Embed Size (px)
Citation preview
Improving Access to HCBS Services for People Directing their Own Services
Steve Edelstein, PHI Carrie Blakeway, The Lewin Group
2013 National HCBS Conference: September 11, 2013
Session Overview
Provide Opportunities for Participants to:
Consider how workforce availability and strength influences experience of people in participant-directed services (PDS) programs
Share strategies for supporting and developing the workforce providing PDS
Discuss strategies for connecting workers to individuals receiving PDS HCBS
Desired Outcomes:
Session participants identify strategies they can use to support choice and control of individuals in PDS as well as support the people providing services
1
Carrie Blakeway: The Lewin Group, DSW Resource Center
Framing the Issue: Trends and Policy Considerations
2
Increasing number of people receive Medicaid-funded HCBS through a participant-directed service (PDS) model
Enrollment not as high as desired in many states
PDS represents a paradigm shift in HCBS delivery
Approximately 800,000 workers in PDS
Many Affordable Care Act provisions promote PDS and person-centered approach to HCBS delivery
Department of Labor proposed rule change to companionship exemption on the horizon
Framing the Issue: Workforce Development in Participant-directed Models
3
States, MCOs and employers must think about workforce development in PDS differently
Many friends and family members
Often work for one individual only
Find their work rewarding, are satisfied with their jobs and feel they use their skills well
Training needs and preferences are different
Many states have either implemented or are considering implementing managed care for LTSS.
Managed care organizations (MCOs) historically have had limited experience with LTSS including PDS
Who is here today? Introductions and questions to think about
Do people in my state have easy access to the participant directed model of services?
Can people in PDS in my state easily find people to support them in their homes and communities?
What types of supports are available to family members and friends supporting people in participant-direction in my state?
What types of supports are available to other workers – non-relatives - supporting people in participant-direction in my state?
4
Agenda: Information and Strategies to Discuss
Findings from Michigan’s surveys of participant-directed workers
Different training strategies
Potential of matching services registries and design considerations
Role of No Wrong Door systems in promoting PDS and supporting PDS workers
5
Lori Sedlezky: University of Minnesota, DSW Resource Center
Background on Michigan Surveys
2010 Office of Services to the Aging received federal funding through CMS State Profile Tool grant.
Based on guidance from the Direct Service Worker Resource Center on how to build a minimum data set of workforce information.
National baseline survey effort with seven other states.
All reports available at:
www.phinational.org/michigan/workforcesurveys
Goals: Workers in Self-Determination Surveys
Community Metal Health Self-Determination Surveys
Understand motivations, satisfaction and training needs to secure the option
Collect baseline demographic data
Identify strategies to strengthen and support recruitment and retention
Analyze data by worker relationship to participant
Key Findings – Workers in Self-Determination
DSWs supporting self-determination participants are, overall, satisfied with their jobs
DSWs believe training in certain core-competencies should be mandatory including:
Nearly 40 % of DSWs in self direction are uninsured
Notable differences are reported between DSWs based on relationship to participant
First Aid/Universal Precautions Person Centered Planning
Consumer Rights & Responsibilities Stress Management
Understanding Mental Illness Health Conditions
Behavior Management Communication Skills
MI Surveys - Recommendations and Strategies
Establish competency-based training infrastructure to prepare workers for first 6 months of employment and increase on-demand training opportunities
Offer more and continuing work to current DSWs to build and sustain workforce
Provide information and resources to help self-determination workers secure health care coverage
Explore opportunities to increase wages, either at provider level or system-wide
Get to Know Your State’s DSW Workforce
10
Visit PHI PolicyWorks at: www.phinational.org/policy
Initiatives and Lessons Learned from Three States
Dawn Lambert, CT Dept of Social Services DSW Core Competencies and Training for PDS, DSW Advertising Campaign
and DSW Registry
Lorrie Mahar, WA State Dept of Social & Health Services DSW Training
Michelle Morse Jernigan, TN Dept of Finance and Administration, Bureau of TennCare Provisions for PDS and DSW included in Managed Care Contracts
[email protected] (615) 507-6528
11
Training and Recruitment Initiative in CT
DSW Customized Training Established workgroup that included allied health professionals, self-
advocates and other stakeholders
Established DSW competencies
Developed optional PCA training and certification through community colleges
DSW Recruitment Strategies
Established workgroup and hosted focus groups with participant/family-employers and direct service workers (employees)
Launched My Place CT – “One Stop” Source for LTC information
Launched the Workforce Development Campaign
Implement and Maintain a DSW Registry
12
Training and Recruitment Initiative in CT
Workforce Development Campaign
Audience: Potential Workforce
Who they are: students about to enter workforce, mature adults considering a career change, and/or professionals who want a second job.
