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Participant-Directed
Core Competency Project
Aging In America Conference
2011
Presenters
Lori Gerhard
Director
Office of Program Innovation
& Demonstrations
Administration on Aging
202-357-3443
Jim Wironen
Director of Product Development
& Consulting Services
National Resource Center for
Participant-Directed Services
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Use research to develop a LTSS system that delivers participant-directed programs
Through various AoA programs Core Programs, ADRC, EBDP, VD-HCBS, and LTSS Core Competency drive the culture and systems changes that enable participant direction to be the primary way people access, obtain, and receive LTSS
Participant-directed programs are available in every community in the nation
AoA’s Long-Term Vision
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Chronic Care Model
Informed,
Activated
Patient
Productive
Interactions
Prepared,
Proactive
Practice Team
Delivery
System
Design:
Care Mgt
Decision
Support
Clinical
Information
Systems
Self-
Management
Support
Health System
Resources and
Policies
Community
Health Care Organization: Case Mgt
Improved Outcomes4
Transitions In Health Care and LTSS
Perspective of Person
AAA/ADRC
Hospital
Nursing Facility
Primary Care Physician
Rehab Center
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AAA’s/ADRC’s Key LTSS Component
ADRC AAA
Assessment Care
Management
Home Modification
Homemaker Services
Personal Care Services
CDSMP
Transportation
Caregiver Support
Service Plan/Care Plan
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Changes in Federal Law, Regulation, and Policy
2008 Veterans-Directed Home and
Community -Based Services Program
2001 New Freedom Initiative
2005 Deficit Reduction Act
2010 Affordable Care Act
2006 Reauthorization of Older Americans Act
2007 Aging and Disability Resource Center Program
2010 Affordable Care Act
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AoA & NRCPDS Long-Term Services and Supports
Workforce Participant-Directed Core Competencies Project
Environmental Scan and Literature Review
Stakeholder Involvement
Identify Core
Competencies
Develop
Workforce Self-
Assessment Tool
Catalog Course
Curriculum to
Develop Core
Competencies
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Participant
Needs are assessed
Asked questions
Informed of resources
Given an option of agencies
Assigned hours of services
Provides feedback to the agency
What is Participant Direction?
Traditional Services
Participant
Makes decisions based on budget
Hires, manages, dismisses workers
Trains, or arranges for training of,
workers
Evaluates workers
Assigns hours of service
Determines goods and
services purchased
Participant-Directed Services
Why Participant Direction? Comparative effectiveness research on participant-directed programs found:
No increase of fraud or abuse
over the traditional system
Participants were up to 90%
more likely to be very satisfied
with how they led their lives
Significantly reduced unmet
personal care needs
More positive health
outcomes
Cost effective -can decrease use of
more expensive services over long term
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States with employer authority PD programs
States with employer and budget authority PD programs
States with employer authority PD programs and VD-HCBS programs
States with employer, budget authority PD programs, and VD-HCBS programs
Prevalence of Participant-Directed Programs
WAAK
OR
CA
NV
ID
MT
WY
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
CTHawaii
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Department of Labor Long-Term Supports and Services Competency Model
The Participant Direction Competency Model builds on the Department of Labor Long-Term Supports and
Services Competency Model (LTSS-CM [Figure 1]). The LTSS-CM consists of a set of nine tiers of work force
competencies. The nine tiers are divided into blocks representing the skills, knowledge and abilities considered
essential for successful job related performance. The tiers include:
• Tier 9: Management Competencies: These competencies domain are
specific to supervisory and managerial occupations.
• Tier 8: Occupation-Specific Requirements: This domain includes
requirements such as certification, licensure, and specialized educational
degrees, or physical and training requirements.
• Tier 7: Occupation-Specific Technical Competencies: The detailed
skills required for work in a specific occupation.
• Tier 6: Occupation-Specific Knowledge Competencies: The detailed
knowledge areas required for work in a specific occupation.
• Tier 5: Industry-Specific Technical Competencies: Competencies
included in this domain represent the knowledge, skills, abilities and other
characteristics needed by all occupations within an industry segment (e.g.
AAAs, ADRCs).
