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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
1
Massachusetts Executive Office of Elder Affairs,
Massachusetts Rehabilitation Commission, with assistance from the Lewin Group
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
The Art of Options Counseling in Massachusetts
2
Massachusetts Executive Office of Elder Affairs,
Massachusetts Rehabilitation Commission, with assistance from the Lewin Group
May 2013
The Art of Options Counseling in Massachusetts
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
3
Massachusetts Executive Office of Elder Affairs,
Massachusetts Rehabilitation Commission, with assistance from the Lewin Group
May 2013
OC Service Provided to Consumer
The Art of Options Counseling in Massachusetts
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
4
Massachusetts Executive Office of Elder Affairs,
Massachusetts Rehabilitation Commission, with assistance from the Lewin Group
May 2013
The Art of Options Counseling in Massachusetts
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
5
Massachusetts Executive Office of Elder Affairs,
Massachusetts Rehabilitation Commission, with assistance from the Lewin Group
May 2013
The Art of Options Counseling in Massachusetts
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
7
Massachusetts Executive Office of Elder Affairs,
Massachusetts Rehabilitation Commission, with assistance from the Lewin Group
May 2013
The Art of Options Counseling in Massachusetts
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.
8
Massachusetts Executive Office of Elder Affairs,
Massachusetts Rehabilitation Commission, with assistance from the Lewin Group
May 2013
The Art of Options Counseling in Massachusetts
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
9
Massachusetts Executive Office of Elder Affairs,
Massachusetts Rehabilitation Commission, with assistance from the Lewin Group
May 2013
The Art of Options Counseling in Massachusetts
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
10
Massachusetts Executive Office of Elder Affairs,
Massachusetts Rehabilitation Commission, with assistance from the Lewin Group
May 2013
The Art of Options Counseling in Massachusetts
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
11
Massachusetts Executive Office of Elder Affairs,
Massachusetts Rehabilitation Commission, with assistance from the Lewin Group
May 2013
The Art of Options Counseling in Massachusetts
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.
12
Massachusetts Executive Office of Elder Affairs,
Massachusetts Rehabilitation Commission, with assistance from the Lewin Group
May 2013
The Art of Options Counseling in Massachusetts
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
13
Massachusetts Executive Office of Elder Affairs,
Massachusetts Rehabilitation Commission, with assistance from the Lewin Group
May 2013
The Art of Options Counseling in Massachusetts
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?
14
Massachusetts Executive Office of Elder Affairs,
Massachusetts Rehabilitation Commission, with assistance from the Lewin Group
May 2013
The Art of Options Counseling in Massachusetts
Face-to-face in a: nursing home rehabilitation facility hospital home agency assisted living public meeting place
Over the phone
Methods for Delivering Options Counseling
15
Massachusetts Executive Office of Elder Affairs,
Massachusetts Rehabilitation Commission, with assistance from the Lewin Group
May 2013
The Art of Options Counseling in Massachusetts
Core Competencies
Skill Sets Needed by Options Counselors
16
Massachusetts Executive Office of Elder Affairs,
Massachusetts Rehabilitation Commission, with assistance from the Lewin Group
May 2013
The Art of Options Counseling in Massachusetts
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
17
Massachusetts Executive Office of Elder Affairs,
Massachusetts Rehabilitation Commission, with assistance from the Lewin Group
May 2013
The Art of Options Counseling in Massachusetts
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
18
Massachusetts Executive Office of Elder Affairs,
Massachusetts Rehabilitation Commission, with assistance from the Lewin Group
May 2013
Active Listening Supports the Process
The Art of Options Counseling in Massachusetts
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
19
Massachusetts Executive Office of Elder Affairs,
Massachusetts Rehabilitation Commission, with assistance from the Lewin Group
May 2013
The Art of Options Counseling in Massachusetts
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
20
Massachusetts Executive Office of Elder Affairs,
Massachusetts Rehabilitation Commission, with assistance from the Lewin Group
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 ?
