1. Empowering the Consumer: Agency Transition to Person-Centered Planning and Participant Direction for Elders  Jeffrey Keilson, Vice-President, Advocates, Inc. System Transformation Grant, Commonwealth of Massachusetts  Christine Alessandro, Executive Director BayPath Elder Services, Inc.

2. Jeffrey Keilson, Vice-President Advocates, Inc. jkeilson@advocatesinc.org 781-910-7216 Christine Alessandro, Executive Director BayPath Elder Services, Inc. calessandro@baypath.org 508-573-7200

3. Who Are We? Executive Office of Elder Affairs (EOEA): State agency for elders under the auspices of the Executive Office of Health and Human Services (EOHHS), also the State Unit on Aging Advocates, Inc.: A private, non-profit agency supporting elders and people with disabilities for over 30 years in more than 50 cities and towns in Massachusetts BayPath Elder Services, Inc. (Area Agency on Aging and Aging Services Access Point): A private, non-profit agency serving elders, caregivers and persons with disabilities in 14 communities in the MetroWest area of Massachusetts

4. The Home Care System in Massachusetts Through Aging Services Access Points (ASAPs), the state provides funding for in-home services for elders who meet criteria for age, income and functional impairment ASAPs also provide services for Medicaid-enrolled elders through state-plan services and the Frail Elder Waiver Case managers at each ASAP assess elders and develop a service plan based on the individual’s needs. Services are limited to those approved by the Executive Office of Elder Affairs (EOEA) The system has traditionally been agency-driven

5. Climate for Change: Massachusetts Robert Wood Johnson Foundation Grant CMS Community-Integrated Personal Assistance Services & Supports Grant CMS System Transformation Grant Recommendations for Advancing Self-Direction in Massachusetts’ Long-term Care Delivery Systems, report to EOHHS and EOEA CMS Person-Centered Planning Implementation Grant AoA Community Living Program grants AoA and Dept. of Veterans Affairs grant

6. System Transformation Historically, state home care system one of the systems in the Commonwealth without a model of consumer direction Staff: “We’re the experts and we know what you need” Beginning of transformation: The introduction of consumer-directed care – limited to home maker and personal care for consumer choice. The elder is the employer of record

7. System Transformation for Staff Challenge the belief that there is only one way to provide services Shift of the “power” from the staff to the consumer Dealing with risk adverse staff (and risk aversive political environment) Support in implementing a consumer directed model of service delivery – the effort to shift the paradigm of the entire agency Then we took the next step ….

8. Next Step: From Limited “Consumer Direction” to Full Authority in Management of an Individual Budget Summer 2007 - Presentation to, and approval from, the Executive Office of Elder Affairs for a person-centered planning and consumer-direction initiative for elders EOEA supported the design and implementation of a new initiative for non-MassHealth nursing home eligible elders (Enhanced Community Options Program-ECOP) Collaboration between Advocates, Inc. and BayPath Elder Services, Inc. The Dialogue: How to get needs met in a different way – helping staff (and consumer) to think outside the box The Champion: someone who really believes in this concept and is dedicated to making it work

9. Who Was Involved? Senior leadership from EOEA The Board of Directors of BayPath The Executive Directors and Senior Managers of BayPath and Advocates The Staff – get buy-in from across the spectrum of staff The Consumer (and, where appropriate, their families) The Community

10. Creating the Environment and Culture Within Agencies to Support Change Leadership Collaboration Shared vision Process for a diverse and representative group to meet regularly to effect change Educate the general public

11. Centers for Medicare and Medicaid (CMS) CMS defines self-determination as a: Process applied to the service delivery system whereby older persons, individuals with disabilities, and, where appropriate, families have… direct involvement, control and choice in identifying, accessing and managing the services they obtain to meet their personal assistance and other needs.

12. Internal Steps to Implementation Development of Person-Centered Planning tool for use with elders Develop materials – brochure, tool, pre- and post-survey Restructure staff “caseload” Develop basic facilitator training curriculum Train case managers as facilitators Integrate activities with person-centered planning initiatives across the elder and disability communities Educate consumers and their families Bi-monthly training and other support meetings Develop manual, policies and procedures Deal with resistance

13. Person-Centered Planning is … Not limited by lists of services Utilizes a unique strength-based assessment strategy and on-going monitoring Breaks down barriers Actualizes hopes, dreams and desires Involves the individual holistically

14. Person-Centered Planning Person-centered planning is a process, directed by the participant, intended to identify the strengths, capacities, preferences, needs and desired outcomes of the participant. The Centers of Medicare and Medicaid

15. Person-Centered Planning Move from system-driven service planning to a person-directed process Individual identifies what is important to him or her Expand circle of supports to assist individual to achieve his or her goals while maintaining safeguards

16. Key Elements of the PCP Is driven by the person and his/her preferences Establishes a vision based on strengths, capacities and preferences Based on informal and formal knowledge Emphasis on network building Requires collaborative teamwork Requires a commitment to action Process uses a facilitator

17. The Person-Centered Planning Framework Circle of support Caregiver assessment Personal preferences – likes and dislikes Beliefs & Traditions that must be honored: Must haves? What must continue in my life? What cannot change in my life? What cultural traditions do I value?

18. The Person-Centered Planning Framework (continued) Fostering hopes and dreams Development of goals Action plan  Timeframe  Who is responsible? Ongoing meetings Evaluate effectiveness

19. Circle of Support 1. Circle of Intimacy 2. Circle of Friendship 3. Circle of Participation 4. Circle of Exchange 5. Mentors 6. Re-connect

20. Changing Role of the BayPath Elder Services Case Manager Help people to plan, create and manage a network of services and supports Act on behalf of the individual as his or her personal agent to arrange for needed services Helps define the needs and dreams of the person Provides information on resources, and evaluates effectiveness of supports

21. Flexible Budgeting Departure from “the usual way we do business” Allows the individual to carry-over funds from one month to the next Individualized to each budget, according to the person-centered plan Assessed critical needs must still be met, i.e. personal care What are the allowable expenses?

22. Quality of Life Indicators Personal wellness Connecting with your home environment Community integration and inclusion Improving personal relationships Connecting with your culture

23. Vision for the Future Expand person-centered planning and participant direction initiative state-wide for all individuals enrolled in the state home care ECOP program Use of a more person-centered planning framework for all Medicaid waiver participants Integration of consumer direction in the AoA/VA grant

24. “We’ve got to start taking risks if we want to see the world.” Ted Esteves, 71

25. The Person-Center Planning Packet Tool was developed by Advocates Inc., BayPath Elder Services, the Department of Mental Health, and others in 2009. The Tool was developed to aid facilitators in developing Person-Centered Plans that work towards Participant Direction and improve quality of life. Funding for this project was provided by the U.S. Centers for Medicare and Medicaid (CMS) under a Massachusetts Building Blocks for Person-Centered Planning Implementation Grant (#5947-0011). The grantee is the Executive Office of Health & Human Services and it is a collaborative effort with the six sister/partner agencies: Department of Developmental Services; Department of Mental Health; Executive Office of Elder Affairs; Massachusetts Commission for the Blind; Massachusetts Commission for the Deaf & Hard-of-Hearing; and Massachusetts Rehabilitation Commission.