1. Adding and Sustaining Consumer Direction in Aging Network Programs: Challenges, Insights, and Successes National Resource Center for Participant-Directed Services December 15, 2009

2. AoA Welcoming Remarks Linda Velgouse Community Living Program Project Officer AoA

3. What is Consumer Direction? Mark Sciegaj Senior Training Consultant, NRCPDS

4. Outline Define Consumer Direction Compare Traditional Agency and Consumer- Directed Services Evaluation Results  Participant Outcomes  Informal Caregiver Outcomes  Paid Worker Outcomes  Quality Outcomes 4

5. What is Consumer Direction? Long-term care services that help people of all ages, across all types of disabilities, maintain their independence and determine for themselves what mix of personal care services and supports work best for them 5

6. Traditional versus Consumer-Directed Services 6 Participant Workers recruited and report to agency Program standards and agency policy set tasks Agency specifies salary, schedule, benefits Case manager makes needs and services decisions Worker training required by agency Workers available during normal work hours Participant Workers recruited and report to participant Sets tasks Specifies worker salary, schedule, and benefits (optional) Makes decisions about needs and services Trains or arranges for training (with assistance from counselor) of workers Flexible work hours based on needs and preferences Traditional ServicesConsumer-Directed Services

7. Participant Makes decision based on individual budget Hires, manages, dismisses, workers Trains (or arranges for training) of workers Evaluates worker performance Determines goods and services to be purchased 7 Shift in Participant Responsibilities Participant Needs are assessed Asked questions Informed of resources Given an option of agencies Assigned hours of services Provides feedback to the agency Traditional ServicesConsumer-Directed Services

8. Shift in Support System Medical Model Determines needs and service plan Oversees provision of services May seek participant input Establishes goals and outcomes Program parameters and standards limit flexibility Solves problems Assesses quality of services and supports The Traditional System Case Manager Social Model Works with participant to determine needs and service plan Assists participant with overseeing provision of services Participant involvement is critical Participant is responsible for goals and outcomes High flexibility of services and supports Advises participant on problem solving strategies Participant assesses quality of services and supports The Consumer- Directed Services Counselor 8

9. Evaluation Outcome Highlights Positive influence on quality of life and health Informal caregivers expressed less emotional, financial, and physical strain Paid workers high levels of job satisfaction Significantly reduced unmet personal care needs Did not result in the misuse of Medicaid funds or abuse of participants 9

10. Consumer Direction Perspectives: Program Administrator William A. B. Ditto, MSW LSW Director, New Jersey Division of Disability Services Program Director, Personal Preference Program

11. Consumer Direction: Program Administrator Perspective Consumer direction as a Service Delivery Model Working in a multi-agency collaboration Why did New Jersey choose to implement consumer-directed services? Some common concerns for program administrators:  Role change for staff  Shift in locus of control 11

12. Consumer Direction: Program Administrator Perspective (continued) Some common concerns for program administrators:  Assuring quality and affording participant protection  The issue of risk The benefits of consumer direction  Efficient use of limited funds  Care that is more culturally competent  Increasing participant responsibility

13. Consumer Direction Perspectives: Area Agency on Aging (AAA) Jerry L. Mitchell Executive Director, Area Agency on Aging of Northwest Arkansas

14. Consumer Direction: AAA Perspective Area Agency on Aging of Northwest Arkansas Why consumer direction?  Advocate for home and community-based services and participant input into care  Good business decision for our agency Consumer direction insights  Shifting the care responsibility to the participant  Participant learning what self-direction means

15. Consumer Direction: AAA Perspective Area Agency on Aging of Northwest Arkansas Consumer direction challenges and solutions  Staffing  Participants that can self-direct  Standardized assessment and budgeting

16. Consumer Direction: AAA Perspective Area Agency on Aging of Northwest Arkansas Future direction of consumer-directed care  Participants will take ownership  Participants will know their rights  More reporting of fraud and abuse by participants  More effectiveness of the overall system of care  More funding will go toward consumer-directed care

17. Consumer Direction Perspectives: Case Manager Brenda Adelman Social Worker, Big Stone County Family Services

18. Consumer Direction: Case Manager Perspective Original impressions Making the move to consumer direction How consumer direction affects the case manager role Common challenges and solutions Benefits of consumer direction 18

