The Art of Options Counseling in Massachusetts · The Art of Options Counseling in Massachusetts...

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Massachusetts Executive Office of Elder Affairs,

Massachusetts Rehabilitation Commission, with assistance from the Lewin Group

May 2013

The Art of Options Counseling

in

Massachusetts

May 20, 2013

The Art of Options Counseling in Massachusetts

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May 2013

Understand the Options Counseling model in Massachusetts

Understand the components and core competencies of Options Counseling

Learn how traditional support planning differs from a consumer-focused approach

Increase knowledge of long-term support services and housing options

Learning Objectives


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May 2013


Lots of information is available, but it can be complex, contradictory, and confusing

Individuals and families may need individualized support making decisions about long-term care

Few people plan ahead for long term support needs

Institutional placements often occur without consideration of available community-based options

The Value of Options Counseling

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May 2013

OC Service Provided to Consumer


A consumer-directed, culturally competent approach that ensures the consumer’s personal goals and preferences are respected;

Unbiased information about long term services and supports;

Information about resources available to pay for the services;

Sessions are organized to meet the needs of the individual allowing for variation in the level of support and the number, duration, and delivery method of the service

Identification of next steps;

Assistance in facilitating referrals if needed;

30 days after the final counseling session, the counselor checks in with the consumer to understand whether goals are being met or barriers exist;

Every consumer is asked to participate in a OC consumer survey

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May 2013


More individuals have the information and support they need to make an informed choice

An increase in the number of individuals choosing to remain in the community for longer periods of time

An increase in the number of nursing home residents transitioning to a less restrictive setting with appropriate support

Anticipated Outcomes of Options Counseling

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May 2013


National model developed and supported by the Administration for Community Living (ACL) the Centers for Medicare and Medicaid Services (CMS) and the Veterans Health Administration

ADRCs serve as highly visible and trusted places that provide one-on-one counseling about the full range of long term support service options for people of all ages, incomes and disabilities. ADRC support state efforts to streamline access to long-term services and support (LTSS) options for older adults and individuals with disabilities.

No Wrong Door Approach

Across the lifespan - Connects with all age groups

Use principles of consumer control, self-direction, cultural competency and accessibility

Options counseling is a core function of the ADRC

Options Counseling & Aging & Disability Resource Consortia (ADRC)

Adapted from the MA ADRC Strategic plan, March,2011

Key Stakeholders/Community Partners

(not inclusive)

ADRC Member Agencies

At a minimum include:

Aging Service Access Points (ASAPs)

Area Agencies on Aging (AAAs)

Ind ependent Living Centers (ILCs)

Each ADRC may identify other member agencies as

appropriate and desired based upon their regional

uniqueness.

Primarily adults age 18 and over seeking information

and access to long term services and supports.

Caregivers/support

persons/loved ones of

Persons looking to

plan for their

future LTSS needs

Health and

social

service

providers

Recovery Learning

Communities

Transportation

TBI/ABI

Providers

Hospitals/Acute

care facilities

Other Medical

Providers SCOs /PACE ARCs Consumers

VA and Veterans

Home health

Nursing facilities

Community mental

health

Assisted Living/Supportive

Housing/Residential Care

Schools

Substance

abuse

State and

regional offices

Councils on Aging

Community Based Flexible Supports (DMH-CBFS)

Massachusetts Executive Office of Elder Affairs, Massachusetts Rehabilitation Commission, May 2013

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May 2013


Massachusetts Model for Options Counseling

OC is an interactive, short-term process to assist individuals to make an informed choice about how and where to receive their long term support services, allowing for the wide use of community based-options.

The counselor provides unbiased information about relevant long term care resources and payment sources and supports consumers as they explore the options that move them toward their goal. Follow-up services are available to address the changing needs and preferences of consumers and to further the decision-making process.

To promote awareness of the service active, on-going outreach and education is provided.

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May 2013


Provides unbiased information & decision-support, but not case management

Consumer sets the pace, and the counselor follows

Flexibility – the consumer is in control, and actively determines and pursues a course of action, but if help is needed to connect with resources and referrals the OC may assist

Helps the consumer work through the pros and cons of different options

If the consumer needs help applying for benefits or filling out applications, the OC should identify a resource that can help

Counselor does more listening and less talking

Role of the Options Counselor

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May 2013


Information & Referral – by phone; limited, specific information

Family Caregiver – services “wrap around” the needs of the caregiver

Community Transition/Nursing Home Transition –

for nursing home residents; long term, comprehensive involvement

Elder Care Advisor – available at limited number of ASAPs; uniquely

configured

Care Manager – creates service plan; arranges services

Comprehensive Screening & Service Model (CSSM) -

for nursing home residents who are MassHealth members & applicants

Skills Trainer – supports development of skills to meet individual goals

Distinguishing OC from Other ILC and ASAP Services

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May 2013


Consumers in acute care hospitals and rehabilitation facilities, at risk of discharge to a long term care facility, and who are not under care management (ASAPs) or receiving comprehensive services (ILCs)

