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MFP: California Community Transitions Preference Interview Tool.

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Presentation on theme: "MFP: California Community Transitions Preference Interview Tool."— Presentation transcript:

1 MFP: California Community Transitions Preference Interview Tool

2 Use of the Preference Interview for the transition of inpatient facility residents to community living.

3 PREFERENCE INTERVIEW TOOL A screening instrument used to determine a residents: Preference to transition Ability to transition Feasibility of transition Service needs for transition and community living

4 Preference Interview Training: Session Overview What is Transitioning? Your Role as Interviewer Identifying Potential Transition Participants Conducting the Preference Interview Eligibility Criteria Minimum Data Set (MDS) Referrals

5 Session Objectives At the end of this training you will be able to: 1.Understand your role in the process 2.Identify Potential Transition Participants 3.Determine Cognitive Impairment 4.Conduct a Preference Interview a.With a Resident b.With a Proxy 5.Prepare a Referral Packet

6 What does TRANSITIONING mean ?

7 Reasons people choose to transition into the community Individuals right Promote independence Avoid institutional setting

8 Who is eligible to transition under the CCT Recipients of custodial & health care services for at least 6 months. Medi-cal recipients for at least 30 days before participation. People of all ages.

9 The road to the community Identify an individuals preference to transition. Assess an individuals service and care needs. Develop Comprehensive Service Plan to meet individuals needs.

10 Your Your Role in the Transition Process Establish relationship with inpatient facility administrative staff and community agencies. Conduct preference and stability interviews. Assess residents needs and feasibility of transition. Coordinate needed services.

11 Identifying Transition Candidates

12 Minimum Data Set (MDS) Physical and psychological profile of resident MDS data needed to assess level of care Two types of MDS Full MDS Complete data set Annual or Change of Condition Quarterly MDS Subset of MDS data points Compiled every three months Copy of most recent FULL MDS required Copy of Quarterly needed if most recent MDS

13 Identification of Potential Transition Participants Obtain names from: CCT project Team Nursing Facility Staff ( Social Worker or Business Office ) Referrals

14 Getting Started Determine persons cognitive level using the MDS Recall Sub-scale. Scoring determines who will receive the initial interview.

15 Determining Cognitive Impairment MDS Recall Sub-scale 1. The current season 2. Location of own room 3. Staff names and/or faces 4. Awareness of being in a nursing home SCORING: Each correct response = 1 point Total points: 2 – 4 administer resident interview 0 – 1 administer proxy interview

16 Interview Basics

17 Basic Interview Techniques Greet person warmly using a calm voice. Smile and speak clearly. Use residents name. Identify yourself and state why you are visiting.

18 Basic Interview Techniques (continued) Ask permission to speak with resident. Choose a quiet, private location outside of residents room to meet free of distractions (such as television or radio programs), if possible. Observe and consider the persons facial expressions and body language.

19 Basic Interview Techniques (continued) Be aware of interviewees physical and/or cognitive limitations. Use conversational-type interaction. Too much social interaction can sidetrack the interview, or misrepresent the visit as a social call. State current care and services will not be affected by anything said at this interview.

20 Basic Interview Techniques (continued) Assure resident that information given to interviewer will remain private and confidential, unless interviewer is legally required to disclose information for persons health and safety. Be aware of your facial expressions and body language.

21 Basic Interview Techniques (continued) Check to make sure you and resident are comfortable before starting. Check partway through questions to see if resident is tiring. If resident is too tired to continue, reschedule another session to complete survey.

22 Background Information

23 A Word About HIPAA Residents personal information is protected. Resident or proxy must grant permission. Informed, written and signed HIPAA consent form. HIPAA consent required for outside agencies.

24 A Word about Housing

25 Demonstration Participation Residences must adhere to the following federal requirements: A single family home, duplex or condominium. A rental apartment with lockable entry/exit, with living, sleeping, bathing and cooking areas under participant/familys control. A subsidized housing unit or apartment.

26 What about 24 hour care? Is 24 hour care available in the community? 23/7 care is available through the NF/AH Waiver.

27 Preference Interview Process

28 Introduce yourself Explain that the interview provides an opportunity for a resident to express their preference to transition. Explain that resident has the right to refuse or discontinue interview at any time.

