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httpswwwResourcesForIntegratedCarecom
Self - Direction for Dually Eligible Individuals Utilizing LTSS Credit Information sect If you are a social worker in a National Association of Social Workers (NASW) state and
would like to receive CE credits through NASW for this event or a nurse looking to obtain CNE credits through the California Board of Registered Nursing please complete the pre - test posted here httpswwwsurveymonkeycomrselfdirectionpresectYou will also be required to complete a post - test a link to this test will appear at the end of the presentation
sectFor more information about obtaining CE credit for social workers in non - NASW states psychologists PAs nurses (NP APRN RN LPN) pharmacists marriage and family counselors etc or CME credit via the Centers for Medicare amp Medicaid Services Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
Audio and Platform Information sectThe audio portion of the presentation will automatically stream through your computer speakers If you experience challenges with the audio please click the phone icon at the bottom of the screen for dial - in information sectIf you are experiencing any technical difficulties with this platform please use the QampA feature for assistance or click the help button for additional information
1
httpswwwResourcesForIntegratedCarecom
August 21 2019
Self - Direction for Dually Eligible Individuals Utilizing Long - Term Services and Supports
(LTSS)
httpswwwResourcesForIntegratedCarecom
Overview
sect This session will be interactive (eg polls and interactive chat functions) with 60 minutes of presenter - led discussion followed by 30 minutes of presenter and participant discussions
sect Video replay and slide presentation are available after each session at httpswwwresourcesforintegratedcarecom
2
httpswwwResourcesForIntegratedCarecom
Accreditation sect Individuals are strongly encouraged to check with their specific regulatory
boards or other agencies to confirm that courses taken from these accrediting bodies will be accepted by that entity
sect The American Geriatrics Society has been approved by the California Board of Registered Nursing to provide continuing education
sect The American Geriatrics Society is accredited by the National Association of Social Workers (NASW) to provide continuing education for social workers
sect This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the providership of the Centers for Medicare amp Medicaid Services CMS is accredited by ACCME to provide continuing medical education for physicians
sect The Centers for Medicare amp Medicaid Services is accredited by the International Association for Continuing Education and Training (IACET) The Centers for Medicare amp Medicaid Services complies with the ANSIIACET Standard which is recognized internationally as a standard of excellence in instructional practices As a result of this accreditation the Centers for Medicare amp Medicaid Services is authorized to issue the IACET CEU
3
httpswwwResourcesForIntegratedCarecom
Disclosure StatementThe following plannersfaculty have returned disclosure forms indicating that they (andor their spousespartners) have no affiliation with or financial interest in any commercial interest that may have direct interest in the subject matter of their presentation(s) sect Nancy Wilson MA MSW Maida Castellanos
No relevant financial interests or affiliations No relevant financial interests or affiliations
sect Corinne Eldridge Carole Stewart No relevant financial interests or affiliation No relevant financial interests or affiliations
sect Courtland Townes No relevant financial interests or affiliations
sect Kristen BugaraNo relevant financial interests or affiliations
4
httpswwwResourcesForIntegratedCarecom
Continuing Education Information
5
If You Are A Credit Options RequirementsOption 1 National Association of Social Workers amp Continuing Nursing Education Credits
Social Worker
The National Association of Social Workers designates this webinar for a maximum of 1 Continuing Education (CE) credit hour
Please note New York Michigan and West Virginia do not accept National CE Approval Programs for Social Work New Jersey Idaho and Oregon do not recognize NASW National Approval
1 Complete the pre - test at the beginning of the webinar 2 Complete the post - test with a score of 80 or higher by midnight August 22 2019
NurseThe American Geriatrics Society designates this program eligible for 1 nursing contact hour through the California Board of Registered Nursing
1 Complete the pre - test at the beginning of the webinar 2 Complete the post - test with a score of 70 or higher by midnight on August 22 2019
Option 2 Centers for Medicare amp Medicaid Services (CMS)
Physician (MD or DO)
The Centers for Medicare amp Medicaid Services (CMS) is evaluating this activity for continuing medical education (CME) credit The number of credits awarded will be calculated following the activity based on the actual learning time Final CME information on the amount of credit will be available to participants within the Learning Management System (LMS) after the live activity
Complete the post-test through CMSrsquoLearning Management System with a score of 80 or higher by midnight September 9 2019
Other
The Centers for Medicare amp Medicaid Services (CMS) is evaluating this activity for continuing education (CE) credit The number of credits awarded will be calculated following the activity based on the actual learning time Final CE information on the amount of credit will be available to participants within the Learning Management System (LMS) after the live activity
Complete the post-test through CMSrsquoLearning Management System with a score of 80 or higher by midnight September 9 2019
httpswwwResourcesForIntegratedCarecom
Support Statement
sect This webinar is supported through the Medicare - Medicaid Coordination Office (MMCO) in the Centers for Medicare amp Medicaid Services (CMS) to help beneficiaries dually eligible for Medicare and Medicaid have access to seamless high - quality health care that includes the full range of covered services in both programs To support providers in their efforts to deliver more integrated coordinated care to dually eligible beneficiaries MMCO is developing technical assistance and actionable tools based on successful innovations and care models such as this webinar
sect To learn more about current efforts and resources visit Resources for Integrated Care at httpswwwresourcesforintegratedcarecom
6
httpswwwResourcesForIntegratedCarecom
Introductions
Kristen Bugara MSW LSW Care Management Supervisor Direction Home Akron Canton Area Agency on Aging and Disabilities
Courtland Townes Deputy Director Boston Center for Independent Living
Corinne Eldridge Executive Director California Long-Term Care Education Center
7
httpswwwResourcesForIntegratedCarecom
Introductions
Carole Stewart IHSS Consumer
Maida Castellanos Personal Care Attendant
8
httpswwwResourcesForIntegratedCarecom
Learning Objectives
sect Describe key features of self - direction and what it entails for the consumer
sect Identify the role of care managers and care coordinators in facilitating decisions on self - direction as part of developing andor amending the person - centered care plan
sect Define the role of a personal care attendant (PCA) in the interdisciplinary care team
9
httpswwwResourcesForIntegratedCarecom
Webinar OutlineAgenda
sect Poll Questions sect Overview of Self - Direction and the Role of Care Managers sect The Role of LTSS Coordinators in Supporting Consumer
Choice sect Personal Care Attendants and the Interdisciplinary Care
Team sect Making it Work Voices of a Consumer and In - Home
Supportive Services Provider sect QampA sect Evaluation
10
httpswwwResourcesForIntegratedCarecom
Overview of Self - Direction and the Role of Care Managers
Kristen Bugara Care Management Supervisor Direction Home Akron Canton Area Agency on Aging and Disabilities
11
httpswwwResourcesForIntegratedCarecom
What is Self-Direction
1 Applied Self Direction (2018) What is Self-Direction Retrieved from
12
httpwwwappliedselfdirectioncomwhat-self-direction2 Family Caregiver Alliance (2013) The National Resource Center for Participant-Directed Services Retrieved from httpswwwcaregiverorgnational-resource-
center-participant-directed-services
Self-Direction (self-directed services)
bull Helps people of all ages with all types of disabilities maintain their independence at home by choosing the mix of services and supports that work best for them
bull Built on the belief that the people receiving the services and supports know their needs best and are in the best position to plan and manage their own services1
bull Also referred to as participant direction or consumer direction
History of Self-Direction
bull Grounded in the Independent Living philosophy self-direction options for home-and-community based services (HCBS) were included in health care reform recommendations and proposed legislation introduced in Congress beginning in 1993
bull In 2002 CMS released the Independence Plus waiver application to streamline approval for waiver programs offering self-direction
bull In 2010 the Affordable Care Act (ACA) improved options for self-direction in Medicaid and authorized a new voluntary social insurance the CLASS program with participant direction at the core2
httpswwwResourcesForIntegratedCarecom
The Self-Direction Model
sect Empowers consumers by expanding their degree of choice and control over the services and supports they need to live independently
sect Helps people maintain their independence sect Allows people to determine for themselves what mix of
services and supports work best for them
13
httpswwwResourcesForIntegratedCarecom
Goals of Self-Direction
sect Seeks to maximize each personrsquos ability to control their own decisions
sect Allows the person to be at the center of the process sect Promotes self - efficacy sect Empowers each person to take responsibility for their
supports and services sect Complements person - centered planning and facilitation
14
httpswwwResourcesForIntegratedCarecom
Characteristics of Candidates for Self-Directionsect Desire to have control of decisions regarding supports sect Understanding of what is allowable for each service and role
(eg personal care attendants cannot administer medication) sect Ability to manage and communicate decisions sect Ability to be the ldquoemployerrdquo sect Strong problem solving skills including ability to interview
hire train supervise and terminate employees sect Safe and stable living environment sect Strong back - up plan sect Agreement to work with a Fiscal Management Service sect Available authorized representative for people who cannot
self - direct
15
httpswwwResourcesForIntegratedCarecom
Authorized Representatives for Self-Direction
sect If the person cannot maintain control of their own supports and services they may assign an Authorized Representative to act on their behalf
sect Authorized Representative A personrsquos legal guardian family member or any other person identified by the member to help manage services as defined in the care plan and supervise employees if the person is unable to do so independently sect In Ohio the Authorized Representative MAY NOT also serve
as the paid care provider for the person
16
httpswwwResourcesForIntegratedCarecom
Self - Direction Authority Employer Authority
sect Employer Authority people have decision - making authority to recruit hire train and supervise the people who furnish their services3
sect In Ohio care managers must have assessed the person and determined a need for personal care services provided by a Consumer Directed Personal Care Provider or a Choices Home Care Attendant Service Provider
sect The person assumes responsibility for being the Personal Care Providerrsquos employer including hiring training setting pay rate (within guidelines) directing care and terminating providers if necessary
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from https
17
wwwmedicaidgovmedicaidltssself-directedindexhtml
httpswwwResourcesForIntegratedCarecom
Self - Direction Authority Budget Authority
sect Budget Authority person has decision - making authority over how the Medicaid funds in a budget are spent3
sect In Ohio the care manager must have assessed the person and determined a need for sect Choices Home Care Attendant Service sect Alternative Meal Service sect Pest Control sect Home Modification Maintenance and Repair sect Home Medical Equipment Supplemental Adaptive and Assistive
Devices sect The person assumes responsibility for choosing provider for
service scheduling service and setting pay rate (within guidelines)
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from https
18
wwwmedicaidgovmedicaidltssself-directedindexhtml
httpswwwResourcesForIntegratedCarecom
Traditional Care Management vs Self-Directed Care Management
19
Traditional Care Management Self-Directed Care ManagementConsumer and Care Manager decide which services are needed based on assessment
Consumer and Care Manager decide which services are needed based on assessment
Care Manager locates providers Consumer locates providers with assistance from care manager
Provider agency decides which worker to send and when to provide careservice
Consumer determines schedule based on assessed need
Provider agency hires trains and manages employees
Consumer hires trains and manages employees
Care Manager is responsible for management of provider issues
Consumer addresses service issues directly with assistance from care manager as needed
Care Manager contacts provider with any service issues
Care Manager monitors quality of service and satisfaction
httpswwwResourcesForIntegratedCarecom
The Role of Care Management in Self-Direction
sect Care managers play important roles in supporting consumers who are self - directing through bull Education bull Facilitation bull Support
20
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Education
sect Care managers can support consumers through education to ensure that the person is sect Well - informed and capable of making decisions sect Able to understand the tasks provided by the chosen
service sect Aware of their responsibilities as the employer and the
responsibilities of the provider sect In Ohio care managers answer questions about self-
direction and provide support when needed during quarterly visits or when people experience significant changes
21
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Facilitation
sect Care Managers can facilitate self - direction by sect Providing structure for the planning process sect Empowering the person to make decisions and take
action sect Helping the person identify goals sect Working with the person to guide the selection of supports
and services sect Assisting when possible with the application process rate
negotiation and service reviews
22
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Support
sect Care Managers can support consumers by sect Providing encouragement sect Working with people to help reduce potential negative
outcomes associated with their decisions sect Helping people adapt to their role as an employer sect Educating people on the importance of a back - up plan sect Helping people implement standard employment
application processes when possible sect Helping people understand supervisory responsibilities
23
httpswwwResourcesForIntegratedCarecom
Consumer Benefits of Self-Direction
sect Consumer is in control of their own supports and services sect Flexible scheduling sect Reduces unmet needscall - offs sect Enhances feelings of safety sect Promotes independence choice and self - determination sect Returns the choice to the consumer
24
httpswwwResourcesForIntegratedCarecom
Care Management Benefits of Self-Direction
sect Reduced service gaps sect Helps arrange supports and services in ldquohard to serverdquo
areas such as rural areas with direct care worker shortages
sect Helps ensure supports and services for consumers with complex service needs such as people who need assistance with toileting hourly
sect Fewer requests for change of service providers sect Satisfaction with all services increases
25
httpswwwResourcesForIntegratedCarecom
The Role of the LTSS Coordinator in Supporting Consumer Choice
Courtland Townes Deputy Director Boston Center for Independent Living
27
httpswwwResourcesForIntegratedCarecom
Massachusetts One Care Programrsquos Independent Living LTSS Model
sect One Care is the Massachusettsrsquo Medicare - Medicaid Financial Alignment Demonstration for adults living with disabilities who are dually eligible for Medicare and Medicaid
sect One Care uses a consumer - driven interdisciplinary care team comprised of medical professionals and long - term care coordinators
sect Once enrolled members have the right to have an independent living and LTSS coordinator ( IL - LTSSC) as part of their care team
27
httpswwwResourcesForIntegratedCarecom
Supporting Consumers who Choose to Live Independently
sect IL - LTSSCs are not employed by health plans but by independent community organizations such as Independent Living Centers Recovery Learning Centers and Aging Services Access Points sect This ensures that IL - LTSSCs can advocate for the
memberrsquos needs in an unbiased manner sect An important purpose of the Independent Living planning
process is to provide consumers with opportunities to learn and develop new skills that can help them succeed in achieving and maintaining their independent living goals
28
httpswwwResourcesForIntegratedCarecom
The Role of IL-LTSSCs
sect Support consumers in developing and working toward quality of life goals for independent living wellness and recovery
sect Conduct initial assessments to help consumers identify the services they need
sect Work as a care team member providing expertise in LTSS Independent Living Philosophy and Recovery Model
sect Have experience working with people with disabilities (may include lived experience with a disability)
sect Provide expertise on community services and community service providers
29
httpswwwResourcesForIntegratedCarecom
Supporting Individuals Who are Self-Directing Personal Care Services
sect The IL - LTSSC discusses the Independent Living Philosophy framework of Consumer Direction and Control with the consumer sect ldquoIndependencerdquo is different for each consumer
sect IL-LTSSCs assist consumers in identifying short- and long-term goals and current barriers to independence sect In initial assessment in the home IL - LTSSCs help consumers
identify the services they need sect Once services are approved through the Care Management
Team the IL - LTSSC begins the necessary service coordination to put vendor services in place
sect Consumers have the right to make changes to their selected services
30
httpswwwResourcesForIntegratedCarecom
What Other Types of Supports and Services are Offered to Individuals
sect Skills training and education sect Peer support sect Non - medical transportation sect Assistive technology sect Home modifications sect Home delivered meals sect Adult day health programs sect Homemaker and companion services
31
httpswwwResourcesForIntegratedCarecom
Strength-Based Needs Assessments
sect Every person regardless of his or her personal situation has unique strengths These basic strengths can be used as a starting place to begin developing other new strengths that will support the personrsquos efforts to reach his or her goals and dreams
sect Often someone from outside the personrsquos immediate environment can best help the person identify his or her unique talents abilities and strengths
32
httpswwwResourcesForIntegratedCarecom
Utilizing a Strength-Based Approach
sect IL - LTSSCs conduct strength - based initial assessments sect Key questions for a strength - based approach to
assessments sect What is working well right now in your life sect What do you want to accomplish in the future sect What is working well that you can build on sect What are some creative ways that you or someone you know has
addressed this problem in the past
sect Instead of assuming that a person has a weakness in a particular area assume that the person has not yet had opportunities that are essential to learning developing and mastering a skill in that particular area
33
httpswwwResourcesForIntegratedCarecom
Case Study 1 ldquoKarenrdquo
sect 51 - year - old woman with history of falls and diagnoses of PTSD anxiety bipolar disorder chronic respiratory disease dizziness and unspecified psychosis
sect Extremely reliant on her brother and mother for assistance with IADLs
sect Worked with IL - LTSSC to access the following Homemaker Services Companion Services Social and Medical Transportation
sect Karen reports that these services have lessened her feelings of anxiety and stress and have allowed her to feel safer and more self-sufficient in her environment
34
httpswwwResourcesForIntegratedCarecom
Case Study 2 ldquoRicardordquo
sect 53 - year - old consumer with diagnoses of depression anxiety and cognitive disabilities
sect Experienced homelessness for approximately 5 years and had to forfeit his service animal upon entering the shelter system Left the shelter after a few months and has lived in a U - Haul van for the last 2 years
sect IL - LTSSCrsquos initial focus was on housing assistance and was able to get consumer into a one - year Single Room Occupancy (SRO) Program that will give him access to permanent housing upon successful completion of program
sect IL - LTSSC is now working with care team to obtain approval for additional supports like home - delivered meals and laundry service
35
httpswwwResourcesForIntegratedCarecom
Personal Care Attendants and the Interdisciplinary Care Team
Corinne Eldridge Executive Director California Long - Term Care Education Center
37
httpswwwResourcesForIntegratedCarecom
Californiarsquos In - Home Supportive Services (IHSS) Program
sect There are 14 million dually eligible individuals in California4
sect The IHSS program serves 564000 consumers in CA5
sect 56 are 65 years or older 37 are 18 - 64 7 are under 18 sect 50 speak a primary language other than English
sect Californiarsquos IHSS program is the oldest Personal Care Attendant program in the country
sect There are 509000 IHSS workers in CA5
sect Over 50 of IHSS workers are family members
4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D5 Claire Ramsey (2019) In - Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
37
httpswwwResourcesForIntegratedCarecom
California Long - Term Care Education Center (CLTCEC) IHSS Training
sect CLTCEC began training IHSS consumer and provider pairs in 2012 sect Began with 6 health plans across 3 counties in California as
part of a Health Care Innovations Awards grant through the Center for Medicare amp Medicaid Innovation (CMMI)
sect Continued IHSS training program with 2 health plan partners LA Care Blue Shield California
38
httpswwwResourcesForIntegratedCarecom
Basic Tenants of the IHSS Training Program
39
Voluntary participation
IHSS provider learns new skills
Honors consumer-directed model of care
Competency-based education
httpswwwResourcesForIntegratedCarecom
IHSS Training Program
sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training
and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes
if possible sect 17-week course includes additional modules on body systems and disease-
specific care sect Training modules discuss the role of the IHSS provider and integration
into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration
are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have
discussions with IHSS consumer about what was learned in class that week
40
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
August 21 2019
Self - Direction for Dually Eligible Individuals Utilizing Long - Term Services and Supports
(LTSS)
httpswwwResourcesForIntegratedCarecom
Overview
sect This session will be interactive (eg polls and interactive chat functions) with 60 minutes of presenter - led discussion followed by 30 minutes of presenter and participant discussions
sect Video replay and slide presentation are available after each session at httpswwwresourcesforintegratedcarecom
2
httpswwwResourcesForIntegratedCarecom
Accreditation sect Individuals are strongly encouraged to check with their specific regulatory
boards or other agencies to confirm that courses taken from these accrediting bodies will be accepted by that entity
sect The American Geriatrics Society has been approved by the California Board of Registered Nursing to provide continuing education
sect The American Geriatrics Society is accredited by the National Association of Social Workers (NASW) to provide continuing education for social workers
sect This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the providership of the Centers for Medicare amp Medicaid Services CMS is accredited by ACCME to provide continuing medical education for physicians
sect The Centers for Medicare amp Medicaid Services is accredited by the International Association for Continuing Education and Training (IACET) The Centers for Medicare amp Medicaid Services complies with the ANSIIACET Standard which is recognized internationally as a standard of excellence in instructional practices As a result of this accreditation the Centers for Medicare amp Medicaid Services is authorized to issue the IACET CEU
3
httpswwwResourcesForIntegratedCarecom
Disclosure StatementThe following plannersfaculty have returned disclosure forms indicating that they (andor their spousespartners) have no affiliation with or financial interest in any commercial interest that may have direct interest in the subject matter of their presentation(s) sect Nancy Wilson MA MSW Maida Castellanos
No relevant financial interests or affiliations No relevant financial interests or affiliations
sect Corinne Eldridge Carole Stewart No relevant financial interests or affiliation No relevant financial interests or affiliations
sect Courtland Townes No relevant financial interests or affiliations
sect Kristen BugaraNo relevant financial interests or affiliations
4
httpswwwResourcesForIntegratedCarecom
Continuing Education Information
5
If You Are A Credit Options RequirementsOption 1 National Association of Social Workers amp Continuing Nursing Education Credits
Social Worker
The National Association of Social Workers designates this webinar for a maximum of 1 Continuing Education (CE) credit hour
Please note New York Michigan and West Virginia do not accept National CE Approval Programs for Social Work New Jersey Idaho and Oregon do not recognize NASW National Approval
1 Complete the pre - test at the beginning of the webinar 2 Complete the post - test with a score of 80 or higher by midnight August 22 2019
NurseThe American Geriatrics Society designates this program eligible for 1 nursing contact hour through the California Board of Registered Nursing
1 Complete the pre - test at the beginning of the webinar 2 Complete the post - test with a score of 70 or higher by midnight on August 22 2019
Option 2 Centers for Medicare amp Medicaid Services (CMS)
Physician (MD or DO)
The Centers for Medicare amp Medicaid Services (CMS) is evaluating this activity for continuing medical education (CME) credit The number of credits awarded will be calculated following the activity based on the actual learning time Final CME information on the amount of credit will be available to participants within the Learning Management System (LMS) after the live activity
Complete the post-test through CMSrsquoLearning Management System with a score of 80 or higher by midnight September 9 2019
Other
The Centers for Medicare amp Medicaid Services (CMS) is evaluating this activity for continuing education (CE) credit The number of credits awarded will be calculated following the activity based on the actual learning time Final CE information on the amount of credit will be available to participants within the Learning Management System (LMS) after the live activity
Complete the post-test through CMSrsquoLearning Management System with a score of 80 or higher by midnight September 9 2019
httpswwwResourcesForIntegratedCarecom
Support Statement
sect This webinar is supported through the Medicare - Medicaid Coordination Office (MMCO) in the Centers for Medicare amp Medicaid Services (CMS) to help beneficiaries dually eligible for Medicare and Medicaid have access to seamless high - quality health care that includes the full range of covered services in both programs To support providers in their efforts to deliver more integrated coordinated care to dually eligible beneficiaries MMCO is developing technical assistance and actionable tools based on successful innovations and care models such as this webinar
sect To learn more about current efforts and resources visit Resources for Integrated Care at httpswwwresourcesforintegratedcarecom
6
httpswwwResourcesForIntegratedCarecom
Introductions
Kristen Bugara MSW LSW Care Management Supervisor Direction Home Akron Canton Area Agency on Aging and Disabilities
Courtland Townes Deputy Director Boston Center for Independent Living
Corinne Eldridge Executive Director California Long-Term Care Education Center
7
httpswwwResourcesForIntegratedCarecom
Introductions
Carole Stewart IHSS Consumer
Maida Castellanos Personal Care Attendant
8
httpswwwResourcesForIntegratedCarecom
Learning Objectives
sect Describe key features of self - direction and what it entails for the consumer
sect Identify the role of care managers and care coordinators in facilitating decisions on self - direction as part of developing andor amending the person - centered care plan
sect Define the role of a personal care attendant (PCA) in the interdisciplinary care team
9
httpswwwResourcesForIntegratedCarecom
Webinar OutlineAgenda
sect Poll Questions sect Overview of Self - Direction and the Role of Care Managers sect The Role of LTSS Coordinators in Supporting Consumer
Choice sect Personal Care Attendants and the Interdisciplinary Care
Team sect Making it Work Voices of a Consumer and In - Home
Supportive Services Provider sect QampA sect Evaluation
10
httpswwwResourcesForIntegratedCarecom
Overview of Self - Direction and the Role of Care Managers
Kristen Bugara Care Management Supervisor Direction Home Akron Canton Area Agency on Aging and Disabilities
11
httpswwwResourcesForIntegratedCarecom
What is Self-Direction
1 Applied Self Direction (2018) What is Self-Direction Retrieved from
12
httpwwwappliedselfdirectioncomwhat-self-direction2 Family Caregiver Alliance (2013) The National Resource Center for Participant-Directed Services Retrieved from httpswwwcaregiverorgnational-resource-
center-participant-directed-services
Self-Direction (self-directed services)
bull Helps people of all ages with all types of disabilities maintain their independence at home by choosing the mix of services and supports that work best for them
bull Built on the belief that the people receiving the services and supports know their needs best and are in the best position to plan and manage their own services1
bull Also referred to as participant direction or consumer direction
History of Self-Direction
bull Grounded in the Independent Living philosophy self-direction options for home-and-community based services (HCBS) were included in health care reform recommendations and proposed legislation introduced in Congress beginning in 1993
bull In 2002 CMS released the Independence Plus waiver application to streamline approval for waiver programs offering self-direction
bull In 2010 the Affordable Care Act (ACA) improved options for self-direction in Medicaid and authorized a new voluntary social insurance the CLASS program with participant direction at the core2
httpswwwResourcesForIntegratedCarecom
The Self-Direction Model
sect Empowers consumers by expanding their degree of choice and control over the services and supports they need to live independently
sect Helps people maintain their independence sect Allows people to determine for themselves what mix of
services and supports work best for them
13
httpswwwResourcesForIntegratedCarecom
Goals of Self-Direction
sect Seeks to maximize each personrsquos ability to control their own decisions
sect Allows the person to be at the center of the process sect Promotes self - efficacy sect Empowers each person to take responsibility for their
supports and services sect Complements person - centered planning and facilitation
14
httpswwwResourcesForIntegratedCarecom
Characteristics of Candidates for Self-Directionsect Desire to have control of decisions regarding supports sect Understanding of what is allowable for each service and role
(eg personal care attendants cannot administer medication) sect Ability to manage and communicate decisions sect Ability to be the ldquoemployerrdquo sect Strong problem solving skills including ability to interview
hire train supervise and terminate employees sect Safe and stable living environment sect Strong back - up plan sect Agreement to work with a Fiscal Management Service sect Available authorized representative for people who cannot
self - direct
15
httpswwwResourcesForIntegratedCarecom
Authorized Representatives for Self-Direction
sect If the person cannot maintain control of their own supports and services they may assign an Authorized Representative to act on their behalf
sect Authorized Representative A personrsquos legal guardian family member or any other person identified by the member to help manage services as defined in the care plan and supervise employees if the person is unable to do so independently sect In Ohio the Authorized Representative MAY NOT also serve
as the paid care provider for the person
16
httpswwwResourcesForIntegratedCarecom
Self - Direction Authority Employer Authority
sect Employer Authority people have decision - making authority to recruit hire train and supervise the people who furnish their services3
sect In Ohio care managers must have assessed the person and determined a need for personal care services provided by a Consumer Directed Personal Care Provider or a Choices Home Care Attendant Service Provider
sect The person assumes responsibility for being the Personal Care Providerrsquos employer including hiring training setting pay rate (within guidelines) directing care and terminating providers if necessary
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from https
17
wwwmedicaidgovmedicaidltssself-directedindexhtml
httpswwwResourcesForIntegratedCarecom
Self - Direction Authority Budget Authority
sect Budget Authority person has decision - making authority over how the Medicaid funds in a budget are spent3
sect In Ohio the care manager must have assessed the person and determined a need for sect Choices Home Care Attendant Service sect Alternative Meal Service sect Pest Control sect Home Modification Maintenance and Repair sect Home Medical Equipment Supplemental Adaptive and Assistive
Devices sect The person assumes responsibility for choosing provider for
service scheduling service and setting pay rate (within guidelines)
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from https
18
wwwmedicaidgovmedicaidltssself-directedindexhtml
httpswwwResourcesForIntegratedCarecom
Traditional Care Management vs Self-Directed Care Management
19
Traditional Care Management Self-Directed Care ManagementConsumer and Care Manager decide which services are needed based on assessment
Consumer and Care Manager decide which services are needed based on assessment
Care Manager locates providers Consumer locates providers with assistance from care manager
Provider agency decides which worker to send and when to provide careservice
Consumer determines schedule based on assessed need
Provider agency hires trains and manages employees
Consumer hires trains and manages employees
Care Manager is responsible for management of provider issues
Consumer addresses service issues directly with assistance from care manager as needed
Care Manager contacts provider with any service issues
