevalence of Consumer Direction: 1970’s
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WA AK
Hawaii
OR
CA
NV
ID
MT
WY
UT
AZ
CO
NM
TX
OK
KS
NE
SD
ND MN
IA
MO
AR
LA
MS
TN
KY
IL
WI
MI
IN WV
AL GA
FL
SC
NC
VA
PA
NY
DC
MD
DE
NJ
RI
MA
NH
VT
ME
OH
CT
Prevalence of Consumer Direction: 1990’s
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WA AK
Hawaii
OR
CA
NV
ID
MT
WY
UT
AZ
CO
NM
TX
OK
KS
NE
SD
ND MN
IA
MO
AR
LA
MS
TN
KY
IL
WI
MI
IN WV
AL GA
FL
SC
NC
VA
PA
NY
DC
MD
DE
NJ
RI
MA
NH
VT
ME
OH
CT
Prevalence of Consumer Direction: 2000’s
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WatershedforConsumerDirec3on:CashandCounselingDemonstra3onand
Evalua3on
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Cash & Counseling participants were up to 90% more likely to be very satisfied with how they led their lives.
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Changes in Federal Law, Regulation, and Policy
2008 Veterans-Directed Home and Community -Based Care Program
2001 New Freedom Initiative 2006 Deficit Reduction Act
2006 Reauthorization of Older Americans Act 2007 Aging and Disability Resource Center Program
2008 Community Living Program
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2010 Patient Protection and Affordable Care Act
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Traditional versus Consumer-Directed Services
Participant
Workers recruited
and report to agency
Program and
agency set tasks
Agency specifies
salary and benefits
Normal work hour schedule
Worker training required
by agency
Case managers determine needs & services
Participant
Recruits and
manages workers
Sets tasks
Specifies salary and
benefits (optional)
Assigns flexible work
hour schedule
Trains/ arranges worker training
Makes decisions
about needs and services
Traditional Services Consumer-Directed Services
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CommonlyUsedTerms• Par3cipant:thepersonwhoreceivesservices.
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Par3cipant
Consumer
EmployerofRecord
Individual
McInnis-Dittrich, Simone, and Mahoney (April, 2006)
CommonlyUsedTerms• Par3cipant‐DirectedCounselor:Individualwhoworkswiththepar3cipant
indesigningtheirplan.Thepersonthepar3cipantgoestowithques3ons.Rolecanbetakenonbystaffasa“CareAdvisor.”
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SupportBroker
SkillsTrainer
Consultant
CaseManager
Counselor
McInnis-Dittrich, Simone, and Mahoney (April, 2006)
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DefiningPar3cipant‐Direc3on
• Thosewhoprovidecareorservicesareaccountabletotheelderand/orsurrogate
• Thefreedomforonetoplanhis/herownlife
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What
When Who
How
Participant controls
McInnis-Dittrich, Simone, and Mahoney (April, 2006)
Components of Decision Making
And questions to consider….
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Where Would You Sit (and Why or Why Not)?
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Intellectual Factors to Decision-Making
What knowledge do elders bring to the table to make decisions about their services?
What kinds of gaps in knowledge may affect the kinds of decisions elders will make?
How do we “educate” elders while supporting self-determination?
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McInnis-Dittrich, Simone, and Mahoney (April, 2006)
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Emotional Factors to Decision-Making
How do past emotional experiences affect the decisions an elder makes?
What kinds of things do individuals have strong emotional reactions to? Fear? Joy? Anxiety? Anger?
How do emotional factors cloud the role of knowledge in decision-making?
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McInnis-Dittrich, Simone, and Mahoney (April, 2006)
Social Factors to Decision-Making
What social experiences (or desired social experiences) will affect who the elder chooses to interact with?
How do you think the elder sees himself or herself in a relationship to greater society? How does this affect decision-making?
What is the influence of formal networks? What is the influence of family dynamics or
other informal networks?