Consumers in community settings who are not under care management

(ASAPs) or receiving comprehensive services (ILCs) and who are at risk of admission to a long term care facility, due to their support needs or to a lack of awareness of community-based options

“Private Pay” Consumers residing in a SNF/long term care facility looking to

return to a community setting”*

Note: * Nursing home residents on MassHealth or who are MassHealth applicants are seen by the ASAP CSSM (Comprehensive Screening and Service Model) team who conduct weekly on-site visits to nursing facilities. CSSM staff provide options to these members and applicants. Options counselors may be an additional resource if requested.

Primary Consumers seen by Options Counselors

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May 2013


Family members/significant others seeking information and decision-

support in conjunction with the consumer or independently (i.e., in situations where there is a legal guardian, a consumer living out of state who wishes to return to Massachusetts, communication barriers, etc.). In these situations, every effort should be made to bring the consumer into the process to ensure that their needs and wishes remain the focal point of the counseling session.

Options Counseling is also appropriate for

Consumers in community settings, who are not under care management

(ASAPs) or receiving comprehensive services (ILCs), and who need both information and decision support to understand and evaluate their long term support options.

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May 2013


Prepare for the conversation Identify the right people to talk with Build positive relationships Tailor the message to your audience Be persistent Leave written materials and contact information Within your agency: Educate agency staff about your role and how it intersects

with other staff positions Brochures and written materials reinforce the message

Generating Referrals to OC

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May 2013


Community: Consumers who contact an ADRC considering admission to a LTC facility will be informed of OC.

Hospitals and Rehabilitation Facilities: Discharge planners may inform patients about the service prior to discharge.

Nursing Facilities: Prior to admission, or within a reasonable time after admission, individuals may receive information about options counseling.

At community events where Options Counselors & other ADRC staff provide materials & information about the service

Word of mouth – a OC consumer may tell a friend about OC

How Will Consumers Learn About Options Counseling?

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May 2013


Face-to-face in a: nursing home rehabilitation facility hospital home agency assisted living public meeting place

Over the phone

Email

Methods for Delivering Options Counseling

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May 2013


Core Competencies

Skill Sets Needed by Options Counselors

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May 2013


Determine the need for OC Work with the consumer to help identify needs, values

& preferences Support self-determination Encourage future orientation

Understand public and private sector resources Provide Follow-Up

ACTIVE LISTENING SKILLS

Core Competencies/Skills

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May 2013


Paraphrase, reflect and ask open and closed-ended

questions

Articulate, clarify and challenge assumptions

Understand that people may not immediately know what they want or need

Take time to listen

Evaluate pros and cons

Active Listening Skills Facilitate the Conversation

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May 2013

Active Listening Supports the Process


4 Components of Active listening: Listening to feelings

Giving feedback

Being Nonjudgmental

Developing Empathy

With practice you can become a better listener

ACTIVE LISTENING SKILLS

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May 2013


During the initial contact, staff determine if OC is appropriate.

Assess the purpose of the contact by asking such questions as:

What kind of help are you looking for?

How do you describe the underlying problem?

Would you like support making these difficult choices?

Determine if the person is looking for immediate help or is doing advance planning

Core Competency 1 : Determine the Need for OC

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May 2013

Options Counseling Supports Self-determination:

In addition to basic demographic information, gather information about:

What is important to the individual

Physical and/or mental status

Support System (family, friends, neighbors, etc.)

Decide how you will gather additional information and

begin to form relationship with individual and, when appropriate, family

Introductory phone call ?

Home visit ?


Core Competency 2: Work with Consumer to Identify Needs, Values, & Preferences

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May 2013

Core Competency 2: Work with Consumer to Identify Needs, Values, & Preferences


Is cost important?

Is proximity to family and friends important?

Is autonomy in hiring my own providers important?

Is hiring caregivers through and agency important?

Is the quality of the services important?

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May 2013

Additional Considerations:


What services might fit their needs and situation?

Is availability of the service an issue?

Do they have financial needs or are they able to pay for services privately?

Do these services exist or are their waiting lists?

Any unmet needs?

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May 2013


Core Competency 3: Support Self-Determination

Does the person have all the relevant information needed to make the

decision?

Is the information being explained or presented in a way that is easiest

for the person to understand? For example, some people might find it

easier to communicate using pictures, photographs, videos, tapes or

sign language.

Are the counseling sessions being offered at the time and place that the

consumer prefers?