Care Manager monitors quality of service and satisfaction
httpswwwResourcesForIntegratedCarecom
The Role of Care Management in Self-Direction
sect Care managers play important roles in supporting consumers who are self - directing through bull Education bull Facilitation bull Support
20
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Education
sect Care managers can support consumers through education to ensure that the person is sect Well - informed and capable of making decisions sect Able to understand the tasks provided by the chosen
service sect Aware of their responsibilities as the employer and the
responsibilities of the provider sect In Ohio care managers answer questions about self-
direction and provide support when needed during quarterly visits or when people experience significant changes
21
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Facilitation
sect Care Managers can facilitate self - direction by sect Providing structure for the planning process sect Empowering the person to make decisions and take
action sect Helping the person identify goals sect Working with the person to guide the selection of supports
and services sect Assisting when possible with the application process rate
negotiation and service reviews
22
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Support
sect Care Managers can support consumers by sect Providing encouragement sect Working with people to help reduce potential negative
outcomes associated with their decisions sect Helping people adapt to their role as an employer sect Educating people on the importance of a back - up plan sect Helping people implement standard employment
application processes when possible sect Helping people understand supervisory responsibilities
23
httpswwwResourcesForIntegratedCarecom
Consumer Benefits of Self-Direction
sect Consumer is in control of their own supports and services sect Flexible scheduling sect Reduces unmet needscall - offs sect Enhances feelings of safety sect Promotes independence choice and self - determination sect Returns the choice to the consumer
24
httpswwwResourcesForIntegratedCarecom
Care Management Benefits of Self-Direction
sect Reduced service gaps sect Helps arrange supports and services in ldquohard to serverdquo
areas such as rural areas with direct care worker shortages
sect Helps ensure supports and services for consumers with complex service needs such as people who need assistance with toileting hourly
sect Fewer requests for change of service providers sect Satisfaction with all services increases
25
httpswwwResourcesForIntegratedCarecom
The Role of the LTSS Coordinator in Supporting Consumer Choice
Courtland Townes Deputy Director Boston Center for Independent Living
27
httpswwwResourcesForIntegratedCarecom
Massachusetts One Care Programrsquos Independent Living LTSS Model
sect One Care is the Massachusettsrsquo Medicare - Medicaid Financial Alignment Demonstration for adults living with disabilities who are dually eligible for Medicare and Medicaid
sect One Care uses a consumer - driven interdisciplinary care team comprised of medical professionals and long - term care coordinators
sect Once enrolled members have the right to have an independent living and LTSS coordinator ( IL - LTSSC) as part of their care team
27
httpswwwResourcesForIntegratedCarecom
Supporting Consumers who Choose to Live Independently
sect IL - LTSSCs are not employed by health plans but by independent community organizations such as Independent Living Centers Recovery Learning Centers and Aging Services Access Points sect This ensures that IL - LTSSCs can advocate for the
memberrsquos needs in an unbiased manner sect An important purpose of the Independent Living planning
process is to provide consumers with opportunities to learn and develop new skills that can help them succeed in achieving and maintaining their independent living goals
28
httpswwwResourcesForIntegratedCarecom
The Role of IL-LTSSCs
sect Support consumers in developing and working toward quality of life goals for independent living wellness and recovery
sect Conduct initial assessments to help consumers identify the services they need
sect Work as a care team member providing expertise in LTSS Independent Living Philosophy and Recovery Model
sect Have experience working with people with disabilities (may include lived experience with a disability)
sect Provide expertise on community services and community service providers
29
httpswwwResourcesForIntegratedCarecom
Supporting Individuals Who are Self-Directing Personal Care Services
sect The IL - LTSSC discusses the Independent Living Philosophy framework of Consumer Direction and Control with the consumer sect ldquoIndependencerdquo is different for each consumer
sect IL-LTSSCs assist consumers in identifying short- and long-term goals and current barriers to independence sect In initial assessment in the home IL - LTSSCs help consumers
identify the services they need sect Once services are approved through the Care Management
Team the IL - LTSSC begins the necessary service coordination to put vendor services in place
sect Consumers have the right to make changes to their selected services
30
httpswwwResourcesForIntegratedCarecom
What Other Types of Supports and Services are Offered to Individuals
sect Skills training and education sect Peer support sect Non - medical transportation sect Assistive technology sect Home modifications sect Home delivered meals sect Adult day health programs sect Homemaker and companion services
31
httpswwwResourcesForIntegratedCarecom
Strength-Based Needs Assessments
sect Every person regardless of his or her personal situation has unique strengths These basic strengths can be used as a starting place to begin developing other new strengths that will support the personrsquos efforts to reach his or her goals and dreams
sect Often someone from outside the personrsquos immediate environment can best help the person identify his or her unique talents abilities and strengths
32
httpswwwResourcesForIntegratedCarecom
Utilizing a Strength-Based Approach
sect IL - LTSSCs conduct strength - based initial assessments sect Key questions for a strength - based approach to
assessments sect What is working well right now in your life sect What do you want to accomplish in the future sect What is working well that you can build on sect What are some creative ways that you or someone you know has
addressed this problem in the past
sect Instead of assuming that a person has a weakness in a particular area assume that the person has not yet had opportunities that are essential to learning developing and mastering a skill in that particular area
33
httpswwwResourcesForIntegratedCarecom
Case Study 1 ldquoKarenrdquo
sect 51 - year - old woman with history of falls and diagnoses of PTSD anxiety bipolar disorder chronic respiratory disease dizziness and unspecified psychosis
sect Extremely reliant on her brother and mother for assistance with IADLs
sect Worked with IL - LTSSC to access the following Homemaker Services Companion Services Social and Medical Transportation
sect Karen reports that these services have lessened her feelings of anxiety and stress and have allowed her to feel safer and more self-sufficient in her environment
34
httpswwwResourcesForIntegratedCarecom
Case Study 2 ldquoRicardordquo
sect 53 - year - old consumer with diagnoses of depression anxiety and cognitive disabilities
sect Experienced homelessness for approximately 5 years and had to forfeit his service animal upon entering the shelter system Left the shelter after a few months and has lived in a U - Haul van for the last 2 years
sect IL - LTSSCrsquos initial focus was on housing assistance and was able to get consumer into a one - year Single Room Occupancy (SRO) Program that will give him access to permanent housing upon successful completion of program
sect IL - LTSSC is now working with care team to obtain approval for additional supports like home - delivered meals and laundry service
35
httpswwwResourcesForIntegratedCarecom
Personal Care Attendants and the Interdisciplinary Care Team
Corinne Eldridge Executive Director California Long - Term Care Education Center
37
httpswwwResourcesForIntegratedCarecom
Californiarsquos In - Home Supportive Services (IHSS) Program
sect There are 14 million dually eligible individuals in California4
sect The IHSS program serves 564000 consumers in CA5
sect 56 are 65 years or older 37 are 18 - 64 7 are under 18 sect 50 speak a primary language other than English
sect Californiarsquos IHSS program is the oldest Personal Care Attendant program in the country
sect There are 509000 IHSS workers in CA5
sect Over 50 of IHSS workers are family members
4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D5 Claire Ramsey (2019) In - Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
37
httpswwwResourcesForIntegratedCarecom
California Long - Term Care Education Center (CLTCEC) IHSS Training
sect CLTCEC began training IHSS consumer and provider pairs in 2012 sect Began with 6 health plans across 3 counties in California as
part of a Health Care Innovations Awards grant through the Center for Medicare amp Medicaid Innovation (CMMI)
sect Continued IHSS training program with 2 health plan partners LA Care Blue Shield California
38
httpswwwResourcesForIntegratedCarecom
Basic Tenants of the IHSS Training Program
39
Voluntary participation
IHSS provider learns new skills
Honors consumer-directed model of care
Competency-based education
httpswwwResourcesForIntegratedCarecom
IHSS Training Program
sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training
and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes
if possible sect 17-week course includes additional modules on body systems and disease-
specific care sect Training modules discuss the role of the IHSS provider and integration
into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration
are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have
discussions with IHSS consumer about what was learned in class that week
40
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
Overview
sect This session will be interactive (eg polls and interactive chat functions) with 60 minutes of presenter - led discussion followed by 30 minutes of presenter and participant discussions
sect Video replay and slide presentation are available after each session at httpswwwresourcesforintegratedcarecom
2
httpswwwResourcesForIntegratedCarecom
Accreditation sect Individuals are strongly encouraged to check with their specific regulatory
boards or other agencies to confirm that courses taken from these accrediting bodies will be accepted by that entity
sect The American Geriatrics Society has been approved by the California Board of Registered Nursing to provide continuing education
sect The American Geriatrics Society is accredited by the National Association of Social Workers (NASW) to provide continuing education for social workers
sect This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the providership of the Centers for Medicare amp Medicaid Services CMS is accredited by ACCME to provide continuing medical education for physicians
sect The Centers for Medicare amp Medicaid Services is accredited by the International Association for Continuing Education and Training (IACET) The Centers for Medicare amp Medicaid Services complies with the ANSIIACET Standard which is recognized internationally as a standard of excellence in instructional practices As a result of this accreditation the Centers for Medicare amp Medicaid Services is authorized to issue the IACET CEU
3
httpswwwResourcesForIntegratedCarecom
Disclosure StatementThe following plannersfaculty have returned disclosure forms indicating that they (andor their spousespartners) have no affiliation with or financial interest in any commercial interest that may have direct interest in the subject matter of their presentation(s) sect Nancy Wilson MA MSW Maida Castellanos
No relevant financial interests or affiliations No relevant financial interests or affiliations
sect Corinne Eldridge Carole Stewart No relevant financial interests or affiliation No relevant financial interests or affiliations
sect Courtland Townes No relevant financial interests or affiliations
sect Kristen BugaraNo relevant financial interests or affiliations
4
httpswwwResourcesForIntegratedCarecom
Continuing Education Information
5
If You Are A Credit Options RequirementsOption 1 National Association of Social Workers amp Continuing Nursing Education Credits
Social Worker
The National Association of Social Workers designates this webinar for a maximum of 1 Continuing Education (CE) credit hour
Please note New York Michigan and West Virginia do not accept National CE Approval Programs for Social Work New Jersey Idaho and Oregon do not recognize NASW National Approval
1 Complete the pre - test at the beginning of the webinar 2 Complete the post - test with a score of 80 or higher by midnight August 22 2019
NurseThe American Geriatrics Society designates this program eligible for 1 nursing contact hour through the California Board of Registered Nursing
1 Complete the pre - test at the beginning of the webinar 2 Complete the post - test with a score of 70 or higher by midnight on August 22 2019
Option 2 Centers for Medicare amp Medicaid Services (CMS)
Physician (MD or DO)
The Centers for Medicare amp Medicaid Services (CMS) is evaluating this activity for continuing medical education (CME) credit The number of credits awarded will be calculated following the activity based on the actual learning time Final CME information on the amount of credit will be available to participants within the Learning Management System (LMS) after the live activity
Complete the post-test through CMSrsquoLearning Management System with a score of 80 or higher by midnight September 9 2019
Other
The Centers for Medicare amp Medicaid Services (CMS) is evaluating this activity for continuing education (CE) credit The number of credits awarded will be calculated following the activity based on the actual learning time Final CE information on the amount of credit will be available to participants within the Learning Management System (LMS) after the live activity
Complete the post-test through CMSrsquoLearning Management System with a score of 80 or higher by midnight September 9 2019
httpswwwResourcesForIntegratedCarecom
Support Statement
sect This webinar is supported through the Medicare - Medicaid Coordination Office (MMCO) in the Centers for Medicare amp Medicaid Services (CMS) to help beneficiaries dually eligible for Medicare and Medicaid have access to seamless high - quality health care that includes the full range of covered services in both programs To support providers in their efforts to deliver more integrated coordinated care to dually eligible beneficiaries MMCO is developing technical assistance and actionable tools based on successful innovations and care models such as this webinar
sect To learn more about current efforts and resources visit Resources for Integrated Care at httpswwwresourcesforintegratedcarecom
6
httpswwwResourcesForIntegratedCarecom
Introductions
Kristen Bugara MSW LSW Care Management Supervisor Direction Home Akron Canton Area Agency on Aging and Disabilities
Courtland Townes Deputy Director Boston Center for Independent Living
Corinne Eldridge Executive Director California Long-Term Care Education Center
7
httpswwwResourcesForIntegratedCarecom
Introductions
Carole Stewart IHSS Consumer
Maida Castellanos Personal Care Attendant
8
httpswwwResourcesForIntegratedCarecom
Learning Objectives
sect Describe key features of self - direction and what it entails for the consumer
sect Identify the role of care managers and care coordinators in facilitating decisions on self - direction as part of developing andor amending the person - centered care plan
sect Define the role of a personal care attendant (PCA) in the interdisciplinary care team
9
httpswwwResourcesForIntegratedCarecom
Webinar OutlineAgenda
sect Poll Questions sect Overview of Self - Direction and the Role of Care Managers sect The Role of LTSS Coordinators in Supporting Consumer
Choice sect Personal Care Attendants and the Interdisciplinary Care
Team sect Making it Work Voices of a Consumer and In - Home
Supportive Services Provider sect QampA sect Evaluation
10
httpswwwResourcesForIntegratedCarecom
Overview of Self - Direction and the Role of Care Managers
Kristen Bugara Care Management Supervisor Direction Home Akron Canton Area Agency on Aging and Disabilities
11
httpswwwResourcesForIntegratedCarecom
What is Self-Direction
1 Applied Self Direction (2018) What is Self-Direction Retrieved from
12
httpwwwappliedselfdirectioncomwhat-self-direction2 Family Caregiver Alliance (2013) The National Resource Center for Participant-Directed Services Retrieved from httpswwwcaregiverorgnational-resource-
center-participant-directed-services
Self-Direction (self-directed services)
bull Helps people of all ages with all types of disabilities maintain their independence at home by choosing the mix of services and supports that work best for them
bull Built on the belief that the people receiving the services and supports know their needs best and are in the best position to plan and manage their own services1
bull Also referred to as participant direction or consumer direction
History of Self-Direction
bull Grounded in the Independent Living philosophy self-direction options for home-and-community based services (HCBS) were included in health care reform recommendations and proposed legislation introduced in Congress beginning in 1993
bull In 2002 CMS released the Independence Plus waiver application to streamline approval for waiver programs offering self-direction
bull In 2010 the Affordable Care Act (ACA) improved options for self-direction in Medicaid and authorized a new voluntary social insurance the CLASS program with participant direction at the core2
httpswwwResourcesForIntegratedCarecom
The Self-Direction Model
sect Empowers consumers by expanding their degree of choice and control over the services and supports they need to live independently
sect Helps people maintain their independence sect Allows people to determine for themselves what mix of
services and supports work best for them
13
httpswwwResourcesForIntegratedCarecom
Goals of Self-Direction
sect Seeks to maximize each personrsquos ability to control their own decisions
sect Allows the person to be at the center of the process sect Promotes self - efficacy sect Empowers each person to take responsibility for their
supports and services sect Complements person - centered planning and facilitation
14
httpswwwResourcesForIntegratedCarecom
Characteristics of Candidates for Self-Directionsect Desire to have control of decisions regarding supports sect Understanding of what is allowable for each service and role
(eg personal care attendants cannot administer medication) sect Ability to manage and communicate decisions sect Ability to be the ldquoemployerrdquo sect Strong problem solving skills including ability to interview
hire train supervise and terminate employees sect Safe and stable living environment sect Strong back - up plan sect Agreement to work with a Fiscal Management Service sect Available authorized representative for people who cannot
self - direct
15
httpswwwResourcesForIntegratedCarecom
Authorized Representatives for Self-Direction
sect If the person cannot maintain control of their own supports and services they may assign an Authorized Representative to act on their behalf
sect Authorized Representative A personrsquos legal guardian family member or any other person identified by the member to help manage services as defined in the care plan and supervise employees if the person is unable to do so independently sect In Ohio the Authorized Representative MAY NOT also serve
as the paid care provider for the person
16
httpswwwResourcesForIntegratedCarecom
Self - Direction Authority Employer Authority
sect Employer Authority people have decision - making authority to recruit hire train and supervise the people who furnish their services3
sect In Ohio care managers must have assessed the person and determined a need for personal care services provided by a Consumer Directed Personal Care Provider or a Choices Home Care Attendant Service Provider
sect The person assumes responsibility for being the Personal Care Providerrsquos employer including hiring training setting pay rate (within guidelines) directing care and terminating providers if necessary
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from https
17
wwwmedicaidgovmedicaidltssself-directedindexhtml
httpswwwResourcesForIntegratedCarecom
Self - Direction Authority Budget Authority
sect Budget Authority person has decision - making authority over how the Medicaid funds in a budget are spent3
sect In Ohio the care manager must have assessed the person and determined a need for sect Choices Home Care Attendant Service sect Alternative Meal Service sect Pest Control sect Home Modification Maintenance and Repair sect Home Medical Equipment Supplemental Adaptive and Assistive
Devices sect The person assumes responsibility for choosing provider for
service scheduling service and setting pay rate (within guidelines)
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from https
18
wwwmedicaidgovmedicaidltssself-directedindexhtml
httpswwwResourcesForIntegratedCarecom
Traditional Care Management vs Self-Directed Care Management
19
Traditional Care Management Self-Directed Care ManagementConsumer and Care Manager decide which services are needed based on assessment
Consumer and Care Manager decide which services are needed based on assessment
Care Manager locates providers Consumer locates providers with assistance from care manager
Provider agency decides which worker to send and when to provide careservice
Consumer determines schedule based on assessed need
Provider agency hires trains and manages employees
Consumer hires trains and manages employees
Care Manager is responsible for management of provider issues
Consumer addresses service issues directly with assistance from care manager as needed
Care Manager contacts provider with any service issues
Care Manager monitors quality of service and satisfaction
httpswwwResourcesForIntegratedCarecom
The Role of Care Management in Self-Direction
sect Care managers play important roles in supporting consumers who are self - directing through bull Education bull Facilitation bull Support
20
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Education
sect Care managers can support consumers through education to ensure that the person is sect Well - informed and capable of making decisions sect Able to understand the tasks provided by the chosen
service sect Aware of their responsibilities as the employer and the
responsibilities of the provider sect In Ohio care managers answer questions about self-
direction and provide support when needed during quarterly visits or when people experience significant changes
21
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Facilitation
sect Care Managers can facilitate self - direction by sect Providing structure for the planning process sect Empowering the person to make decisions and take
action sect Helping the person identify goals sect Working with the person to guide the selection of supports
and services sect Assisting when possible with the application process rate
negotiation and service reviews
22
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Support
sect Care Managers can support consumers by sect Providing encouragement sect Working with people to help reduce potential negative
outcomes associated with their decisions sect Helping people adapt to their role as an employer sect Educating people on the importance of a back - up plan sect Helping people implement standard employment
application processes when possible sect Helping people understand supervisory responsibilities
23
httpswwwResourcesForIntegratedCarecom
Consumer Benefits of Self-Direction
sect Consumer is in control of their own supports and services sect Flexible scheduling sect Reduces unmet needscall - offs sect Enhances feelings of safety sect Promotes independence choice and self - determination sect Returns the choice to the consumer
24
httpswwwResourcesForIntegratedCarecom
Care Management Benefits of Self-Direction
sect Reduced service gaps sect Helps arrange supports and services in ldquohard to serverdquo
areas such as rural areas with direct care worker shortages
sect Helps ensure supports and services for consumers with complex service needs such as people who need assistance with toileting hourly
sect Fewer requests for change of service providers sect Satisfaction with all services increases
25
httpswwwResourcesForIntegratedCarecom
The Role of the LTSS Coordinator in Supporting Consumer Choice
Courtland Townes Deputy Director Boston Center for Independent Living
27
httpswwwResourcesForIntegratedCarecom
Massachusetts One Care Programrsquos Independent Living LTSS Model
sect One Care is the Massachusettsrsquo Medicare - Medicaid Financial Alignment Demonstration for adults living with disabilities who are dually eligible for Medicare and Medicaid
sect One Care uses a consumer - driven interdisciplinary care team comprised of medical professionals and long - term care coordinators
sect Once enrolled members have the right to have an independent living and LTSS coordinator ( IL - LTSSC) as part of their care team
27
httpswwwResourcesForIntegratedCarecom
Supporting Consumers who Choose to Live Independently
sect IL - LTSSCs are not employed by health plans but by independent community organizations such as Independent Living Centers Recovery Learning Centers and Aging Services Access Points sect This ensures that IL - LTSSCs can advocate for the
memberrsquos needs in an unbiased manner sect An important purpose of the Independent Living planning
process is to provide consumers with opportunities to learn and develop new skills that can help them succeed in achieving and maintaining their independent living goals
28
httpswwwResourcesForIntegratedCarecom
The Role of IL-LTSSCs
sect Support consumers in developing and working toward quality of life goals for independent living wellness and recovery
sect Conduct initial assessments to help consumers identify the services they need
sect Work as a care team member providing expertise in LTSS Independent Living Philosophy and Recovery Model
sect Have experience working with people with disabilities (may include lived experience with a disability)
sect Provide expertise on community services and community service providers
29
httpswwwResourcesForIntegratedCarecom
Supporting Individuals Who are Self-Directing Personal Care Services
sect The IL - LTSSC discusses the Independent Living Philosophy framework of Consumer Direction and Control with the consumer sect ldquoIndependencerdquo is different for each consumer
sect IL-LTSSCs assist consumers in identifying short- and long-term goals and current barriers to independence sect In initial assessment in the home IL - LTSSCs help consumers
identify the services they need sect Once services are approved through the Care Management
Team the IL - LTSSC begins the necessary service coordination to put vendor services in place
sect Consumers have the right to make changes to their selected services
30
httpswwwResourcesForIntegratedCarecom
What Other Types of Supports and Services are Offered to Individuals
sect Skills training and education sect Peer support sect Non - medical transportation sect Assistive technology sect Home modifications sect Home delivered meals sect Adult day health programs sect Homemaker and companion services
31
httpswwwResourcesForIntegratedCarecom
Strength-Based Needs Assessments
sect Every person regardless of his or her personal situation has unique strengths These basic strengths can be used as a starting place to begin developing other new strengths that will support the personrsquos efforts to reach his or her goals and dreams
sect Often someone from outside the personrsquos immediate environment can best help the person identify his or her unique talents abilities and strengths
32
httpswwwResourcesForIntegratedCarecom
Utilizing a Strength-Based Approach
sect IL - LTSSCs conduct strength - based initial assessments sect Key questions for a strength - based approach to
assessments sect What is working well right now in your life sect What do you want to accomplish in the future sect What is working well that you can build on sect What are some creative ways that you or someone you know has
addressed this problem in the past
sect Instead of assuming that a person has a weakness in a particular area assume that the person has not yet had opportunities that are essential to learning developing and mastering a skill in that particular area
33
httpswwwResourcesForIntegratedCarecom
Case Study 1 ldquoKarenrdquo
sect 51 - year - old woman with history of falls and diagnoses of PTSD anxiety bipolar disorder chronic respiratory disease dizziness and unspecified psychosis
sect Extremely reliant on her brother and mother for assistance with IADLs
sect Worked with IL - LTSSC to access the following Homemaker Services Companion Services Social and Medical Transportation
sect Karen reports that these services have lessened her feelings of anxiety and stress and have allowed her to feel safer and more self-sufficient in her environment
34
httpswwwResourcesForIntegratedCarecom
Case Study 2 ldquoRicardordquo
sect 53 - year - old consumer with diagnoses of depression anxiety and cognitive disabilities
sect Experienced homelessness for approximately 5 years and had to forfeit his service animal upon entering the shelter system Left the shelter after a few months and has lived in a U - Haul van for the last 2 years
sect IL - LTSSCrsquos initial focus was on housing assistance and was able to get consumer into a one - year Single Room Occupancy (SRO) Program that will give him access to permanent housing upon successful completion of program
sect IL - LTSSC is now working with care team to obtain approval for additional supports like home - delivered meals and laundry service
35
httpswwwResourcesForIntegratedCarecom
Personal Care Attendants and the Interdisciplinary Care Team
Corinne Eldridge Executive Director California Long - Term Care Education Center
37
httpswwwResourcesForIntegratedCarecom
Californiarsquos In - Home Supportive Services (IHSS) Program
sect There are 14 million dually eligible individuals in California4
sect The IHSS program serves 564000 consumers in CA5
sect 56 are 65 years or older 37 are 18 - 64 7 are under 18 sect 50 speak a primary language other than English
sect Californiarsquos IHSS program is the oldest Personal Care Attendant program in the country
sect There are 509000 IHSS workers in CA5
sect Over 50 of IHSS workers are family members
4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D5 Claire Ramsey (2019) In - Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
37
httpswwwResourcesForIntegratedCarecom
California Long - Term Care Education Center (CLTCEC) IHSS Training
sect CLTCEC began training IHSS consumer and provider pairs in 2012 sect Began with 6 health plans across 3 counties in California as
part of a Health Care Innovations Awards grant through the Center for Medicare amp Medicaid Innovation (CMMI)
sect Continued IHSS training program with 2 health plan partners LA Care Blue Shield California
38
httpswwwResourcesForIntegratedCarecom
Basic Tenants of the IHSS Training Program
39
Voluntary participation
IHSS provider learns new skills
Honors consumer-directed model of care
Competency-based education
httpswwwResourcesForIntegratedCarecom
IHSS Training Program
sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training
and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes
if possible sect 17-week course includes additional modules on body systems and disease-
specific care sect Training modules discuss the role of the IHSS provider and integration
into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration
are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have
discussions with IHSS consumer about what was learned in class that week
40
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
Accreditation sect Individuals are strongly encouraged to check with their specific regulatory
boards or other agencies to confirm that courses taken from these accrediting bodies will be accepted by that entity
sect The American Geriatrics Society has been approved by the California Board of Registered Nursing to provide continuing education
sect The American Geriatrics Society is accredited by the National Association of Social Workers (NASW) to provide continuing education for social workers
sect This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the providership of the Centers for Medicare amp Medicaid Services CMS is accredited by ACCME to provide continuing medical education for physicians
sect The Centers for Medicare amp Medicaid Services is accredited by the International Association for Continuing Education and Training (IACET) The Centers for Medicare amp Medicaid Services complies with the ANSIIACET Standard which is recognized internationally as a standard of excellence in instructional practices As a result of this accreditation the Centers for Medicare amp Medicaid Services is authorized to issue the IACET CEU
3
httpswwwResourcesForIntegratedCarecom
Disclosure StatementThe following plannersfaculty have returned disclosure forms indicating that they (andor their spousespartners) have no affiliation with or financial interest in any commercial interest that may have direct interest in the subject matter of their presentation(s) sect Nancy Wilson MA MSW Maida Castellanos
No relevant financial interests or affiliations No relevant financial interests or affiliations
sect Corinne Eldridge Carole Stewart No relevant financial interests or affiliation No relevant financial interests or affiliations
sect Courtland Townes No relevant financial interests or affiliations
sect Kristen BugaraNo relevant financial interests or affiliations
4
httpswwwResourcesForIntegratedCarecom
Continuing Education Information
5
If You Are A Credit Options RequirementsOption 1 National Association of Social Workers amp Continuing Nursing Education Credits
Social Worker
The National Association of Social Workers designates this webinar for a maximum of 1 Continuing Education (CE) credit hour
Please note New York Michigan and West Virginia do not accept National CE Approval Programs for Social Work New Jersey Idaho and Oregon do not recognize NASW National Approval
1 Complete the pre - test at the beginning of the webinar 2 Complete the post - test with a score of 80 or higher by midnight August 22 2019
NurseThe American Geriatrics Society designates this program eligible for 1 nursing contact hour through the California Board of Registered Nursing
1 Complete the pre - test at the beginning of the webinar 2 Complete the post - test with a score of 70 or higher by midnight on August 22 2019
Option 2 Centers for Medicare amp Medicaid Services (CMS)
Physician (MD or DO)
The Centers for Medicare amp Medicaid Services (CMS) is evaluating this activity for continuing medical education (CME) credit The number of credits awarded will be calculated following the activity based on the actual learning time Final CME information on the amount of credit will be available to participants within the Learning Management System (LMS) after the live activity
Complete the post-test through CMSrsquoLearning Management System with a score of 80 or higher by midnight September 9 2019
Other
The Centers for Medicare amp Medicaid Services (CMS) is evaluating this activity for continuing education (CE) credit The number of credits awarded will be calculated following the activity based on the actual learning time Final CE information on the amount of credit will be available to participants within the Learning Management System (LMS) after the live activity
