Options Counseling in Arkansas Supporting Individuals in Making Long Term Care Decisions

1. Options Counseling in ArkansasSupporting Individuals in Making Long Term Care Decisions Arkansas Aging Conference October 28, 2011

2. What is Options Counseling? • Support for Options Counseling • Arkansas perspective • Act 516 • Federal Perspective • MDS Section Q

3. Long-term Care Options Counseling Defined Long-term care options counseling is an interactive decision-support process whereby consumers, family members and/or significant others are supported in their deliberations to determine appropriate long-term support choices in the context of the consumer’s needs, preferences, values, and individual circumstances.

4. “When it comes to long-term health care, each patient has a unique mix of medical and social needs that must be considered. Our health care system can offer many options to meeting those needs from traditional nursing home care to home and community-based services. ” Dr. Donald Berwick Centers for Medicare and Medicaid Services

5. Just the Facts NEVER BEFORE IN HUMAN HISTORY has our planet contained so many older people— or such a large percentage of them. This has not always been the case. As late as 1930, America's older population numbered less than 7 million—only 5.4% of the population.

6. Just the Facts Population - Percent of Persons 65 and Over 14%

7. Just the Facts Population - Percent of Persons 65 and over

8. Just the Facts Population Highest Proportion Over 65 years in Arkansas

9. Just the Facts Life Expectancy in US

10. Just the Facts Percent of People 65 Years+ Below FPL

11. Just the Facts Disability status of the non-institutional population 65 and over

12. Summary

13. Just the Facts Low health literacy According to the US Dept of Health and Human Services: Health literacy affects the ability to: • navigate the healthcare system, including filling out complex forms and locating providers and services • share personal information, such as health history, with providers • engage in self-care and chronic-disease management

14. Just the Facts Health Literacy Level in Arkansas • 56% of adult Arkansans (1.1 million adults) are functionally and/or marginally illiterate • Adults 65 or older are more likely to have below basic or basic health literacy skills than those under 65 Source: Peggy Sissel-Phelan, Ed.D

15. Importance of Options Counseling Increase Baby Boomers Increase Longevity Over 65 with disabilities Increase Poverty

17. I’ll think about it tomorrow….

18. Consumer Facts • Families need individualized support making decisions about long-term services and supports • Lots of information is available on-line and from different I&R providers, but it can be complex, contradictory, and confusing • Few people plan ahead for long term support needs • Information for consumers is often not accessible and at too high of a literacy level

19. Arkansas Response to Options Counseling • An Act to Create the Arkansas Options Counseling for Long Term Care • Implemented in 2008 • Must be offered to: • An individual or their representative • Newly admitted individuals to NHs or AL Level II regardless of payment source • All individuals seeking Medicaid reimbursement

20. Form 9571

21. Act 516 Options Counseling Process • NH submits 9571 for each new admission • Informational letter and brochure with ADRC toll-free number mailed • Follow-up call made within 10 working days • ADRC pre-screens for eligibility • Not eligible/ADRC counsels on options • Nurse makes face-to-face contact • Can complete functional eligibility • Referral to Case Manager to comp. LTC app.

22. New Admissions – Act 516

23. Federal Response to Options Counseling MDS assessment is conducted in Nursing Facilities: • a standardized, primary screening and assessment tool of health status • forms the foundation of the comprehensive assessment for all individuals of long-term care facilities • Completed on all residents regardless of payer source

24. MDS Options Counseling • Effective October 2010, a revised Section Q identifies individuals who may want to talk to someone about moving back into the community. • On admission and with the quarterly and annual assessments, residents are asked if they would like to learn about community choices and supports. • If the resident answers yes the NF is required to act on this request through care planning and referral to the designated local contact agency.

25. Findings MDS Options Counseling

26. Findings MDS Options Counseling

27. Findings Options Counseling

28. Findings MDS Options Counseling

29. Options Counseling Process Service Design (each step directed by individual) • Activation • Personal Interview • Exploring Options - Follow-up • Decision Support • Link to services

30. What’s Next Opportunity Follow- up Survey to determine • Remained in community • Re-admitted to a facility • Length of time in the community • Services or programs • Satisfaction Level with living situation

31. More Information Kris Baldwin Division of Aging and Adult Services 501-682-8509