19. Consumer Direction Perspectives: Participant Lynn MacDonald Consumer Directed Community Supports, Caregiver Participant Representative NRCPDS National Participant Network (NPN), Core Leadership

20. Participant Stories 20

21. Consumer Direction: Participant Perspective Life before consumer direction Components of consumer direction  Needs assessment  Goods and services  Writing plan and budget  Fiscal Support entity Challenges of consumer direction Benefits of consumer direction 21

22. “As I talk with seniors, what I hear most is that they want to stay in their homes as long as they can. However, too many seniors struggle to afford quality home-and community-based care, and as a result, are forced into institutional care they don’t want, adding to the strain on our Medicaid program.” 22 Hillary Rodham Clinton, in April 2006, introducing her “Community-Based Choices for Older Americans Act” Questions & Answers

23. Consumer Direction Website Resources Elizabeth Maguire Assistant Director of Marketing & Communications, NRCPDS

24. Outline Introduce and Tour Websites ParticipantDirection.org CashandCounseling.org HCBS.org Others helpful sites

25. ParticipantDirection.org 25

26. ParticipantDirection.org 26 Conference notices and presentations Issue Briefs I nformation about the Consumer Direction Module (CDM)

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28. Handbook on Self-Direction Designed for staff in Aging and Disability service systems who are interested in and/or responsible for designing and implementing self-direction programs Chapters include: Involving Participants, Individual Budgeting, Counseling, and Quality 28

29. CashandCounseling.org 29

30. CashandCounseling.org Information about the Original Demonstration and Replication States Success Stories, Videos, Photos News and Special Announcements Interactive Data Tool Library ChoiceWords: Sign up for our online newsletter 30

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32. CashandCounseling.org Key Resources Consultant Training Program Communications Toolkit State Produced Materials FMS Resources 32

33. HCBS.org- screen shots which illustrates the homepage features including: 1. Browse & Search 2. New & Notable 3. Top Articles 4. Highlight 5. Theme Pages 6. Header – Glossary, Calendar, Submit Your Resources HCBS.org

34. Features of HCBS.org Highlights and New & Notable Theme Pages Top Articles Forward to a Friend myLIBRARY Event Calendar Glossary Submit Your Resources Social Networking: LinkedIN e-CLIPS- SIGN UP for the bi-weekly mailing

35. Search vs. Browse With over 2,000 resources-how do I find what I’m looking for? Browse Tool  Explore resources by one or more facets  Especially helpful if you do not know name of document, but are interested in specific topic, state or type of publication.  Example: Bookstore on vacation Search Function  Use when you know an exact piece of information; located at top left of screen  Advanced and Full Text are also options.  Example: Know the author or a conference

36. Our websites include resources to make program development easier for you- if you don’t see something you need, ask! Elizabeth Maguire Elizabeth.maguire.1@bc.edu 36

37. Other Helpful Websites: 37 Technical Assistance Exchange:  http://www.adrc-tae.org/ http://www.adrc-tae.org/ Community Living Program, ADRC, LT Support Services National Direct Service Workforce (DSW) Resource Center  http://www.dswresourcecenter.org/ http://www.dswresourcecenter.org/ Quality Mall- person-centered supports for people with disabilities  http://www.qualitymall.org/main/ http://www.qualitymall.org/main/ Kaiser Commission on Medicaid  http://www.kff.org/about/kcmu.cfm http://www.kff.org/about/kcmu.cfm

38. Additional Tools and Resources Suzanne Crisp Director of Program Implementation and Design, NRCPDS

39. Resource Guide FAQ Documents Older Americans Act (OAA) Cash & Counseling Evaluation Results Useful Documents Developing and Implementing Self-Direction Programs and Policies: A Handbook Consultant Training Program Commonly Used Acronyms and Definitions NRCPDS Staff Directory 39

40. Upcoming Webinars Changing Practices, Attitudes, and Roles of Case Managers Winter 2010 Managing Changes: Introducing Consumer Direction to Aging Network Management, Spring 2010 Community Living Program: Challenges, Insights, and Successes, Summer 2010 40

41. NRCPDS Contact for Questions Jim Wironen Director of Product Development & Consulting (617) 552-2936 james.wironen.1@bc.edu 41

42. Advancing choice and control for people living with disabilities