Complete the post-test through CMSrsquoLearning Management System with a score of 80 or higher by midnight September 9 2019
httpswwwResourcesForIntegratedCarecom
Support Statement
sect This webinar is supported through the Medicare - Medicaid Coordination Office (MMCO) in the Centers for Medicare amp Medicaid Services (CMS) to help beneficiaries dually eligible for Medicare and Medicaid have access to seamless high - quality health care that includes the full range of covered services in both programs To support providers in their efforts to deliver more integrated coordinated care to dually eligible beneficiaries MMCO is developing technical assistance and actionable tools based on successful innovations and care models such as this webinar
sect To learn more about current efforts and resources visit Resources for Integrated Care at httpswwwresourcesforintegratedcarecom
6
httpswwwResourcesForIntegratedCarecom
Introductions
Kristen Bugara MSW LSW Care Management Supervisor Direction Home Akron Canton Area Agency on Aging and Disabilities
Courtland Townes Deputy Director Boston Center for Independent Living
Corinne Eldridge Executive Director California Long-Term Care Education Center
7
httpswwwResourcesForIntegratedCarecom
Introductions
Carole Stewart IHSS Consumer
Maida Castellanos Personal Care Attendant
8
httpswwwResourcesForIntegratedCarecom
Learning Objectives
sect Describe key features of self - direction and what it entails for the consumer
sect Identify the role of care managers and care coordinators in facilitating decisions on self - direction as part of developing andor amending the person - centered care plan
sect Define the role of a personal care attendant (PCA) in the interdisciplinary care team
9
httpswwwResourcesForIntegratedCarecom
Webinar OutlineAgenda
sect Poll Questions sect Overview of Self - Direction and the Role of Care Managers sect The Role of LTSS Coordinators in Supporting Consumer
Choice sect Personal Care Attendants and the Interdisciplinary Care
Team sect Making it Work Voices of a Consumer and In - Home
Supportive Services Provider sect QampA sect Evaluation
10
httpswwwResourcesForIntegratedCarecom
Overview of Self - Direction and the Role of Care Managers
Kristen Bugara Care Management Supervisor Direction Home Akron Canton Area Agency on Aging and Disabilities
11
httpswwwResourcesForIntegratedCarecom
What is Self-Direction
1 Applied Self Direction (2018) What is Self-Direction Retrieved from
12
httpwwwappliedselfdirectioncomwhat-self-direction2 Family Caregiver Alliance (2013) The National Resource Center for Participant-Directed Services Retrieved from httpswwwcaregiverorgnational-resource-
center-participant-directed-services
Self-Direction (self-directed services)
bull Helps people of all ages with all types of disabilities maintain their independence at home by choosing the mix of services and supports that work best for them
bull Built on the belief that the people receiving the services and supports know their needs best and are in the best position to plan and manage their own services1
bull Also referred to as participant direction or consumer direction
History of Self-Direction
bull Grounded in the Independent Living philosophy self-direction options for home-and-community based services (HCBS) were included in health care reform recommendations and proposed legislation introduced in Congress beginning in 1993
bull In 2002 CMS released the Independence Plus waiver application to streamline approval for waiver programs offering self-direction
bull In 2010 the Affordable Care Act (ACA) improved options for self-direction in Medicaid and authorized a new voluntary social insurance the CLASS program with participant direction at the core2
httpswwwResourcesForIntegratedCarecom
The Self-Direction Model
sect Empowers consumers by expanding their degree of choice and control over the services and supports they need to live independently
sect Helps people maintain their independence sect Allows people to determine for themselves what mix of
services and supports work best for them
13
httpswwwResourcesForIntegratedCarecom
Goals of Self-Direction
sect Seeks to maximize each personrsquos ability to control their own decisions
sect Allows the person to be at the center of the process sect Promotes self - efficacy sect Empowers each person to take responsibility for their
supports and services sect Complements person - centered planning and facilitation
14
httpswwwResourcesForIntegratedCarecom
Characteristics of Candidates for Self-Directionsect Desire to have control of decisions regarding supports sect Understanding of what is allowable for each service and role
(eg personal care attendants cannot administer medication) sect Ability to manage and communicate decisions sect Ability to be the ldquoemployerrdquo sect Strong problem solving skills including ability to interview
hire train supervise and terminate employees sect Safe and stable living environment sect Strong back - up plan sect Agreement to work with a Fiscal Management Service sect Available authorized representative for people who cannot
self - direct
15
httpswwwResourcesForIntegratedCarecom
Authorized Representatives for Self-Direction
sect If the person cannot maintain control of their own supports and services they may assign an Authorized Representative to act on their behalf
sect Authorized Representative A personrsquos legal guardian family member or any other person identified by the member to help manage services as defined in the care plan and supervise employees if the person is unable to do so independently sect In Ohio the Authorized Representative MAY NOT also serve
as the paid care provider for the person
16
httpswwwResourcesForIntegratedCarecom
Self - Direction Authority Employer Authority
sect Employer Authority people have decision - making authority to recruit hire train and supervise the people who furnish their services3
sect In Ohio care managers must have assessed the person and determined a need for personal care services provided by a Consumer Directed Personal Care Provider or a Choices Home Care Attendant Service Provider
sect The person assumes responsibility for being the Personal Care Providerrsquos employer including hiring training setting pay rate (within guidelines) directing care and terminating providers if necessary
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from https
17
wwwmedicaidgovmedicaidltssself-directedindexhtml
httpswwwResourcesForIntegratedCarecom
Self - Direction Authority Budget Authority
sect Budget Authority person has decision - making authority over how the Medicaid funds in a budget are spent3
sect In Ohio the care manager must have assessed the person and determined a need for sect Choices Home Care Attendant Service sect Alternative Meal Service sect Pest Control sect Home Modification Maintenance and Repair sect Home Medical Equipment Supplemental Adaptive and Assistive
Devices sect The person assumes responsibility for choosing provider for
service scheduling service and setting pay rate (within guidelines)
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from https
18
wwwmedicaidgovmedicaidltssself-directedindexhtml
httpswwwResourcesForIntegratedCarecom
Traditional Care Management vs Self-Directed Care Management
19
Traditional Care Management Self-Directed Care ManagementConsumer and Care Manager decide which services are needed based on assessment
Consumer and Care Manager decide which services are needed based on assessment
Care Manager locates providers Consumer locates providers with assistance from care manager
Provider agency decides which worker to send and when to provide careservice
Consumer determines schedule based on assessed need
Provider agency hires trains and manages employees
Consumer hires trains and manages employees
Care Manager is responsible for management of provider issues
Consumer addresses service issues directly with assistance from care manager as needed
Care Manager contacts provider with any service issues
Care Manager monitors quality of service and satisfaction
httpswwwResourcesForIntegratedCarecom
The Role of Care Management in Self-Direction
sect Care managers play important roles in supporting consumers who are self - directing through bull Education bull Facilitation bull Support
20
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Education
sect Care managers can support consumers through education to ensure that the person is sect Well - informed and capable of making decisions sect Able to understand the tasks provided by the chosen
service sect Aware of their responsibilities as the employer and the
responsibilities of the provider sect In Ohio care managers answer questions about self-
direction and provide support when needed during quarterly visits or when people experience significant changes
21
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Facilitation
sect Care Managers can facilitate self - direction by sect Providing structure for the planning process sect Empowering the person to make decisions and take
action sect Helping the person identify goals sect Working with the person to guide the selection of supports
and services sect Assisting when possible with the application process rate
negotiation and service reviews
22
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Support
sect Care Managers can support consumers by sect Providing encouragement sect Working with people to help reduce potential negative
outcomes associated with their decisions sect Helping people adapt to their role as an employer sect Educating people on the importance of a back - up plan sect Helping people implement standard employment
application processes when possible sect Helping people understand supervisory responsibilities
23
httpswwwResourcesForIntegratedCarecom
Consumer Benefits of Self-Direction
sect Consumer is in control of their own supports and services sect Flexible scheduling sect Reduces unmet needscall - offs sect Enhances feelings of safety sect Promotes independence choice and self - determination sect Returns the choice to the consumer
24
httpswwwResourcesForIntegratedCarecom
Care Management Benefits of Self-Direction
sect Reduced service gaps sect Helps arrange supports and services in ldquohard to serverdquo
areas such as rural areas with direct care worker shortages
sect Helps ensure supports and services for consumers with complex service needs such as people who need assistance with toileting hourly
sect Fewer requests for change of service providers sect Satisfaction with all services increases
25
httpswwwResourcesForIntegratedCarecom
The Role of the LTSS Coordinator in Supporting Consumer Choice
Courtland Townes Deputy Director Boston Center for Independent Living
27
httpswwwResourcesForIntegratedCarecom
Massachusetts One Care Programrsquos Independent Living LTSS Model
sect One Care is the Massachusettsrsquo Medicare - Medicaid Financial Alignment Demonstration for adults living with disabilities who are dually eligible for Medicare and Medicaid
sect One Care uses a consumer - driven interdisciplinary care team comprised of medical professionals and long - term care coordinators
sect Once enrolled members have the right to have an independent living and LTSS coordinator ( IL - LTSSC) as part of their care team
27
httpswwwResourcesForIntegratedCarecom
Supporting Consumers who Choose to Live Independently
sect IL - LTSSCs are not employed by health plans but by independent community organizations such as Independent Living Centers Recovery Learning Centers and Aging Services Access Points sect This ensures that IL - LTSSCs can advocate for the
memberrsquos needs in an unbiased manner sect An important purpose of the Independent Living planning
process is to provide consumers with opportunities to learn and develop new skills that can help them succeed in achieving and maintaining their independent living goals
28
httpswwwResourcesForIntegratedCarecom
The Role of IL-LTSSCs
sect Support consumers in developing and working toward quality of life goals for independent living wellness and recovery
sect Conduct initial assessments to help consumers identify the services they need
sect Work as a care team member providing expertise in LTSS Independent Living Philosophy and Recovery Model
sect Have experience working with people with disabilities (may include lived experience with a disability)
sect Provide expertise on community services and community service providers
29
httpswwwResourcesForIntegratedCarecom
Supporting Individuals Who are Self-Directing Personal Care Services
sect The IL - LTSSC discusses the Independent Living Philosophy framework of Consumer Direction and Control with the consumer sect ldquoIndependencerdquo is different for each consumer
sect IL-LTSSCs assist consumers in identifying short- and long-term goals and current barriers to independence sect In initial assessment in the home IL - LTSSCs help consumers
identify the services they need sect Once services are approved through the Care Management
Team the IL - LTSSC begins the necessary service coordination to put vendor services in place
sect Consumers have the right to make changes to their selected services
30
httpswwwResourcesForIntegratedCarecom
What Other Types of Supports and Services are Offered to Individuals
sect Skills training and education sect Peer support sect Non - medical transportation sect Assistive technology sect Home modifications sect Home delivered meals sect Adult day health programs sect Homemaker and companion services
31
httpswwwResourcesForIntegratedCarecom
Strength-Based Needs Assessments
sect Every person regardless of his or her personal situation has unique strengths These basic strengths can be used as a starting place to begin developing other new strengths that will support the personrsquos efforts to reach his or her goals and dreams
sect Often someone from outside the personrsquos immediate environment can best help the person identify his or her unique talents abilities and strengths
32
httpswwwResourcesForIntegratedCarecom
Utilizing a Strength-Based Approach
sect IL - LTSSCs conduct strength - based initial assessments sect Key questions for a strength - based approach to
assessments sect What is working well right now in your life sect What do you want to accomplish in the future sect What is working well that you can build on sect What are some creative ways that you or someone you know has
addressed this problem in the past
sect Instead of assuming that a person has a weakness in a particular area assume that the person has not yet had opportunities that are essential to learning developing and mastering a skill in that particular area
33
httpswwwResourcesForIntegratedCarecom
Case Study 1 ldquoKarenrdquo
sect 51 - year - old woman with history of falls and diagnoses of PTSD anxiety bipolar disorder chronic respiratory disease dizziness and unspecified psychosis
sect Extremely reliant on her brother and mother for assistance with IADLs
sect Worked with IL - LTSSC to access the following Homemaker Services Companion Services Social and Medical Transportation
sect Karen reports that these services have lessened her feelings of anxiety and stress and have allowed her to feel safer and more self-sufficient in her environment
34
httpswwwResourcesForIntegratedCarecom
Case Study 2 ldquoRicardordquo
sect 53 - year - old consumer with diagnoses of depression anxiety and cognitive disabilities
sect Experienced homelessness for approximately 5 years and had to forfeit his service animal upon entering the shelter system Left the shelter after a few months and has lived in a U - Haul van for the last 2 years
sect IL - LTSSCrsquos initial focus was on housing assistance and was able to get consumer into a one - year Single Room Occupancy (SRO) Program that will give him access to permanent housing upon successful completion of program
sect IL - LTSSC is now working with care team to obtain approval for additional supports like home - delivered meals and laundry service
35
httpswwwResourcesForIntegratedCarecom
Personal Care Attendants and the Interdisciplinary Care Team
Corinne Eldridge Executive Director California Long - Term Care Education Center
37
httpswwwResourcesForIntegratedCarecom
Californiarsquos In - Home Supportive Services (IHSS) Program
sect There are 14 million dually eligible individuals in California4
sect The IHSS program serves 564000 consumers in CA5
sect 56 are 65 years or older 37 are 18 - 64 7 are under 18 sect 50 speak a primary language other than English
sect Californiarsquos IHSS program is the oldest Personal Care Attendant program in the country
sect There are 509000 IHSS workers in CA5
sect Over 50 of IHSS workers are family members
4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D5 Claire Ramsey (2019) In - Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
37
httpswwwResourcesForIntegratedCarecom
California Long - Term Care Education Center (CLTCEC) IHSS Training
sect CLTCEC began training IHSS consumer and provider pairs in 2012 sect Began with 6 health plans across 3 counties in California as
part of a Health Care Innovations Awards grant through the Center for Medicare amp Medicaid Innovation (CMMI)
sect Continued IHSS training program with 2 health plan partners LA Care Blue Shield California
38
httpswwwResourcesForIntegratedCarecom
Basic Tenants of the IHSS Training Program
39
Voluntary participation
IHSS provider learns new skills
Honors consumer-directed model of care
Competency-based education
httpswwwResourcesForIntegratedCarecom
IHSS Training Program
sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training
and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes
if possible sect 17-week course includes additional modules on body systems and disease-
specific care sect Training modules discuss the role of the IHSS provider and integration
into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration
are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have
discussions with IHSS consumer about what was learned in class that week
40
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
Disclosure StatementThe following plannersfaculty have returned disclosure forms indicating that they (andor their spousespartners) have no affiliation with or financial interest in any commercial interest that may have direct interest in the subject matter of their presentation(s) sect Nancy Wilson MA MSW Maida Castellanos
No relevant financial interests or affiliations No relevant financial interests or affiliations
sect Corinne Eldridge Carole Stewart No relevant financial interests or affiliation No relevant financial interests or affiliations
sect Courtland Townes No relevant financial interests or affiliations
sect Kristen BugaraNo relevant financial interests or affiliations
4
httpswwwResourcesForIntegratedCarecom
Continuing Education Information
5
If You Are A Credit Options RequirementsOption 1 National Association of Social Workers amp Continuing Nursing Education Credits
Social Worker
The National Association of Social Workers designates this webinar for a maximum of 1 Continuing Education (CE) credit hour
Please note New York Michigan and West Virginia do not accept National CE Approval Programs for Social Work New Jersey Idaho and Oregon do not recognize NASW National Approval
1 Complete the pre - test at the beginning of the webinar 2 Complete the post - test with a score of 80 or higher by midnight August 22 2019
NurseThe American Geriatrics Society designates this program eligible for 1 nursing contact hour through the California Board of Registered Nursing
1 Complete the pre - test at the beginning of the webinar 2 Complete the post - test with a score of 70 or higher by midnight on August 22 2019
Option 2 Centers for Medicare amp Medicaid Services (CMS)
Physician (MD or DO)
The Centers for Medicare amp Medicaid Services (CMS) is evaluating this activity for continuing medical education (CME) credit The number of credits awarded will be calculated following the activity based on the actual learning time Final CME information on the amount of credit will be available to participants within the Learning Management System (LMS) after the live activity
Complete the post-test through CMSrsquoLearning Management System with a score of 80 or higher by midnight September 9 2019
Other
The Centers for Medicare amp Medicaid Services (CMS) is evaluating this activity for continuing education (CE) credit The number of credits awarded will be calculated following the activity based on the actual learning time Final CE information on the amount of credit will be available to participants within the Learning Management System (LMS) after the live activity
Complete the post-test through CMSrsquoLearning Management System with a score of 80 or higher by midnight September 9 2019
httpswwwResourcesForIntegratedCarecom
Support Statement
sect This webinar is supported through the Medicare - Medicaid Coordination Office (MMCO) in the Centers for Medicare amp Medicaid Services (CMS) to help beneficiaries dually eligible for Medicare and Medicaid have access to seamless high - quality health care that includes the full range of covered services in both programs To support providers in their efforts to deliver more integrated coordinated care to dually eligible beneficiaries MMCO is developing technical assistance and actionable tools based on successful innovations and care models such as this webinar
sect To learn more about current efforts and resources visit Resources for Integrated Care at httpswwwresourcesforintegratedcarecom
6
httpswwwResourcesForIntegratedCarecom
Introductions
Kristen Bugara MSW LSW Care Management Supervisor Direction Home Akron Canton Area Agency on Aging and Disabilities
Courtland Townes Deputy Director Boston Center for Independent Living
Corinne Eldridge Executive Director California Long-Term Care Education Center
7
httpswwwResourcesForIntegratedCarecom
Introductions
Carole Stewart IHSS Consumer
Maida Castellanos Personal Care Attendant
8
httpswwwResourcesForIntegratedCarecom
Learning Objectives
sect Describe key features of self - direction and what it entails for the consumer
sect Identify the role of care managers and care coordinators in facilitating decisions on self - direction as part of developing andor amending the person - centered care plan
sect Define the role of a personal care attendant (PCA) in the interdisciplinary care team
9
httpswwwResourcesForIntegratedCarecom
Webinar OutlineAgenda
sect Poll Questions sect Overview of Self - Direction and the Role of Care Managers sect The Role of LTSS Coordinators in Supporting Consumer
Choice sect Personal Care Attendants and the Interdisciplinary Care
Team sect Making it Work Voices of a Consumer and In - Home
Supportive Services Provider sect QampA sect Evaluation
10
httpswwwResourcesForIntegratedCarecom
Overview of Self - Direction and the Role of Care Managers
Kristen Bugara Care Management Supervisor Direction Home Akron Canton Area Agency on Aging and Disabilities
11
httpswwwResourcesForIntegratedCarecom
What is Self-Direction
1 Applied Self Direction (2018) What is Self-Direction Retrieved from
12
httpwwwappliedselfdirectioncomwhat-self-direction2 Family Caregiver Alliance (2013) The National Resource Center for Participant-Directed Services Retrieved from httpswwwcaregiverorgnational-resource-
center-participant-directed-services
Self-Direction (self-directed services)
bull Helps people of all ages with all types of disabilities maintain their independence at home by choosing the mix of services and supports that work best for them
bull Built on the belief that the people receiving the services and supports know their needs best and are in the best position to plan and manage their own services1
bull Also referred to as participant direction or consumer direction
History of Self-Direction
bull Grounded in the Independent Living philosophy self-direction options for home-and-community based services (HCBS) were included in health care reform recommendations and proposed legislation introduced in Congress beginning in 1993
bull In 2002 CMS released the Independence Plus waiver application to streamline approval for waiver programs offering self-direction
bull In 2010 the Affordable Care Act (ACA) improved options for self-direction in Medicaid and authorized a new voluntary social insurance the CLASS program with participant direction at the core2
httpswwwResourcesForIntegratedCarecom
The Self-Direction Model
sect Empowers consumers by expanding their degree of choice and control over the services and supports they need to live independently
sect Helps people maintain their independence sect Allows people to determine for themselves what mix of
services and supports work best for them
13
httpswwwResourcesForIntegratedCarecom
Goals of Self-Direction
sect Seeks to maximize each personrsquos ability to control their own decisions
sect Allows the person to be at the center of the process sect Promotes self - efficacy sect Empowers each person to take responsibility for their
supports and services sect Complements person - centered planning and facilitation
14
httpswwwResourcesForIntegratedCarecom
Characteristics of Candidates for Self-Directionsect Desire to have control of decisions regarding supports sect Understanding of what is allowable for each service and role
(eg personal care attendants cannot administer medication) sect Ability to manage and communicate decisions sect Ability to be the ldquoemployerrdquo sect Strong problem solving skills including ability to interview
hire train supervise and terminate employees sect Safe and stable living environment sect Strong back - up plan sect Agreement to work with a Fiscal Management Service sect Available authorized representative for people who cannot
self - direct
15
httpswwwResourcesForIntegratedCarecom
Authorized Representatives for Self-Direction
sect If the person cannot maintain control of their own supports and services they may assign an Authorized Representative to act on their behalf
sect Authorized Representative A personrsquos legal guardian family member or any other person identified by the member to help manage services as defined in the care plan and supervise employees if the person is unable to do so independently sect In Ohio the Authorized Representative MAY NOT also serve
as the paid care provider for the person
16
httpswwwResourcesForIntegratedCarecom
Self - Direction Authority Employer Authority
sect Employer Authority people have decision - making authority to recruit hire train and supervise the people who furnish their services3
sect In Ohio care managers must have assessed the person and determined a need for personal care services provided by a Consumer Directed Personal Care Provider or a Choices Home Care Attendant Service Provider
sect The person assumes responsibility for being the Personal Care Providerrsquos employer including hiring training setting pay rate (within guidelines) directing care and terminating providers if necessary
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from https
17
wwwmedicaidgovmedicaidltssself-directedindexhtml
httpswwwResourcesForIntegratedCarecom
Self - Direction Authority Budget Authority
sect Budget Authority person has decision - making authority over how the Medicaid funds in a budget are spent3
sect In Ohio the care manager must have assessed the person and determined a need for sect Choices Home Care Attendant Service sect Alternative Meal Service sect Pest Control sect Home Modification Maintenance and Repair sect Home Medical Equipment Supplemental Adaptive and Assistive
Devices sect The person assumes responsibility for choosing provider for
service scheduling service and setting pay rate (within guidelines)
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from https
18
wwwmedicaidgovmedicaidltssself-directedindexhtml
httpswwwResourcesForIntegratedCarecom
Traditional Care Management vs Self-Directed Care Management
19
Traditional Care Management Self-Directed Care ManagementConsumer and Care Manager decide which services are needed based on assessment
Consumer and Care Manager decide which services are needed based on assessment
Care Manager locates providers Consumer locates providers with assistance from care manager
Provider agency decides which worker to send and when to provide careservice
Consumer determines schedule based on assessed need
Provider agency hires trains and manages employees
Consumer hires trains and manages employees
Care Manager is responsible for management of provider issues
Consumer addresses service issues directly with assistance from care manager as needed
Care Manager contacts provider with any service issues
Care Manager monitors quality of service and satisfaction
httpswwwResourcesForIntegratedCarecom
The Role of Care Management in Self-Direction
sect Care managers play important roles in supporting consumers who are self - directing through bull Education bull Facilitation bull Support
20
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Education
sect Care managers can support consumers through education to ensure that the person is sect Well - informed and capable of making decisions sect Able to understand the tasks provided by the chosen
service sect Aware of their responsibilities as the employer and the
responsibilities of the provider sect In Ohio care managers answer questions about self-
direction and provide support when needed during quarterly visits or when people experience significant changes
21
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Facilitation
sect Care Managers can facilitate self - direction by sect Providing structure for the planning process sect Empowering the person to make decisions and take
action sect Helping the person identify goals sect Working with the person to guide the selection of supports
and services sect Assisting when possible with the application process rate
negotiation and service reviews
22
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Support
sect Care Managers can support consumers by sect Providing encouragement sect Working with people to help reduce potential negative
outcomes associated with their decisions sect Helping people adapt to their role as an employer sect Educating people on the importance of a back - up plan sect Helping people implement standard employment
application processes when possible sect Helping people understand supervisory responsibilities
23
httpswwwResourcesForIntegratedCarecom
Consumer Benefits of Self-Direction
sect Consumer is in control of their own supports and services sect Flexible scheduling sect Reduces unmet needscall - offs sect Enhances feelings of safety sect Promotes independence choice and self - determination sect Returns the choice to the consumer
24
httpswwwResourcesForIntegratedCarecom
Care Management Benefits of Self-Direction
sect Reduced service gaps sect Helps arrange supports and services in ldquohard to serverdquo
areas such as rural areas with direct care worker shortages
sect Helps ensure supports and services for consumers with complex service needs such as people who need assistance with toileting hourly
sect Fewer requests for change of service providers sect Satisfaction with all services increases
25
httpswwwResourcesForIntegratedCarecom
The Role of the LTSS Coordinator in Supporting Consumer Choice
Courtland Townes Deputy Director Boston Center for Independent Living
27
httpswwwResourcesForIntegratedCarecom
Massachusetts One Care Programrsquos Independent Living LTSS Model
sect One Care is the Massachusettsrsquo Medicare - Medicaid Financial Alignment Demonstration for adults living with disabilities who are dually eligible for Medicare and Medicaid
sect One Care uses a consumer - driven interdisciplinary care team comprised of medical professionals and long - term care coordinators
sect Once enrolled members have the right to have an independent living and LTSS coordinator ( IL - LTSSC) as part of their care team
27
httpswwwResourcesForIntegratedCarecom
Supporting Consumers who Choose to Live Independently
sect IL - LTSSCs are not employed by health plans but by independent community organizations such as Independent Living Centers Recovery Learning Centers and Aging Services Access Points sect This ensures that IL - LTSSCs can advocate for the
memberrsquos needs in an unbiased manner sect An important purpose of the Independent Living planning
process is to provide consumers with opportunities to learn and develop new skills that can help them succeed in achieving and maintaining their independent living goals
28
httpswwwResourcesForIntegratedCarecom
The Role of IL-LTSSCs
sect Support consumers in developing and working toward quality of life goals for independent living wellness and recovery
sect Conduct initial assessments to help consumers identify the services they need
sect Work as a care team member providing expertise in LTSS Independent Living Philosophy and Recovery Model
sect Have experience working with people with disabilities (may include lived experience with a disability)
sect Provide expertise on community services and community service providers
29
httpswwwResourcesForIntegratedCarecom
Supporting Individuals Who are Self-Directing Personal Care Services
sect The IL - LTSSC discusses the Independent Living Philosophy framework of Consumer Direction and Control with the consumer sect ldquoIndependencerdquo is different for each consumer
sect IL-LTSSCs assist consumers in identifying short- and long-term goals and current barriers to independence sect In initial assessment in the home IL - LTSSCs help consumers
identify the services they need sect Once services are approved through the Care Management
Team the IL - LTSSC begins the necessary service coordination to put vendor services in place
sect Consumers have the right to make changes to their selected services
30
httpswwwResourcesForIntegratedCarecom
What Other Types of Supports and Services are Offered to Individuals
sect Skills training and education sect Peer support sect Non - medical transportation sect Assistive technology sect Home modifications sect Home delivered meals sect Adult day health programs sect Homemaker and companion services
31
httpswwwResourcesForIntegratedCarecom
Strength-Based Needs Assessments
sect Every person regardless of his or her personal situation has unique strengths These basic strengths can be used as a starting place to begin developing other new strengths that will support the personrsquos efforts to reach his or her goals and dreams
sect Often someone from outside the personrsquos immediate environment can best help the person identify his or her unique talents abilities and strengths
32
httpswwwResourcesForIntegratedCarecom
Utilizing a Strength-Based Approach
sect IL - LTSSCs conduct strength - based initial assessments sect Key questions for a strength - based approach to
assessments sect What is working well right now in your life sect What do you want to accomplish in the future sect What is working well that you can build on sect What are some creative ways that you or someone you know has
addressed this problem in the past
sect Instead of assuming that a person has a weakness in a particular area assume that the person has not yet had opportunities that are essential to learning developing and mastering a skill in that particular area
33
httpswwwResourcesForIntegratedCarecom
Case Study 1 ldquoKarenrdquo
sect 51 - year - old woman with history of falls and diagnoses of PTSD anxiety bipolar disorder chronic respiratory disease dizziness and unspecified psychosis
sect Extremely reliant on her brother and mother for assistance with IADLs
sect Worked with IL - LTSSC to access the following Homemaker Services Companion Services Social and Medical Transportation
sect Karen reports that these services have lessened her feelings of anxiety and stress and have allowed her to feel safer and more self-sufficient in her environment