29 Basic Interview Techniques (continued) State interview does not guarantee transition to community living. Explain the following: -Type of questions asked. -Length of time to take. -Use of a script -You will be writing response answers on survey papers you use.

30 Preference Interview Process (Continued) Restate the following information: Right to refuse or discontinue interview Confidential and private No guaranteed outcomes

31 Interview with Resident In person Meet with them at the facilityMeet with them at the facility Use scriptUse script Attempt contact at different times during dayAttempt contact at different times during day Log all attemptsLog all attempts No more than 5 attemptsNo more than 5 attempts

32 Interview with Proxy In person – meet at nursing home.In person – meet at nursing home. By telephone - initiate call.By telephone - initiate call. Process:Process: –Use script –Attempt contact at different times during day –Leave detailed message –Log all attempts –No more than 3 attempts

33 Preference Interview: A look at the Questions

34 Interview Overview Interview is designed to be conducted as a conversation. Areas are queried: History Ability Preference Self-Assessment Feasibility

35 Question 1: History What led to residents current stay in nursing home? Medical health change Post-surgery rehabilitation Change in physical status Long illness Need 24 hour care Money problems Provide insight into support network

36 Question 2: Ability to Transfer Initial perception of residents ability to transfer. What are the reasons for this perception?

37 Question 3: Preference to Transfer Does resident WANT to leave nursing home? Reasons for wanting to remain in nursing home. Distinction between Ability and Desire.

38 Question 4: Living Options Present alternative living options in community. Provide education about options. Enables informed decision.

39 Question 5: Service Options Present list of services available in community Educate about wide range of services Enable informed decision Re-assess decision to leave nursing home YES continue with interview NO end interview

40 Question 6: Housing and Support Feasibility of transition Housing options Existing housing options Affordability Adequate support network Alternatives Private home Senior apartment

41 Questions 7–26: Service Needs Assessment Activities of Daily Living (ADLs) Transfer Mobility Toileting Hygiene Grooming Dressing Instrumental Activities of Daily Living (IADLs) Communication Meals Medication Housekeeping Shopping Transportation Finances

42 Service Needs Assessments Systematically Identifies Needs Influence Decision to Transition Research vs. Operational Format Research limited probing Outside agency assessment (IHSS) Operational format more in depth Provide better sense of resident need from start

43 Questions 7-19: Activities of Daily Living Determine if nursing services are needed Risk of overestimation of ability or unrecognized assistance Tasks broken down into smaller components Survey residents room for assistive devices Performance of task in last 7-14 days Dont take NO for an answer

44 Question 7: Transfer Assistance Help getting out of bed? Set up only (positioning of side rails, wheelchair) Supervision Limited assistance (non or light - weight bearing support) Extensive/total assistance (significant or total weight bearing support) Probe all responses

45 Questions 8 – 9: Meal Assistance Help getting started to eat? Cutting up food Opening cartons Getting silverware Help eating? Food Intake assistance Use of special utensils and/or cup

46 Question 10: Bed Mobility Resident need assistance to turn in bed? Bed rails count as assistance

47 Question 11: Toileting Assistance Sensitive subject Help getting to toilet? Adult briefs or pads? How often briefs or pads? Help changing briefs or pads? Use of briefs/pads inability to use toilet

48 Question 12: Toileting Assistance Frequency How often assistance is required during day Getting to the toilet Changing adult brief/pad Identify points in day assistance received Morning (before/after breakfast) Afternoon (before/after lunch, before dinner) Evening (after dinner, before bed)

49 Questions 13 & 14: Grooming and Hygiene Assistance with morning grooming Brush teeth Wash face Comb hair Assistance with bathing Shower Bath Level of assistance Set-up only (i.e., toiletries laid out) Supervision Limited (resident performs most activities) Extensive/Total (resident dependent on nurse aides for most or all activities)

50 Questions 15, 16 & 17: Mobility Help walking: Inside/Outside Specify type of assistance Cane Walker Safety rails Wheelchair: Inside/Outside

51 Questions 18 & 19: Dressing Assistance to dress and undress Able to put on/remove: Shoes/socks Reach feet Tie laces Shirt/dress Buttons Zippers Pants Bend Pull Fasten

52 Question 20-26: Instrumental Activities of Daily Living (IADLs) Auxiliary services needed to function in community IADLs currently performed by Nursing Home or family Probe responses

53 Question 20: Communication Help using telephone?Help using telephone? –Volume increase –Large numbers –Dialing assistance Does resident use an amplifier?Does resident use an amplifier?