The Art of Options Counseling in Massachusetts
Core Competency 2: Work with Consumer to Identify Needs, Values, & Preferences
21
Massachusetts Executive Office of Elder Affairs,
Massachusetts Rehabilitation Commission, with assistance from the Lewin Group
May 2013
Core Competency 2: Work with Consumer to Identify Needs, Values, & Preferences
The Art of Options Counseling in Massachusetts
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?
22
Massachusetts Executive Office of Elder Affairs,
Massachusetts Rehabilitation Commission, with assistance from the Lewin Group
May 2013
Additional Considerations:
The Art of Options Counseling in Massachusetts
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?
23
Massachusetts Executive Office of Elder Affairs,
Massachusetts Rehabilitation Commission, with assistance from the Lewin Group
May 2013
The Art of Options Counseling in Massachusetts
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.
24
Massachusetts Executive Office of Elder Affairs,
Massachusetts Rehabilitation Commission, with assistance from the Lewin Group
May 2013
The Art of Options Counseling in Massachusetts
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.
Core Competency 3: Support Self-Determination
25
Massachusetts Executive Office of Elder Affairs,
Massachusetts Rehabilitation Commission, with assistance from the Lewin Group
May 2013
The Art of Options Counseling in Massachusetts
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
Core Competency 3: Support Self-Determination
26
Massachusetts Executive Office of Elder Affairs,
Massachusetts Rehabilitation Commission, with assistance from the Lewin Group
May 2013
The Art of Options Counseling in Massachusetts
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.
Core Competency 3: Support Self-Determination
27
Massachusetts Executive Office of Elder Affairs,
Massachusetts Rehabilitation Commission, with assistance from the Lewin Group
May 2013
The Art of Options Counseling in Massachusetts
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
28
Massachusetts Executive Office of Elder Affairs,
Massachusetts Rehabilitation Commission, with assistance from the Lewin Group
May 2013
The Art of Options Counseling in Massachusetts
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
29
Massachusetts Executive Office of Elder Affairs,
Massachusetts Rehabilitation Commission, with assistance from the Lewin Group
May 2013
The Art of Options Counseling in Massachusetts
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
30
Massachusetts Executive Office of Elder Affairs,
Massachusetts Rehabilitation Commission, with assistance from the Lewin Group
May 2013
The Art of Options Counseling in Massachusetts
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
31
Massachusetts Executive Office of Elder Affairs,
Massachusetts Rehabilitation Commission, with assistance from the Lewin Group
May 2013
The Counseling Session: Closure
The Art of Options Counseling in Massachusetts
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.
32
Massachusetts Executive Office of Elder Affairs,
Massachusetts Rehabilitation Commission, with assistance from the Lewin Group
May 2013
30-Day Check-In
The Art of Options Counseling in Massachusetts
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
33
Massachusetts Executive Office of Elder Affairs,
Massachusetts Rehabilitation Commission, with assistance from the Lewin Group
May 2013
30-Day Check-In(continued)
The Art of Options Counseling in Massachusetts
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.
34
Massachusetts Executive Office of Elder Affairs,
Massachusetts Rehabilitation Commission, with assistance from the Lewin Group
May 2013
Measuring our Effectiveness – Consumer Experience Survey
The Art of Options Counseling in Massachusetts
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
35
Massachusetts Executive Office of Elder Affairs,
Massachusetts Rehabilitation Commission, with assistance from the Lewin Group
May 2013
Documentation: Early in the Process
The Art of Options Counseling in Massachusetts
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)
36
Massachusetts Executive Office of Elder Affairs,
Massachusetts Rehabilitation Commission, with assistance from the Lewin Group
May 2013
Documentation: Information to Capture Along the Way
The Art of Options Counseling in Massachusetts
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)
37
Massachusetts Executive Office of Elder Affairs,
Massachusetts Rehabilitation Commission, with assistance from the Lewin Group
May 2013
Documentation – Closing the Record
The Art of Options Counseling in Massachusetts
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)