34
httpswwwResourcesForIntegratedCarecom
Case Study 2 ldquoRicardordquo
sect 53 - year - old consumer with diagnoses of depression anxiety and cognitive disabilities
sect Experienced homelessness for approximately 5 years and had to forfeit his service animal upon entering the shelter system Left the shelter after a few months and has lived in a U - Haul van for the last 2 years
sect IL - LTSSCrsquos initial focus was on housing assistance and was able to get consumer into a one - year Single Room Occupancy (SRO) Program that will give him access to permanent housing upon successful completion of program
sect IL - LTSSC is now working with care team to obtain approval for additional supports like home - delivered meals and laundry service
35
httpswwwResourcesForIntegratedCarecom
Personal Care Attendants and the Interdisciplinary Care Team
Corinne Eldridge Executive Director California Long - Term Care Education Center
37
httpswwwResourcesForIntegratedCarecom
Californiarsquos In - Home Supportive Services (IHSS) Program
sect There are 14 million dually eligible individuals in California4
sect The IHSS program serves 564000 consumers in CA5
sect 56 are 65 years or older 37 are 18 - 64 7 are under 18 sect 50 speak a primary language other than English
sect Californiarsquos IHSS program is the oldest Personal Care Attendant program in the country
sect There are 509000 IHSS workers in CA5
sect Over 50 of IHSS workers are family members
4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D5 Claire Ramsey (2019) In - Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
37
httpswwwResourcesForIntegratedCarecom
California Long - Term Care Education Center (CLTCEC) IHSS Training
sect CLTCEC began training IHSS consumer and provider pairs in 2012 sect Began with 6 health plans across 3 counties in California as
part of a Health Care Innovations Awards grant through the Center for Medicare amp Medicaid Innovation (CMMI)
sect Continued IHSS training program with 2 health plan partners LA Care Blue Shield California
38
httpswwwResourcesForIntegratedCarecom
Basic Tenants of the IHSS Training Program
39
Voluntary participation
IHSS provider learns new skills
Honors consumer-directed model of care
Competency-based education
httpswwwResourcesForIntegratedCarecom
IHSS Training Program
sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training
and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes
if possible sect 17-week course includes additional modules on body systems and disease-
specific care sect Training modules discuss the role of the IHSS provider and integration
into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration
are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have
discussions with IHSS consumer about what was learned in class that week
40
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
Continuing Education Information
5
If You Are A Credit Options RequirementsOption 1 National Association of Social Workers amp Continuing Nursing Education Credits
Social Worker
The National Association of Social Workers designates this webinar for a maximum of 1 Continuing Education (CE) credit hour
Please note New York Michigan and West Virginia do not accept National CE Approval Programs for Social Work New Jersey Idaho and Oregon do not recognize NASW National Approval
1 Complete the pre - test at the beginning of the webinar 2 Complete the post - test with a score of 80 or higher by midnight August 22 2019
NurseThe American Geriatrics Society designates this program eligible for 1 nursing contact hour through the California Board of Registered Nursing
1 Complete the pre - test at the beginning of the webinar 2 Complete the post - test with a score of 70 or higher by midnight on August 22 2019
Option 2 Centers for Medicare amp Medicaid Services (CMS)
Physician (MD or DO)
The Centers for Medicare amp Medicaid Services (CMS) is evaluating this activity for continuing medical education (CME) credit The number of credits awarded will be calculated following the activity based on the actual learning time Final CME information on the amount of credit will be available to participants within the Learning Management System (LMS) after the live activity
Complete the post-test through CMSrsquoLearning Management System with a score of 80 or higher by midnight September 9 2019
Other
The Centers for Medicare amp Medicaid Services (CMS) is evaluating this activity for continuing education (CE) credit The number of credits awarded will be calculated following the activity based on the actual learning time Final CE information on the amount of credit will be available to participants within the Learning Management System (LMS) after the live activity
Complete the post-test through CMSrsquoLearning Management System with a score of 80 or higher by midnight September 9 2019
httpswwwResourcesForIntegratedCarecom
Support Statement
sect This webinar is supported through the Medicare - Medicaid Coordination Office (MMCO) in the Centers for Medicare amp Medicaid Services (CMS) to help beneficiaries dually eligible for Medicare and Medicaid have access to seamless high - quality health care that includes the full range of covered services in both programs To support providers in their efforts to deliver more integrated coordinated care to dually eligible beneficiaries MMCO is developing technical assistance and actionable tools based on successful innovations and care models such as this webinar
sect To learn more about current efforts and resources visit Resources for Integrated Care at httpswwwresourcesforintegratedcarecom
6
httpswwwResourcesForIntegratedCarecom
Introductions
Kristen Bugara MSW LSW Care Management Supervisor Direction Home Akron Canton Area Agency on Aging and Disabilities
Courtland Townes Deputy Director Boston Center for Independent Living
Corinne Eldridge Executive Director California Long-Term Care Education Center
7
httpswwwResourcesForIntegratedCarecom
Introductions
Carole Stewart IHSS Consumer
Maida Castellanos Personal Care Attendant
8
httpswwwResourcesForIntegratedCarecom
Learning Objectives
sect Describe key features of self - direction and what it entails for the consumer
sect Identify the role of care managers and care coordinators in facilitating decisions on self - direction as part of developing andor amending the person - centered care plan
sect Define the role of a personal care attendant (PCA) in the interdisciplinary care team
9
httpswwwResourcesForIntegratedCarecom
Webinar OutlineAgenda
sect Poll Questions sect Overview of Self - Direction and the Role of Care Managers sect The Role of LTSS Coordinators in Supporting Consumer
Choice sect Personal Care Attendants and the Interdisciplinary Care
Team sect Making it Work Voices of a Consumer and In - Home
Supportive Services Provider sect QampA sect Evaluation
10
httpswwwResourcesForIntegratedCarecom
Overview of Self - Direction and the Role of Care Managers
Kristen Bugara Care Management Supervisor Direction Home Akron Canton Area Agency on Aging and Disabilities
11
httpswwwResourcesForIntegratedCarecom
What is Self-Direction
1 Applied Self Direction (2018) What is Self-Direction Retrieved from
12
httpwwwappliedselfdirectioncomwhat-self-direction2 Family Caregiver Alliance (2013) The National Resource Center for Participant-Directed Services Retrieved from httpswwwcaregiverorgnational-resource-
center-participant-directed-services
Self-Direction (self-directed services)
bull Helps people of all ages with all types of disabilities maintain their independence at home by choosing the mix of services and supports that work best for them
bull Built on the belief that the people receiving the services and supports know their needs best and are in the best position to plan and manage their own services1
bull Also referred to as participant direction or consumer direction
History of Self-Direction
bull Grounded in the Independent Living philosophy self-direction options for home-and-community based services (HCBS) were included in health care reform recommendations and proposed legislation introduced in Congress beginning in 1993
bull In 2002 CMS released the Independence Plus waiver application to streamline approval for waiver programs offering self-direction
bull In 2010 the Affordable Care Act (ACA) improved options for self-direction in Medicaid and authorized a new voluntary social insurance the CLASS program with participant direction at the core2
httpswwwResourcesForIntegratedCarecom
The Self-Direction Model
sect Empowers consumers by expanding their degree of choice and control over the services and supports they need to live independently
sect Helps people maintain their independence sect Allows people to determine for themselves what mix of
services and supports work best for them
13
httpswwwResourcesForIntegratedCarecom
Goals of Self-Direction
sect Seeks to maximize each personrsquos ability to control their own decisions
sect Allows the person to be at the center of the process sect Promotes self - efficacy sect Empowers each person to take responsibility for their
supports and services sect Complements person - centered planning and facilitation
14
httpswwwResourcesForIntegratedCarecom
Characteristics of Candidates for Self-Directionsect Desire to have control of decisions regarding supports sect Understanding of what is allowable for each service and role
(eg personal care attendants cannot administer medication) sect Ability to manage and communicate decisions sect Ability to be the ldquoemployerrdquo sect Strong problem solving skills including ability to interview
hire train supervise and terminate employees sect Safe and stable living environment sect Strong back - up plan sect Agreement to work with a Fiscal Management Service sect Available authorized representative for people who cannot
self - direct
15
httpswwwResourcesForIntegratedCarecom
Authorized Representatives for Self-Direction
sect If the person cannot maintain control of their own supports and services they may assign an Authorized Representative to act on their behalf
sect Authorized Representative A personrsquos legal guardian family member or any other person identified by the member to help manage services as defined in the care plan and supervise employees if the person is unable to do so independently sect In Ohio the Authorized Representative MAY NOT also serve
as the paid care provider for the person
16
httpswwwResourcesForIntegratedCarecom
Self - Direction Authority Employer Authority
sect Employer Authority people have decision - making authority to recruit hire train and supervise the people who furnish their services3
sect In Ohio care managers must have assessed the person and determined a need for personal care services provided by a Consumer Directed Personal Care Provider or a Choices Home Care Attendant Service Provider
sect The person assumes responsibility for being the Personal Care Providerrsquos employer including hiring training setting pay rate (within guidelines) directing care and terminating providers if necessary
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from https
17
wwwmedicaidgovmedicaidltssself-directedindexhtml
httpswwwResourcesForIntegratedCarecom
Self - Direction Authority Budget Authority
sect Budget Authority person has decision - making authority over how the Medicaid funds in a budget are spent3
sect In Ohio the care manager must have assessed the person and determined a need for sect Choices Home Care Attendant Service sect Alternative Meal Service sect Pest Control sect Home Modification Maintenance and Repair sect Home Medical Equipment Supplemental Adaptive and Assistive
Devices sect The person assumes responsibility for choosing provider for
service scheduling service and setting pay rate (within guidelines)
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from https
18
wwwmedicaidgovmedicaidltssself-directedindexhtml
httpswwwResourcesForIntegratedCarecom
Traditional Care Management vs Self-Directed Care Management
19
Traditional Care Management Self-Directed Care ManagementConsumer and Care Manager decide which services are needed based on assessment
Consumer and Care Manager decide which services are needed based on assessment
Care Manager locates providers Consumer locates providers with assistance from care manager
Provider agency decides which worker to send and when to provide careservice
Consumer determines schedule based on assessed need
Provider agency hires trains and manages employees
Consumer hires trains and manages employees
Care Manager is responsible for management of provider issues
Consumer addresses service issues directly with assistance from care manager as needed
Care Manager contacts provider with any service issues
Care Manager monitors quality of service and satisfaction
httpswwwResourcesForIntegratedCarecom
The Role of Care Management in Self-Direction
sect Care managers play important roles in supporting consumers who are self - directing through bull Education bull Facilitation bull Support
20
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Education
sect Care managers can support consumers through education to ensure that the person is sect Well - informed and capable of making decisions sect Able to understand the tasks provided by the chosen
service sect Aware of their responsibilities as the employer and the
responsibilities of the provider sect In Ohio care managers answer questions about self-
direction and provide support when needed during quarterly visits or when people experience significant changes
21
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Facilitation
sect Care Managers can facilitate self - direction by sect Providing structure for the planning process sect Empowering the person to make decisions and take
action sect Helping the person identify goals sect Working with the person to guide the selection of supports
and services sect Assisting when possible with the application process rate
negotiation and service reviews
22
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Support
sect Care Managers can support consumers by sect Providing encouragement sect Working with people to help reduce potential negative
outcomes associated with their decisions sect Helping people adapt to their role as an employer sect Educating people on the importance of a back - up plan sect Helping people implement standard employment
application processes when possible sect Helping people understand supervisory responsibilities
23
httpswwwResourcesForIntegratedCarecom
Consumer Benefits of Self-Direction
sect Consumer is in control of their own supports and services sect Flexible scheduling sect Reduces unmet needscall - offs sect Enhances feelings of safety sect Promotes independence choice and self - determination sect Returns the choice to the consumer
24
httpswwwResourcesForIntegratedCarecom
Care Management Benefits of Self-Direction
sect Reduced service gaps sect Helps arrange supports and services in ldquohard to serverdquo
areas such as rural areas with direct care worker shortages
sect Helps ensure supports and services for consumers with complex service needs such as people who need assistance with toileting hourly
sect Fewer requests for change of service providers sect Satisfaction with all services increases
25
httpswwwResourcesForIntegratedCarecom
The Role of the LTSS Coordinator in Supporting Consumer Choice
Courtland Townes Deputy Director Boston Center for Independent Living
27
httpswwwResourcesForIntegratedCarecom
Massachusetts One Care Programrsquos Independent Living LTSS Model
sect One Care is the Massachusettsrsquo Medicare - Medicaid Financial Alignment Demonstration for adults living with disabilities who are dually eligible for Medicare and Medicaid
sect One Care uses a consumer - driven interdisciplinary care team comprised of medical professionals and long - term care coordinators
sect Once enrolled members have the right to have an independent living and LTSS coordinator ( IL - LTSSC) as part of their care team
27
httpswwwResourcesForIntegratedCarecom
Supporting Consumers who Choose to Live Independently
sect IL - LTSSCs are not employed by health plans but by independent community organizations such as Independent Living Centers Recovery Learning Centers and Aging Services Access Points sect This ensures that IL - LTSSCs can advocate for the
memberrsquos needs in an unbiased manner sect An important purpose of the Independent Living planning
process is to provide consumers with opportunities to learn and develop new skills that can help them succeed in achieving and maintaining their independent living goals
28
httpswwwResourcesForIntegratedCarecom
The Role of IL-LTSSCs
sect Support consumers in developing and working toward quality of life goals for independent living wellness and recovery
sect Conduct initial assessments to help consumers identify the services they need
sect Work as a care team member providing expertise in LTSS Independent Living Philosophy and Recovery Model
sect Have experience working with people with disabilities (may include lived experience with a disability)
sect Provide expertise on community services and community service providers
29
httpswwwResourcesForIntegratedCarecom
Supporting Individuals Who are Self-Directing Personal Care Services
sect The IL - LTSSC discusses the Independent Living Philosophy framework of Consumer Direction and Control with the consumer sect ldquoIndependencerdquo is different for each consumer
sect IL-LTSSCs assist consumers in identifying short- and long-term goals and current barriers to independence sect In initial assessment in the home IL - LTSSCs help consumers
identify the services they need sect Once services are approved through the Care Management
Team the IL - LTSSC begins the necessary service coordination to put vendor services in place
sect Consumers have the right to make changes to their selected services
30
httpswwwResourcesForIntegratedCarecom
What Other Types of Supports and Services are Offered to Individuals
sect Skills training and education sect Peer support sect Non - medical transportation sect Assistive technology sect Home modifications sect Home delivered meals sect Adult day health programs sect Homemaker and companion services
31
httpswwwResourcesForIntegratedCarecom
Strength-Based Needs Assessments
sect Every person regardless of his or her personal situation has unique strengths These basic strengths can be used as a starting place to begin developing other new strengths that will support the personrsquos efforts to reach his or her goals and dreams
sect Often someone from outside the personrsquos immediate environment can best help the person identify his or her unique talents abilities and strengths
32
httpswwwResourcesForIntegratedCarecom
Utilizing a Strength-Based Approach
sect IL - LTSSCs conduct strength - based initial assessments sect Key questions for a strength - based approach to
assessments sect What is working well right now in your life sect What do you want to accomplish in the future sect What is working well that you can build on sect What are some creative ways that you or someone you know has
addressed this problem in the past
sect Instead of assuming that a person has a weakness in a particular area assume that the person has not yet had opportunities that are essential to learning developing and mastering a skill in that particular area
33
httpswwwResourcesForIntegratedCarecom
Case Study 1 ldquoKarenrdquo
sect 51 - year - old woman with history of falls and diagnoses of PTSD anxiety bipolar disorder chronic respiratory disease dizziness and unspecified psychosis
sect Extremely reliant on her brother and mother for assistance with IADLs
sect Worked with IL - LTSSC to access the following Homemaker Services Companion Services Social and Medical Transportation
sect Karen reports that these services have lessened her feelings of anxiety and stress and have allowed her to feel safer and more self-sufficient in her environment
34
httpswwwResourcesForIntegratedCarecom
Case Study 2 ldquoRicardordquo
sect 53 - year - old consumer with diagnoses of depression anxiety and cognitive disabilities
sect Experienced homelessness for approximately 5 years and had to forfeit his service animal upon entering the shelter system Left the shelter after a few months and has lived in a U - Haul van for the last 2 years
sect IL - LTSSCrsquos initial focus was on housing assistance and was able to get consumer into a one - year Single Room Occupancy (SRO) Program that will give him access to permanent housing upon successful completion of program
sect IL - LTSSC is now working with care team to obtain approval for additional supports like home - delivered meals and laundry service
35
httpswwwResourcesForIntegratedCarecom
Personal Care Attendants and the Interdisciplinary Care Team
Corinne Eldridge Executive Director California Long - Term Care Education Center
37
httpswwwResourcesForIntegratedCarecom
Californiarsquos In - Home Supportive Services (IHSS) Program
sect There are 14 million dually eligible individuals in California4
sect The IHSS program serves 564000 consumers in CA5
sect 56 are 65 years or older 37 are 18 - 64 7 are under 18 sect 50 speak a primary language other than English
sect Californiarsquos IHSS program is the oldest Personal Care Attendant program in the country
sect There are 509000 IHSS workers in CA5
sect Over 50 of IHSS workers are family members
4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D5 Claire Ramsey (2019) In - Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
37
httpswwwResourcesForIntegratedCarecom
California Long - Term Care Education Center (CLTCEC) IHSS Training
sect CLTCEC began training IHSS consumer and provider pairs in 2012 sect Began with 6 health plans across 3 counties in California as
part of a Health Care Innovations Awards grant through the Center for Medicare amp Medicaid Innovation (CMMI)
sect Continued IHSS training program with 2 health plan partners LA Care Blue Shield California
38
httpswwwResourcesForIntegratedCarecom
Basic Tenants of the IHSS Training Program
39
Voluntary participation
IHSS provider learns new skills
Honors consumer-directed model of care
Competency-based education
httpswwwResourcesForIntegratedCarecom
IHSS Training Program
sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training
and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes
if possible sect 17-week course includes additional modules on body systems and disease-
specific care sect Training modules discuss the role of the IHSS provider and integration
into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration
are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have
discussions with IHSS consumer about what was learned in class that week
40
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
Support Statement
sect This webinar is supported through the Medicare - Medicaid Coordination Office (MMCO) in the Centers for Medicare amp Medicaid Services (CMS) to help beneficiaries dually eligible for Medicare and Medicaid have access to seamless high - quality health care that includes the full range of covered services in both programs To support providers in their efforts to deliver more integrated coordinated care to dually eligible beneficiaries MMCO is developing technical assistance and actionable tools based on successful innovations and care models such as this webinar
sect To learn more about current efforts and resources visit Resources for Integrated Care at httpswwwresourcesforintegratedcarecom
6
httpswwwResourcesForIntegratedCarecom
Introductions
Kristen Bugara MSW LSW Care Management Supervisor Direction Home Akron Canton Area Agency on Aging and Disabilities
Courtland Townes Deputy Director Boston Center for Independent Living
Corinne Eldridge Executive Director California Long-Term Care Education Center
7
httpswwwResourcesForIntegratedCarecom
Introductions
Carole Stewart IHSS Consumer
Maida Castellanos Personal Care Attendant
8
httpswwwResourcesForIntegratedCarecom
Learning Objectives
sect Describe key features of self - direction and what it entails for the consumer
sect Identify the role of care managers and care coordinators in facilitating decisions on self - direction as part of developing andor amending the person - centered care plan
sect Define the role of a personal care attendant (PCA) in the interdisciplinary care team
9
httpswwwResourcesForIntegratedCarecom
Webinar OutlineAgenda
sect Poll Questions sect Overview of Self - Direction and the Role of Care Managers sect The Role of LTSS Coordinators in Supporting Consumer
Choice sect Personal Care Attendants and the Interdisciplinary Care
Team sect Making it Work Voices of a Consumer and In - Home
Supportive Services Provider sect QampA sect Evaluation
10
httpswwwResourcesForIntegratedCarecom
Overview of Self - Direction and the Role of Care Managers
Kristen Bugara Care Management Supervisor Direction Home Akron Canton Area Agency on Aging and Disabilities
11
httpswwwResourcesForIntegratedCarecom
What is Self-Direction
1 Applied Self Direction (2018) What is Self-Direction Retrieved from
12
httpwwwappliedselfdirectioncomwhat-self-direction2 Family Caregiver Alliance (2013) The National Resource Center for Participant-Directed Services Retrieved from httpswwwcaregiverorgnational-resource-
center-participant-directed-services
Self-Direction (self-directed services)
bull Helps people of all ages with all types of disabilities maintain their independence at home by choosing the mix of services and supports that work best for them
bull Built on the belief that the people receiving the services and supports know their needs best and are in the best position to plan and manage their own services1
bull Also referred to as participant direction or consumer direction
History of Self-Direction
bull Grounded in the Independent Living philosophy self-direction options for home-and-community based services (HCBS) were included in health care reform recommendations and proposed legislation introduced in Congress beginning in 1993
bull In 2002 CMS released the Independence Plus waiver application to streamline approval for waiver programs offering self-direction
bull In 2010 the Affordable Care Act (ACA) improved options for self-direction in Medicaid and authorized a new voluntary social insurance the CLASS program with participant direction at the core2
httpswwwResourcesForIntegratedCarecom
The Self-Direction Model
sect Empowers consumers by expanding their degree of choice and control over the services and supports they need to live independently
sect Helps people maintain their independence sect Allows people to determine for themselves what mix of
services and supports work best for them
13
httpswwwResourcesForIntegratedCarecom
Goals of Self-Direction
sect Seeks to maximize each personrsquos ability to control their own decisions
sect Allows the person to be at the center of the process sect Promotes self - efficacy sect Empowers each person to take responsibility for their
supports and services sect Complements person - centered planning and facilitation
14
httpswwwResourcesForIntegratedCarecom
Characteristics of Candidates for Self-Directionsect Desire to have control of decisions regarding supports sect Understanding of what is allowable for each service and role
(eg personal care attendants cannot administer medication) sect Ability to manage and communicate decisions sect Ability to be the ldquoemployerrdquo sect Strong problem solving skills including ability to interview
hire train supervise and terminate employees sect Safe and stable living environment sect Strong back - up plan sect Agreement to work with a Fiscal Management Service sect Available authorized representative for people who cannot
self - direct
15
httpswwwResourcesForIntegratedCarecom
Authorized Representatives for Self-Direction
sect If the person cannot maintain control of their own supports and services they may assign an Authorized Representative to act on their behalf
sect Authorized Representative A personrsquos legal guardian family member or any other person identified by the member to help manage services as defined in the care plan and supervise employees if the person is unable to do so independently sect In Ohio the Authorized Representative MAY NOT also serve
as the paid care provider for the person
16
httpswwwResourcesForIntegratedCarecom
Self - Direction Authority Employer Authority
sect Employer Authority people have decision - making authority to recruit hire train and supervise the people who furnish their services3
sect In Ohio care managers must have assessed the person and determined a need for personal care services provided by a Consumer Directed Personal Care Provider or a Choices Home Care Attendant Service Provider
sect The person assumes responsibility for being the Personal Care Providerrsquos employer including hiring training setting pay rate (within guidelines) directing care and terminating providers if necessary
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from https
17
wwwmedicaidgovmedicaidltssself-directedindexhtml
httpswwwResourcesForIntegratedCarecom
Self - Direction Authority Budget Authority
sect Budget Authority person has decision - making authority over how the Medicaid funds in a budget are spent3
sect In Ohio the care manager must have assessed the person and determined a need for sect Choices Home Care Attendant Service sect Alternative Meal Service sect Pest Control sect Home Modification Maintenance and Repair sect Home Medical Equipment Supplemental Adaptive and Assistive
Devices sect The person assumes responsibility for choosing provider for
service scheduling service and setting pay rate (within guidelines)
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from https
18
wwwmedicaidgovmedicaidltssself-directedindexhtml
httpswwwResourcesForIntegratedCarecom
Traditional Care Management vs Self-Directed Care Management
19
Traditional Care Management Self-Directed Care ManagementConsumer and Care Manager decide which services are needed based on assessment
Consumer and Care Manager decide which services are needed based on assessment
Care Manager locates providers Consumer locates providers with assistance from care manager
Provider agency decides which worker to send and when to provide careservice
Consumer determines schedule based on assessed need
Provider agency hires trains and manages employees
Consumer hires trains and manages employees
Care Manager is responsible for management of provider issues
Consumer addresses service issues directly with assistance from care manager as needed
Care Manager contacts provider with any service issues
Care Manager monitors quality of service and satisfaction
httpswwwResourcesForIntegratedCarecom
The Role of Care Management in Self-Direction
sect Care managers play important roles in supporting consumers who are self - directing through bull Education bull Facilitation bull Support
20
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Education
sect Care managers can support consumers through education to ensure that the person is sect Well - informed and capable of making decisions sect Able to understand the tasks provided by the chosen
service sect Aware of their responsibilities as the employer and the
responsibilities of the provider sect In Ohio care managers answer questions about self-
direction and provide support when needed during quarterly visits or when people experience significant changes
21
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Facilitation
sect Care Managers can facilitate self - direction by sect Providing structure for the planning process sect Empowering the person to make decisions and take
action sect Helping the person identify goals sect Working with the person to guide the selection of supports
and services sect Assisting when possible with the application process rate
negotiation and service reviews
22
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Support
sect Care Managers can support consumers by sect Providing encouragement sect Working with people to help reduce potential negative
outcomes associated with their decisions sect Helping people adapt to their role as an employer sect Educating people on the importance of a back - up plan sect Helping people implement standard employment
application processes when possible sect Helping people understand supervisory responsibilities
23
httpswwwResourcesForIntegratedCarecom
Consumer Benefits of Self-Direction
sect Consumer is in control of their own supports and services sect Flexible scheduling sect Reduces unmet needscall - offs sect Enhances feelings of safety sect Promotes independence choice and self - determination sect Returns the choice to the consumer
24
httpswwwResourcesForIntegratedCarecom
Care Management Benefits of Self-Direction
sect Reduced service gaps sect Helps arrange supports and services in ldquohard to serverdquo
areas such as rural areas with direct care worker shortages
sect Helps ensure supports and services for consumers with complex service needs such as people who need assistance with toileting hourly
sect Fewer requests for change of service providers sect Satisfaction with all services increases
25
httpswwwResourcesForIntegratedCarecom
The Role of the LTSS Coordinator in Supporting Consumer Choice
Courtland Townes Deputy Director Boston Center for Independent Living
27
httpswwwResourcesForIntegratedCarecom
Massachusetts One Care Programrsquos Independent Living LTSS Model
sect One Care is the Massachusettsrsquo Medicare - Medicaid Financial Alignment Demonstration for adults living with disabilities who are dually eligible for Medicare and Medicaid
sect One Care uses a consumer - driven interdisciplinary care team comprised of medical professionals and long - term care coordinators
sect Once enrolled members have the right to have an independent living and LTSS coordinator ( IL - LTSSC) as part of their care team
27
httpswwwResourcesForIntegratedCarecom
Supporting Consumers who Choose to Live Independently
sect IL - LTSSCs are not employed by health plans but by independent community organizations such as Independent Living Centers Recovery Learning Centers and Aging Services Access Points sect This ensures that IL - LTSSCs can advocate for the
memberrsquos needs in an unbiased manner sect An important purpose of the Independent Living planning
process is to provide consumers with opportunities to learn and develop new skills that can help them succeed in achieving and maintaining their independent living goals
28
httpswwwResourcesForIntegratedCarecom
The Role of IL-LTSSCs
sect Support consumers in developing and working toward quality of life goals for independent living wellness and recovery
sect Conduct initial assessments to help consumers identify the services they need
sect Work as a care team member providing expertise in LTSS Independent Living Philosophy and Recovery Model
sect Have experience working with people with disabilities (may include lived experience with a disability)
sect Provide expertise on community services and community service providers
29
httpswwwResourcesForIntegratedCarecom
Supporting Individuals Who are Self-Directing Personal Care Services
sect The IL - LTSSC discusses the Independent Living Philosophy framework of Consumer Direction and Control with the consumer sect ldquoIndependencerdquo is different for each consumer
sect IL-LTSSCs assist consumers in identifying short- and long-term goals and current barriers to independence sect In initial assessment in the home IL - LTSSCs help consumers
identify the services they need sect Once services are approved through the Care Management
Team the IL - LTSSC begins the necessary service coordination to put vendor services in place
sect Consumers have the right to make changes to their selected services
30
httpswwwResourcesForIntegratedCarecom
What Other Types of Supports and Services are Offered to Individuals