54 Question 21: Meal Preparation Help cooking or preparing meals? In their own household Use or operate appliances, i.e., microwave

55 Question 22: Medication Management Help with medications? Read labels Open packaging/ bottles

56 Question 23: Housework Help with housework? Laundry Washing dishes Stand for extended period of time Cleaning house Bend over

57 Question 24: Shopping Help with shopping? Type of help? Reach shelves Place things in basket

58 Question 25: Transportation Help with transportation? Type of transportation Frequency of transportation

59 Question 26: Financial Management Help managing money or finances? Paying bills Balancing checkbook Tracking bank accounts

60 Question 27: Feasibility If needed services are available in community, is resident able to leave nursing home? Response determines course of action

61 Where to after question 27? Interviewees response determines next step in identifying transition candidates Primary Interview with Resident YES or NO Conduct second preference interview in 2 weeks Primary Interview with Proxy YES Conduct second preference interview in 2 weeks NO Final response No transition

62 Interviewers Perception of Residents responses

63 Questions 28 & 29: Impressions Interviewers perception Post-interview Measure interviewers confidence in residents response Understanding of what services are needed process (Question 28) Level of motivation to relocate (Question 29) Optional

64 Stability of Preference to Transition

65 Determination of preference stability is evaluated twice using the Preference Interview both times. 1 st interview: Preference is assessed and information is shared on transition issues and services. 2 nd interview: Preference is assessed and how transition issues and services will affect them in a potential transition.

66 Determining Residents Stability Of Preference to Transition Stable if: Resident responded YES to question 5. Resident responded YES to question 27. Not Stable if: Resident responded NO to question 5. Resident responded No to question 27.

67 Second Interview Repeat Preference Interview with Primary Interviewee 2 weeks after primary interview

68 Second Interview (Continued) Primary interviewee determines who secondary interviewee will be: If primary interviewee is RESIDENT, then secondary conducted with potential caregiver. If primary interviewee is PROXY, then secondary conducted with resident. Permission is required.

69 Two Interviews – Now What? Do findings show: Preference Stability Initial preference does not change over time. Measure desire and commitment to transition. Transition Eligibility Permission to refer HIPAA consent

70 Preference Interview Findings

71 Person is a candidate for transition if: Agreement among resident, proxy, and/or family regarding transition preference shows stability. Resident or Proxy responded YES on two consecutive interviews: Primary = YES Secondary = YES

72 PREFERENCE = YES Ask residents permission to refer for possible transition and participation in demonstration. Obtain signature on Participant Information Form to review process.

73 Person is a possible candidate for transition if: A third interview may be needed to discuss transition issues and confirm findings. Resident responded YES on 2 nd interview Primary = NO Secondary = YES

74 Person is not a candidate for transition if: Resident responded No to 2 nd interview Primary = Yes Secondary = No Leave contact information with resident/ support person in case future contact is requested.

75 Transitioning Referral Packet MDS copy(s) Permission to Refer HIPAA consent form Copies of Interviews Resident Summary

76 Permission to Refer Once the preference to transition to community is established, interviewee must provide written, informed permission to have information forwarded to transitioning agency. Permission to Refer form is standardized notice signed by interviewee. Presented to interviewee once stability interviews are complete.

77 Resident Summary Demographics: Name, DOB and AGE Significant considerations Physical (i.e., wheelchair) Medical Psychological Consent status Proxy name and contact information Potential caregiver name and contact information Housing information Housing preferences Desired locations Amount willing/able to pay Interviewer impressions (Questions 28 & 29)

78 Final Note: Inter-Rater Reliability Agreement between interviewers Necessary Establish reliability among all interviewers Pair up interviewers One interviewer conducts interview Other interviewer audits Minimum 80% agreement

79 Interview Practice Role play: –Interviewer –Resident –Inter-rater reliability test

80 Questions and Discussions

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