The Art of Options Counseling in Massachusetts March 23, 2015

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 consumer’s 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 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 • 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 (consumer’s age, gender, setting) • Contact information • Consumer’s 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. Needs & preferences understood Support & information led to informed decision Info. about relevant programs/services & how to access them Consumer’s Experience Identified next steps Information about cost of services More efficient use of resources Measuring our Effectiveness:The Consumer Experience Survey

36. Time to take a break and….