sect Skills training and education sect Peer support sect Non - medical transportation sect Assistive technology sect Home modifications sect Home delivered meals sect Adult day health programs sect Homemaker and companion services
31
httpswwwResourcesForIntegratedCarecom
Strength-Based Needs Assessments
sect Every person regardless of his or her personal situation has unique strengths These basic strengths can be used as a starting place to begin developing other new strengths that will support the personrsquos efforts to reach his or her goals and dreams
sect Often someone from outside the personrsquos immediate environment can best help the person identify his or her unique talents abilities and strengths
32
httpswwwResourcesForIntegratedCarecom
Utilizing a Strength-Based Approach
sect IL - LTSSCs conduct strength - based initial assessments sect Key questions for a strength - based approach to
assessments sect What is working well right now in your life sect What do you want to accomplish in the future sect What is working well that you can build on sect What are some creative ways that you or someone you know has
addressed this problem in the past
sect Instead of assuming that a person has a weakness in a particular area assume that the person has not yet had opportunities that are essential to learning developing and mastering a skill in that particular area
33
httpswwwResourcesForIntegratedCarecom
Case Study 1 ldquoKarenrdquo
sect 51 - year - old woman with history of falls and diagnoses of PTSD anxiety bipolar disorder chronic respiratory disease dizziness and unspecified psychosis
sect Extremely reliant on her brother and mother for assistance with IADLs
sect Worked with IL - LTSSC to access the following Homemaker Services Companion Services Social and Medical Transportation
sect Karen reports that these services have lessened her feelings of anxiety and stress and have allowed her to feel safer and more self-sufficient in her environment
34
httpswwwResourcesForIntegratedCarecom
Case Study 2 ldquoRicardordquo
sect 53 - year - old consumer with diagnoses of depression anxiety and cognitive disabilities
sect Experienced homelessness for approximately 5 years and had to forfeit his service animal upon entering the shelter system Left the shelter after a few months and has lived in a U - Haul van for the last 2 years
sect IL - LTSSCrsquos initial focus was on housing assistance and was able to get consumer into a one - year Single Room Occupancy (SRO) Program that will give him access to permanent housing upon successful completion of program
sect IL - LTSSC is now working with care team to obtain approval for additional supports like home - delivered meals and laundry service
35
httpswwwResourcesForIntegratedCarecom
Personal Care Attendants and the Interdisciplinary Care Team
Corinne Eldridge Executive Director California Long - Term Care Education Center
37
httpswwwResourcesForIntegratedCarecom
Californiarsquos In - Home Supportive Services (IHSS) Program
sect There are 14 million dually eligible individuals in California4
sect The IHSS program serves 564000 consumers in CA5
sect 56 are 65 years or older 37 are 18 - 64 7 are under 18 sect 50 speak a primary language other than English
sect Californiarsquos IHSS program is the oldest Personal Care Attendant program in the country
sect There are 509000 IHSS workers in CA5
sect Over 50 of IHSS workers are family members
4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D5 Claire Ramsey (2019) In - Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
37
httpswwwResourcesForIntegratedCarecom
California Long - Term Care Education Center (CLTCEC) IHSS Training
sect CLTCEC began training IHSS consumer and provider pairs in 2012 sect Began with 6 health plans across 3 counties in California as
part of a Health Care Innovations Awards grant through the Center for Medicare amp Medicaid Innovation (CMMI)
sect Continued IHSS training program with 2 health plan partners LA Care Blue Shield California
38
httpswwwResourcesForIntegratedCarecom
Basic Tenants of the IHSS Training Program
39
Voluntary participation
IHSS provider learns new skills
Honors consumer-directed model of care
Competency-based education
httpswwwResourcesForIntegratedCarecom
IHSS Training Program
sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training
and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes
if possible sect 17-week course includes additional modules on body systems and disease-
specific care sect Training modules discuss the role of the IHSS provider and integration
into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration
are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have
discussions with IHSS consumer about what was learned in class that week
40
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
Introductions
Kristen Bugara MSW LSW Care Management Supervisor Direction Home Akron Canton Area Agency on Aging and Disabilities
Courtland Townes Deputy Director Boston Center for Independent Living
Corinne Eldridge Executive Director California Long-Term Care Education Center
7
httpswwwResourcesForIntegratedCarecom
Introductions
Carole Stewart IHSS Consumer
Maida Castellanos Personal Care Attendant
8
httpswwwResourcesForIntegratedCarecom
Learning Objectives
sect Describe key features of self - direction and what it entails for the consumer
sect Identify the role of care managers and care coordinators in facilitating decisions on self - direction as part of developing andor amending the person - centered care plan
sect Define the role of a personal care attendant (PCA) in the interdisciplinary care team
9
httpswwwResourcesForIntegratedCarecom
Webinar OutlineAgenda
sect Poll Questions sect Overview of Self - Direction and the Role of Care Managers sect The Role of LTSS Coordinators in Supporting Consumer
Choice sect Personal Care Attendants and the Interdisciplinary Care
Team sect Making it Work Voices of a Consumer and In - Home
Supportive Services Provider sect QampA sect Evaluation
10
httpswwwResourcesForIntegratedCarecom
Overview of Self - Direction and the Role of Care Managers
Kristen Bugara Care Management Supervisor Direction Home Akron Canton Area Agency on Aging and Disabilities
11
httpswwwResourcesForIntegratedCarecom
What is Self-Direction
1 Applied Self Direction (2018) What is Self-Direction Retrieved from
12
httpwwwappliedselfdirectioncomwhat-self-direction2 Family Caregiver Alliance (2013) The National Resource Center for Participant-Directed Services Retrieved from httpswwwcaregiverorgnational-resource-
center-participant-directed-services
Self-Direction (self-directed services)
bull Helps people of all ages with all types of disabilities maintain their independence at home by choosing the mix of services and supports that work best for them
bull Built on the belief that the people receiving the services and supports know their needs best and are in the best position to plan and manage their own services1
bull Also referred to as participant direction or consumer direction
History of Self-Direction
bull Grounded in the Independent Living philosophy self-direction options for home-and-community based services (HCBS) were included in health care reform recommendations and proposed legislation introduced in Congress beginning in 1993
bull In 2002 CMS released the Independence Plus waiver application to streamline approval for waiver programs offering self-direction
bull In 2010 the Affordable Care Act (ACA) improved options for self-direction in Medicaid and authorized a new voluntary social insurance the CLASS program with participant direction at the core2
httpswwwResourcesForIntegratedCarecom
The Self-Direction Model
sect Empowers consumers by expanding their degree of choice and control over the services and supports they need to live independently
sect Helps people maintain their independence sect Allows people to determine for themselves what mix of
services and supports work best for them
13
httpswwwResourcesForIntegratedCarecom
Goals of Self-Direction
sect Seeks to maximize each personrsquos ability to control their own decisions
sect Allows the person to be at the center of the process sect Promotes self - efficacy sect Empowers each person to take responsibility for their
supports and services sect Complements person - centered planning and facilitation
14
httpswwwResourcesForIntegratedCarecom
Characteristics of Candidates for Self-Directionsect Desire to have control of decisions regarding supports sect Understanding of what is allowable for each service and role
(eg personal care attendants cannot administer medication) sect Ability to manage and communicate decisions sect Ability to be the ldquoemployerrdquo sect Strong problem solving skills including ability to interview
hire train supervise and terminate employees sect Safe and stable living environment sect Strong back - up plan sect Agreement to work with a Fiscal Management Service sect Available authorized representative for people who cannot
self - direct
15
httpswwwResourcesForIntegratedCarecom
Authorized Representatives for Self-Direction
sect If the person cannot maintain control of their own supports and services they may assign an Authorized Representative to act on their behalf
sect Authorized Representative A personrsquos legal guardian family member or any other person identified by the member to help manage services as defined in the care plan and supervise employees if the person is unable to do so independently sect In Ohio the Authorized Representative MAY NOT also serve
as the paid care provider for the person
16
httpswwwResourcesForIntegratedCarecom
Self - Direction Authority Employer Authority
sect Employer Authority people have decision - making authority to recruit hire train and supervise the people who furnish their services3
sect In Ohio care managers must have assessed the person and determined a need for personal care services provided by a Consumer Directed Personal Care Provider or a Choices Home Care Attendant Service Provider
sect The person assumes responsibility for being the Personal Care Providerrsquos employer including hiring training setting pay rate (within guidelines) directing care and terminating providers if necessary
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from https
17
wwwmedicaidgovmedicaidltssself-directedindexhtml
httpswwwResourcesForIntegratedCarecom
Self - Direction Authority Budget Authority
sect Budget Authority person has decision - making authority over how the Medicaid funds in a budget are spent3
sect In Ohio the care manager must have assessed the person and determined a need for sect Choices Home Care Attendant Service sect Alternative Meal Service sect Pest Control sect Home Modification Maintenance and Repair sect Home Medical Equipment Supplemental Adaptive and Assistive
Devices sect The person assumes responsibility for choosing provider for
service scheduling service and setting pay rate (within guidelines)
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from https
18
wwwmedicaidgovmedicaidltssself-directedindexhtml
httpswwwResourcesForIntegratedCarecom
Traditional Care Management vs Self-Directed Care Management
19
Traditional Care Management Self-Directed Care ManagementConsumer and Care Manager decide which services are needed based on assessment
Consumer and Care Manager decide which services are needed based on assessment
Care Manager locates providers Consumer locates providers with assistance from care manager
Provider agency decides which worker to send and when to provide careservice
Consumer determines schedule based on assessed need
Provider agency hires trains and manages employees
Consumer hires trains and manages employees
Care Manager is responsible for management of provider issues
Consumer addresses service issues directly with assistance from care manager as needed
Care Manager contacts provider with any service issues
Care Manager monitors quality of service and satisfaction
httpswwwResourcesForIntegratedCarecom
The Role of Care Management in Self-Direction
sect Care managers play important roles in supporting consumers who are self - directing through bull Education bull Facilitation bull Support
20
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Education
sect Care managers can support consumers through education to ensure that the person is sect Well - informed and capable of making decisions sect Able to understand the tasks provided by the chosen
service sect Aware of their responsibilities as the employer and the
responsibilities of the provider sect In Ohio care managers answer questions about self-
direction and provide support when needed during quarterly visits or when people experience significant changes
21
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Facilitation
sect Care Managers can facilitate self - direction by sect Providing structure for the planning process sect Empowering the person to make decisions and take
action sect Helping the person identify goals sect Working with the person to guide the selection of supports
and services sect Assisting when possible with the application process rate
negotiation and service reviews
22
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Support
sect Care Managers can support consumers by sect Providing encouragement sect Working with people to help reduce potential negative
outcomes associated with their decisions sect Helping people adapt to their role as an employer sect Educating people on the importance of a back - up plan sect Helping people implement standard employment
application processes when possible sect Helping people understand supervisory responsibilities
23
httpswwwResourcesForIntegratedCarecom
Consumer Benefits of Self-Direction
sect Consumer is in control of their own supports and services sect Flexible scheduling sect Reduces unmet needscall - offs sect Enhances feelings of safety sect Promotes independence choice and self - determination sect Returns the choice to the consumer
24
httpswwwResourcesForIntegratedCarecom
Care Management Benefits of Self-Direction
sect Reduced service gaps sect Helps arrange supports and services in ldquohard to serverdquo
areas such as rural areas with direct care worker shortages
sect Helps ensure supports and services for consumers with complex service needs such as people who need assistance with toileting hourly
sect Fewer requests for change of service providers sect Satisfaction with all services increases
25
httpswwwResourcesForIntegratedCarecom
The Role of the LTSS Coordinator in Supporting Consumer Choice
Courtland Townes Deputy Director Boston Center for Independent Living
27
httpswwwResourcesForIntegratedCarecom
Massachusetts One Care Programrsquos Independent Living LTSS Model
sect One Care is the Massachusettsrsquo Medicare - Medicaid Financial Alignment Demonstration for adults living with disabilities who are dually eligible for Medicare and Medicaid
sect One Care uses a consumer - driven interdisciplinary care team comprised of medical professionals and long - term care coordinators
sect Once enrolled members have the right to have an independent living and LTSS coordinator ( IL - LTSSC) as part of their care team
27
httpswwwResourcesForIntegratedCarecom
Supporting Consumers who Choose to Live Independently
sect IL - LTSSCs are not employed by health plans but by independent community organizations such as Independent Living Centers Recovery Learning Centers and Aging Services Access Points sect This ensures that IL - LTSSCs can advocate for the
memberrsquos needs in an unbiased manner sect An important purpose of the Independent Living planning
process is to provide consumers with opportunities to learn and develop new skills that can help them succeed in achieving and maintaining their independent living goals
28
httpswwwResourcesForIntegratedCarecom
The Role of IL-LTSSCs
sect Support consumers in developing and working toward quality of life goals for independent living wellness and recovery
sect Conduct initial assessments to help consumers identify the services they need
sect Work as a care team member providing expertise in LTSS Independent Living Philosophy and Recovery Model
sect Have experience working with people with disabilities (may include lived experience with a disability)
sect Provide expertise on community services and community service providers
29
httpswwwResourcesForIntegratedCarecom
Supporting Individuals Who are Self-Directing Personal Care Services
sect The IL - LTSSC discusses the Independent Living Philosophy framework of Consumer Direction and Control with the consumer sect ldquoIndependencerdquo is different for each consumer
sect IL-LTSSCs assist consumers in identifying short- and long-term goals and current barriers to independence sect In initial assessment in the home IL - LTSSCs help consumers
identify the services they need sect Once services are approved through the Care Management
Team the IL - LTSSC begins the necessary service coordination to put vendor services in place
sect Consumers have the right to make changes to their selected services
30
httpswwwResourcesForIntegratedCarecom
What Other Types of Supports and Services are Offered to Individuals
sect Skills training and education sect Peer support sect Non - medical transportation sect Assistive technology sect Home modifications sect Home delivered meals sect Adult day health programs sect Homemaker and companion services
31
httpswwwResourcesForIntegratedCarecom
Strength-Based Needs Assessments
sect Every person regardless of his or her personal situation has unique strengths These basic strengths can be used as a starting place to begin developing other new strengths that will support the personrsquos efforts to reach his or her goals and dreams
sect Often someone from outside the personrsquos immediate environment can best help the person identify his or her unique talents abilities and strengths
32
httpswwwResourcesForIntegratedCarecom
Utilizing a Strength-Based Approach
sect IL - LTSSCs conduct strength - based initial assessments sect Key questions for a strength - based approach to
assessments sect What is working well right now in your life sect What do you want to accomplish in the future sect What is working well that you can build on sect What are some creative ways that you or someone you know has
addressed this problem in the past
sect Instead of assuming that a person has a weakness in a particular area assume that the person has not yet had opportunities that are essential to learning developing and mastering a skill in that particular area
33
httpswwwResourcesForIntegratedCarecom
Case Study 1 ldquoKarenrdquo
sect 51 - year - old woman with history of falls and diagnoses of PTSD anxiety bipolar disorder chronic respiratory disease dizziness and unspecified psychosis
sect Extremely reliant on her brother and mother for assistance with IADLs
sect Worked with IL - LTSSC to access the following Homemaker Services Companion Services Social and Medical Transportation
sect Karen reports that these services have lessened her feelings of anxiety and stress and have allowed her to feel safer and more self-sufficient in her environment
34
httpswwwResourcesForIntegratedCarecom
Case Study 2 ldquoRicardordquo
sect 53 - year - old consumer with diagnoses of depression anxiety and cognitive disabilities
sect Experienced homelessness for approximately 5 years and had to forfeit his service animal upon entering the shelter system Left the shelter after a few months and has lived in a U - Haul van for the last 2 years
sect IL - LTSSCrsquos initial focus was on housing assistance and was able to get consumer into a one - year Single Room Occupancy (SRO) Program that will give him access to permanent housing upon successful completion of program
sect IL - LTSSC is now working with care team to obtain approval for additional supports like home - delivered meals and laundry service
35
httpswwwResourcesForIntegratedCarecom
Personal Care Attendants and the Interdisciplinary Care Team
Corinne Eldridge Executive Director California Long - Term Care Education Center
37
httpswwwResourcesForIntegratedCarecom
Californiarsquos In - Home Supportive Services (IHSS) Program
sect There are 14 million dually eligible individuals in California4
sect The IHSS program serves 564000 consumers in CA5
sect 56 are 65 years or older 37 are 18 - 64 7 are under 18 sect 50 speak a primary language other than English
sect Californiarsquos IHSS program is the oldest Personal Care Attendant program in the country
sect There are 509000 IHSS workers in CA5
sect Over 50 of IHSS workers are family members
4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D5 Claire Ramsey (2019) In - Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
37
httpswwwResourcesForIntegratedCarecom
California Long - Term Care Education Center (CLTCEC) IHSS Training
sect CLTCEC began training IHSS consumer and provider pairs in 2012 sect Began with 6 health plans across 3 counties in California as
part of a Health Care Innovations Awards grant through the Center for Medicare amp Medicaid Innovation (CMMI)
sect Continued IHSS training program with 2 health plan partners LA Care Blue Shield California
38
httpswwwResourcesForIntegratedCarecom
Basic Tenants of the IHSS Training Program
39
Voluntary participation
IHSS provider learns new skills
Honors consumer-directed model of care
Competency-based education
httpswwwResourcesForIntegratedCarecom
IHSS Training Program
sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training
and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes
if possible sect 17-week course includes additional modules on body systems and disease-
specific care sect Training modules discuss the role of the IHSS provider and integration
into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration
are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have
discussions with IHSS consumer about what was learned in class that week
40
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
Introductions
Carole Stewart IHSS Consumer
Maida Castellanos Personal Care Attendant
8
httpswwwResourcesForIntegratedCarecom
Learning Objectives
sect Describe key features of self - direction and what it entails for the consumer
sect Identify the role of care managers and care coordinators in facilitating decisions on self - direction as part of developing andor amending the person - centered care plan
sect Define the role of a personal care attendant (PCA) in the interdisciplinary care team
9
httpswwwResourcesForIntegratedCarecom
Webinar OutlineAgenda
sect Poll Questions sect Overview of Self - Direction and the Role of Care Managers sect The Role of LTSS Coordinators in Supporting Consumer
Choice sect Personal Care Attendants and the Interdisciplinary Care
Team sect Making it Work Voices of a Consumer and In - Home
Supportive Services Provider sect QampA sect Evaluation
10
httpswwwResourcesForIntegratedCarecom
Overview of Self - Direction and the Role of Care Managers
Kristen Bugara Care Management Supervisor Direction Home Akron Canton Area Agency on Aging and Disabilities
11
httpswwwResourcesForIntegratedCarecom
What is Self-Direction
1 Applied Self Direction (2018) What is Self-Direction Retrieved from
12
httpwwwappliedselfdirectioncomwhat-self-direction2 Family Caregiver Alliance (2013) The National Resource Center for Participant-Directed Services Retrieved from httpswwwcaregiverorgnational-resource-
center-participant-directed-services
Self-Direction (self-directed services)
bull Helps people of all ages with all types of disabilities maintain their independence at home by choosing the mix of services and supports that work best for them
bull Built on the belief that the people receiving the services and supports know their needs best and are in the best position to plan and manage their own services1
bull Also referred to as participant direction or consumer direction
History of Self-Direction
bull Grounded in the Independent Living philosophy self-direction options for home-and-community based services (HCBS) were included in health care reform recommendations and proposed legislation introduced in Congress beginning in 1993
bull In 2002 CMS released the Independence Plus waiver application to streamline approval for waiver programs offering self-direction
bull In 2010 the Affordable Care Act (ACA) improved options for self-direction in Medicaid and authorized a new voluntary social insurance the CLASS program with participant direction at the core2
httpswwwResourcesForIntegratedCarecom
The Self-Direction Model
sect Empowers consumers by expanding their degree of choice and control over the services and supports they need to live independently
sect Helps people maintain their independence sect Allows people to determine for themselves what mix of
services and supports work best for them
13
httpswwwResourcesForIntegratedCarecom
Goals of Self-Direction
sect Seeks to maximize each personrsquos ability to control their own decisions
sect Allows the person to be at the center of the process sect Promotes self - efficacy sect Empowers each person to take responsibility for their
supports and services sect Complements person - centered planning and facilitation
14
httpswwwResourcesForIntegratedCarecom
Characteristics of Candidates for Self-Directionsect Desire to have control of decisions regarding supports sect Understanding of what is allowable for each service and role
(eg personal care attendants cannot administer medication) sect Ability to manage and communicate decisions sect Ability to be the ldquoemployerrdquo sect Strong problem solving skills including ability to interview
hire train supervise and terminate employees sect Safe and stable living environment sect Strong back - up plan sect Agreement to work with a Fiscal Management Service sect Available authorized representative for people who cannot
self - direct
15
httpswwwResourcesForIntegratedCarecom
Authorized Representatives for Self-Direction
sect If the person cannot maintain control of their own supports and services they may assign an Authorized Representative to act on their behalf
sect Authorized Representative A personrsquos legal guardian family member or any other person identified by the member to help manage services as defined in the care plan and supervise employees if the person is unable to do so independently sect In Ohio the Authorized Representative MAY NOT also serve
as the paid care provider for the person
16
httpswwwResourcesForIntegratedCarecom
Self - Direction Authority Employer Authority
sect Employer Authority people have decision - making authority to recruit hire train and supervise the people who furnish their services3
sect In Ohio care managers must have assessed the person and determined a need for personal care services provided by a Consumer Directed Personal Care Provider or a Choices Home Care Attendant Service Provider
sect The person assumes responsibility for being the Personal Care Providerrsquos employer including hiring training setting pay rate (within guidelines) directing care and terminating providers if necessary
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from https
17
wwwmedicaidgovmedicaidltssself-directedindexhtml
httpswwwResourcesForIntegratedCarecom
Self - Direction Authority Budget Authority
sect Budget Authority person has decision - making authority over how the Medicaid funds in a budget are spent3
sect In Ohio the care manager must have assessed the person and determined a need for sect Choices Home Care Attendant Service sect Alternative Meal Service sect Pest Control sect Home Modification Maintenance and Repair sect Home Medical Equipment Supplemental Adaptive and Assistive
Devices sect The person assumes responsibility for choosing provider for
service scheduling service and setting pay rate (within guidelines)
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from https
18
wwwmedicaidgovmedicaidltssself-directedindexhtml
httpswwwResourcesForIntegratedCarecom
Traditional Care Management vs Self-Directed Care Management
19
Traditional Care Management Self-Directed Care ManagementConsumer and Care Manager decide which services are needed based on assessment
Consumer and Care Manager decide which services are needed based on assessment
Care Manager locates providers Consumer locates providers with assistance from care manager
Provider agency decides which worker to send and when to provide careservice
Consumer determines schedule based on assessed need
Provider agency hires trains and manages employees
Consumer hires trains and manages employees
Care Manager is responsible for management of provider issues
Consumer addresses service issues directly with assistance from care manager as needed
Care Manager contacts provider with any service issues
Care Manager monitors quality of service and satisfaction
httpswwwResourcesForIntegratedCarecom
The Role of Care Management in Self-Direction
sect Care managers play important roles in supporting consumers who are self - directing through bull Education bull Facilitation bull Support
20
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Education
sect Care managers can support consumers through education to ensure that the person is sect Well - informed and capable of making decisions sect Able to understand the tasks provided by the chosen
service sect Aware of their responsibilities as the employer and the
responsibilities of the provider sect In Ohio care managers answer questions about self-
direction and provide support when needed during quarterly visits or when people experience significant changes
21
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Facilitation
sect Care Managers can facilitate self - direction by sect Providing structure for the planning process sect Empowering the person to make decisions and take
action sect Helping the person identify goals sect Working with the person to guide the selection of supports
and services sect Assisting when possible with the application process rate
negotiation and service reviews
22
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Support
sect Care Managers can support consumers by sect Providing encouragement sect Working with people to help reduce potential negative
outcomes associated with their decisions sect Helping people adapt to their role as an employer sect Educating people on the importance of a back - up plan sect Helping people implement standard employment
application processes when possible sect Helping people understand supervisory responsibilities
23
httpswwwResourcesForIntegratedCarecom
Consumer Benefits of Self-Direction
sect Consumer is in control of their own supports and services sect Flexible scheduling sect Reduces unmet needscall - offs sect Enhances feelings of safety sect Promotes independence choice and self - determination sect Returns the choice to the consumer
24
httpswwwResourcesForIntegratedCarecom
Care Management Benefits of Self-Direction
sect Reduced service gaps sect Helps arrange supports and services in ldquohard to serverdquo
areas such as rural areas with direct care worker shortages
sect Helps ensure supports and services for consumers with complex service needs such as people who need assistance with toileting hourly
sect Fewer requests for change of service providers sect Satisfaction with all services increases
25
httpswwwResourcesForIntegratedCarecom
The Role of the LTSS Coordinator in Supporting Consumer Choice
Courtland Townes Deputy Director Boston Center for Independent Living
27
httpswwwResourcesForIntegratedCarecom
Massachusetts One Care Programrsquos Independent Living LTSS Model
sect One Care is the Massachusettsrsquo Medicare - Medicaid Financial Alignment Demonstration for adults living with disabilities who are dually eligible for Medicare and Medicaid
sect One Care uses a consumer - driven interdisciplinary care team comprised of medical professionals and long - term care coordinators
sect Once enrolled members have the right to have an independent living and LTSS coordinator ( IL - LTSSC) as part of their care team
27
httpswwwResourcesForIntegratedCarecom
Supporting Consumers who Choose to Live Independently
sect IL - LTSSCs are not employed by health plans but by independent community organizations such as Independent Living Centers Recovery Learning Centers and Aging Services Access Points sect This ensures that IL - LTSSCs can advocate for the
memberrsquos needs in an unbiased manner sect An important purpose of the Independent Living planning
process is to provide consumers with opportunities to learn and develop new skills that can help them succeed in achieving and maintaining their independent living goals
28
httpswwwResourcesForIntegratedCarecom
The Role of IL-LTSSCs
sect Support consumers in developing and working toward quality of life goals for independent living wellness and recovery
sect Conduct initial assessments to help consumers identify the services they need
sect Work as a care team member providing expertise in LTSS Independent Living Philosophy and Recovery Model
sect Have experience working with people with disabilities (may include lived experience with a disability)
sect Provide expertise on community services and community service providers
29
httpswwwResourcesForIntegratedCarecom
Supporting Individuals Who are Self-Directing Personal Care Services
sect The IL - LTSSC discusses the Independent Living Philosophy framework of Consumer Direction and Control with the consumer sect ldquoIndependencerdquo is different for each consumer
sect IL-LTSSCs assist consumers in identifying short- and long-term goals and current barriers to independence sect In initial assessment in the home IL - LTSSCs help consumers
identify the services they need sect Once services are approved through the Care Management
Team the IL - LTSSC begins the necessary service coordination to put vendor services in place
sect Consumers have the right to make changes to their selected services
30
httpswwwResourcesForIntegratedCarecom
What Other Types of Supports and Services are Offered to Individuals
sect Skills training and education sect Peer support sect Non - medical transportation sect Assistive technology sect Home modifications sect Home delivered meals sect Adult day health programs sect Homemaker and companion services
31
httpswwwResourcesForIntegratedCarecom
Strength-Based Needs Assessments
sect Every person regardless of his or her personal situation has unique strengths These basic strengths can be used as a starting place to begin developing other new strengths that will support the personrsquos efforts to reach his or her goals and dreams
sect Often someone from outside the personrsquos immediate environment can best help the person identify his or her unique talents abilities and strengths
32
httpswwwResourcesForIntegratedCarecom
Utilizing a Strength-Based Approach
sect IL - LTSSCs conduct strength - based initial assessments sect Key questions for a strength - based approach to
assessments sect What is working well right now in your life sect What do you want to accomplish in the future sect What is working well that you can build on sect What are some creative ways that you or someone you know has
addressed this problem in the past
sect Instead of assuming that a person has a weakness in a particular area assume that the person has not yet had opportunities that are essential to learning developing and mastering a skill in that particular area
33
httpswwwResourcesForIntegratedCarecom
Case Study 1 ldquoKarenrdquo
sect 51 - year - old woman with history of falls and diagnoses of PTSD anxiety bipolar disorder chronic respiratory disease dizziness and unspecified psychosis
sect Extremely reliant on her brother and mother for assistance with IADLs
sect Worked with IL - LTSSC to access the following Homemaker Services Companion Services Social and Medical Transportation
sect Karen reports that these services have lessened her feelings of anxiety and stress and have allowed her to feel safer and more self-sufficient in her environment
34
httpswwwResourcesForIntegratedCarecom
Case Study 2 ldquoRicardordquo