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McInnis-Dittrich, Simone, and Mahoney (April, 2006)
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Par3cipant‐DirectedModels
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Par3cipant‐directedindividualbudgets
AgencywithChoicemodels
Directlyhired
personalcareworkers
Support System in Consumer Direction
• Embraces paradigm shift
• Explains the program
• Completes enrollment
• Collaborates with participant to complete the assessment, service plan, spending plan, and reassessments
• Offers skills training
• Partners with participant
• Assures that spending plan is followed
• Pays invoices including timesheets
• Figures tax liability and pays taxes
• Maintains savings • Provides accounting
reports
• Makes decision based on individual budget
• Hires, manages, and dismisses workers
• Sets tasks
• Trains (or arranges for training) of workers
• Evaluates worker performance
• Determines goods and services to be purchased
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Relationship is between the program and the provider
Provider is accountable for health, welfare, and outcomes
Participant is responsible for decision-making, safety, and adequacy of services
Participants have the opportunity to learn from their mistakes
Effectiveness and quality are measured by the participant
Shifts in Responsibility for Risks
Role of Counselor in Risk Management
Counselor will
collaborate with
participant to
Employ person- centered approach
Assess need and capacity
Develop plan to manage
risks
Monitor plan,
collect and analyze
data
Address outcomes
and amend plan as
necessary
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Navigating Choice and Change in Later Life: Tools for Person-Centered Planning
The following Person-Centered Planning Tools have been developed (modified) by Susan Fox and Patty Cotton of
University of New Hampshire Institute on Disability
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Traditional Support Planning vs. Person-Centered Planning
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Traditional Support Planning Person-Centered Planning Decisions are to be made by “consensus” of a planning team that typically consists primarily of staff and professionals and are driven by medical needs.
Focus of planning is primarily defined by a menu of service options that are offered under the HCBC waiver or other programs. Natural supports are sometimes used to augment programmatic supports.
Planning occurs periodically during annual meetings or isolated problem solving events.
Attention is focused on problems and “fixing.”
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Traditional Support Planning vs. Person-Centered Planning
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Traditional Support Planning Person-Centered Planning Decisions are to be made by “consensus” of a planning team that typically consists primarily of staff and professionals and are driven by medical needs.
The participant drives decisions and invites people who they feel have important contributions to make, often including family, friends, community members and trusted allies from the service system.
Focus of planning is primarily defined by a menu of service options that are offered under the HCBC waiver or other programs. Natural supports are sometimes used to augment programmatic supports.
Focus of planning is defined by desired outcomes of the participant. Programmatic supports are used to augment natural supports.
Planning occurs periodically during annual meetings or isolated problem solving events.
Planning occurs as a process that evolves over time.
Attention is focused on problems and “fixing.”
Attention is focused on strengths and “building.”
Graphic Tools to Facilitate Person-Centered Planning
Visual tools can increase attentiveness, accommodate various learning styles, improve “group memory”, increase learning, and decrease meeting time.
Visual tools alleviate the professional/client perception.
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Person in Life Course Perspective: Creating an Experiences Timeline
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Potential Applications of Experiences Timeline Urgent/Emergent Application Short-Term Planning Application Long-Range Planning Application
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Person in Relationship Perspective: Relationship Maps
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Potential Applications of Relationship Maps Urgent/Emergent Application Short-Term Planning Application Long-Range Planning Application
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Person-Centered Tool: Preferences Map
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Potential Applications of Preferences Maps Urgent/Emergent Application Short-Term Planning Application Long-Range Planning Application
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Person-Centered Tool: Routines Map
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Potential Applications of Routines Maps
Urgent/Emergent Application Short-Term Planning Application Long-Range Planning Application
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Person-Centered Tool: Places Map
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Potential Applications of Places Map
Urgent/Emergent Application Short-Term Planning Application Long-Range Planning Application
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Additional Tools and Resources
www.participantdirection.org
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www.participantdirection.org
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Resource Guide Myths and Realities of Consumer-Directed Services for
Older Persons Person-Centered Planning Materials Self-Direction Handbook A Guide to Quality in Consumer Directed Services Consultant Training Program Sample Manuals, Handbooks, and Brochures National Participant Network (NPN) Resources Additional Tools, Articles, and Websites Glossary
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Helpful Websites National Resource Center for Participant-Directed Services:
www.participantdirection.org www.bc.edu/schools/gssw/nrcpds/training.html
Cash & Counseling: www.cashandcounseling.org The Clearinghouse for Home and Community Based
Services: www.hcbs.org University of New Hampshire Institute on Disability:
www.iod.unh.edu New Hampshire Real Choice: www.realchoicenh.org Technical Assistance Exchange: www.adrc-tae.org
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Contact Information
Mark Sciegaj, PhD, MPH Associate Professor of Health Policy and Administration
601F Ford Building Pennsylvania State University
University Park, PA 16803 O: 814-863-2861 mxs838@psu.edu
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