managing changes: introducing consumer direction to aging … · 2020. 10. 15. · list roles and...

Managing Changes: Introducing Consumer Direction to Aging Network Management

AoA Consumer Direction Webinar Series

National Resource Center for Participant-Directed Services (NRCPDS)

April 20, 2010

1

AoA Welcoming Remarks

Linda VelgouseCommunity Living Program Project Officer

AoA

2

Prevalence in Existing States

Mark SciegajSenior Training Consultant

NRCPDS

3

Cash & Counseling participants were up to 90% more likely to be very satisfied with how they led their lives.4

Changes in Federal Law, Regulation, and Policy

2008 Veterans-Directed Home and Community -Based Care Program

2001 New Freedom Initiative2006 Deficit Reduction Act

2006 Reauthorization of Older Americans Act2007 Aging and Disability Resource Center Program

2008 Community Living Program

5

WAAK

Hawaii

OR

CA

NV

ID

MT

WY

AZ

CO

NM

TX

OK

KS

NE

SD

NDMN

IA

MO

AR

LAMS

TN

KY

IL

WI

MI

INWV

AL GA

FL

SC

NC

VA

PA

NY

DC

MD

DE

NJ

RI

MA

NH

VT

ME

OH

CT

Prevalence of Consumer Direction: 1970’s

6

WAAK

Hawaii

OR

CA

NV

ID

MT

WY

AZ

CO

NM

TX

OK

KS

NE

SD

NDMN

IA

MO

AR

LAMS

TN

KY

IL

WI

MI

INWV

AL GA

FL

SC

NC

VA

PA

NY

DC

MD

DE

NJ

RI

MA

NH

VT

ME

OH

CT


7

WAAK

Hawaii

OR

CA

NV

ID

MT

WY

AZ

CO

NM

TX

OK

KS

NE

SD

NDMN

IA

MO

AR

LAMS

TN

KY

IL

WI

MI

INWV

AL GA

FL

SC

NC

VA

PA

NY

DC

MD

DE

NJ

RI

MA

NH

VT

ME

OH

CT


8

WAAK

Hawaii

OR

CA

NV

ID

MT

WY

AZ

CO

NM

TX

OK

KS

NE

SD

NDMN

IA

MO

AR

LAMS

TN

KY

IL

WI

MI

INWV

AL GA

FL

SC

NC

VA

PA

NY

DC

MD

DE

NJ

RI

MA

NH

VT

ME

OH

CT


9

Questions? Please type your question

in the “Chat” box found in the lower left-hand corner of your screen.

If we are unable to answer your question at this time, it will be included in our follow-up Q&A document posted on our website:

10

www.training.participantdirection.org

http://www.training.participantdirection.org/�

Developing Operational Plans

Dianne KayalaDirector of New Initiatives

NRCPDS

11

Early Considerations

Policies & Procedures

Training

Risk Mitigation

Screening

Involuntary Discharge

Quality Management

12

Early Considerations Establish advisory group Outreach and public information campaign Potential participants Local and state leadership Politicians Current long-term services and supports staff Medical and home health service providers

Address provider resistance proactively Provider Resistance Toolkit

13

http://www.cashandcounseling.org/resources/20080415-145147�

Policies and Procedures Identify program funder requirements State, AoA, VHA, Medicaid

List roles and identify responsibilities

Develop job descriptions or certification standards Draft full document and review for compliance with

state and funder regulations

14

CD Counselor

• Roles• Responsibilities

FMS


Participant


Representative


Program Office


Training

15

1• The Big Picture

2• The Nitty Gritty: Policies, Procedures,

and Forms

3• Supporting Participants in Consumer

Direction

Risk Mitigation

Dignity of risk is key assumption! Two primary considerations: Imminent risk of harm Perception of fraud/poor use of public funds

Policies and quality management system

16

Back-Up Plans

Critical element of ANY consumer-directed program Participant identifies who will cover for each component

s/he believes critical with assistance of consumer-directed counselor

May be paid or unpaid, but should arrange and verify feasibility ahead of time

Spending plan should reflect savings toward an emergency back-up if more expensive than scheduled worker

17

Screening

Is a representative needed for decision making? What tools can be used? How do you screen the representative? What representative policies are needed?

