1. 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

2. Welcome and Introduction 2

3. Options Counseling 101: Introduction to Options Counseling  Definition of Options Counseling  History and context (ADRC development)  Options Counseling in Oregon  Values and Principles  Core Competencies 3

4. Options Counseling 102: The Art of Options Counseling  Skills for Options Counseling  Communication  Assessment  Understanding Change and Motivation  Documentation 4

5. Options 103: Advanced Options Counseling  Advanced Options Counseling Skill Development  Decision Making Support  Problem Solving  Family Meetings 5

6. Options Counseling 202: Supervision  The Role of Supervisor in Implementing Options Counseling 6

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8.  Your Goals: What do you want to come away with today?  Commitments to each other  Commitment to all sessions 8

9. 9 For Staff  How is it working?  What do you need (e.g., information, support)? For Consumers  Preferences, values and needs supported.  Empowered.  Aware of all options.  Making decisions that preserve resources & independence.  Satisfaction with Options Counseling services.

10. 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 ADDRC managers & supervisors, and AAA Directors. 10

11. What is Options Counseling?  History and context  Defining Options Counseling  Understanding the value of Options Counseling for our consumers. 11

12.  Older American’s Act of 1965 ◦ Fast Facts Handout ◦ 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 12

13.  2008-Development of Real Choices ◦ Funds from Center for Medicare/Medicaid Services ◦ Person-centered hospital discharge planning ◦ Demonstration site for ADRC in Lane County  2009-Development of statewide ADRC Plan ◦ Funds for Administration on Aging ◦ Added Cascades West AAA and NW Disability Services to ADRC project ◦ Community Living Plan: keep private pay clients in the community; divert people from nursing homes 13

14. ADRCs What are they?  Awareness, Assistance, Access  Benefits to consumers  Single entry access  Person-centered values  Wide rage of resources  Broad consumer population 14

15. Three ADRC pilot sites in Oregon  Lane Council of Governments (LCOG)  Oregon Cascades West Council of Governments (OCWCOG)  Northwest Senior and Disability Services (NWSDS) 15

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17. The Four Core Services  Information and Referral  Options Counseling  Care Transitions  Healthy Aging 17

18. Options Counseling one of the Four Pillars of ADRCs 18

19. 19 Oregon Definition 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.

20. 20 “So every decision we make-residential, financial, medical, was a crapshoot that changed the landscape for the next decision, usually by limiting options I didn’t even realize we had” -Jane Gross, New York Times July 7, 2008

21.  Institutional placements often occur without consideration of available community-based options.  Lots of information is available online, but it can be complex, contradictory, and confusing.  Families need individualized support making decisions about long-term care.  Few people plan ahead for long-term care support needs. 21

22.  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 preserve their resources and maintain their independence. 22

23.  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 documenting decision support provided and action steps for consumers, families and the ADRC.  Follow-up activities to support the consumer in their planning process. 23

24. I&RI&A Options Counseling Case Management 24

25. Scenarios for understanding continuum 25

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28.  Relationship-Based  Empowering Personal Choice  Facilitating Connection to Resources 28

29. Adults with disabilities over 18 years old and all older adults and their families, regardless of income. 29

30. Wherever the consumer needs it to happen  On the Phone  E Mail  Face-to-Face  In-Home Visit 30

31.  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. 31

32. Person- Centered Assessment Information about Resources and Options Knowledge Needed for Decision- Making 32

33.  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. 33

34. Consumers and Options Counselors Wisconsin 34

35. 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 35

36. 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. 36

37.  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. 37

38. Skills Needed Active Listening Skills  Take time to listen.  Paraphrase, reflect and ask open and closed-ended questions. Understand that people may not know what they want or need. Articulate, clarify and discuss assumptions. 38

39. Harold and Marjorie 39

40. 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? 40

41. Understanding Culture ◦ Self Awareness.  Implicit Bias.  Personal Values ◦ Awareness of Others  Understanding difference.  Suspending judgment. 41

42. What do these things mean in your family culture?  Personal Independence  Caring for elders  Asking for help  Family togetherness 42

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44. 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 44

45. Assess needs, values and preferences  What are some of the physical, emotional or mental needs?  What are the strengths and resources?  What are the primary issues the family needs help with?  What would you do to further engage them? 45

46.  Understand and facilitate access to resources Public Community Private Personal supports  Be able to discuss potential availability, criteria and costs.  Give information in doses.  ADRC website: www.ADRCofOregon.org 46

47.  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. 47

48. 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 48

49.  Empowering ◦ Building competency ◦ Increasing confidence  Enabling ◦ Working harder than the client ◦ Deprives people of the opportunity to learn and grow.  Abandoning: not offering enough. 49

50. PersecutorRescuer Karpman’s Triangle Victim 50

51. 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. 51

52. 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. 52

53. Harold and Marjorie  What would be important to consider to support this family to make their own informed choices?  Discuss any personal bias you might have.  Do you have thoughts about what this family “should” do? What a “right decision” might be?  What would help you to put aside any possible bias aside? 53

54.  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. 54

55. Harold and Marjorie  What are some future needs or changes to consider?  What are some ideas, resources or referrals to consider for future planning? 55

56. Elements of Documentation  Assessment of need  Options discussed  Action Plan 56

57. 57 Follow-up serves a critical role in assessing the usefulness of services as well as strengthening the consumer’s relationship with the ADRC.

58. 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. 58

59. Considerations and challenges  What are the challenges and/or barriers to consumer following through with plan?  Leaving the door open for future contact. 59

60. 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. 60

61. Review:  Assess needs and strengths  Identify and consider values and preferences  Identify options available to meet needs  Identify the next steps for addressing long-term care needs  Develop a written plan to help guide future decisions and actions  Support individuals who require extra help to access necessary services  Follow-up to support person with implementation of their action plan 61

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63.  ADRC Website: www.adrc-tae.org  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. www.lewin.com. 63