Aging and Disability Resource Center of Western Wisconsin Long Term Care Options Counseling Peggy Herbeck October 1, 2008

Who Are We And Where Are We Located? The ADRC is located in the western part of Wisconsin The first ten years we were an ADRC serving one county with a population of 110,000 Currently we are expanding into a regional model that will serve four counties and approximately 220,00O people

Why Did We Start A Resource Center And A Care Management Organization? The old system did not work well for people who needed long-term care –Medicaid usually only paid for institutional placements –Most adults prefer to receive assistance at home rather than in an institution and usually it is less costly –There were long waiting lists for programs offering home and community based care –Too many different programs and confusing rules in the old system

The ADRC Is A Concept Not A Place Calls placed to the ADRC local number and well publicized phone number People come to the ADRC without an appointment People request a meeting in their own home ADRC staff meet people while they are in the hospital or nursing home The ADRC goes out to the consumer

A Changed Philosophy In Wisconsin Information and Assistance is NOT Intake Options counseling in not one size fits all!

What Do People Want To Know? Services, supports and living arrangements that are available Costs associated with various options Funding sources available to pay for services Someone wants to assist them to find the answers The ADRC sees this as our mission

Training Curriculum New staff shadow existing staff for 4-8 weeks Each staff member is responsible for training in a particular area with supervisory review Professional staff - we have chosen to use certified social workers Weekly unit meetings Supervisory review of all referrals

Protocols Written protocols for all situations such as: –How to process an enrollment in Managed Care Every step is detailed –How to refer for Adult Protective Service –How to explain the Self Directed Supports Waiver We have evolved into all protocols being electronic - no paper copies Weekly unit meetings – a venue to introduce new programs and protocols Will be using teleconferencing with satellite offices

Database Web based database that allows tracking of every call Set up to track all encounters –Allows for extensive case noting – not just outcomes –Can scan copies of letters or documents into the record, so it is immediately accessible Partnered with 211 to utilize their database of services and resources

How to be Consumer Ready How to serve the non scheduled appointment - the “walk–in” consumer How to plan for staffing? How to handle the crisis situation? How to handle the situation when there aren’t any available resources

How The ADRC Offers Information And Assistance And The Next Step - Options Counseling ADRC of Western Wisconsin: we see the person, not the issue Try to serve holistically –Financial –Disability application, if necessary –LTC Functional Screen for Family Care (Home and Community Based Waiver) –Ability to recognize mental health concerns or crisis situations referral –Housing –Caregiver Support Determine functional eligibility Assist with financial determination for public benefits and programs Work closely with provider network to refer private pay individuals

Primary Relations to Develop in Your Community Public Assistance- Economic Support or Income Maintenance Units Public Health Hospital Discharge Planners Aging Departments Mental Health Services, Private and Public Local Veterans Service Departments Home Care, Personal Care and Supportive Home Care Agencies Churches Support Groups

Why Did Wisconsin Expand The Focus Of ADRC’s To Serve Those With Mental Health Or AODA Issues? It makes sense All inclusive Already seeing many individuals with dual diagnoses Makes it less threatening for people to ask for information regarding these topics

Level of Knowledge Regarding Financial Programs Must know basic Medical Assistance Managed Care SSI, SSDI, Presumptive Disability MAPP Medical Assistance Purchase Plan Estate Recovery Knowledge of other benefits interact Railroad, Veterans and Private pensions Disability Benefit Specialist to cover complicated issues

Special professionals work here New challenges every day. The social workers help people stabilize their lives. Work with all socio-economic groups. Advocacy –Consumer specific –Can make system changes also

Options Counseling Helps The Consumer Plan and Make Informed Decisions Identify what the individual sees as their primary outcome –What steps need to be taken to achieve? –Who can take on the responsibility? Help the consumer look at options that fit their unique situation –What is the most cost effective? –What is the best option for them?

Financial Eligibility If consumer has private resources –assist to understand private resources available –help to set up Help determine if financially eligible for public assistance to help pay for services Help the consumer prepare for the financial interview with the Human Services Department’s financial department

Functional Eligibility Long Term Care Functional Screen We work with doctors and hospitals to verify medical conditions to establish eligibility for help Even if consumer is not eligible for Family Care or a Waiver program, the Functional Screen can be used as a planning tool

Enrollment Final review of options in managed care or the waiver Make sure that the consumer wants to proceed Set the enrollment date Refer on to the managed care organization or care management agency

Tools To Assist With Options Counseling Process at the consumers home –Packets that have all basic information in them –Social Workers have laptops –Cell phones –Social Worker is with the consumer through the entire process Detailed “Access Plans/Mou’s” worked out with all departments that everyone agrees to Predictable access and follow up at any location

Ongoing Support Initially and In the Future Consumers can call ADRC staff directly for ongoing support & information

Specialized Roles: The Disability Benefit or Elderly Benefit Specialist Role Help people apply for a disability benefit if they never worked or if they worked for a period of time and no longer can Assist with appeals and reconsiderations They are the “go to expert” for all staff in the ADRC

Reaching Out to Young Adults With Special Needs The ADRC has staff who provide options counseling & handle transition cases Staff perform outreach duties Families and providers given direct contact information for ongoing transition assistance

Options Counseling and the Dis-enrollment Process If enrollee does not want to be a member of the Managed Care Organization, the ADRC offers one more consultation so they understand what they will be eligible for without the MCO The ADRC will offer options counseling to individuals who decide to withdraw from the Self Directed Supports Waiver-IRIS (Include Respect I Self Direct) Many are voluntary programs so consumer decides

Options Counseling It is an art that requites strong professional skill, a large knowledge base and the belief that all people should have the information they need to make informed decisions ADRC staff are truly the “special forces” of managed care