sect 53 - year - old consumer with diagnoses of depression anxiety and cognitive disabilities
sect Experienced homelessness for approximately 5 years and had to forfeit his service animal upon entering the shelter system Left the shelter after a few months and has lived in a U - Haul van for the last 2 years
sect IL - LTSSCrsquos initial focus was on housing assistance and was able to get consumer into a one - year Single Room Occupancy (SRO) Program that will give him access to permanent housing upon successful completion of program
sect IL - LTSSC is now working with care team to obtain approval for additional supports like home - delivered meals and laundry service
35
httpswwwResourcesForIntegratedCarecom
Personal Care Attendants and the Interdisciplinary Care Team
Corinne Eldridge Executive Director California Long - Term Care Education Center
37
httpswwwResourcesForIntegratedCarecom
Californiarsquos In - Home Supportive Services (IHSS) Program
sect There are 14 million dually eligible individuals in California4
sect The IHSS program serves 564000 consumers in CA5
sect 56 are 65 years or older 37 are 18 - 64 7 are under 18 sect 50 speak a primary language other than English
sect Californiarsquos IHSS program is the oldest Personal Care Attendant program in the country
sect There are 509000 IHSS workers in CA5
sect Over 50 of IHSS workers are family members
4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D5 Claire Ramsey (2019) In - Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
37
httpswwwResourcesForIntegratedCarecom
California Long - Term Care Education Center (CLTCEC) IHSS Training
sect CLTCEC began training IHSS consumer and provider pairs in 2012 sect Began with 6 health plans across 3 counties in California as
part of a Health Care Innovations Awards grant through the Center for Medicare amp Medicaid Innovation (CMMI)
sect Continued IHSS training program with 2 health plan partners LA Care Blue Shield California
38
httpswwwResourcesForIntegratedCarecom
Basic Tenants of the IHSS Training Program
39
Voluntary participation
IHSS provider learns new skills
Honors consumer-directed model of care
Competency-based education
httpswwwResourcesForIntegratedCarecom
IHSS Training Program
sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training
and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes
if possible sect 17-week course includes additional modules on body systems and disease-
specific care sect Training modules discuss the role of the IHSS provider and integration
into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration
are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have
discussions with IHSS consumer about what was learned in class that week
40
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
Learning Objectives
sect Describe key features of self - direction and what it entails for the consumer
sect Identify the role of care managers and care coordinators in facilitating decisions on self - direction as part of developing andor amending the person - centered care plan
sect Define the role of a personal care attendant (PCA) in the interdisciplinary care team
9
httpswwwResourcesForIntegratedCarecom
Webinar OutlineAgenda
sect Poll Questions sect Overview of Self - Direction and the Role of Care Managers sect The Role of LTSS Coordinators in Supporting Consumer
Choice sect Personal Care Attendants and the Interdisciplinary Care
Team sect Making it Work Voices of a Consumer and In - Home
Supportive Services Provider sect QampA sect Evaluation
10
httpswwwResourcesForIntegratedCarecom
Overview of Self - Direction and the Role of Care Managers
Kristen Bugara Care Management Supervisor Direction Home Akron Canton Area Agency on Aging and Disabilities
11
httpswwwResourcesForIntegratedCarecom
What is Self-Direction
1 Applied Self Direction (2018) What is Self-Direction Retrieved from
12
httpwwwappliedselfdirectioncomwhat-self-direction2 Family Caregiver Alliance (2013) The National Resource Center for Participant-Directed Services Retrieved from httpswwwcaregiverorgnational-resource-
center-participant-directed-services
Self-Direction (self-directed services)
bull Helps people of all ages with all types of disabilities maintain their independence at home by choosing the mix of services and supports that work best for them
bull Built on the belief that the people receiving the services and supports know their needs best and are in the best position to plan and manage their own services1
bull Also referred to as participant direction or consumer direction
History of Self-Direction
bull Grounded in the Independent Living philosophy self-direction options for home-and-community based services (HCBS) were included in health care reform recommendations and proposed legislation introduced in Congress beginning in 1993
bull In 2002 CMS released the Independence Plus waiver application to streamline approval for waiver programs offering self-direction
bull In 2010 the Affordable Care Act (ACA) improved options for self-direction in Medicaid and authorized a new voluntary social insurance the CLASS program with participant direction at the core2
httpswwwResourcesForIntegratedCarecom
The Self-Direction Model
sect Empowers consumers by expanding their degree of choice and control over the services and supports they need to live independently
sect Helps people maintain their independence sect Allows people to determine for themselves what mix of
services and supports work best for them
13
httpswwwResourcesForIntegratedCarecom
Goals of Self-Direction
sect Seeks to maximize each personrsquos ability to control their own decisions
sect Allows the person to be at the center of the process sect Promotes self - efficacy sect Empowers each person to take responsibility for their
supports and services sect Complements person - centered planning and facilitation
14
httpswwwResourcesForIntegratedCarecom
Characteristics of Candidates for Self-Directionsect Desire to have control of decisions regarding supports sect Understanding of what is allowable for each service and role
(eg personal care attendants cannot administer medication) sect Ability to manage and communicate decisions sect Ability to be the ldquoemployerrdquo sect Strong problem solving skills including ability to interview
hire train supervise and terminate employees sect Safe and stable living environment sect Strong back - up plan sect Agreement to work with a Fiscal Management Service sect Available authorized representative for people who cannot
self - direct
15
httpswwwResourcesForIntegratedCarecom
Authorized Representatives for Self-Direction
sect If the person cannot maintain control of their own supports and services they may assign an Authorized Representative to act on their behalf
sect Authorized Representative A personrsquos legal guardian family member or any other person identified by the member to help manage services as defined in the care plan and supervise employees if the person is unable to do so independently sect In Ohio the Authorized Representative MAY NOT also serve
as the paid care provider for the person
16
httpswwwResourcesForIntegratedCarecom
Self - Direction Authority Employer Authority
sect Employer Authority people have decision - making authority to recruit hire train and supervise the people who furnish their services3
sect In Ohio care managers must have assessed the person and determined a need for personal care services provided by a Consumer Directed Personal Care Provider or a Choices Home Care Attendant Service Provider
sect The person assumes responsibility for being the Personal Care Providerrsquos employer including hiring training setting pay rate (within guidelines) directing care and terminating providers if necessary
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from https
17
wwwmedicaidgovmedicaidltssself-directedindexhtml
httpswwwResourcesForIntegratedCarecom
Self - Direction Authority Budget Authority
sect Budget Authority person has decision - making authority over how the Medicaid funds in a budget are spent3
sect In Ohio the care manager must have assessed the person and determined a need for sect Choices Home Care Attendant Service sect Alternative Meal Service sect Pest Control sect Home Modification Maintenance and Repair sect Home Medical Equipment Supplemental Adaptive and Assistive
Devices sect The person assumes responsibility for choosing provider for
service scheduling service and setting pay rate (within guidelines)
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from https
18
wwwmedicaidgovmedicaidltssself-directedindexhtml
httpswwwResourcesForIntegratedCarecom
Traditional Care Management vs Self-Directed Care Management
19
Traditional Care Management Self-Directed Care ManagementConsumer and Care Manager decide which services are needed based on assessment
Consumer and Care Manager decide which services are needed based on assessment
Care Manager locates providers Consumer locates providers with assistance from care manager
Provider agency decides which worker to send and when to provide careservice
Consumer determines schedule based on assessed need
Provider agency hires trains and manages employees
Consumer hires trains and manages employees
Care Manager is responsible for management of provider issues
Consumer addresses service issues directly with assistance from care manager as needed
Care Manager contacts provider with any service issues
Care Manager monitors quality of service and satisfaction
httpswwwResourcesForIntegratedCarecom
The Role of Care Management in Self-Direction
sect Care managers play important roles in supporting consumers who are self - directing through bull Education bull Facilitation bull Support
20
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Education
sect Care managers can support consumers through education to ensure that the person is sect Well - informed and capable of making decisions sect Able to understand the tasks provided by the chosen
service sect Aware of their responsibilities as the employer and the
responsibilities of the provider sect In Ohio care managers answer questions about self-
direction and provide support when needed during quarterly visits or when people experience significant changes
21
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Facilitation
sect Care Managers can facilitate self - direction by sect Providing structure for the planning process sect Empowering the person to make decisions and take
action sect Helping the person identify goals sect Working with the person to guide the selection of supports
and services sect Assisting when possible with the application process rate
negotiation and service reviews
22
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Support
sect Care Managers can support consumers by sect Providing encouragement sect Working with people to help reduce potential negative
outcomes associated with their decisions sect Helping people adapt to their role as an employer sect Educating people on the importance of a back - up plan sect Helping people implement standard employment
application processes when possible sect Helping people understand supervisory responsibilities
23
httpswwwResourcesForIntegratedCarecom
Consumer Benefits of Self-Direction
sect Consumer is in control of their own supports and services sect Flexible scheduling sect Reduces unmet needscall - offs sect Enhances feelings of safety sect Promotes independence choice and self - determination sect Returns the choice to the consumer
24
httpswwwResourcesForIntegratedCarecom
Care Management Benefits of Self-Direction
sect Reduced service gaps sect Helps arrange supports and services in ldquohard to serverdquo
areas such as rural areas with direct care worker shortages
sect Helps ensure supports and services for consumers with complex service needs such as people who need assistance with toileting hourly
sect Fewer requests for change of service providers sect Satisfaction with all services increases
25
httpswwwResourcesForIntegratedCarecom
The Role of the LTSS Coordinator in Supporting Consumer Choice
Courtland Townes Deputy Director Boston Center for Independent Living
27
httpswwwResourcesForIntegratedCarecom
Massachusetts One Care Programrsquos Independent Living LTSS Model
sect One Care is the Massachusettsrsquo Medicare - Medicaid Financial Alignment Demonstration for adults living with disabilities who are dually eligible for Medicare and Medicaid
sect One Care uses a consumer - driven interdisciplinary care team comprised of medical professionals and long - term care coordinators
sect Once enrolled members have the right to have an independent living and LTSS coordinator ( IL - LTSSC) as part of their care team
27
httpswwwResourcesForIntegratedCarecom
Supporting Consumers who Choose to Live Independently
sect IL - LTSSCs are not employed by health plans but by independent community organizations such as Independent Living Centers Recovery Learning Centers and Aging Services Access Points sect This ensures that IL - LTSSCs can advocate for the
memberrsquos needs in an unbiased manner sect An important purpose of the Independent Living planning
process is to provide consumers with opportunities to learn and develop new skills that can help them succeed in achieving and maintaining their independent living goals
28
httpswwwResourcesForIntegratedCarecom
The Role of IL-LTSSCs
sect Support consumers in developing and working toward quality of life goals for independent living wellness and recovery
sect Conduct initial assessments to help consumers identify the services they need
sect Work as a care team member providing expertise in LTSS Independent Living Philosophy and Recovery Model
sect Have experience working with people with disabilities (may include lived experience with a disability)
sect Provide expertise on community services and community service providers
29
httpswwwResourcesForIntegratedCarecom
Supporting Individuals Who are Self-Directing Personal Care Services
sect The IL - LTSSC discusses the Independent Living Philosophy framework of Consumer Direction and Control with the consumer sect ldquoIndependencerdquo is different for each consumer
sect IL-LTSSCs assist consumers in identifying short- and long-term goals and current barriers to independence sect In initial assessment in the home IL - LTSSCs help consumers
identify the services they need sect Once services are approved through the Care Management
Team the IL - LTSSC begins the necessary service coordination to put vendor services in place
sect Consumers have the right to make changes to their selected services
30
httpswwwResourcesForIntegratedCarecom
What Other Types of Supports and Services are Offered to Individuals
sect Skills training and education sect Peer support sect Non - medical transportation sect Assistive technology sect Home modifications sect Home delivered meals sect Adult day health programs sect Homemaker and companion services
31
httpswwwResourcesForIntegratedCarecom
Strength-Based Needs Assessments
sect Every person regardless of his or her personal situation has unique strengths These basic strengths can be used as a starting place to begin developing other new strengths that will support the personrsquos efforts to reach his or her goals and dreams
sect Often someone from outside the personrsquos immediate environment can best help the person identify his or her unique talents abilities and strengths
32
httpswwwResourcesForIntegratedCarecom
Utilizing a Strength-Based Approach
sect IL - LTSSCs conduct strength - based initial assessments sect Key questions for a strength - based approach to
assessments sect What is working well right now in your life sect What do you want to accomplish in the future sect What is working well that you can build on sect What are some creative ways that you or someone you know has
addressed this problem in the past
sect Instead of assuming that a person has a weakness in a particular area assume that the person has not yet had opportunities that are essential to learning developing and mastering a skill in that particular area
33
httpswwwResourcesForIntegratedCarecom
Case Study 1 ldquoKarenrdquo
sect 51 - year - old woman with history of falls and diagnoses of PTSD anxiety bipolar disorder chronic respiratory disease dizziness and unspecified psychosis
sect Extremely reliant on her brother and mother for assistance with IADLs
sect Worked with IL - LTSSC to access the following Homemaker Services Companion Services Social and Medical Transportation
sect Karen reports that these services have lessened her feelings of anxiety and stress and have allowed her to feel safer and more self-sufficient in her environment
34
httpswwwResourcesForIntegratedCarecom
Case Study 2 ldquoRicardordquo
sect 53 - year - old consumer with diagnoses of depression anxiety and cognitive disabilities
sect Experienced homelessness for approximately 5 years and had to forfeit his service animal upon entering the shelter system Left the shelter after a few months and has lived in a U - Haul van for the last 2 years
sect IL - LTSSCrsquos initial focus was on housing assistance and was able to get consumer into a one - year Single Room Occupancy (SRO) Program that will give him access to permanent housing upon successful completion of program
sect IL - LTSSC is now working with care team to obtain approval for additional supports like home - delivered meals and laundry service
35
httpswwwResourcesForIntegratedCarecom
Personal Care Attendants and the Interdisciplinary Care Team
Corinne Eldridge Executive Director California Long - Term Care Education Center
37
httpswwwResourcesForIntegratedCarecom
Californiarsquos In - Home Supportive Services (IHSS) Program
sect There are 14 million dually eligible individuals in California4
sect The IHSS program serves 564000 consumers in CA5
sect 56 are 65 years or older 37 are 18 - 64 7 are under 18 sect 50 speak a primary language other than English
sect Californiarsquos IHSS program is the oldest Personal Care Attendant program in the country
sect There are 509000 IHSS workers in CA5
sect Over 50 of IHSS workers are family members
4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D5 Claire Ramsey (2019) In - Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
37
httpswwwResourcesForIntegratedCarecom
California Long - Term Care Education Center (CLTCEC) IHSS Training
sect CLTCEC began training IHSS consumer and provider pairs in 2012 sect Began with 6 health plans across 3 counties in California as
part of a Health Care Innovations Awards grant through the Center for Medicare amp Medicaid Innovation (CMMI)
sect Continued IHSS training program with 2 health plan partners LA Care Blue Shield California
38
httpswwwResourcesForIntegratedCarecom
Basic Tenants of the IHSS Training Program
39
Voluntary participation
IHSS provider learns new skills
Honors consumer-directed model of care
Competency-based education
httpswwwResourcesForIntegratedCarecom
IHSS Training Program
sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training
and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes
if possible sect 17-week course includes additional modules on body systems and disease-
specific care sect Training modules discuss the role of the IHSS provider and integration
into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration
are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have
discussions with IHSS consumer about what was learned in class that week
40
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
Webinar OutlineAgenda
sect Poll Questions sect Overview of Self - Direction and the Role of Care Managers sect The Role of LTSS Coordinators in Supporting Consumer
Choice sect Personal Care Attendants and the Interdisciplinary Care
Team sect Making it Work Voices of a Consumer and In - Home
Supportive Services Provider sect QampA sect Evaluation
10
httpswwwResourcesForIntegratedCarecom
Overview of Self - Direction and the Role of Care Managers
Kristen Bugara Care Management Supervisor Direction Home Akron Canton Area Agency on Aging and Disabilities
11
httpswwwResourcesForIntegratedCarecom
What is Self-Direction
1 Applied Self Direction (2018) What is Self-Direction Retrieved from
12
httpwwwappliedselfdirectioncomwhat-self-direction2 Family Caregiver Alliance (2013) The National Resource Center for Participant-Directed Services Retrieved from httpswwwcaregiverorgnational-resource-
center-participant-directed-services
Self-Direction (self-directed services)
bull Helps people of all ages with all types of disabilities maintain their independence at home by choosing the mix of services and supports that work best for them
bull Built on the belief that the people receiving the services and supports know their needs best and are in the best position to plan and manage their own services1
bull Also referred to as participant direction or consumer direction
History of Self-Direction
bull Grounded in the Independent Living philosophy self-direction options for home-and-community based services (HCBS) were included in health care reform recommendations and proposed legislation introduced in Congress beginning in 1993
bull In 2002 CMS released the Independence Plus waiver application to streamline approval for waiver programs offering self-direction
bull In 2010 the Affordable Care Act (ACA) improved options for self-direction in Medicaid and authorized a new voluntary social insurance the CLASS program with participant direction at the core2
httpswwwResourcesForIntegratedCarecom
The Self-Direction Model
sect Empowers consumers by expanding their degree of choice and control over the services and supports they need to live independently
sect Helps people maintain their independence sect Allows people to determine for themselves what mix of
services and supports work best for them
13
httpswwwResourcesForIntegratedCarecom
Goals of Self-Direction
sect Seeks to maximize each personrsquos ability to control their own decisions
sect Allows the person to be at the center of the process sect Promotes self - efficacy sect Empowers each person to take responsibility for their
supports and services sect Complements person - centered planning and facilitation
14
httpswwwResourcesForIntegratedCarecom
Characteristics of Candidates for Self-Directionsect Desire to have control of decisions regarding supports sect Understanding of what is allowable for each service and role
(eg personal care attendants cannot administer medication) sect Ability to manage and communicate decisions sect Ability to be the ldquoemployerrdquo sect Strong problem solving skills including ability to interview
hire train supervise and terminate employees sect Safe and stable living environment sect Strong back - up plan sect Agreement to work with a Fiscal Management Service sect Available authorized representative for people who cannot
self - direct
15
httpswwwResourcesForIntegratedCarecom
Authorized Representatives for Self-Direction
sect If the person cannot maintain control of their own supports and services they may assign an Authorized Representative to act on their behalf
sect Authorized Representative A personrsquos legal guardian family member or any other person identified by the member to help manage services as defined in the care plan and supervise employees if the person is unable to do so independently sect In Ohio the Authorized Representative MAY NOT also serve
as the paid care provider for the person
16
httpswwwResourcesForIntegratedCarecom
Self - Direction Authority Employer Authority
sect Employer Authority people have decision - making authority to recruit hire train and supervise the people who furnish their services3
sect In Ohio care managers must have assessed the person and determined a need for personal care services provided by a Consumer Directed Personal Care Provider or a Choices Home Care Attendant Service Provider
sect The person assumes responsibility for being the Personal Care Providerrsquos employer including hiring training setting pay rate (within guidelines) directing care and terminating providers if necessary
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from https
17
wwwmedicaidgovmedicaidltssself-directedindexhtml
httpswwwResourcesForIntegratedCarecom
Self - Direction Authority Budget Authority
sect Budget Authority person has decision - making authority over how the Medicaid funds in a budget are spent3
sect In Ohio the care manager must have assessed the person and determined a need for sect Choices Home Care Attendant Service sect Alternative Meal Service sect Pest Control sect Home Modification Maintenance and Repair sect Home Medical Equipment Supplemental Adaptive and Assistive
Devices sect The person assumes responsibility for choosing provider for
service scheduling service and setting pay rate (within guidelines)
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from https
18
wwwmedicaidgovmedicaidltssself-directedindexhtml
httpswwwResourcesForIntegratedCarecom
Traditional Care Management vs Self-Directed Care Management
19
Traditional Care Management Self-Directed Care ManagementConsumer and Care Manager decide which services are needed based on assessment
Consumer and Care Manager decide which services are needed based on assessment
Care Manager locates providers Consumer locates providers with assistance from care manager
Provider agency decides which worker to send and when to provide careservice
Consumer determines schedule based on assessed need
Provider agency hires trains and manages employees
Consumer hires trains and manages employees
Care Manager is responsible for management of provider issues
Consumer addresses service issues directly with assistance from care manager as needed
Care Manager contacts provider with any service issues
Care Manager monitors quality of service and satisfaction
httpswwwResourcesForIntegratedCarecom
The Role of Care Management in Self-Direction
sect Care managers play important roles in supporting consumers who are self - directing through bull Education bull Facilitation bull Support
20
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Education
sect Care managers can support consumers through education to ensure that the person is sect Well - informed and capable of making decisions sect Able to understand the tasks provided by the chosen
service sect Aware of their responsibilities as the employer and the
responsibilities of the provider sect In Ohio care managers answer questions about self-
direction and provide support when needed during quarterly visits or when people experience significant changes
21
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Facilitation
sect Care Managers can facilitate self - direction by sect Providing structure for the planning process sect Empowering the person to make decisions and take
action sect Helping the person identify goals sect Working with the person to guide the selection of supports
and services sect Assisting when possible with the application process rate
negotiation and service reviews
22
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Support
sect Care Managers can support consumers by sect Providing encouragement sect Working with people to help reduce potential negative
outcomes associated with their decisions sect Helping people adapt to their role as an employer sect Educating people on the importance of a back - up plan sect Helping people implement standard employment
application processes when possible sect Helping people understand supervisory responsibilities
23
httpswwwResourcesForIntegratedCarecom
Consumer Benefits of Self-Direction
sect Consumer is in control of their own supports and services sect Flexible scheduling sect Reduces unmet needscall - offs sect Enhances feelings of safety sect Promotes independence choice and self - determination sect Returns the choice to the consumer
24
httpswwwResourcesForIntegratedCarecom
Care Management Benefits of Self-Direction
sect Reduced service gaps sect Helps arrange supports and services in ldquohard to serverdquo
areas such as rural areas with direct care worker shortages
sect Helps ensure supports and services for consumers with complex service needs such as people who need assistance with toileting hourly
sect Fewer requests for change of service providers sect Satisfaction with all services increases
25
httpswwwResourcesForIntegratedCarecom
The Role of the LTSS Coordinator in Supporting Consumer Choice
Courtland Townes Deputy Director Boston Center for Independent Living
27
httpswwwResourcesForIntegratedCarecom
Massachusetts One Care Programrsquos Independent Living LTSS Model
sect One Care is the Massachusettsrsquo Medicare - Medicaid Financial Alignment Demonstration for adults living with disabilities who are dually eligible for Medicare and Medicaid
sect One Care uses a consumer - driven interdisciplinary care team comprised of medical professionals and long - term care coordinators
sect Once enrolled members have the right to have an independent living and LTSS coordinator ( IL - LTSSC) as part of their care team
27
httpswwwResourcesForIntegratedCarecom
Supporting Consumers who Choose to Live Independently
sect IL - LTSSCs are not employed by health plans but by independent community organizations such as Independent Living Centers Recovery Learning Centers and Aging Services Access Points sect This ensures that IL - LTSSCs can advocate for the
memberrsquos needs in an unbiased manner sect An important purpose of the Independent Living planning
process is to provide consumers with opportunities to learn and develop new skills that can help them succeed in achieving and maintaining their independent living goals
28
httpswwwResourcesForIntegratedCarecom
The Role of IL-LTSSCs
sect Support consumers in developing and working toward quality of life goals for independent living wellness and recovery
sect Conduct initial assessments to help consumers identify the services they need
sect Work as a care team member providing expertise in LTSS Independent Living Philosophy and Recovery Model
sect Have experience working with people with disabilities (may include lived experience with a disability)
sect Provide expertise on community services and community service providers
29
httpswwwResourcesForIntegratedCarecom
Supporting Individuals Who are Self-Directing Personal Care Services
sect The IL - LTSSC discusses the Independent Living Philosophy framework of Consumer Direction and Control with the consumer sect ldquoIndependencerdquo is different for each consumer
sect IL-LTSSCs assist consumers in identifying short- and long-term goals and current barriers to independence sect In initial assessment in the home IL - LTSSCs help consumers
identify the services they need sect Once services are approved through the Care Management
Team the IL - LTSSC begins the necessary service coordination to put vendor services in place
sect Consumers have the right to make changes to their selected services
30
httpswwwResourcesForIntegratedCarecom
What Other Types of Supports and Services are Offered to Individuals
sect Skills training and education sect Peer support sect Non - medical transportation sect Assistive technology sect Home modifications sect Home delivered meals sect Adult day health programs sect Homemaker and companion services
31
httpswwwResourcesForIntegratedCarecom
Strength-Based Needs Assessments
sect Every person regardless of his or her personal situation has unique strengths These basic strengths can be used as a starting place to begin developing other new strengths that will support the personrsquos efforts to reach his or her goals and dreams
sect Often someone from outside the personrsquos immediate environment can best help the person identify his or her unique talents abilities and strengths
32
httpswwwResourcesForIntegratedCarecom
Utilizing a Strength-Based Approach
sect IL - LTSSCs conduct strength - based initial assessments sect Key questions for a strength - based approach to
assessments sect What is working well right now in your life sect What do you want to accomplish in the future sect What is working well that you can build on sect What are some creative ways that you or someone you know has
addressed this problem in the past
sect Instead of assuming that a person has a weakness in a particular area assume that the person has not yet had opportunities that are essential to learning developing and mastering a skill in that particular area
33
httpswwwResourcesForIntegratedCarecom
Case Study 1 ldquoKarenrdquo
sect 51 - year - old woman with history of falls and diagnoses of PTSD anxiety bipolar disorder chronic respiratory disease dizziness and unspecified psychosis
sect Extremely reliant on her brother and mother for assistance with IADLs
sect Worked with IL - LTSSC to access the following Homemaker Services Companion Services Social and Medical Transportation
sect Karen reports that these services have lessened her feelings of anxiety and stress and have allowed her to feel safer and more self-sufficient in her environment
34
httpswwwResourcesForIntegratedCarecom
Case Study 2 ldquoRicardordquo
sect 53 - year - old consumer with diagnoses of depression anxiety and cognitive disabilities
sect Experienced homelessness for approximately 5 years and had to forfeit his service animal upon entering the shelter system Left the shelter after a few months and has lived in a U - Haul van for the last 2 years
sect IL - LTSSCrsquos initial focus was on housing assistance and was able to get consumer into a one - year Single Room Occupancy (SRO) Program that will give him access to permanent housing upon successful completion of program
sect IL - LTSSC is now working with care team to obtain approval for additional supports like home - delivered meals and laundry service
35
httpswwwResourcesForIntegratedCarecom
Personal Care Attendants and the Interdisciplinary Care Team
Corinne Eldridge Executive Director California Long - Term Care Education Center
37
httpswwwResourcesForIntegratedCarecom
Californiarsquos In - Home Supportive Services (IHSS) Program
sect There are 14 million dually eligible individuals in California4
sect The IHSS program serves 564000 consumers in CA5
sect 56 are 65 years or older 37 are 18 - 64 7 are under 18 sect 50 speak a primary language other than English
sect Californiarsquos IHSS program is the oldest Personal Care Attendant program in the country
sect There are 509000 IHSS workers in CA5
sect Over 50 of IHSS workers are family members
4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D5 Claire Ramsey (2019) In - Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
37
httpswwwResourcesForIntegratedCarecom
California Long - Term Care Education Center (CLTCEC) IHSS Training
sect CLTCEC began training IHSS consumer and provider pairs in 2012 sect Began with 6 health plans across 3 counties in California as
part of a Health Care Innovations Awards grant through the Center for Medicare amp Medicaid Innovation (CMMI)
sect Continued IHSS training program with 2 health plan partners LA Care Blue Shield California
38
httpswwwResourcesForIntegratedCarecom
Basic Tenants of the IHSS Training Program
39
Voluntary participation
IHSS provider learns new skills
Honors consumer-directed model of care
Competency-based education
httpswwwResourcesForIntegratedCarecom
IHSS Training Program
sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training
and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes
if possible sect 17-week course includes additional modules on body systems and disease-
specific care sect Training modules discuss the role of the IHSS provider and integration
into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration
are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have
discussions with IHSS consumer about what was learned in class that week
40
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
Overview of Self - Direction and the Role of Care Managers
Kristen Bugara Care Management Supervisor Direction Home Akron Canton Area Agency on Aging and Disabilities
11
