1. The Art of Options Counseling: Person-Centered, Decision Support Thea Griffin, LMSW 1

2. Prerequsite for Options Counselors Complete the NY Connects Information and Assistance Training that provides the necessary core competencies and communication skills instruction.  This includes active listening and interviewing techniques, empowering callers and handling difficult situations. 2

3. Learning Objectives Define Options Counseling Distinguish Options Counseling from Information and Assistance Apply Person-centered interviewing techniques Empower individuals to make decisions Track Options Counseling 3

4. NY Connects: Choices for Long Term Care An essential part of NYS’ effort to rebalance the long term care system A central component of federal long term care reform initiatives for both the AOA and CMS, and functions as NYS’ Aging and Disability Resource Center (ADRC) Streamlines access to information and assistance about long term care services, reduces fragmentation and empowers individuals to make informed choices 4

5. Key Functions of NY Connects Information and Assistance Public Education Long Term Care Councils 5

6. Aging and Disability Resource Center Grant Two NY Connects programs awarded the federal ADRC grant award in 2009. Improving access to long term care and improving transitions in care aimed at reducing preventable re-hospitalizations. 6

7. Defining Options Counseling An interactive and individualized process whereby consumers are assisted in evaluating all of their long term care options and are supported in making a decision based on their values, needs and preferences and cost. A distinct and specialized service offered by Aging and Disability Resource Centers 7

8. Options Counseling is…. Information and Assistance + Decision Support/Counseling = Enhanced Information & Assistance! 8

9. Goals of Options Counseling To provide people with the information they need to make informed choices To provide guidance by matching people’s needs and preferences with available services and supports To help plan for the future To help improve the quality of life of people receiving long term care services 9

10. Person-Centered Planning: The Foundation of Options Counseling An approach that generated from the Disabilities Rights Movement Consistent with direction of NY Connects Focuses on the individual, not on fitting the person into available services Highlights strengths, capacities, preferences, and desired goals of individual 10

11. Importance of Self-Determination Each person determines what is necessary and desirable to create a meaningful life. Options Counselors give individuals control to create the results they want.  “What do you need to help you make this decision?”  “What will help you make this decision better?” Counselors letting go of the need to “resolve the problem”. 11

12. Elements of Options Counseling Identifying consumer and family needs, values, and preferences Providing information on public and private resources Connecting consumers with resources Assisting consumers in deciding course of action and allowing for self- determination Counseling and support through the process Following up 12

13. Distinguishing Features of Options Counseling Takes more time than I & A Is a process, not an event Involves multiple conversations Occurs in person and involves the family, as appropriate and feasible Encourages future planning Provides decision support, including action steps Requires documentation and tracking 13

14. Defining Decision Support Prioritize the individual’s needs and wants Identify their preferences and values Identify options available Help individuals weigh the pros and cons of different choices  “What might happen if you decide not to take any action?” 14

15. Decision Support Continued…. Helps anticipate and plan for future needs  “What would you like to do when your daughter (caregiver) goes back to work full time?” Develop an Action Plan 15

16. Getting the Information Needed to Provide Options Counseling Ask individual to tell their personal story Ask open-ended up questions:  “What type of assistance are you looking for?”  “How would you describe your current situation?” Listen for cues that the person is at the point of decision making:  “Maybe I… I don’t know…Someone told me I need… I can’t…” Ask if she/he would like support evaluating the options and making decisions 16

17. Individuals Who Would Benefit from Options Counseling Individuals with immediate long term care needs (e.g. after major life changing event) Individuals who are planning for future needs Caregivers who need help in caring for their loved one Individuals who are transitioning from one setting to another, such as from the hospital to their homes. 17

18. When Might Options Counseling Not Be Helpful? During a crisis When individual does not have the capacity to make decisions When individual only wants a referral or telephone number 18

19. Examples of Components of an Optional Counseling Session Individual/Family Needs and Preferences  Personal history and preferred lifestyle  Functional limitations and capacities  Support system  Financial situation Exploration of Choices and Options 19

20. AoA Distinctions Benefits Counseling Provides accurate and objective information on public benefits and entitlements, such as that provided by the HIICAP coordinator. Futures Planning Focuses on planning for anticipated long term care needs. 20

21. Skills of an Options Counselor  Received I&A training Understanding of person centered planning Respect for self-determination Ability to provide counseling and support Knowledge of all available resources, public and private, and their cost Active listening skills Ability to work with families 21

22. Key Questions for Options Counselors YourselfConsumers/Family Feelings What bias do I bring? Do I have a strong opinion about what they should do? Where are they in their ability or willingness to make a decision? Are they anxious or laid back? Knowledge Do I have a handle on all the potential resources in the community that may be useful to this family? Who else should I consult? What information have they received already? How much information can they handle right now? What do they see as options? Skills What clinical skills are most important in this situation? What strategies have they already tried? How likely are they to follow up after discussions? 22

23. Tools to Guide the Delivery of Decision Support Importance and Readiness Rulers Preferences Map Relationship Map Options Counseling Action Plan 23

24. Importance and Readiness Rulers Helps with future planning 24

25. Preferences Map Assess values, needs and preferences 25

26. Relationship Map Assesses values, needs and preferences 26

27. LTC Options Counseling Action Plan Challenges and Preferences 27

28. Strengths and Possibilities 28

29. Options, Next Steps and Follow Up 29

30. Challenges Faced by Options Counselors Dealing with family dynamics and handling conflicts Helping individuals who have limited “options” Working with individuals who do not qualify for public programs and have limited resources Repeat callers who refuse to accept services Letting individuals take risks. 30

31. Discussion What will you bring back with you? What was most/least useful? What would you like more information about? 31

32. Programmatic Requirements for Implementing Options Counseling Track and document Create methods for continued staff competence Develop and implement operational protocols, including referral procedures with hospital discharge planners 32

33. Tracking Options Counseling 33

34. Additional Resources Technical Assistance Exchange www.adrc-tae.org Thea Griffin T_griffin@ofa.state.ny.us 34