• Tier 4: Industry-Wide Technical Competencies: Competencies
included in this domain represent the knowledge, skills and abilities needed
by all occupations within an industry (e.g. LTSS).
• Tier 3: Workplace Competencies: Competencies included in this domain
represent those skills and abilities that allow individuals to function in an
organizational setting. As with the Academic Competencies, these are
generally applicable to a large number of occupations and industries on a
national level.
• Tier 2: Academic Competencies: Basic academic skills of reading,
writing, etc apply to all organizations represented by a single industry or
industry association nationwide.
• Tier 1: Personal Effectiveness Competencies: These competencies are
the base tier because they are essential for all life roles not exclusive to the
competencies needed for a successful career or role in the workplace.
Figure 1: Long-Term Supports and Services Competency Model12
Relationship of Participant Direction Core
Competencies Project to Other Participant-Directed Activities
DHHS: AoA-NRCPDS: Consumer Direction Core Competencies ProjectIdentify the competencies necessary to assist and support participants in managing their services effectively through informed decision-making
DHHS: AoA
ADRCDHHS
DHHS:
CMS
DHHS: Office of
Minority Health
DHHS:
Office of
Disability
DHHS:
SAMHSA
Veterans Health
Administration
Supports Options
Counseling
National
Standards Project
Supports DHHS
Provisions of Patient
Protection and Affordable
Care Act
Supports Taxonomy Supports National
Standards on Culturally and
Linguistically Appropriate
Services (CLAS)
Supports
Community Living
Initiative Activities
Complements
developing recovery
competencies
for individuals
working in
behavioral health
care project
Supports the Veteran-
Directed Home and
Community-Based
Services Program
(VD-HCBS)
Develop
national
minimum
standards to
guide how
options
counseling is
delivered
Section 2402(a):
Common framework
establishing principles
and process elements
supporting participant
direction; the
Community Living
Assistance Services and
Supports (CLASS)
Program; Community
First Choice (Section
1915(k)), and revisions
in the 1915(i) authority;
Money Follows the
Person (MFP) ; Aging
and Disability
Resource Centers
(ADRCs); Care
Transitions; Health
Homes
Information and
assistance in support
of participant
direction (supports
brokerage)
The CLAS standards are
primarily directed at
organizations, but
individuals are also
encouraged to use the
standards, to make their
practices more culturally
and linguistically
accessible: the Participant
Direction Core Competencies
Project supports
Standards 1 (respectful
and appropriate care), 3
(ongoing training and
education), 6 (oral
communication), 7
(written
communication), and 12
(participatory,
collaborative
partnerships)
Affirming the
right of persons
with disabilities to
obtain services in
the “most
integrated setting
appropriate” to
meet their needs
Identifying
competencies
needed of staff to
operationalize
guiding principles
of recovery
(including being
person-driven) in
everyday practice
VD-HCBS is a
program that
purchases a package
of participant-
directed services
from an entity in the
Aging Network;
through VD-HCBS,
Veterans decide for
themselves what mix
of services and goods
will best meet their
needs to live
independently in the
community
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Relationship of Participant Direction Core
Competencies Project to Other Participant-Directed Activities
DHHS: AoA-NRCPDS: Consumer Direction Core Competencies ProjectIdentify the competencies necessary to assist and support participants
in managing their services effectively through informed decision-making
The National Association
of State Directors of
Developmental
Disabilities Services
(NASDDDS)
National Council on
Independent Living
(NCIL)
National Association of
States United for Aging
and Disability (NASUAD)
World Institute on
Disability (WID)
The National Core Indicators
ProjectStrategic Plan
Strengthening the Aging Network
(SAN)Health Access Initiative
Develop a standard set of
performance measures used by
states to manage quality, set
benchmarks, compare findings
with other states, and compare
with national findings
Develop a measurement system
that demonstrates NCIL’s
effectiveness in its mission
through efficient utilization of
resources
Special initiative aimed at
increasing the capacity of state
agencies across the country to
enhance their ability to play
leadership roles in the
development and
implementation of cutting edge
long term services and supports
(LTSS) systems
Trains doctors and medical
staff in culturally competent
health care and in how to
make services and
equipment accessible
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