Self Determination in Long Term Care

1. Self Determination in Long Term Care • Self-determination is a set of concepts and values that people with disabilities should have the freedom and support to decide how they live and participate in the community.

2. Self Determination Principles • Freedom The opportunity for the individual to plan a life with necessary supports • Authority The ability of individuals to control budgeted funds for purchasing supports • Support The arranging of resources and personnel – both formal and informal- that will assist and individual to achieve meaningful community participation • Responsibility Acceptance of valued community role and accountability for public dollars

3. Individual Plan of Services & Supports • Participants, with their allies, develop an individual plan of services and supports through the person-centered planning process • A participant’s allies are chosen by the participants and may include: family members, friends,paid staff,other professionals, and community members, etc

4. Individual Budget • An individual budget is the cost of implementing a person’s individual plan of services & supports • The individual budget is authorized by the Waiver Agent to provide a defined amount of money to implement the plan

5. Fiscal Intermediary • A Fiscal Intermediary is an independent legal entity that acts as a fiscal agent of the Waiver Agent for the purpose of assuring financial accountability for the funds in a participant’s individual budget • The Fiscal Intermediary performs essential tasks that support self-determined arrangements for participants

6. Fiscal Intermediary Functions • Functions as the employer agent for participants directly employing workers • Ensures public funds are properly managed and provider requirements for workers are met

7. Fiscal Intermediary Functions • Offers supportive services to enable participants to self-determine and direct the services and supports they need • Provide monthly budget status reports to participant and Waiver Agent and monitor the use of the budget

8. Cash & Counseling • Robert Wood Johnson Foundation sponsors three states to implement consumer-directed personal care services • Arkansas • Florida • New Jersey

9. Cash & Counseling Outcomes • Cost neutrality • Increase in services • Improved quality of life • Reduced stress on caregivers

10. Cash & Counseling in Michigan • Part of 11 states to receive funding from RJWF to implement project • In the second year of a three-year grant • Supported by the Boston College Graduate School of Social Work as the National Program Office

11. Self Determination in Long Term Care • Michigan’s Cash and Counseling • 4 Pioneer Sites are initiating project • Detroit Area of Aging • Burnham Brook • Tri-County Office on Aging • UPCAP Services

12. Systems Changes to implement • Amend the current MI Choice Waiver • Reduce the assessment • Provide training and support to Pioneer Sites

13. Project Goals • MI Choice Waiver participants will be able to choose self-determination as a method for receiving supports and services on a state-wide basis

14. For More Information • Tari Muñiz, Project Coordinator 517.335.5671 munizt@michigan.gov www.cashandcounseling.org