How they think (that makes them candidates): personal experience with loved one, value compassion over monetary reward, like to help others, and/or want to make difference.
Approach
Hartford Courant CareerBuilders ads
Radio spots
Bus shelters & billboards-located near medical centers and potential workforce
Public relations to educate prospective career prospects-
opportunities and how they can learn more
Community outreach
13
Recommendations from CT
Develop and work with a diverse workgroup
Create strategies that balance professional concerns with self-directing participant/family-employers’ concerns
Start building the direct service workforce now
14
Training Initiative in WA
In an initiative process, WA State citizens vote to create a law that is implemented.
These Initiatives require increased training (75 hours) for long-term care (LTC) workers/Individual Providers or (IPs) in community-based settings and certification as home health aide.
IPs exempt from full training requirement include:
IP (adult child) caring for biological, step or adoptive parent only – 35 hrs plus 12 hrs of continuing education (CE)
IP (parent) caring for biological, step or adoptive son or daughter w/ ID/DD only – 12 hrs
IP (parent) caring for biological, step or adoptive son or daughter
w/out ID/DD only – 35 hrs
15
Training Initiative in WA (cont.)
IPs (related-non legally responsible individual or unrelated individual) providing services to one person for under 20 hours/month
35 hrs of training required or 75 hrs of training or CNA
If performing nurse delegation for nursing assistants or home care aides an additional 9 hours of training required
If performing nurse delegation w/special focus diabetes an additional 3 hrs of training required
16
Considerations from WA
To get good outcomes LTC workers need quality training
Consumers and families must be engaged in and willing to direct the provision of consumers’ care
It is very important to evaluate the quality and effectiveness of training for LTC workers
17
Recommendations from TN for MCOs Supporting Members in PDS
Take the time to educate MCOs about PDS
Obtain top down buy-in to get MCOs on board.
Provide vendor training for MCOs’ front line staff on participant direction.
Have state agency staff participate in at least one MCO staff training session.
Make sure MCO contract language is clear and comprehensive – it drives everything
Conduct Readiness Reviews with MCOs and VF/EA FMS organizations
Develop and implement DSW and member training
Establish qualifications, core competencies and training requirements for DSWs.
Require member-specific training.
Get required signatures (“sign-offs”) from members and DSWs
18
Matching Services Registries
19
What We Know About Consumer Directed Services
Lack of infrastructure to support consumer-directed personal assistance services (PAS)
Evidence of unmet need due to inability to locate worker
Expanding PAS workforce but generally poor job quality
What consumers & workers want
Quick access to up-to-date info
Safety & quality
Good matches
One-stop type efficiencies and functions
Defining “Matching Services”
“Dynamic” registry services that…
• Gather info about consumers’ needs/ preferences AND workers’ availability/ skills / preferences
• Match consumers and workers in one of two ways:
Electronic searches of worker database using searchable criteria
Individualized contact with trained staff who conduct searches and report results to consumer
How are Matching Service Registries Different from Other Types of Registries?
“Matching Services” Connect consumers with individual PAS workers
“Safety Registries” Identify PAS workers with questionable backgrounds
“Quality Assurance Registries” Verify training and certification compliance; check background
Matching Registries – National Picture
15 statewide matching services
4 states with a regional matching service
1 matching services under consideration or development
28 states with no state or regional matching service
Promise of robust registries
Create a platform for shaping access of workers & consumers to each other
Help overcome “market imperfections” due to decentralized Participant Direction system
Meet needs of both consumers & workers for “more than a list”
Matching Service Registries: What’s in it for NWDs?
Supports No Wrong Door systems
Supports No Wrong Door systems in connecting private pay individuals with services
Supports No Wrong Door systems role facilitating consumer-directed services for Medicaid and Veterans Affairs programs
Builds on No Wrong Door systems knowledge and experience creating and maintaining searchable resource databases
31
Role of NWDs in PDS and Support for Workers and Participants
Facilitate coordination and collaboration on workforce supports across community-based organizations and stakeholders
Host or support matching registry services
Market to and provide counseling and assistance to workers
Provide systems navigation and benefits enrollment to workers
Offer networking opportunities and supports to paid workers and unpaid family caregivers
Engage family caregivers and unrelated direct service workers in care transitions interventions
Develop policies that support the inclusion of paid and unpaid support workers in person-centered planning efforts, at the individual’s direction
32
For more information, See Starter Kit on Strengthening the Workforce for NWD/SEPs : http://www.dswresourcecenter.org/tiki-download_file.php?fileId=620
Contact Us
Kate King, Project Officer CMS, CMSO, DEHPG, DCST
Carrie Blakeway, Managing Consultant The Lewin Group
Steve Edelstein, National Policy Director PHI
33
National DSW Resource Center [email protected]
1-877-822-2647
