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The Art of Options Counseling

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The Art of Options Counseling in Massachusetts March 23, 2015 Massachusetts Executive Office of Elder Affairs Massachusetts Rehabilitation Commission – PowerPoint PPT presentation

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Title: The Art of Options Counseling


1
  • The Art of Options Counseling
  • in
  • Massachusetts
  • March 23, 2015
  • Massachusetts Executive Office of Elder Affairs
  • Massachusetts Rehabilitation Commission

2
Learning Objectives
  • Understand the OC model in Massachusetts
  • Understand the components core competencies of
    OC
  • Learn how traditional support planning differs
    from a consumer-focused approach
  • Increase knowledge of long-term support services
    and housing options

3
Options Counseling Model
4
The Value of Options Counseling
  • 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 services
    and supports
  • Few people plan ahead for long term support needs
  • Institutional placements often occur without
    consideration of available community-based
    options

5
Core Competencies/Skills
  • Determine the need for OC
  • Work with the consumer to help identify life
    goals, needs, values preferences
  • Provide Decision-Support
  • Support Self-Determination
  • Provide Follow-Up
  • Understand public and private sector resources

ACTIVE LISTENING SKILLS
6
Goal of Options Counseling
  • 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

7
Options Counseling and ADRCs
  • ADRCs provide consumers, regardless of age,
    disability or income, with access to I R
    services, decision support, service planning,
    consumer-directed options regarding their choices
    for LTSS and community integration.
  • OC is a core function of the ADRC
  • Each ADRC is an equal partnership between Aging
    Service Access Points (ASAPs) and Independent
    Living Centers (ILCs), organized into 11
    geographic regions.
  • ADRCs welcome partnerships with a variety
    community organizations

8
OC Service Provisions
  • Discuss personal goals, needs, informal formal
    supports, financial resources
  • Explore support options setting,
    programs/services funding sources
  • Where and how sessions are provided is determined
    by needs of the consumer
  • Informational materials
  • Assistance as needed to connect with resources
  • Determination of next steps
  • Follow up contact from Options Counselor

9
How to Distinguish OC from other Services
  • Information Referral by phone more general
    information, quick response
  • Family Caregiver services wrap around the
    needs of the caregiver
  • Care Manager creates service plan arranges
    services
  • IL Skills Trainer supports development of
    skills to meet individual goals
  • Care Transitions specific protocol for
    consumers in acute care setting
  • Comprehensive Screening Service Model (CSSM) -
    for nursing home residents who are MassHealth
    members applicants
  • Transitions Coordinator for nursing home
    residents long term, comprehensive involvement

10
Supportive Framework for OC Ch. 211of the Acts
of 2006 (Equal Choice Law)
  • Mandates that counseling about community long
    term support options be provided to individuals
    prior to admission to a long term care facility
  • Directs the state to report on the number of
    consumers who received counseling and the number
    of diversions to the community generated by the
    options counseling service

11
Primary Consumers seen by Options Counselors
  • Consumers in hospitals and rehabilitation
    facilities, at risk of discharge to a long term
    care facility
  • Consumers in community settings at risk of
    admission to a long term care facility
  • Private Pay Consumers residing in a SNF/long
    term care facility looking to return to a
    community setting

12
Options Counseling is also appropriate for
  • Family members/significant others seeking
    information and decision-support
  • Consumers seeking information and decision
    support about their long term support options for
    future planning.

13
Preparing for the Conversation
14
Things to think about in advance
  • The best way to communicate with the person
  • How to gather additional information from the
    individual and, when appropriate, family
  • 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?
  • Any unmet needs?

15
Flexible Service Delivery
  • Face-to-face in a
  • nursing home
  • rehabilitation facility
  • hospital
  • home
  • agency
  • assisted living
  • public meeting place
  • Over the phone
  • Email

16
Starting the OC Process
  • Understand that people may not immediately know
    what they want or need
  • Take time to listen
  • Paraphrase, reflect and ask
  • open and closed-ended questions
  • Help the consumer evaluate the
  • pros and cons

17
Active listening skills
facilitate the
conversation
  • Ask
  • How do you describe the underlying problem?
  • What kind of help are you looking for?
  • Would you like support making these difficult
    choices?
  • In addition to basic demographic information
    determine
  • What is important to the individual
  • If the person is looking for immediate help or
  • planning in advance
  • Existing Support System (family, friends,
    neighbors, etc.)

18
Focus on Life Goals
  • Help consumers to proactively consider future
    possibilities,
  • and outcomes
  • of decisions

19
Self-Determination and Decision-Support
20
Support Self-Determination
  • Everyone 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

21
Provide Decision-Support
  • 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.

22
Follow-through with the consumer
  • Follow-up serves a critical role in assessing
  • whether additional information
  • or support is needed and
  • helps strengthen the
  • consumers relationship
  • with the ADRC.

23
COMING TO..
24
Closure
  • To determine if 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?
  • Note
  • The total number of counseling sessions provided
    will vary depending on the needs of the consumer
  • Recognize that letting go of the consumer can
    be hard

25
Final Check-In
  • 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.
  • Has the consumer been able to take next steps?
  • If not, what barriers still exist?
  • Identify where the consumer is living
  • Offer additional support and/or information if it
    is needed
  • 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.

26
  • Access
  • Collaboration
  • Outreach

27
ACCESS How consumers learn about OC
  • Community Consumers who contact an ADRC
    considering admission to a LTC facility
  • 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 OCs other ADRC staff
    provide materials information about the service
  • Through other community organizations
  • Word of mouth a consumer may tell a friend about
    OC

28
COLLABORATION Building Relationships with
public and private agencies
  • Options counselors must have working knowledge of
    public and private programs (e.g. private
    services, community resources)
  • Formal trainings increase understanding
  • Building on-going relationships with your agency
    colleagues and ADRC partner agencies will expand
    awareness of local and regional resources
  • up-to-date database and/or resource guide will
    help ensure that lesser known options are
    included in the mix

29
Outreach
  • Community Outreach
  • Identify the right people to talk with
  • Build positive relationships
  • Prepare for the conversation
  • 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
  • Learn about outreach opportunities from
    colleagues
  • Brochures written materials reinforce the
    message

30
Documentation
31
Early in the Process
  • Record the consumers 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
  • From a rehabilitation hospital (e.g. New England
    Rehab.) or a designated rehabilitation bed or
    rehabilitation unit in a skilled nursing
    facility)
  • From acute care hospital
  • 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)

32
Information to record along the way
  • Basic demographic information (consumers age,
    gender, setting)
  • Contact information
  • Consumers consent (or not) to contact others
    about situation
  • Notes
  • Referrals made

33
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)

34
Options Counseling Program Survey
35
Measuring our Effectiveness The Consumer
Experience Survey

36
Time to take a break and.
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