18

Involuntary Discharge

Last resort Imminent risk of harm or fraudulent actions Longer term lack of compliance with program rules

Retraining or new representative

Establish policies and definitions ahead of time

19




20



Developing Operational Plans: Quality Management

Suzanne CrispDirector of Program Development & Implementation

NRCPDS

21

22

What is Quality?

Satisfied

Rights and desires are acknowledged as key

Well-being is safeguarded

Goals are met

Services and supports are accessible and

available

Outcomes are positive

Individual

22

23

What is Quality?

As intended

Effectively

Financially responsibly

With person-driven practices

Meets system goals

Applies performance

indicators

Program Operates

23

24

What is Quality?

Sets expectations

Builds processes to meet those

expectations

Measures and determines if processes

are in place and effective

Continues to improveQuality System

24

25

NRCPDS Quality Approach

What do you want to happen?

How do you know it is happening?

What do you do when it doesn’t happen?

How do you improve your program?

Participant System

25

Common Elements

Participants play a significant role to define, report, and evaluate quality

Quality is essential to program integrity Critical first step is designing quality into a program We must know how our program is working Apply performance indicators

There is always room for improvement

26

27

Unique Quality Management Opportunities

Participant

Authority, responsibility, and decision-

making

Primary authority to

balance safety &

accountability

Defines quality on individual

basis

Measures effectiveness of services

and support

Involved in policy

development, program

management, & evaluation

Acknowledges and accept

risks

27

Unique Quality Management Opportunities (continued) Offers a unique support system Consumer-directed counseling Financial Management Services (FMS)

Role of traditional case management system modified

Involvement of provider agency replaced Individual budget provides a road-map to deliver

desired services and supports Opens the door to creative solutions

28

Troubling Thoughts How do I safeguard health, safety, and well-being? How do I know if something goes wrong? Are workers qualified to perform work? How much training do workers need? Who should provide training? Are budgets being used wisely? Are supports appropriate and adequate? How do I manage costs? How do I manage wants versus needs?

29

Quality Program Design Features Develop a platform to inform the participant: Consumer-directed philosophy Developing skills to achieve independence and make

informed decisions All phases involve participants (systemically and

individually) How to access resources, supports, and assistance Responsibilities and risks How the program works

What is permissible and what is not? Consequences of intentional deception or misuse

30

Quality Program Design Features

Create an Assessment Process that: Actively involves the individual Identifies participant needs, preferences, and strengths Yields consistent outcomes Presents assessors trained on the administration of the

assessment Represents the first step to the risk mitigation process Assesses cognition and recommends if a representative is

needed and level of supports

31

Quality Program Design Features Establish a Service Plan that: Establishes back-up plan Builds the blueprint of services Identifies skills training opportunities Negotiates with the participant, a monitoring plan based

on risk mitigation process

32

Additional Quality Design Features

Individual Budgeting Participant input is critical and process is understandable Methodology is consistently applied Modifications are made timely and easily Individual expenditures are tracked accurately Balances are accessible to the participant Over- and under- expenditures are identified and acted

upon

33

Additional Quality Design Features Consumer-Directed Counseling

Operates under consumer-directed practices with continuous training

Clearly articulated roles and responsibilities Assists participant to understand individual budget and

program allowables Assists participant with recruiting and managing workers, as

needed Assists participant with problem solving and identifying

resources as needed Communicates with other support activities Participant knows who to call, how to call and receives timely

response Staffing ratio (participant to counselor) is reasonable

34

Additional Quality Design Features Financial Management Services Operates under person-driven practices with continuous

training Clearly articulated roles and responsibilities Operates under established timelines Provides participant with easily accessible budget

information Performs employer functions to ensure participants are

legally protected from liability Reimburses invoices that have been approved Releases routine and ad hoc reports

35

How do we know our program design features are working? Feedback

Participant and worker surveys Complaint lines Counselor informal and survey Financial Management Services informal and survey

Monitoring Routine counselor visits Develop peer network Compare consumer direction costs with traditional service

costs

36

Auditing Compare individual budgets with service use Verify withholdings, filings and deposits are performed

accurately and timely

Evaluations Perform pre- and post-evaluations to measure change and

effectiveness of training

Case Review Counselor performs duties Monitoring visits are documented

37

How do we know our features are working? (continued)

Risk Mitigation System What are recurring issues?

