1 Oregon Department of Human Services Senior and People with Disabilities State Unit on Aging-ADRC In partnership with  Portland State University School of Social Work Center for Improvement of Child and Family Services

Challenge

An Overview of Options Counseling for AAA Directors and Program Staff 3

 Definition of Options Counseling  History and context (ADRC development)  Options Counseling in Oregon  Values and Principles  Core Competencies 4 Introduction to Options Counseling

Learning Objective:  Have a working understanding of the definition of Options Counseling (OC) and how it is different from information, referral and assistance and case management.

OC 101, 102 & 103  Introduction to Options Counseling  The Art of Options Counseling – skills ◦ Communication, Assessment, Decision-Making Support, Documentation  Advanced Options Counseling ◦ Understanding Change and Motivation ◦ Decision-Making Support ◦ Problem Solving, Conflict Resolution ◦ Facilitating Family Meetings

7 For Staff  How is it working?  What do you need (e.g., information, training, support)? For Consumers  Preferences, values and needs supported.  Empowered.  Aware of all options.  Making decisions that preserve resources & independence.  Satisfaction with Options Counseling services.

The evaluation of the ADRC program is being conducted by Portland State University's Institute on Aging in partnership with the ADRC and SPD Staff.  Evaluation forms at each training session  Brief electronic survey 3 times a year  Focus groups Other evaluation activities include:  Consumer satisfaction telephone survey.  Interviews or focus groups with ADRC managers & supervisors, and AAA Directors. 8

What is Options Counseling?  History and context  Defining Options Counseling  Understanding the value of Options Counseling for our consumers. 9

 Older American’s Act of 1965  Information & Referral ◦ Amendments in 2000, 2006  Home and community-based long term care development activities  Evidence-based disease prevention and health promotion services  Family Caregiver support  Aging and Disability Resource Centers 10

 2008-Development of Real Choices ◦ Funds from Center for Medicare/Medicaid Services ◦ Person-centered hospital discharge planning ◦ Demonstration site for ADRC at LCOG  2009-Development of statewide ADRC Plan ◦ Funds for Administration on Aging ◦ Added Oregon Cascades West COG and NW Senior and Disability Services to ADRC project ◦ Community Living Plan: keep private pay clients in the community; divert people from nursing homes 11

ADRCs What are they?  Awareness, Access, Assistance  Benefits to consumers  Single entry access  Person-centered values  Wide range of resources  Broad consumer population 12

The Four Core Services  Information and Referral  Options Counseling  Care Transitions  Healthy Aging 13

Options Counseling one of the Four Pillars of ADRCs 14

15 Options Counseling supports informed long- term care decision making through assistance provided to individuals and families to help them understand their strengths, needs, preferences and unique situations and translates this knowledge into possible support strategies, plans and tactics based on the choices available in the community.

16 "I was thrust into a situation I wasn't fully prepared for," Susan said. "Care-giving on my own consumed the time otherwise needed to arrange the appropriate short and-long term care and support for both my parents. I thought to myself, what do I do now? Where do I start? I cannot do this by myself.“ Susan Turpin of Hillsboro

 Consideration of available community-based options before institutional placements happen.  Help sorting through lots of information that is available online, but can be complex, contradictory, and confusing.  Individualized support for families making decisions about long-term care.  Helping make people aware that they can and need to plan ahead for long-term care support needs. 17

 Options Counseling is proactive and interactive.  Options counselors are able to connect consumers to a full range of community supports, both public and private.  Options Counseling may help consumers to preserve their resources and maintain their independence. 18

 Options Counseling is more than information and referral.  Emphasis is on relationship building, counseling and decision support.  May involve more time spent with consumer and their family.  Includes documentation of decision support provided and action steps for consumers, families and the ADRC.  Follow-up activities to support the consumer in their planning process. 19

Understanding the Role of Options Counselor  Facilitator of Options Counseling process ◦ Moving from I&R/A to Options Counseling ◦ Providing decision-making support ◦ Working with broader definition of “consumer” 20

I&RI&A Options Counseling Case Management 21

Activity  For each scenario, identify whether this is I&R I&A Options Counseling  Discuss the reasons for your decision  Write a list of 4-6 questions to help staff identify the difference.  Share with larger group 22

 Relationship-Based  Empowering Personal Choice  Facilitating Connection to Resources 23

Adults with disabilities over 18 years old and all older adults and their families, regardless of income. 24 Who Receives Options Counseling?

