goals for today’s training - appliedselfdirection...skills trainer consultant case manager...

6/24/10

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PERSON CENTERED PLANNING FOR CONSUMER-DIRECTED CARE

Supporting Consumers in the 21st Century Conference

Mark Sciegaj Associate Professor of Health Policy and Administration

Penn State University Senior Consultant for Research and Training

National Resource Center for Participant-Directed Services

Goals for Today’s Training

  Develop a shared understanding of “person centered planning”.

  Discuss the growth of consumer-directed programs   Discuss the differences between person-centered

and traditional service planning.   Become familiar with several person-centered

planning tools and their applications.   Become aware of additional resources on person-

centered planning and consumer direction   Resource guide available

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What is Person-Centered Planning?

  A process to develop an individual support plan   Identifying participant preferences, strengths, capacities,

needs, supports, and desired outcomes or goals.

  Planned series of conversations, learning experiences and/or activities that are purposefully sequenced.

  A structure for expanding the focus from program menus to the broader perspective of individual’s life.

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Why is Person-Centered Planning Important?   Rebalancing of long-term care dollars

  Increase in home and community based services

  The growth of consumer-directed long-term care

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WA AK

Hawaii

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IN WV

AL GA

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PA

NY

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MA

NH

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ME

OH

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Prevalence of Consumer Direction: 1970’s

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WA AK

Hawaii

OR

CA

NV

ID

MT

WY

UT

AZ

CO

NM

TX

OK

KS

NE

SD

ND MN

IA

MO

AR

LA

MS

TN

KY

IL

WI

MI

IN WV

AL GA

FL

SC

NC

VA

PA

NY

DC

MD

DE

NJ

RI

MA

NH

VT

ME

OH

CT


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WatershedforConsumerDirec3on:CashandCounselingDemonstra3onand

Evalua3on

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Cash & Counseling participants were up to 90% more likely to be very satisfied with how they led their lives.

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Changes in Federal Law, Regulation, and Policy

2008 Veterans-Directed Home and Community -Based Care Program

2001 New Freedom Initiative 2006 Deficit Reduction Act

2006 Reauthorization of Older Americans Act 2007 Aging and Disability Resource Center Program

2008 Community Living Program

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2010 Patient Protection and Affordable Care Act

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Traditional versus Consumer-Directed Services

Participant

Workers recruited

and report to agency

Program and

agency set tasks

Agency specifies

salary and benefits

Normal work hour schedule

Worker training required

by agency

Case managers determine needs & services

Participant

Recruits and

manages workers

Sets tasks

Specifies salary and

benefits (optional)

Assigns flexible work

hour schedule

Trains/ arranges worker training

Makes decisions

about needs and services

Traditional Services Consumer-Directed Services

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CommonlyUsedTerms•  Par3cipant:thepersonwhoreceivesservices.

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Par3cipant

Consumer

EmployerofRecord

Individual

McInnis-Dittrich, Simone, and Mahoney (April, 2006)

CommonlyUsedTerms•  Par3cipant‐DirectedCounselor:Individualwhoworkswiththepar3cipant

indesigningtheirplan.Thepersonthepar3cipantgoestowithques3ons.Rolecanbetakenonbystaffasa“CareAdvisor.”

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SupportBroker

SkillsTrainer

Consultant

CaseManager

Counselor


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DefiningPar3cipant‐Direc3on

•  Thosewhoprovidecareorservicesareaccountabletotheelderand/orsurrogate

•  Thefreedomforonetoplanhis/herownlife

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What

When Who

How

Participant controls


Components of Decision Making

And questions to consider….

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Where Would You Sit (and Why or Why Not)?

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Intellectual Factors to Decision-Making

  What knowledge do elders bring to the table to make decisions about their services?

  What kinds of gaps in knowledge may affect the kinds of decisions elders will make?

  How do we “educate” elders while supporting self-determination?

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Emotional Factors to Decision-Making

  How do past emotional experiences affect the decisions an elder makes?

  What kinds of things do individuals have strong emotional reactions to? Fear? Joy? Anxiety? Anger?

  How do emotional factors cloud the role of knowledge in decision-making?

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Social Factors to Decision-Making

  What social experiences (or desired social experiences) will affect who the elder chooses to interact with?

  How do you think the elder sees himself or herself in a relationship to greater society? How does this affect decision-making?

  What is the influence of formal networks?   What is the influence of family dynamics or

other informal networks?

