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Greater Nashua Consumer Directed Services

State of the ArtConsumer Directed Services

For Families, Children, Adults andElders

September 19, 2002

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Lakes Region Agenda Building The Foundation Where Are We Today Getting The Individual Process

Started Developing the Individual Budget Individual Stories Struggles & Insights New Initiatives Questions & Answers

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Greater Nashua

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Building the Foundation We believe that choice and control

can be enhanced if a family or individual assume true management control of funded supports and services

We believe that the supporting agency needs a strong foundation of multi-level support to stand behind the families and individuals who have joined the management team

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First Steps Developed concept in 1997 Build true Consumer Directed Model Meet people on Wait List and in Crisis

and offer alternative to agency & program directed services

Create economy through careful allocation of funds and additional close management by consumers

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Change From Top to Bottom

Success required total agency support Advisory Group of administration,

quality, business, service coordination, human resources, and family support met for two years.

Worked through personnel, contractual, choice, budgeting, funding, and other start-up issues.

Transition to a new business practice supporting choice and control

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Network Change Great Nashua uses 16 vendors Vendors hesitant to offer some models Vendors bound by history and practice Area Agency bound by CM practice New CDS opened in the midst of

existing services providing solid option at Area Agency for individual budget and consumer directed management

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We Imagined That….. Families and individuals would come

to us to resolve problems arising from traditional system roadblocks

Service Coordinators would eventually refer as CDS became integrated into Area Agency operations

Our future regional system would be at least 10% CDS

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We Hoped That…… We would create a transformational

service which would both change our agency as well as change the lives of the people we support through access to new options

Families and individuals would manage their funds wisely and prudently and achieve a lower average cost.

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Where we are today……5 years later

47 CDS participants (49 individuals) 44 Adults (22-77) DD-ABD

29 Live with Family 6 live with roommates 4 with ‘provider’ 5 live alone

3 Families with children 2 on Waiver 1 school funded

6 Individuals take lead in their support

12 Participants use Vendors 20 Participants manage 27 Employees 18 have assigned service coordinators

Medicaid Billing Categories

•28 521 Certifications

•7 Consolidated

•3 State Certified Residences

•9 Community Support Services

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CDS Department Structure Staff

Full time Manager Full time Sr. Associate Part time Financial Assistant (25 hr/wk)

Budgets total over $1,000,000 Individuals manage ~$900,000

Range ~ $4,000 to $78,000 Average budget $21,000 47 Cost Centers + Department

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What makes it different …… Family use traditional ‘group’ funding to create 1

to 1 services Family recruits, schedules and supervises workers Family authorizes all payments Family negotiates directly with Vendor for

services and costs Creates agreement to document negotiations

Family does Medicaid Attendance & Monthly report

Family uses ‘System’ to brain storm, provide education about the system, discuss options, check compliance with funding source, collaboratively problem solve

Note: Family = Individual or Individual + Family

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Getting Started With Consumer Direction

We knew we would need referrals to originate on a year round basis from the system that we oversee

We anticipated that there would be a number of stages of development in building this referral base

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Referrals, Budgets, and Intake

Guided referrals come from Area Agency Crisis Team, Wait List Committee, and Administration

Service Planning referrals come from Teams, Service Coordinators, and Families

Problem Resolution referrals come from people facing obstacles in existing services

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How To Figure The Money Compare to existing system

programs for a benchmark For Day Programs use existing

Medicaid rates Cost up the actual service by

adding different components Provide teams at outset with

estimate of revenue

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Does this Family or Individual Belong In CDS? There is an initial review of the facts of

the referral by CDS and Administration We check to determine if there is a

strong element of consumer direction potential

We assess the basic feasibility of the funding, Medicaid restrictions, services desires, and issues of ability to trust

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Are There Additional Resource Considerations? There are some funding and service

situations that preclude enrollment in CDS

The supports are structured with significant work at intake and development, and then consumer direction picking up most of the management maintenance

Additional resources have to be funded

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Developing the Individual Budget

CDS has general idea of funding Kitchen Table Planning

Reality based: discuss wants vs. needs Key elements are the Individual/Family- THEIR:

Desired routine Assessment of Quality Knowledge & Insight of what works and what doesn’t work

Outcome individually designed & tailored ‘program’

Find ‘best fit’ Medicaid category

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Reality Based Budgeting Stephanie’s Story

SituationSingle working Mom with daughter

Graduating in June requiring 24 hour care

NeedSupport Monday through Friday 8 am to 5 pm

(activities, transportation, therapy)

VisionTo have an active week that involved community

activities, opportunities to form friendships, one to one support and continuing therapies.

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Sorry we can’t afford it! Honest and open conversation about funding (cut budget by

$20,000) Need and Vision remained the same Asked questions to clarify and prioritize needs Budget line items

Day Hab cost/day Transportation Worker cost = rate of pay + % for taxes etc. Area Agency % for GM and allocated expenses

Brain stormed ideas to develop staged plans 2 Week plan – met immediate needs 2 Month plan – gave time research & cost Yearly plan – annualized costs

3 years later we are still ok – Steph has 1 to 1 for 9 hrs/day

Mom has handled: her broken leg, worker’s maternity leave, and Vendor just about doubling their price

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Past & Present Stories

Exhausted the resources of Home Health Providers

Pilot to build in-home supports Costed out actual wrap around

supports in workgroup with all involved from Executive Director to Family

Three children with PDD/Autism

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Stories continued…… Developed a schedule week to week

and season to season that would interlock with the school resources

Due to size of staff team needed- added a liaison resource to help recruit and oversee personnel resources

Arranged for legal consult to review family plan to use teenage supports

Submitted plan for funding approval

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Stories continued…. Developed agreement with family

and during initial implementation entire team met on regular schedule

Support structure is in place today and over 70 hours of week are arranged by family

Family oversees budget resources as well as provides documentation and management updates.

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Struggles Fitting family dreams into Medicaid categories Family who always wants more money & is

never satisfied Lack of work force Finding approaches that get the individual

actively involved Holding to the forefront the Consumer is

directing their services People in the service system don’t ‘see’ the control

they exert Always ask / think how would you handle the

situation if there wasn’t a disability involved

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Insights CDS is not for everyone! Trust that the Individual &Family know best Individual & Family can do more than you think With open honest communication & information

family will work with you The system doesn’t have to have the answers &

often can get in the way It is hard It takes more time

COSNUMER DIRECTION WORKS!

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New Initiatives – what’s next ……

Personal Care Services HBCB – ECI Children's’ In-Home Support Waiver

?

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Your Turn ……

Questions & Answers

Thank you!