Wherever the consumer needs it to happen  On the Phone  E Mail  Face-to-Face  In-Home Visit 25

 When an individual has immediate or short range long-term care needs.  Prior to Hospital or Long-term Care discharge  When a family caregiver needs help to continue providing care.  When a long distance caregiver has concerns about the increased frailty or care needs of a loved one. 26

Person- Centered Assessment Information about Resources and Options Knowledge Needed for Decision- Making 27

 A supportive relationship that helps consumers and their families make informed choices about meeting current and long-term needs.  A firm foundation in quality information about state and local resources  As assessment approach that is person-centered and incorporates consumer preferences, strengths, culture and individual situations.  The skills to assist individuals and families in decision making. 28

Six Core Competencies 1.Determine the need for Options Counseling 2.Assess needs, values and preferences 3.Understand public and private sector resources 4.Demonstrate respect for self- determination 5.Encourage future orientation 6.Follow-up 29 Core Competencies of Options Counseling

 Communication  Active Listening  Assessment  Values, needs, goals and strengths/resources  Motivation and change.  Decision Making Support  Creating person-centered plans.  Working with family and natural supports.  Clear Documentation  Goals and needs, options considered, action plan. 30 Skills for Options Counseling

During initial contact with the ADRC, staff determine if OC is appropriate. Assess the purpose of the contact.  What kind of help is the consumer looking for?  How do they see their situation and needs?  Do they want assistance in making decisions about their care needs?  Clarify uncertainty. 31

 Introduce and explain your role  Set a welcoming tone and convey openness  Ask open-ended questions  Allow the consumer to tell their personal story.  Listen for underlying issues or concerns  Assess/ask if the person would like to continue the discussion face-to-face, or with family present. 32

Skills Needed Active Listening Skills  Take time to listen.  Paraphrase, reflect and ask open and closed-ended questions to clarify and summarize. Understand that people may not know what they want or need. Articulate, clarify and discuss assumptions. 33

Getting to know the person and their situation Questions to consider:  What are the feelings of the individual and the family regarding the present circumstances?  What are the physical, mental and social needs?  What are the person’s strengths, resources, community, family and friends that can aid in planning?  What are the person’s values, goals, and cultural perspectives? 34

Understanding Culture ◦ Self Awareness.  Implicit Bias.  Personal Values ◦ Awareness of Others  Understanding difference.  Suspending judgment. 35

Identify core issues  Housing  Care needs  Family and social support  Assistive technology  Finances: private and public. What can they afford?  Eligibility and benefits  Future planning 36

 Goals ◦ What the person wants to continue, change or accomplish.  Strengths and Resources ◦ Who this person is: values, culture, family, history ◦ The building blocks for accomplishing the goal.  Needs ◦ Why a change, action or service is needed  Options and Strategies ◦ How that need will be met.  Measurable Outcomes ◦ Results that will tell us we met the needs and accomplished the goal. These can be defined by consumer and by program 37 Skills for Options Counseling Assessment

 Understand and facilitate access to resources Public Community Private Personal supports  Be able to discuss potential availability, criteria and costs.  Give information in doses. 38

 Assist in planning that meets consumer’s needs, values and goals  Work with consumers from a strength-based perspective  Honor Culture  Empower consumer to make the decisions that meet their goals  Be aware of personal bias and assumptions  Let go of the outcome. Stay dedicated to the process. 39

Working with consumer’s natural supports, family and friends to empower consumer-driven planning.  Helping family to help their loved one.  Family Meetings  Working with concerns.  Helping family members discuss concerns  Reinforce that decisions are a process 40

 Empowering ◦ Building competency ◦ Increasing confidence  Enabling ◦ Working harder than the client ◦ Deprives people of the opportunity to learn and grow.  Abandoning: not offering enough. 41

Client Locus of Control ◦ People are invested in plans they help make. ◦ When people are seen as capable they achieve. ◦ Client self-determination involves respect. ◦ Instead of telling clients what to do, we ask them how we can help. 42

Be committed to the process. Let go of the outcome. ◦ Options Counselors are responsible for ensuring the best process for decision-making. ◦ The consumer is responsible for the decisions they make. 43

 Look beyond immediate needs and help consumer consider future needs.  Consider the impact of decision-making on future possibilities, and outcomes of decisions.  Look beyond “fixing”  Think outside the “service box”  Reach out to family caregivers in helping them anticipate and plan for future needs. 44

45 Follow-up serves a critical role in assessing the usefulness of services as well as strengthening the consumer’s relationship with the ADRC.

Follow-up activities  Follow-up with the consumer to assess effectiveness and usefulness of plans and services.  Revise action plans as needed.  Document information from the follow-up call. 46

Considerations and challenges  What are the challenges and/or barriers to consumer following through with plan?  Leaving the door open for future contact. 47

48 How does knowing all this help?  Helps I & R/A and other staff know when to act and when to step back and refer to OC  Takes I & R/A and case manager staff out of the perpetual “fix them” mode  Work smarter, not harder  Helps remove some of the resentment that can develop with consumers who “never take our advice”.

I & R/A Options Counseling Offering the right amount and depth of assistance at the right time in order to support the person, and family, to make an informed decision. 49

Wrap up and Review Six Core Competencies 1.Determine the need for Options Counseling 2.Assess needs, values and preferences 3.Understand public and private sector resources 4.Demonstrate respect for self- determination 5.Encourage future orientation 6.Follow-up 50

I&RI&A Options Counseling Case Management 51 Continuum

How did we do? Learning Objective:  Have a working understanding of Options Counseling (OC) and how it is different from information, referral and assistance and case management.

 ADRC Website:  Training Technical Assistance: The Art of Options Counseling  Wisconsin Department of Health and Family Services, Division of Disability and Elder Services, Bureau of Aging and Disability Resources. Long-Term Care Options Counseling Tool Kit.  The Lewin Group. A healthcare policy research and management consulting firm. 53