Is there anyone else that the consumer would like included in the

counseling sessions? For example, a relative, friend or advocate.

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May 2013


Providing decision-support doesn’t mean that Options Counselors make decisions on someone else's behalf, but that the OC is communicating and listening effectively and respectfully to ensure that the individual understands their range of options and that their preferences and choices are heard.


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May 2013


Every one has the right to make his or her own decisions and must be assumed to have the capacity to do so unless proved otherwise. This means that you cannot assume that people cannot make a decision for themselves.

Everyone has their own values, beliefs and preferences which may not be the same as those of other people


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May 2013


Options Counselors provide decision-support by using effective listening and communication skills that encourage open dialogue and ensure that consumers understand the choices available to them.

Options Counselors facilitate a decision-making process that supports choices that align with the consumers’ values and goals.


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May 2013


Help consumers to proactively consider future possibilities, and outcomes of decisions

Reach out to family caregivers (especially adult children) in helping them anticipate and plan their future needs

Core Competency 4: Encourage Long Term Thinking and Planning

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May 2013


Options counselors must have working knowledge of public and private programs (e.g. private services, community resources)

Collaboration with agency colleagues adds to knowledge

Formal trainings increase understanding

Building on-going relationships with your ADRC partner agencies will expand awareness of local and regional resources

An up-to-date database and/or resource guide will help ensure that lesser known options are included in the mix

Core Competency 5:Understand Public & Private Sector Resources

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May 2013


1. Help the consumer identify needs, strengths, preferences and resources

2. Discuss options (consumer learns about and gathers information in order to make an informed choice and counselor helps facilitate)

3. Work with the consumer to weigh the pros and cons of each option…take into consideration strengths, needs preferences and resources

4. Compare Options

5. Identify next steps – Mary Ann Bedick, T.A.C.E., October 2008

The Counseling Session : Multiple Steps

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May 2013


Follow-up serves a critical role in assessing whether additional information or support is needed and helps strengthen the consumer’s relationship with the ADRC.

The Counseling Session: Continuing the Process

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May 2013

The Counseling Session: Closure


The total number of counseling sessions provided will vary depending on the needs of the consumer

To help determine whether it is time to terminate the counseling, ask yourself: Does the consumer understand the information? Has the consumer made a decision about next steps to take? Does the consumer have the information & support needed to take

those steps? - If not, what else is needed?

Does the consumer have unanswered questions

Recognize that “letting go” of the consumer can be hard

If the counseling is complete, let the consumer know that you would like to have one additional conversation, in 30 days, as a final check in.

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May 2013

30-Day Check-In


30 days after the completion of the final counseling session, check in with the consumer to determine

where they are at:

Another way to gather information

Helps identify barriers

Helps identify diversion

Shows us how our services can be improved

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May 2013

30-Day Check-In(continued)


At the 30-day Check-In:

Has the consumer been able to take next steps?

If not, what barriers exist?

Close the record, if appropriate, and ask the consumer if he or she is willing to participate in an Options Counseling survey by phone, on the web or by mail.

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May 2013

Measuring our Effectiveness – Consumer Experience Survey


Consumer’s experience

Felt needs & preferences

were Understood

Received information

about relevant, programs & Services &

how to access

Received information

about cost of services

More efficient use of

resources

Identified next steps

Support

& information resulted in

an informed Decision

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May 2013

Documentation: Early in the Process


At the onset of OC record the consumer’s initial intention/goal in SIMs or IDMS/WILD

Stay in the Community (private residence alone or with others,

assisted living residence, congregate housing, homeless shelter, rest home or any other non-institutional “homelike” setting)

Re-entry to Community o From a rehabilitation hospital (e.g. New England Rehab.) or a designated

rehabilitation bed or rehabilitation unit in a skilled nursing facility) o From acute care hospital o From long term care setting (LTC in a nursing home or chronic care

hospital providing long term care/support to a consumer)

Long Term Care Facility Admission(nursing home care, or chronic

care hospital)

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May 2013

Documentation: Information to Capture Along the Way


Basic demographic information (consumer’s age, gender, location)

Contact information

Consumer’s consent (or not) to contact others about situation

Consumer’s needs

Consumer’s Preferences

Supports and Resources currently in place

Referrals

Next steps consumer will take (plan)

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May 2013

Documentation – Closing the Record


Select an outcome from the pre-determined list

Follow the procedure for closing the record in SAMS or IDMS/WILD

If consumer was unable to achieve their goal, identify barriers that exist

Document whether the consumer agreed to a survey and by what method (phone, web-based or mail)

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May 2013


Our job is to give people the tools they need to choose the right path for themselves…

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The Art of Options Counseling in Massachusetts · The Art of Options Counseling in Massachusetts...

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