httpswwwResourcesForIntegratedCarecom
What is Self-Direction
1 Applied Self Direction (2018) What is Self-Direction Retrieved from
12
httpwwwappliedselfdirectioncomwhat-self-direction2 Family Caregiver Alliance (2013) The National Resource Center for Participant-Directed Services Retrieved from httpswwwcaregiverorgnational-resource-
center-participant-directed-services
Self-Direction (self-directed services)
bull Helps people of all ages with all types of disabilities maintain their independence at home by choosing the mix of services and supports that work best for them
bull Built on the belief that the people receiving the services and supports know their needs best and are in the best position to plan and manage their own services1
bull Also referred to as participant direction or consumer direction
History of Self-Direction
bull Grounded in the Independent Living philosophy self-direction options for home-and-community based services (HCBS) were included in health care reform recommendations and proposed legislation introduced in Congress beginning in 1993
bull In 2002 CMS released the Independence Plus waiver application to streamline approval for waiver programs offering self-direction
bull In 2010 the Affordable Care Act (ACA) improved options for self-direction in Medicaid and authorized a new voluntary social insurance the CLASS program with participant direction at the core2
httpswwwResourcesForIntegratedCarecom
The Self-Direction Model
sect Empowers consumers by expanding their degree of choice and control over the services and supports they need to live independently
sect Helps people maintain their independence sect Allows people to determine for themselves what mix of
services and supports work best for them
13
httpswwwResourcesForIntegratedCarecom
Goals of Self-Direction
sect Seeks to maximize each personrsquos ability to control their own decisions
sect Allows the person to be at the center of the process sect Promotes self - efficacy sect Empowers each person to take responsibility for their
supports and services sect Complements person - centered planning and facilitation
14
httpswwwResourcesForIntegratedCarecom
Characteristics of Candidates for Self-Directionsect Desire to have control of decisions regarding supports sect Understanding of what is allowable for each service and role
(eg personal care attendants cannot administer medication) sect Ability to manage and communicate decisions sect Ability to be the ldquoemployerrdquo sect Strong problem solving skills including ability to interview
hire train supervise and terminate employees sect Safe and stable living environment sect Strong back - up plan sect Agreement to work with a Fiscal Management Service sect Available authorized representative for people who cannot
self - direct
15
httpswwwResourcesForIntegratedCarecom
Authorized Representatives for Self-Direction
sect If the person cannot maintain control of their own supports and services they may assign an Authorized Representative to act on their behalf
sect Authorized Representative A personrsquos legal guardian family member or any other person identified by the member to help manage services as defined in the care plan and supervise employees if the person is unable to do so independently sect In Ohio the Authorized Representative MAY NOT also serve
as the paid care provider for the person
16
httpswwwResourcesForIntegratedCarecom
Self - Direction Authority Employer Authority
sect Employer Authority people have decision - making authority to recruit hire train and supervise the people who furnish their services3
sect In Ohio care managers must have assessed the person and determined a need for personal care services provided by a Consumer Directed Personal Care Provider or a Choices Home Care Attendant Service Provider
sect The person assumes responsibility for being the Personal Care Providerrsquos employer including hiring training setting pay rate (within guidelines) directing care and terminating providers if necessary
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from https
17
wwwmedicaidgovmedicaidltssself-directedindexhtml
httpswwwResourcesForIntegratedCarecom
Self - Direction Authority Budget Authority
sect Budget Authority person has decision - making authority over how the Medicaid funds in a budget are spent3
sect In Ohio the care manager must have assessed the person and determined a need for sect Choices Home Care Attendant Service sect Alternative Meal Service sect Pest Control sect Home Modification Maintenance and Repair sect Home Medical Equipment Supplemental Adaptive and Assistive
Devices sect The person assumes responsibility for choosing provider for
service scheduling service and setting pay rate (within guidelines)
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from https
18
wwwmedicaidgovmedicaidltssself-directedindexhtml
httpswwwResourcesForIntegratedCarecom
Traditional Care Management vs Self-Directed Care Management
19
Traditional Care Management Self-Directed Care ManagementConsumer and Care Manager decide which services are needed based on assessment
Consumer and Care Manager decide which services are needed based on assessment
Care Manager locates providers Consumer locates providers with assistance from care manager
Provider agency decides which worker to send and when to provide careservice
Consumer determines schedule based on assessed need
Provider agency hires trains and manages employees
Consumer hires trains and manages employees
Care Manager is responsible for management of provider issues
Consumer addresses service issues directly with assistance from care manager as needed
Care Manager contacts provider with any service issues
Care Manager monitors quality of service and satisfaction
httpswwwResourcesForIntegratedCarecom
The Role of Care Management in Self-Direction
sect Care managers play important roles in supporting consumers who are self - directing through bull Education bull Facilitation bull Support
20
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Education
sect Care managers can support consumers through education to ensure that the person is sect Well - informed and capable of making decisions sect Able to understand the tasks provided by the chosen
service sect Aware of their responsibilities as the employer and the
responsibilities of the provider sect In Ohio care managers answer questions about self-
direction and provide support when needed during quarterly visits or when people experience significant changes
21
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Facilitation
sect Care Managers can facilitate self - direction by sect Providing structure for the planning process sect Empowering the person to make decisions and take
action sect Helping the person identify goals sect Working with the person to guide the selection of supports
and services sect Assisting when possible with the application process rate
negotiation and service reviews
22
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Support
sect Care Managers can support consumers by sect Providing encouragement sect Working with people to help reduce potential negative
outcomes associated with their decisions sect Helping people adapt to their role as an employer sect Educating people on the importance of a back - up plan sect Helping people implement standard employment
application processes when possible sect Helping people understand supervisory responsibilities
23
httpswwwResourcesForIntegratedCarecom
Consumer Benefits of Self-Direction
sect Consumer is in control of their own supports and services sect Flexible scheduling sect Reduces unmet needscall - offs sect Enhances feelings of safety sect Promotes independence choice and self - determination sect Returns the choice to the consumer
24
httpswwwResourcesForIntegratedCarecom
Care Management Benefits of Self-Direction
sect Reduced service gaps sect Helps arrange supports and services in ldquohard to serverdquo
areas such as rural areas with direct care worker shortages
sect Helps ensure supports and services for consumers with complex service needs such as people who need assistance with toileting hourly
sect Fewer requests for change of service providers sect Satisfaction with all services increases
25
httpswwwResourcesForIntegratedCarecom
The Role of the LTSS Coordinator in Supporting Consumer Choice
Courtland Townes Deputy Director Boston Center for Independent Living
27
httpswwwResourcesForIntegratedCarecom
Massachusetts One Care Programrsquos Independent Living LTSS Model
sect One Care is the Massachusettsrsquo Medicare - Medicaid Financial Alignment Demonstration for adults living with disabilities who are dually eligible for Medicare and Medicaid
sect One Care uses a consumer - driven interdisciplinary care team comprised of medical professionals and long - term care coordinators
sect Once enrolled members have the right to have an independent living and LTSS coordinator ( IL - LTSSC) as part of their care team
27
httpswwwResourcesForIntegratedCarecom
Supporting Consumers who Choose to Live Independently
sect IL - LTSSCs are not employed by health plans but by independent community organizations such as Independent Living Centers Recovery Learning Centers and Aging Services Access Points sect This ensures that IL - LTSSCs can advocate for the
memberrsquos needs in an unbiased manner sect An important purpose of the Independent Living planning
process is to provide consumers with opportunities to learn and develop new skills that can help them succeed in achieving and maintaining their independent living goals
28
httpswwwResourcesForIntegratedCarecom
The Role of IL-LTSSCs
sect Support consumers in developing and working toward quality of life goals for independent living wellness and recovery
sect Conduct initial assessments to help consumers identify the services they need
sect Work as a care team member providing expertise in LTSS Independent Living Philosophy and Recovery Model
sect Have experience working with people with disabilities (may include lived experience with a disability)
sect Provide expertise on community services and community service providers
29
httpswwwResourcesForIntegratedCarecom
Supporting Individuals Who are Self-Directing Personal Care Services
sect The IL - LTSSC discusses the Independent Living Philosophy framework of Consumer Direction and Control with the consumer sect ldquoIndependencerdquo is different for each consumer
sect IL-LTSSCs assist consumers in identifying short- and long-term goals and current barriers to independence sect In initial assessment in the home IL - LTSSCs help consumers
identify the services they need sect Once services are approved through the Care Management
Team the IL - LTSSC begins the necessary service coordination to put vendor services in place
sect Consumers have the right to make changes to their selected services
30
httpswwwResourcesForIntegratedCarecom
What Other Types of Supports and Services are Offered to Individuals
sect Skills training and education sect Peer support sect Non - medical transportation sect Assistive technology sect Home modifications sect Home delivered meals sect Adult day health programs sect Homemaker and companion services
31
httpswwwResourcesForIntegratedCarecom
Strength-Based Needs Assessments
sect Every person regardless of his or her personal situation has unique strengths These basic strengths can be used as a starting place to begin developing other new strengths that will support the personrsquos efforts to reach his or her goals and dreams
sect Often someone from outside the personrsquos immediate environment can best help the person identify his or her unique talents abilities and strengths
32
httpswwwResourcesForIntegratedCarecom
Utilizing a Strength-Based Approach
sect IL - LTSSCs conduct strength - based initial assessments sect Key questions for a strength - based approach to
assessments sect What is working well right now in your life sect What do you want to accomplish in the future sect What is working well that you can build on sect What are some creative ways that you or someone you know has
addressed this problem in the past
sect Instead of assuming that a person has a weakness in a particular area assume that the person has not yet had opportunities that are essential to learning developing and mastering a skill in that particular area
33
httpswwwResourcesForIntegratedCarecom
Case Study 1 ldquoKarenrdquo
sect 51 - year - old woman with history of falls and diagnoses of PTSD anxiety bipolar disorder chronic respiratory disease dizziness and unspecified psychosis
sect Extremely reliant on her brother and mother for assistance with IADLs
sect Worked with IL - LTSSC to access the following Homemaker Services Companion Services Social and Medical Transportation
sect Karen reports that these services have lessened her feelings of anxiety and stress and have allowed her to feel safer and more self-sufficient in her environment
34
httpswwwResourcesForIntegratedCarecom
Case Study 2 ldquoRicardordquo
sect 53 - year - old consumer with diagnoses of depression anxiety and cognitive disabilities
sect Experienced homelessness for approximately 5 years and had to forfeit his service animal upon entering the shelter system Left the shelter after a few months and has lived in a U - Haul van for the last 2 years
sect IL - LTSSCrsquos initial focus was on housing assistance and was able to get consumer into a one - year Single Room Occupancy (SRO) Program that will give him access to permanent housing upon successful completion of program
sect IL - LTSSC is now working with care team to obtain approval for additional supports like home - delivered meals and laundry service
35
httpswwwResourcesForIntegratedCarecom
Personal Care Attendants and the Interdisciplinary Care Team
Corinne Eldridge Executive Director California Long - Term Care Education Center
37
httpswwwResourcesForIntegratedCarecom
Californiarsquos In - Home Supportive Services (IHSS) Program
sect There are 14 million dually eligible individuals in California4
sect The IHSS program serves 564000 consumers in CA5
sect 56 are 65 years or older 37 are 18 - 64 7 are under 18 sect 50 speak a primary language other than English
sect Californiarsquos IHSS program is the oldest Personal Care Attendant program in the country
sect There are 509000 IHSS workers in CA5
sect Over 50 of IHSS workers are family members
4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D5 Claire Ramsey (2019) In - Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
37
httpswwwResourcesForIntegratedCarecom
California Long - Term Care Education Center (CLTCEC) IHSS Training
sect CLTCEC began training IHSS consumer and provider pairs in 2012 sect Began with 6 health plans across 3 counties in California as
part of a Health Care Innovations Awards grant through the Center for Medicare amp Medicaid Innovation (CMMI)
sect Continued IHSS training program with 2 health plan partners LA Care Blue Shield California
38
httpswwwResourcesForIntegratedCarecom
Basic Tenants of the IHSS Training Program
39
Voluntary participation
IHSS provider learns new skills
Honors consumer-directed model of care
Competency-based education
httpswwwResourcesForIntegratedCarecom
IHSS Training Program
sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training
and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes
if possible sect 17-week course includes additional modules on body systems and disease-
specific care sect Training modules discuss the role of the IHSS provider and integration
into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration
are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have
discussions with IHSS consumer about what was learned in class that week
40
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
What is Self-Direction
1 Applied Self Direction (2018) What is Self-Direction Retrieved from
12
httpwwwappliedselfdirectioncomwhat-self-direction2 Family Caregiver Alliance (2013) The National Resource Center for Participant-Directed Services Retrieved from httpswwwcaregiverorgnational-resource-
center-participant-directed-services
Self-Direction (self-directed services)
bull Helps people of all ages with all types of disabilities maintain their independence at home by choosing the mix of services and supports that work best for them
bull Built on the belief that the people receiving the services and supports know their needs best and are in the best position to plan and manage their own services1
bull Also referred to as participant direction or consumer direction
History of Self-Direction
bull Grounded in the Independent Living philosophy self-direction options for home-and-community based services (HCBS) were included in health care reform recommendations and proposed legislation introduced in Congress beginning in 1993
bull In 2002 CMS released the Independence Plus waiver application to streamline approval for waiver programs offering self-direction
bull In 2010 the Affordable Care Act (ACA) improved options for self-direction in Medicaid and authorized a new voluntary social insurance the CLASS program with participant direction at the core2
httpswwwResourcesForIntegratedCarecom
The Self-Direction Model
sect Empowers consumers by expanding their degree of choice and control over the services and supports they need to live independently
sect Helps people maintain their independence sect Allows people to determine for themselves what mix of
services and supports work best for them
13
httpswwwResourcesForIntegratedCarecom
Goals of Self-Direction
sect Seeks to maximize each personrsquos ability to control their own decisions
sect Allows the person to be at the center of the process sect Promotes self - efficacy sect Empowers each person to take responsibility for their
supports and services sect Complements person - centered planning and facilitation
14
httpswwwResourcesForIntegratedCarecom
Characteristics of Candidates for Self-Directionsect Desire to have control of decisions regarding supports sect Understanding of what is allowable for each service and role
(eg personal care attendants cannot administer medication) sect Ability to manage and communicate decisions sect Ability to be the ldquoemployerrdquo sect Strong problem solving skills including ability to interview
hire train supervise and terminate employees sect Safe and stable living environment sect Strong back - up plan sect Agreement to work with a Fiscal Management Service sect Available authorized representative for people who cannot
self - direct
15
httpswwwResourcesForIntegratedCarecom
Authorized Representatives for Self-Direction
sect If the person cannot maintain control of their own supports and services they may assign an Authorized Representative to act on their behalf
sect Authorized Representative A personrsquos legal guardian family member or any other person identified by the member to help manage services as defined in the care plan and supervise employees if the person is unable to do so independently sect In Ohio the Authorized Representative MAY NOT also serve
as the paid care provider for the person
16
httpswwwResourcesForIntegratedCarecom
Self - Direction Authority Employer Authority
sect Employer Authority people have decision - making authority to recruit hire train and supervise the people who furnish their services3
sect In Ohio care managers must have assessed the person and determined a need for personal care services provided by a Consumer Directed Personal Care Provider or a Choices Home Care Attendant Service Provider
sect The person assumes responsibility for being the Personal Care Providerrsquos employer including hiring training setting pay rate (within guidelines) directing care and terminating providers if necessary
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from https
17
wwwmedicaidgovmedicaidltssself-directedindexhtml
httpswwwResourcesForIntegratedCarecom
Self - Direction Authority Budget Authority
sect Budget Authority person has decision - making authority over how the Medicaid funds in a budget are spent3
sect In Ohio the care manager must have assessed the person and determined a need for sect Choices Home Care Attendant Service sect Alternative Meal Service sect Pest Control sect Home Modification Maintenance and Repair sect Home Medical Equipment Supplemental Adaptive and Assistive
Devices sect The person assumes responsibility for choosing provider for
service scheduling service and setting pay rate (within guidelines)
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from https
18
wwwmedicaidgovmedicaidltssself-directedindexhtml
httpswwwResourcesForIntegratedCarecom
Traditional Care Management vs Self-Directed Care Management
19
Traditional Care Management Self-Directed Care ManagementConsumer and Care Manager decide which services are needed based on assessment
Consumer and Care Manager decide which services are needed based on assessment
Care Manager locates providers Consumer locates providers with assistance from care manager
Provider agency decides which worker to send and when to provide careservice
Consumer determines schedule based on assessed need
Provider agency hires trains and manages employees
Consumer hires trains and manages employees
Care Manager is responsible for management of provider issues
Consumer addresses service issues directly with assistance from care manager as needed
Care Manager contacts provider with any service issues
Care Manager monitors quality of service and satisfaction
httpswwwResourcesForIntegratedCarecom
The Role of Care Management in Self-Direction
sect Care managers play important roles in supporting consumers who are self - directing through bull Education bull Facilitation bull Support
20
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Education
sect Care managers can support consumers through education to ensure that the person is sect Well - informed and capable of making decisions sect Able to understand the tasks provided by the chosen
service sect Aware of their responsibilities as the employer and the
responsibilities of the provider sect In Ohio care managers answer questions about self-
direction and provide support when needed during quarterly visits or when people experience significant changes
21
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Facilitation
sect Care Managers can facilitate self - direction by sect Providing structure for the planning process sect Empowering the person to make decisions and take
action sect Helping the person identify goals sect Working with the person to guide the selection of supports
and services sect Assisting when possible with the application process rate
negotiation and service reviews
22
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Support
sect Care Managers can support consumers by sect Providing encouragement sect Working with people to help reduce potential negative
outcomes associated with their decisions sect Helping people adapt to their role as an employer sect Educating people on the importance of a back - up plan sect Helping people implement standard employment
application processes when possible sect Helping people understand supervisory responsibilities
23
httpswwwResourcesForIntegratedCarecom
Consumer Benefits of Self-Direction
sect Consumer is in control of their own supports and services sect Flexible scheduling sect Reduces unmet needscall - offs sect Enhances feelings of safety sect Promotes independence choice and self - determination sect Returns the choice to the consumer
24
httpswwwResourcesForIntegratedCarecom
Care Management Benefits of Self-Direction
sect Reduced service gaps sect Helps arrange supports and services in ldquohard to serverdquo
areas such as rural areas with direct care worker shortages
sect Helps ensure supports and services for consumers with complex service needs such as people who need assistance with toileting hourly
sect Fewer requests for change of service providers sect Satisfaction with all services increases
25
httpswwwResourcesForIntegratedCarecom
The Role of the LTSS Coordinator in Supporting Consumer Choice
Courtland Townes Deputy Director Boston Center for Independent Living
27
httpswwwResourcesForIntegratedCarecom
Massachusetts One Care Programrsquos Independent Living LTSS Model
sect One Care is the Massachusettsrsquo Medicare - Medicaid Financial Alignment Demonstration for adults living with disabilities who are dually eligible for Medicare and Medicaid
sect One Care uses a consumer - driven interdisciplinary care team comprised of medical professionals and long - term care coordinators
sect Once enrolled members have the right to have an independent living and LTSS coordinator ( IL - LTSSC) as part of their care team
27
httpswwwResourcesForIntegratedCarecom
Supporting Consumers who Choose to Live Independently
sect IL - LTSSCs are not employed by health plans but by independent community organizations such as Independent Living Centers Recovery Learning Centers and Aging Services Access Points sect This ensures that IL - LTSSCs can advocate for the
memberrsquos needs in an unbiased manner sect An important purpose of the Independent Living planning
process is to provide consumers with opportunities to learn and develop new skills that can help them succeed in achieving and maintaining their independent living goals
28
httpswwwResourcesForIntegratedCarecom
The Role of IL-LTSSCs
sect Support consumers in developing and working toward quality of life goals for independent living wellness and recovery
sect Conduct initial assessments to help consumers identify the services they need
sect Work as a care team member providing expertise in LTSS Independent Living Philosophy and Recovery Model
sect Have experience working with people with disabilities (may include lived experience with a disability)
sect Provide expertise on community services and community service providers
29
httpswwwResourcesForIntegratedCarecom
Supporting Individuals Who are Self-Directing Personal Care Services
sect The IL - LTSSC discusses the Independent Living Philosophy framework of Consumer Direction and Control with the consumer sect ldquoIndependencerdquo is different for each consumer
sect IL-LTSSCs assist consumers in identifying short- and long-term goals and current barriers to independence sect In initial assessment in the home IL - LTSSCs help consumers
identify the services they need sect Once services are approved through the Care Management
Team the IL - LTSSC begins the necessary service coordination to put vendor services in place
sect Consumers have the right to make changes to their selected services
30
httpswwwResourcesForIntegratedCarecom
What Other Types of Supports and Services are Offered to Individuals
sect Skills training and education sect Peer support sect Non - medical transportation sect Assistive technology sect Home modifications sect Home delivered meals sect Adult day health programs sect Homemaker and companion services
31
httpswwwResourcesForIntegratedCarecom
Strength-Based Needs Assessments
sect Every person regardless of his or her personal situation has unique strengths These basic strengths can be used as a starting place to begin developing other new strengths that will support the personrsquos efforts to reach his or her goals and dreams
sect Often someone from outside the personrsquos immediate environment can best help the person identify his or her unique talents abilities and strengths
32
httpswwwResourcesForIntegratedCarecom
Utilizing a Strength-Based Approach
sect IL - LTSSCs conduct strength - based initial assessments sect Key questions for a strength - based approach to
assessments sect What is working well right now in your life sect What do you want to accomplish in the future sect What is working well that you can build on sect What are some creative ways that you or someone you know has
addressed this problem in the past
sect Instead of assuming that a person has a weakness in a particular area assume that the person has not yet had opportunities that are essential to learning developing and mastering a skill in that particular area
33
httpswwwResourcesForIntegratedCarecom
Case Study 1 ldquoKarenrdquo
sect 51 - year - old woman with history of falls and diagnoses of PTSD anxiety bipolar disorder chronic respiratory disease dizziness and unspecified psychosis
sect Extremely reliant on her brother and mother for assistance with IADLs
sect Worked with IL - LTSSC to access the following Homemaker Services Companion Services Social and Medical Transportation
sect Karen reports that these services have lessened her feelings of anxiety and stress and have allowed her to feel safer and more self-sufficient in her environment
34
httpswwwResourcesForIntegratedCarecom
Case Study 2 ldquoRicardordquo
sect 53 - year - old consumer with diagnoses of depression anxiety and cognitive disabilities
sect Experienced homelessness for approximately 5 years and had to forfeit his service animal upon entering the shelter system Left the shelter after a few months and has lived in a U - Haul van for the last 2 years
sect IL - LTSSCrsquos initial focus was on housing assistance and was able to get consumer into a one - year Single Room Occupancy (SRO) Program that will give him access to permanent housing upon successful completion of program
sect IL - LTSSC is now working with care team to obtain approval for additional supports like home - delivered meals and laundry service
35
httpswwwResourcesForIntegratedCarecom
Personal Care Attendants and the Interdisciplinary Care Team
Corinne Eldridge Executive Director California Long - Term Care Education Center
37
httpswwwResourcesForIntegratedCarecom
Californiarsquos In - Home Supportive Services (IHSS) Program
sect There are 14 million dually eligible individuals in California4
sect The IHSS program serves 564000 consumers in CA5
sect 56 are 65 years or older 37 are 18 - 64 7 are under 18 sect 50 speak a primary language other than English
sect Californiarsquos IHSS program is the oldest Personal Care Attendant program in the country
sect There are 509000 IHSS workers in CA5
sect Over 50 of IHSS workers are family members
4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D5 Claire Ramsey (2019) In - Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
37
httpswwwResourcesForIntegratedCarecom
California Long - Term Care Education Center (CLTCEC) IHSS Training
sect CLTCEC began training IHSS consumer and provider pairs in 2012 sect Began with 6 health plans across 3 counties in California as
part of a Health Care Innovations Awards grant through the Center for Medicare amp Medicaid Innovation (CMMI)
sect Continued IHSS training program with 2 health plan partners LA Care Blue Shield California
38
httpswwwResourcesForIntegratedCarecom
Basic Tenants of the IHSS Training Program
39
Voluntary participation
IHSS provider learns new skills
Honors consumer-directed model of care
Competency-based education
httpswwwResourcesForIntegratedCarecom
IHSS Training Program
sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training
and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes
if possible sect 17-week course includes additional modules on body systems and disease-
specific care sect Training modules discuss the role of the IHSS provider and integration
into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration
are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have
discussions with IHSS consumer about what was learned in class that week
40
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
The Self-Direction Model
sect Empowers consumers by expanding their degree of choice and control over the services and supports they need to live independently
sect Helps people maintain their independence sect Allows people to determine for themselves what mix of
services and supports work best for them
13
httpswwwResourcesForIntegratedCarecom
Goals of Self-Direction
sect Seeks to maximize each personrsquos ability to control their own decisions
sect Allows the person to be at the center of the process sect Promotes self - efficacy sect Empowers each person to take responsibility for their
supports and services sect Complements person - centered planning and facilitation
14
httpswwwResourcesForIntegratedCarecom
Characteristics of Candidates for Self-Directionsect Desire to have control of decisions regarding supports sect Understanding of what is allowable for each service and role
(eg personal care attendants cannot administer medication) sect Ability to manage and communicate decisions sect Ability to be the ldquoemployerrdquo sect Strong problem solving skills including ability to interview
hire train supervise and terminate employees sect Safe and stable living environment sect Strong back - up plan sect Agreement to work with a Fiscal Management Service sect Available authorized representative for people who cannot
self - direct
15
httpswwwResourcesForIntegratedCarecom
Authorized Representatives for Self-Direction
sect If the person cannot maintain control of their own supports and services they may assign an Authorized Representative to act on their behalf
sect Authorized Representative A personrsquos legal guardian family member or any other person identified by the member to help manage services as defined in the care plan and supervise employees if the person is unable to do so independently sect In Ohio the Authorized Representative MAY NOT also serve
as the paid care provider for the person
16
httpswwwResourcesForIntegratedCarecom
Self - Direction Authority Employer Authority
sect Employer Authority people have decision - making authority to recruit hire train and supervise the people who furnish their services3
sect In Ohio care managers must have assessed the person and determined a need for personal care services provided by a Consumer Directed Personal Care Provider or a Choices Home Care Attendant Service Provider
sect The person assumes responsibility for being the Personal Care Providerrsquos employer including hiring training setting pay rate (within guidelines) directing care and terminating providers if necessary
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from https
17
wwwmedicaidgovmedicaidltssself-directedindexhtml
httpswwwResourcesForIntegratedCarecom
Self - Direction Authority Budget Authority
sect Budget Authority person has decision - making authority over how the Medicaid funds in a budget are spent3
sect In Ohio the care manager must have assessed the person and determined a need for sect Choices Home Care Attendant Service sect Alternative Meal Service sect Pest Control sect Home Modification Maintenance and Repair sect Home Medical Equipment Supplemental Adaptive and Assistive
Devices sect The person assumes responsibility for choosing provider for
service scheduling service and setting pay rate (within guidelines)
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from https
18
wwwmedicaidgovmedicaidltssself-directedindexhtml
httpswwwResourcesForIntegratedCarecom
Traditional Care Management vs Self-Directed Care Management
19
Traditional Care Management Self-Directed Care ManagementConsumer and Care Manager decide which services are needed based on assessment
Consumer and Care Manager decide which services are needed based on assessment
Care Manager locates providers Consumer locates providers with assistance from care manager
Provider agency decides which worker to send and when to provide careservice
Consumer determines schedule based on assessed need
Provider agency hires trains and manages employees
Consumer hires trains and manages employees
Care Manager is responsible for management of provider issues
Consumer addresses service issues directly with assistance from care manager as needed
Care Manager contacts provider with any service issues
Care Manager monitors quality of service and satisfaction
httpswwwResourcesForIntegratedCarecom
The Role of Care Management in Self-Direction
sect Care managers play important roles in supporting consumers who are self - directing through bull Education bull Facilitation bull Support
