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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

Challenge

An Overview ofOptions Counseling

for AAA Directors

and Program Staff

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Definition of Options CounselingHistory and context (ADRC development)Options Counseling in OregonValues and PrinciplesCore Competencies

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Introduction to Options Counseling

Learning Objective:

Have a working understanding of the definition of Options Counseling (OC) and how it is different from information, referral and assistance and case management.

OC 101, 102 & 103 Introduction to Options Counseling

The Art of Options Counseling – skills◦ Communication, Assessment, Decision-Making

Support, Documentation

Advanced Options Counseling◦ Understanding Change and Motivation ◦ Decision-Making Support◦ Problem Solving, Conflict Resolution◦ Facilitating Family Meetings

Evaluation: Making sure we are getting there.

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For Staff How is it working? What do you need (e.g.,

information, training, support)?

For Consumers Preferences, values and needs

supported. Empowered. Aware of all options. Making decisions that preserve

resources & independence. Satisfaction with Options

Counseling services.

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 yearFocus groups

Other evaluation activities include: Consumer satisfaction telephone survey. Interviews or focus groups with ADRC managers & supervisors, and AAA Directors.

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Evaluation

What is Options Counseling?

History and context Defining Options Counseling Understanding the value of Options

Counseling for our consumers.

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Older American’s Act of 1965 Information & Referral

◦ 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

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History and Context of Options Counseling

2008-Development of Real Choices◦ Funds from Center for Medicare/Medicaid Services◦ Person-centered hospital discharge planning◦ Demonstration site for ADRC at LCOG

2009-Development of statewide ADRC Plan◦ Funds for Administration on Aging◦ Added Oregon Cascades West COG and NW Senior and

Disability Services to ADRC project◦ Community Living Plan: keep private pay clients in the

community; divert people from nursing homes

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History and Context of Options Counseling

ADRCs What are they? Awareness, Access, Assistance Benefits to consumers

Single entry access Person-centered values Wide range of resources Broad consumer population

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Aging and Disability Resource Centers

The Four Core Services

Information and ReferralOptions CounselingCare TransitionsHealthy Aging

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ADRCs

Options Counseling one of the Four Pillars of ADRCs

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What is Options Counseling?

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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.

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What is Options Counseling?Sound Familiar?

"I was thrust into a situation I wasn't fully prepared for," Susan said. "Care-giving on my own consumed the time otherwise needed to arrange the appropriate short and-long term care and support for both my parents. I thought to myself, what do I do now? Where do I start? I cannot do this by myself.“

Susan Turpin of Hillsboro

Consideration of available community-based options before institutional placements happen.

Help sorting through lots of information that is available online, but can be complex, contradictory, and confusing.

Individualized support for families making decisions about long-term care.

Helping make people aware that they can and need to plan ahead for long-term care support needs.

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Benefits of Options Counseling

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 to preserve their resources and maintain their independence.

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Benefits of Options Counseling

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 documentation of decision support provided and action steps for consumers, families and the ADRC.

Follow-up activities to support the consumer in their planning process.

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How is it different from what we do?

Understanding the Role of Options Counselor

Facilitator of Options Counseling process◦ Moving from I&R/A to Options Counseling◦ Providing decision-making support◦ Working with broader definition of “consumer”

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I&R I&A Options Counseling

Case Managemen

t

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Continuum

Activity

For each scenario, identify whether this is I&RI&AOptions Counseling

Discuss the reasons for your decision Write a list of 4-6 questions to help staff

identify the difference. Share with larger group

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Relationship-BasedEmpowering Personal ChoiceFacilitating Connection to Resources

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Options CounselingValues and Practices

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

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Who Receives Options Counseling?

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

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Where does it occur?

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.

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Timing for Options Counseling

Person-

Centered Assessment

Informatio

n about Resources and

Options

Knowledge Needed for Decision-Making

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Decision Support in Options Counseling

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.

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What Does Options Counseling Offer?

Six Core Competencies1. Determine the need for Options

Counseling2. Assess needs, values and preferences3. Understand public and private sector

resources4. Demonstrate respect for self-

determination5. Encourage future orientation6. Follow-up

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Core Competencies of Options Counseling

Communication Active Listening

Assessment Values, needs, goals and strengths/resources Motivation and change.

Decision Making Support Creating person-centered plans. Working with family and natural supports.

Clear Documentation Goals and needs, options considered, action plan.

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Skills for Options Counseling

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.

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# 1: Determine the Need for Options Counseling

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.

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Determine the Need for OC

Skills Needed Active Listening Skills

Take time to listen.Paraphrase, reflect and ask open and closed-

ended questions to clarify and summarize.

Understand that people may not know what they want or need. Articulate, clarify and discuss assumptions.

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Determine the need for OC

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?

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# 2: Assess Needs, Values and Preferences

Understanding Culture

◦ Self Awareness. Implicit Bias. Personal Values

◦ Awareness of Others Understanding difference. Suspending judgment.

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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

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Assess Needs, Values and Preferences

Goals◦ What the person wants to continue, change or accomplish.

Strengths and Resources◦ Who this person is: values, culture, family, history◦ The building blocks for accomplishing the goal.

Needs◦ Why a change, action or service is needed

Options and Strategies◦ How that need will be met.

Measurable Outcomes◦ Results that will tell us we met the needs and

accomplished the goal. These can be defined by consumer and by program

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Skills for Options CounselingAssessment

Understand and facilitate access to resources Public Community Private Personal supports

Be able to discuss potential availability, criteria and costs.

Give information in doses.

www.ADRCofOregon.org

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#3: Understand the Public and Private Sector Resources

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.

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#4: Demonstrate Respect for Self-Determination

Working with consumer’s natural supports, family and friends to empower consumer-driven planning.Helping family to help their loved one.

Family MeetingsWorking with concerns.

Helping family members discuss concerns

Reinforce that decisions are a process

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#4: Demonstrate Respect for Self-Determination

Empowering ◦ Building competency◦ Increasing confidence

Enabling◦ Working harder than the client◦ Deprives people of the opportunity to learn and

grow.

Abandoning: not offering enough.

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Respect for Self-Determination

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.

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Respect for Self-Determination

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.

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Respect for Self-Determination

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.

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#5: Encourage Future Orientation

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#6: Follow-Up

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

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.

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#6: Follow-Up

Considerations and challenges What are the challenges and/or barriers to

consumer following through with plan? Leaving the door open for future contact.

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#6: Follow-Up

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How does knowing all this help?

Helps I & R/A and other staff know when to act and when to step back and refer to OC

Takes I & R/A and case manager staff out of the perpetual “fix them” mode

Work smarter, not harder Helps remove some of the resentment

that can develop with consumers who “never take our advice”.

I & R/A - - - Options Counseling

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.

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Wrap up and Review

Six Core Competencies1. Determine the need for Options

Counseling2. Assess needs, values and preferences3. Understand public and private sector

resources4. Demonstrate respect for self-

determination5. Encourage future orientation6. Follow-up

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I&R I&AOptions

Counseling

Case Manageme

nt

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Continuum

How did we do?

Learning Objective:

Have a working understanding of Options Counseling (OC) and how it is different from information, referral and assistance and case management.

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.

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REFERENCESAND

RESOURCES