Back-up Plans How often is back-up used? Was the back-up plan effective? Test the plan periodically – did it work?

Performance Indicators Do performance indicators convey true picture of the

program?

38


Reports Number of timesheet rejected Number of timesheets processed outside of established

timeframes Routine analysis of complaint line To the degree possible, tap into established incident reporting

systems or abuse records

39


What to do when a problem is detected? General Approach

Identify what went wrong and why Could this have been prevented? Explore option to correct/eliminate/reduce impact Identify resources

Participant Issues Assess need for skills training Modify service plan/individual budget Identify additional resources Consider a representative or change with representative Increase level of supports Reassess risk mitigation plan

40

What to do when a problem is detected? Worker Issues

Provider additional training/educational opportunities Review qualifications Consider additional workers or change of worker Assess resources

Counselor Issues Provide additional training Change counselors Issue policy clarifications Issue new policy

Financial Management Services (FMS) Issues Require corrective action plan Review provider certification or contract

41




42



Tools and Resources

Sandy BarrettDirector of Program Implementation and Design

NRCPDS

43

Helpful Websites

National Resource Center for Participant-Directed Services: www.participantdirection.org www.training.participantdirection.org

Cash & Counseling: www.cashandcounseling.org

The Clearinghouse for Home and Community Based Services: www.hcbs.org

Technical Assistance Exchange: www.adrc-tae.org

44

http://www.participantdirection.org/�http://www.training.participantdirection.org/�http://www.cashandcounseling.org/�http://www.hcbs.org/�http://www.adrc-tae.org/�

Resource Guide Prevalence in Existing States Early Considerations Policies and Procedures Training Monitoring and Quality Management Risk Management Screening Involuntary Discharge Q&A with Program Administrators Sample Forms and Manuals

45

Upcoming Webinar

Community Living Program: Challenges, Insights, and Successes, Summer 2010

Our Early Considerations Webinette is now available on our website

46

http://www.bc.edu/schools/gssw/nrcpds/Training_Resources.html�

Advancing choice and control for people living with disabilities

Click here to access the accompanying Webinar Resource Guide

For questions related to the webinar, please email us at [email protected]

47

http://www.bc.edu/schools/gssw/nrcpds/meta-elements/pdf/Managing_Change_Reso1.pdf�mailto:[email protected]�

Managing Changes: Introducing Consumer Direction to Aging Network Management�AoA Welcoming Remarks Prevalence in Existing States Slide Number 4Changes in Federal Law, Regulation, and Policy Slide Number 6Slide Number 7Slide Number 8Slide Number 9Questions?Developing Operational Plans Slide Number 12Early ConsiderationsPolicies and ProceduresTrainingRisk MitigationBack-Up PlansScreeningInvoluntary DischargeQuestions?Developing Operational Plans: Quality Management � Slide Number 22Slide Number 23Slide Number 24Slide Number 25Common ElementsSlide Number 27Unique Quality Management Opportunities (continued)Troubling ThoughtsQuality Program Design Features Quality Program Design Features Quality Program Design Features Additional Quality Design Features Additional Quality Design Features Additional Quality Design Features How do we know our program design features are working?How do we know our features are working? (continued)How do we know our features are working? (continued)How do we know our features are working? (continued)What to do when a problem is detected?What to do when a problem is detected?Questions?Tools and ResourcesHelpful WebsitesResource GuideUpcoming WebinarSlide Number 47

managing changes: introducing consumer direction to aging … · 2020. 10. 15. · list roles and...

Documents