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Par3cipant‐DirectedModels

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Par3cipant‐directedindividualbudgets

AgencywithChoicemodels

Directlyhired

personalcareworkers

Support System in Consumer Direction

• Embraces paradigm shift

• Explains the program

• Completes enrollment

• Collaborates with participant to complete the assessment, service plan, spending plan, and reassessments

• Offers skills training

•  Partners with participant

• Assures that spending plan is followed

•  Pays invoices including timesheets

•  Figures tax liability and pays taxes

• Maintains savings •  Provides accounting

reports

• Makes decision based on individual budget

• Hires, manages, and dismisses workers

• Sets tasks

•  Trains (or arranges for training) of workers

• Evaluates worker performance

• Determines goods and services to be purchased

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Relationship is between the program and the provider

Provider is accountable for health, welfare, and outcomes

Participant is responsible for decision-making, safety, and adequacy of services

Participants have the opportunity to learn from their mistakes

Effectiveness and quality are measured by the participant

Shifts in Responsibility for Risks

Role of Counselor in Risk Management

Counselor will

collaborate with

participant to

Employ person- centered approach

Assess need and capacity

Develop plan to manage

risks

Monitor plan,

collect and analyze

data

Address outcomes

and amend plan as

necessary

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Navigating Choice and Change in Later Life: Tools for Person-Centered Planning

The following Person-Centered Planning Tools have been developed (modified) by Susan Fox and Patty Cotton of

University of New Hampshire Institute on Disability

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Traditional Support Planning vs. Person-Centered Planning

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Traditional Support Planning Person-Centered Planning Decisions are to be made by “consensus” of a planning team that typically consists primarily of staff and professionals and are driven by medical needs.

Focus of planning is primarily defined by a menu of service options that are offered under the HCBC waiver or other programs. Natural supports are sometimes used to augment programmatic supports.

Planning occurs periodically during annual meetings or isolated problem solving events.

Attention is focused on problems and “fixing.”

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Traditional Support Planning vs. Person-Centered Planning

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Traditional Support Planning Person-Centered Planning Decisions are to be made by “consensus” of a planning team that typically consists primarily of staff and professionals and are driven by medical needs.

The participant drives decisions and invites people who they feel have important contributions to make, often including family, friends, community members and trusted allies from the service system.

Focus of planning is primarily defined by a menu of service options that are offered under the HCBC waiver or other programs. Natural supports are sometimes used to augment programmatic supports.

Focus of planning is defined by desired outcomes of the participant. Programmatic supports are used to augment natural supports.

Planning occurs periodically during annual meetings or isolated problem solving events.

Planning occurs as a process that evolves over time.

Attention is focused on problems and “fixing.”

Attention is focused on strengths and “building.”

Graphic Tools to Facilitate Person-Centered Planning

  Visual tools can increase attentiveness, accommodate various learning styles, improve “group memory”, increase learning, and decrease meeting time.

  Visual tools alleviate the professional/client perception.

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Person in Life Course Perspective: Creating an Experiences Timeline

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Potential Applications of Experiences Timeline   Urgent/Emergent Application   Short-Term Planning Application   Long-Range Planning Application

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Person in Relationship Perspective: Relationship Maps

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Potential Applications of Relationship Maps   Urgent/Emergent Application   Short-Term Planning Application   Long-Range Planning Application

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Person-Centered Tool: Preferences Map

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Potential Applications of Preferences Maps   Urgent/Emergent Application   Short-Term Planning Application   Long-Range Planning Application

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Person-Centered Tool: Routines Map

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Potential Applications of Routines Maps

  Urgent/Emergent Application   Short-Term Planning Application   Long-Range Planning Application

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Person-Centered Tool: Places Map

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Potential Applications of Places Map

  Urgent/Emergent Application   Short-Term Planning Application   Long-Range Planning Application

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Additional Tools and Resources

www.participantdirection.org

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www.participantdirection.org

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Resource Guide   Myths and Realities of Consumer-Directed Services for

Older Persons   Person-Centered Planning Materials   Self-Direction Handbook   A Guide to Quality in Consumer Directed Services   Consultant Training Program   Sample Manuals, Handbooks, and Brochures   National Participant Network (NPN) Resources   Additional Tools, Articles, and Websites   Glossary

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Helpful Websites   National Resource Center for Participant-Directed Services:

  www.participantdirection.org   www.bc.edu/schools/gssw/nrcpds/training.html

  Cash & Counseling: www.cashandcounseling.org   The Clearinghouse for Home and Community Based

Services: www.hcbs.org   University of New Hampshire Institute on Disability:

www.iod.unh.edu   New Hampshire Real Choice: www.realchoicenh.org   Technical Assistance Exchange: www.adrc-tae.org

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Contact Information

Mark Sciegaj, PhD, MPH Associate Professor of Health Policy and Administration

601F Ford Building Pennsylvania State University

University Park, PA 16803 O: 814-863-2861 [email protected]

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