20
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Education
sect Care managers can support consumers through education to ensure that the person is sect Well - informed and capable of making decisions sect Able to understand the tasks provided by the chosen
service sect Aware of their responsibilities as the employer and the
responsibilities of the provider sect In Ohio care managers answer questions about self-
direction and provide support when needed during quarterly visits or when people experience significant changes
21
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Facilitation
sect Care Managers can facilitate self - direction by sect Providing structure for the planning process sect Empowering the person to make decisions and take
action sect Helping the person identify goals sect Working with the person to guide the selection of supports
and services sect Assisting when possible with the application process rate
negotiation and service reviews
22
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Support
sect Care Managers can support consumers by sect Providing encouragement sect Working with people to help reduce potential negative
outcomes associated with their decisions sect Helping people adapt to their role as an employer sect Educating people on the importance of a back - up plan sect Helping people implement standard employment
application processes when possible sect Helping people understand supervisory responsibilities
23
httpswwwResourcesForIntegratedCarecom
Consumer Benefits of Self-Direction
sect Consumer is in control of their own supports and services sect Flexible scheduling sect Reduces unmet needscall - offs sect Enhances feelings of safety sect Promotes independence choice and self - determination sect Returns the choice to the consumer
24
httpswwwResourcesForIntegratedCarecom
Care Management Benefits of Self-Direction
sect Reduced service gaps sect Helps arrange supports and services in ldquohard to serverdquo
areas such as rural areas with direct care worker shortages
sect Helps ensure supports and services for consumers with complex service needs such as people who need assistance with toileting hourly
sect Fewer requests for change of service providers sect Satisfaction with all services increases
25
httpswwwResourcesForIntegratedCarecom
The Role of the LTSS Coordinator in Supporting Consumer Choice
Courtland Townes Deputy Director Boston Center for Independent Living
27
httpswwwResourcesForIntegratedCarecom
Massachusetts One Care Programrsquos Independent Living LTSS Model
sect One Care is the Massachusettsrsquo Medicare - Medicaid Financial Alignment Demonstration for adults living with disabilities who are dually eligible for Medicare and Medicaid
sect One Care uses a consumer - driven interdisciplinary care team comprised of medical professionals and long - term care coordinators
sect Once enrolled members have the right to have an independent living and LTSS coordinator ( IL - LTSSC) as part of their care team
27
httpswwwResourcesForIntegratedCarecom
Supporting Consumers who Choose to Live Independently
sect IL - LTSSCs are not employed by health plans but by independent community organizations such as Independent Living Centers Recovery Learning Centers and Aging Services Access Points sect This ensures that IL - LTSSCs can advocate for the
memberrsquos needs in an unbiased manner sect An important purpose of the Independent Living planning
process is to provide consumers with opportunities to learn and develop new skills that can help them succeed in achieving and maintaining their independent living goals
28
httpswwwResourcesForIntegratedCarecom
The Role of IL-LTSSCs
sect Support consumers in developing and working toward quality of life goals for independent living wellness and recovery
sect Conduct initial assessments to help consumers identify the services they need
sect Work as a care team member providing expertise in LTSS Independent Living Philosophy and Recovery Model
sect Have experience working with people with disabilities (may include lived experience with a disability)
sect Provide expertise on community services and community service providers
29
httpswwwResourcesForIntegratedCarecom
Supporting Individuals Who are Self-Directing Personal Care Services
sect The IL - LTSSC discusses the Independent Living Philosophy framework of Consumer Direction and Control with the consumer sect ldquoIndependencerdquo is different for each consumer
sect IL-LTSSCs assist consumers in identifying short- and long-term goals and current barriers to independence sect In initial assessment in the home IL - LTSSCs help consumers
identify the services they need sect Once services are approved through the Care Management
Team the IL - LTSSC begins the necessary service coordination to put vendor services in place
sect Consumers have the right to make changes to their selected services
30
httpswwwResourcesForIntegratedCarecom
What Other Types of Supports and Services are Offered to Individuals
sect Skills training and education sect Peer support sect Non - medical transportation sect Assistive technology sect Home modifications sect Home delivered meals sect Adult day health programs sect Homemaker and companion services
31
httpswwwResourcesForIntegratedCarecom
Strength-Based Needs Assessments
sect Every person regardless of his or her personal situation has unique strengths These basic strengths can be used as a starting place to begin developing other new strengths that will support the personrsquos efforts to reach his or her goals and dreams
sect Often someone from outside the personrsquos immediate environment can best help the person identify his or her unique talents abilities and strengths
32
httpswwwResourcesForIntegratedCarecom
Utilizing a Strength-Based Approach
sect IL - LTSSCs conduct strength - based initial assessments sect Key questions for a strength - based approach to
assessments sect What is working well right now in your life sect What do you want to accomplish in the future sect What is working well that you can build on sect What are some creative ways that you or someone you know has
addressed this problem in the past
sect Instead of assuming that a person has a weakness in a particular area assume that the person has not yet had opportunities that are essential to learning developing and mastering a skill in that particular area
33
httpswwwResourcesForIntegratedCarecom
Case Study 1 ldquoKarenrdquo
sect 51 - year - old woman with history of falls and diagnoses of PTSD anxiety bipolar disorder chronic respiratory disease dizziness and unspecified psychosis
sect Extremely reliant on her brother and mother for assistance with IADLs
sect Worked with IL - LTSSC to access the following Homemaker Services Companion Services Social and Medical Transportation
sect Karen reports that these services have lessened her feelings of anxiety and stress and have allowed her to feel safer and more self-sufficient in her environment
34
httpswwwResourcesForIntegratedCarecom
Case Study 2 ldquoRicardordquo
sect 53 - year - old consumer with diagnoses of depression anxiety and cognitive disabilities
sect Experienced homelessness for approximately 5 years and had to forfeit his service animal upon entering the shelter system Left the shelter after a few months and has lived in a U - Haul van for the last 2 years
sect IL - LTSSCrsquos initial focus was on housing assistance and was able to get consumer into a one - year Single Room Occupancy (SRO) Program that will give him access to permanent housing upon successful completion of program
sect IL - LTSSC is now working with care team to obtain approval for additional supports like home - delivered meals and laundry service
35
httpswwwResourcesForIntegratedCarecom
Personal Care Attendants and the Interdisciplinary Care Team
Corinne Eldridge Executive Director California Long - Term Care Education Center
37
httpswwwResourcesForIntegratedCarecom
Californiarsquos In - Home Supportive Services (IHSS) Program
sect There are 14 million dually eligible individuals in California4
sect The IHSS program serves 564000 consumers in CA5
sect 56 are 65 years or older 37 are 18 - 64 7 are under 18 sect 50 speak a primary language other than English
sect Californiarsquos IHSS program is the oldest Personal Care Attendant program in the country
sect There are 509000 IHSS workers in CA5
sect Over 50 of IHSS workers are family members
4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D5 Claire Ramsey (2019) In - Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
37
httpswwwResourcesForIntegratedCarecom
California Long - Term Care Education Center (CLTCEC) IHSS Training
sect CLTCEC began training IHSS consumer and provider pairs in 2012 sect Began with 6 health plans across 3 counties in California as
part of a Health Care Innovations Awards grant through the Center for Medicare amp Medicaid Innovation (CMMI)
sect Continued IHSS training program with 2 health plan partners LA Care Blue Shield California
38
httpswwwResourcesForIntegratedCarecom
Basic Tenants of the IHSS Training Program
39
Voluntary participation
IHSS provider learns new skills
Honors consumer-directed model of care
Competency-based education
httpswwwResourcesForIntegratedCarecom
IHSS Training Program
sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training
and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes
if possible sect 17-week course includes additional modules on body systems and disease-
specific care sect Training modules discuss the role of the IHSS provider and integration
into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration
are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have
discussions with IHSS consumer about what was learned in class that week
40
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
Goals of Self-Direction
sect Seeks to maximize each personrsquos ability to control their own decisions
sect Allows the person to be at the center of the process sect Promotes self - efficacy sect Empowers each person to take responsibility for their
supports and services sect Complements person - centered planning and facilitation
14
httpswwwResourcesForIntegratedCarecom
Characteristics of Candidates for Self-Directionsect Desire to have control of decisions regarding supports sect Understanding of what is allowable for each service and role
(eg personal care attendants cannot administer medication) sect Ability to manage and communicate decisions sect Ability to be the ldquoemployerrdquo sect Strong problem solving skills including ability to interview
hire train supervise and terminate employees sect Safe and stable living environment sect Strong back - up plan sect Agreement to work with a Fiscal Management Service sect Available authorized representative for people who cannot
self - direct
15
httpswwwResourcesForIntegratedCarecom
Authorized Representatives for Self-Direction
sect If the person cannot maintain control of their own supports and services they may assign an Authorized Representative to act on their behalf
sect Authorized Representative A personrsquos legal guardian family member or any other person identified by the member to help manage services as defined in the care plan and supervise employees if the person is unable to do so independently sect In Ohio the Authorized Representative MAY NOT also serve
as the paid care provider for the person
16
httpswwwResourcesForIntegratedCarecom
Self - Direction Authority Employer Authority
sect Employer Authority people have decision - making authority to recruit hire train and supervise the people who furnish their services3
sect In Ohio care managers must have assessed the person and determined a need for personal care services provided by a Consumer Directed Personal Care Provider or a Choices Home Care Attendant Service Provider
sect The person assumes responsibility for being the Personal Care Providerrsquos employer including hiring training setting pay rate (within guidelines) directing care and terminating providers if necessary
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from https
17
wwwmedicaidgovmedicaidltssself-directedindexhtml
httpswwwResourcesForIntegratedCarecom
Self - Direction Authority Budget Authority
sect Budget Authority person has decision - making authority over how the Medicaid funds in a budget are spent3
sect In Ohio the care manager must have assessed the person and determined a need for sect Choices Home Care Attendant Service sect Alternative Meal Service sect Pest Control sect Home Modification Maintenance and Repair sect Home Medical Equipment Supplemental Adaptive and Assistive
Devices sect The person assumes responsibility for choosing provider for
service scheduling service and setting pay rate (within guidelines)
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from https
18
wwwmedicaidgovmedicaidltssself-directedindexhtml
httpswwwResourcesForIntegratedCarecom
Traditional Care Management vs Self-Directed Care Management
19
Traditional Care Management Self-Directed Care ManagementConsumer and Care Manager decide which services are needed based on assessment
Consumer and Care Manager decide which services are needed based on assessment
Care Manager locates providers Consumer locates providers with assistance from care manager
Provider agency decides which worker to send and when to provide careservice
Consumer determines schedule based on assessed need
Provider agency hires trains and manages employees
Consumer hires trains and manages employees
Care Manager is responsible for management of provider issues
Consumer addresses service issues directly with assistance from care manager as needed
Care Manager contacts provider with any service issues
Care Manager monitors quality of service and satisfaction
httpswwwResourcesForIntegratedCarecom
The Role of Care Management in Self-Direction
sect Care managers play important roles in supporting consumers who are self - directing through bull Education bull Facilitation bull Support
20
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Education
sect Care managers can support consumers through education to ensure that the person is sect Well - informed and capable of making decisions sect Able to understand the tasks provided by the chosen
service sect Aware of their responsibilities as the employer and the
responsibilities of the provider sect In Ohio care managers answer questions about self-
direction and provide support when needed during quarterly visits or when people experience significant changes
21
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Facilitation
sect Care Managers can facilitate self - direction by sect Providing structure for the planning process sect Empowering the person to make decisions and take
action sect Helping the person identify goals sect Working with the person to guide the selection of supports
and services sect Assisting when possible with the application process rate
negotiation and service reviews
22
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Support
sect Care Managers can support consumers by sect Providing encouragement sect Working with people to help reduce potential negative
outcomes associated with their decisions sect Helping people adapt to their role as an employer sect Educating people on the importance of a back - up plan sect Helping people implement standard employment
application processes when possible sect Helping people understand supervisory responsibilities
23
httpswwwResourcesForIntegratedCarecom
Consumer Benefits of Self-Direction
sect Consumer is in control of their own supports and services sect Flexible scheduling sect Reduces unmet needscall - offs sect Enhances feelings of safety sect Promotes independence choice and self - determination sect Returns the choice to the consumer
24
httpswwwResourcesForIntegratedCarecom
Care Management Benefits of Self-Direction
sect Reduced service gaps sect Helps arrange supports and services in ldquohard to serverdquo
areas such as rural areas with direct care worker shortages
sect Helps ensure supports and services for consumers with complex service needs such as people who need assistance with toileting hourly
sect Fewer requests for change of service providers sect Satisfaction with all services increases
25
httpswwwResourcesForIntegratedCarecom
The Role of the LTSS Coordinator in Supporting Consumer Choice
Courtland Townes Deputy Director Boston Center for Independent Living
27
httpswwwResourcesForIntegratedCarecom
Massachusetts One Care Programrsquos Independent Living LTSS Model
sect One Care is the Massachusettsrsquo Medicare - Medicaid Financial Alignment Demonstration for adults living with disabilities who are dually eligible for Medicare and Medicaid
sect One Care uses a consumer - driven interdisciplinary care team comprised of medical professionals and long - term care coordinators
sect Once enrolled members have the right to have an independent living and LTSS coordinator ( IL - LTSSC) as part of their care team
27
httpswwwResourcesForIntegratedCarecom
Supporting Consumers who Choose to Live Independently
sect IL - LTSSCs are not employed by health plans but by independent community organizations such as Independent Living Centers Recovery Learning Centers and Aging Services Access Points sect This ensures that IL - LTSSCs can advocate for the
memberrsquos needs in an unbiased manner sect An important purpose of the Independent Living planning
process is to provide consumers with opportunities to learn and develop new skills that can help them succeed in achieving and maintaining their independent living goals
28
httpswwwResourcesForIntegratedCarecom
The Role of IL-LTSSCs
sect Support consumers in developing and working toward quality of life goals for independent living wellness and recovery
sect Conduct initial assessments to help consumers identify the services they need
sect Work as a care team member providing expertise in LTSS Independent Living Philosophy and Recovery Model
sect Have experience working with people with disabilities (may include lived experience with a disability)
sect Provide expertise on community services and community service providers
29
httpswwwResourcesForIntegratedCarecom
Supporting Individuals Who are Self-Directing Personal Care Services
sect The IL - LTSSC discusses the Independent Living Philosophy framework of Consumer Direction and Control with the consumer sect ldquoIndependencerdquo is different for each consumer
sect IL-LTSSCs assist consumers in identifying short- and long-term goals and current barriers to independence sect In initial assessment in the home IL - LTSSCs help consumers
identify the services they need sect Once services are approved through the Care Management
Team the IL - LTSSC begins the necessary service coordination to put vendor services in place
sect Consumers have the right to make changes to their selected services
30
httpswwwResourcesForIntegratedCarecom
What Other Types of Supports and Services are Offered to Individuals
sect Skills training and education sect Peer support sect Non - medical transportation sect Assistive technology sect Home modifications sect Home delivered meals sect Adult day health programs sect Homemaker and companion services
31
httpswwwResourcesForIntegratedCarecom
Strength-Based Needs Assessments
sect Every person regardless of his or her personal situation has unique strengths These basic strengths can be used as a starting place to begin developing other new strengths that will support the personrsquos efforts to reach his or her goals and dreams
sect Often someone from outside the personrsquos immediate environment can best help the person identify his or her unique talents abilities and strengths
32
httpswwwResourcesForIntegratedCarecom
Utilizing a Strength-Based Approach
sect IL - LTSSCs conduct strength - based initial assessments sect Key questions for a strength - based approach to
assessments sect What is working well right now in your life sect What do you want to accomplish in the future sect What is working well that you can build on sect What are some creative ways that you or someone you know has
addressed this problem in the past
sect Instead of assuming that a person has a weakness in a particular area assume that the person has not yet had opportunities that are essential to learning developing and mastering a skill in that particular area
33
httpswwwResourcesForIntegratedCarecom
Case Study 1 ldquoKarenrdquo
sect 51 - year - old woman with history of falls and diagnoses of PTSD anxiety bipolar disorder chronic respiratory disease dizziness and unspecified psychosis
sect Extremely reliant on her brother and mother for assistance with IADLs
sect Worked with IL - LTSSC to access the following Homemaker Services Companion Services Social and Medical Transportation
sect Karen reports that these services have lessened her feelings of anxiety and stress and have allowed her to feel safer and more self-sufficient in her environment
34
httpswwwResourcesForIntegratedCarecom
Case Study 2 ldquoRicardordquo
sect 53 - year - old consumer with diagnoses of depression anxiety and cognitive disabilities
sect Experienced homelessness for approximately 5 years and had to forfeit his service animal upon entering the shelter system Left the shelter after a few months and has lived in a U - Haul van for the last 2 years
sect IL - LTSSCrsquos initial focus was on housing assistance and was able to get consumer into a one - year Single Room Occupancy (SRO) Program that will give him access to permanent housing upon successful completion of program
sect IL - LTSSC is now working with care team to obtain approval for additional supports like home - delivered meals and laundry service
35
httpswwwResourcesForIntegratedCarecom
Personal Care Attendants and the Interdisciplinary Care Team
Corinne Eldridge Executive Director California Long - Term Care Education Center
37
httpswwwResourcesForIntegratedCarecom
Californiarsquos In - Home Supportive Services (IHSS) Program
sect There are 14 million dually eligible individuals in California4
sect The IHSS program serves 564000 consumers in CA5
sect 56 are 65 years or older 37 are 18 - 64 7 are under 18 sect 50 speak a primary language other than English
sect Californiarsquos IHSS program is the oldest Personal Care Attendant program in the country
sect There are 509000 IHSS workers in CA5
sect Over 50 of IHSS workers are family members
4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D5 Claire Ramsey (2019) In - Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
37
httpswwwResourcesForIntegratedCarecom
California Long - Term Care Education Center (CLTCEC) IHSS Training
sect CLTCEC began training IHSS consumer and provider pairs in 2012 sect Began with 6 health plans across 3 counties in California as
part of a Health Care Innovations Awards grant through the Center for Medicare amp Medicaid Innovation (CMMI)
sect Continued IHSS training program with 2 health plan partners LA Care Blue Shield California
38
httpswwwResourcesForIntegratedCarecom
Basic Tenants of the IHSS Training Program
39
Voluntary participation
IHSS provider learns new skills
Honors consumer-directed model of care
Competency-based education
httpswwwResourcesForIntegratedCarecom
IHSS Training Program
sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training
and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes
if possible sect 17-week course includes additional modules on body systems and disease-
specific care sect Training modules discuss the role of the IHSS provider and integration
into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration
are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have
discussions with IHSS consumer about what was learned in class that week
40
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
Characteristics of Candidates for Self-Directionsect Desire to have control of decisions regarding supports sect Understanding of what is allowable for each service and role
(eg personal care attendants cannot administer medication) sect Ability to manage and communicate decisions sect Ability to be the ldquoemployerrdquo sect Strong problem solving skills including ability to interview
hire train supervise and terminate employees sect Safe and stable living environment sect Strong back - up plan sect Agreement to work with a Fiscal Management Service sect Available authorized representative for people who cannot
self - direct
15
httpswwwResourcesForIntegratedCarecom
Authorized Representatives for Self-Direction
sect If the person cannot maintain control of their own supports and services they may assign an Authorized Representative to act on their behalf
sect Authorized Representative A personrsquos legal guardian family member or any other person identified by the member to help manage services as defined in the care plan and supervise employees if the person is unable to do so independently sect In Ohio the Authorized Representative MAY NOT also serve
as the paid care provider for the person
16
httpswwwResourcesForIntegratedCarecom
Self - Direction Authority Employer Authority
sect Employer Authority people have decision - making authority to recruit hire train and supervise the people who furnish their services3
sect In Ohio care managers must have assessed the person and determined a need for personal care services provided by a Consumer Directed Personal Care Provider or a Choices Home Care Attendant Service Provider
sect The person assumes responsibility for being the Personal Care Providerrsquos employer including hiring training setting pay rate (within guidelines) directing care and terminating providers if necessary
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from https
17
wwwmedicaidgovmedicaidltssself-directedindexhtml
httpswwwResourcesForIntegratedCarecom
Self - Direction Authority Budget Authority
sect Budget Authority person has decision - making authority over how the Medicaid funds in a budget are spent3
sect In Ohio the care manager must have assessed the person and determined a need for sect Choices Home Care Attendant Service sect Alternative Meal Service sect Pest Control sect Home Modification Maintenance and Repair sect Home Medical Equipment Supplemental Adaptive and Assistive
Devices sect The person assumes responsibility for choosing provider for
service scheduling service and setting pay rate (within guidelines)
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from https
18
wwwmedicaidgovmedicaidltssself-directedindexhtml
httpswwwResourcesForIntegratedCarecom
Traditional Care Management vs Self-Directed Care Management
19
Traditional Care Management Self-Directed Care ManagementConsumer and Care Manager decide which services are needed based on assessment
Consumer and Care Manager decide which services are needed based on assessment
Care Manager locates providers Consumer locates providers with assistance from care manager
Provider agency decides which worker to send and when to provide careservice
Consumer determines schedule based on assessed need
Provider agency hires trains and manages employees
Consumer hires trains and manages employees
Care Manager is responsible for management of provider issues
Consumer addresses service issues directly with assistance from care manager as needed
Care Manager contacts provider with any service issues
Care Manager monitors quality of service and satisfaction
httpswwwResourcesForIntegratedCarecom
The Role of Care Management in Self-Direction
sect Care managers play important roles in supporting consumers who are self - directing through bull Education bull Facilitation bull Support
20
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Education
sect Care managers can support consumers through education to ensure that the person is sect Well - informed and capable of making decisions sect Able to understand the tasks provided by the chosen
service sect Aware of their responsibilities as the employer and the
responsibilities of the provider sect In Ohio care managers answer questions about self-
direction and provide support when needed during quarterly visits or when people experience significant changes
21
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Facilitation
sect Care Managers can facilitate self - direction by sect Providing structure for the planning process sect Empowering the person to make decisions and take
action sect Helping the person identify goals sect Working with the person to guide the selection of supports
and services sect Assisting when possible with the application process rate
negotiation and service reviews
22
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Support
sect Care Managers can support consumers by sect Providing encouragement sect Working with people to help reduce potential negative
outcomes associated with their decisions sect Helping people adapt to their role as an employer sect Educating people on the importance of a back - up plan sect Helping people implement standard employment
application processes when possible sect Helping people understand supervisory responsibilities
23
httpswwwResourcesForIntegratedCarecom
Consumer Benefits of Self-Direction
sect Consumer is in control of their own supports and services sect Flexible scheduling sect Reduces unmet needscall - offs sect Enhances feelings of safety sect Promotes independence choice and self - determination sect Returns the choice to the consumer
24
httpswwwResourcesForIntegratedCarecom
Care Management Benefits of Self-Direction
sect Reduced service gaps sect Helps arrange supports and services in ldquohard to serverdquo
areas such as rural areas with direct care worker shortages
sect Helps ensure supports and services for consumers with complex service needs such as people who need assistance with toileting hourly
sect Fewer requests for change of service providers sect Satisfaction with all services increases
25
httpswwwResourcesForIntegratedCarecom
The Role of the LTSS Coordinator in Supporting Consumer Choice
Courtland Townes Deputy Director Boston Center for Independent Living
27
httpswwwResourcesForIntegratedCarecom
Massachusetts One Care Programrsquos Independent Living LTSS Model
sect One Care is the Massachusettsrsquo Medicare - Medicaid Financial Alignment Demonstration for adults living with disabilities who are dually eligible for Medicare and Medicaid
sect One Care uses a consumer - driven interdisciplinary care team comprised of medical professionals and long - term care coordinators
sect Once enrolled members have the right to have an independent living and LTSS coordinator ( IL - LTSSC) as part of their care team
27
httpswwwResourcesForIntegratedCarecom
Supporting Consumers who Choose to Live Independently
sect IL - LTSSCs are not employed by health plans but by independent community organizations such as Independent Living Centers Recovery Learning Centers and Aging Services Access Points sect This ensures that IL - LTSSCs can advocate for the
memberrsquos needs in an unbiased manner sect An important purpose of the Independent Living planning
process is to provide consumers with opportunities to learn and develop new skills that can help them succeed in achieving and maintaining their independent living goals
28
httpswwwResourcesForIntegratedCarecom
The Role of IL-LTSSCs
sect Support consumers in developing and working toward quality of life goals for independent living wellness and recovery
sect Conduct initial assessments to help consumers identify the services they need
sect Work as a care team member providing expertise in LTSS Independent Living Philosophy and Recovery Model
sect Have experience working with people with disabilities (may include lived experience with a disability)
sect Provide expertise on community services and community service providers
29
httpswwwResourcesForIntegratedCarecom
Supporting Individuals Who are Self-Directing Personal Care Services
sect The IL - LTSSC discusses the Independent Living Philosophy framework of Consumer Direction and Control with the consumer sect ldquoIndependencerdquo is different for each consumer
sect IL-LTSSCs assist consumers in identifying short- and long-term goals and current barriers to independence sect In initial assessment in the home IL - LTSSCs help consumers
identify the services they need sect Once services are approved through the Care Management
Team the IL - LTSSC begins the necessary service coordination to put vendor services in place
sect Consumers have the right to make changes to their selected services
30
httpswwwResourcesForIntegratedCarecom
What Other Types of Supports and Services are Offered to Individuals
sect Skills training and education sect Peer support sect Non - medical transportation sect Assistive technology sect Home modifications sect Home delivered meals sect Adult day health programs sect Homemaker and companion services
31
httpswwwResourcesForIntegratedCarecom
Strength-Based Needs Assessments
sect Every person regardless of his or her personal situation has unique strengths These basic strengths can be used as a starting place to begin developing other new strengths that will support the personrsquos efforts to reach his or her goals and dreams
sect Often someone from outside the personrsquos immediate environment can best help the person identify his or her unique talents abilities and strengths
32
httpswwwResourcesForIntegratedCarecom
Utilizing a Strength-Based Approach
sect IL - LTSSCs conduct strength - based initial assessments sect Key questions for a strength - based approach to
assessments sect What is working well right now in your life sect What do you want to accomplish in the future sect What is working well that you can build on sect What are some creative ways that you or someone you know has
addressed this problem in the past
sect Instead of assuming that a person has a weakness in a particular area assume that the person has not yet had opportunities that are essential to learning developing and mastering a skill in that particular area
33
httpswwwResourcesForIntegratedCarecom
Case Study 1 ldquoKarenrdquo
sect 51 - year - old woman with history of falls and diagnoses of PTSD anxiety bipolar disorder chronic respiratory disease dizziness and unspecified psychosis
sect Extremely reliant on her brother and mother for assistance with IADLs
sect Worked with IL - LTSSC to access the following Homemaker Services Companion Services Social and Medical Transportation
sect Karen reports that these services have lessened her feelings of anxiety and stress and have allowed her to feel safer and more self-sufficient in her environment
34
httpswwwResourcesForIntegratedCarecom
Case Study 2 ldquoRicardordquo
sect 53 - year - old consumer with diagnoses of depression anxiety and cognitive disabilities
sect Experienced homelessness for approximately 5 years and had to forfeit his service animal upon entering the shelter system Left the shelter after a few months and has lived in a U - Haul van for the last 2 years
sect IL - LTSSCrsquos initial focus was on housing assistance and was able to get consumer into a one - year Single Room Occupancy (SRO) Program that will give him access to permanent housing upon successful completion of program
sect IL - LTSSC is now working with care team to obtain approval for additional supports like home - delivered meals and laundry service
35
httpswwwResourcesForIntegratedCarecom
Personal Care Attendants and the Interdisciplinary Care Team
Corinne Eldridge Executive Director California Long - Term Care Education Center
37
httpswwwResourcesForIntegratedCarecom
Californiarsquos In - Home Supportive Services (IHSS) Program
sect There are 14 million dually eligible individuals in California4
sect The IHSS program serves 564000 consumers in CA5
sect 56 are 65 years or older 37 are 18 - 64 7 are under 18 sect 50 speak a primary language other than English
sect Californiarsquos IHSS program is the oldest Personal Care Attendant program in the country
sect There are 509000 IHSS workers in CA5
sect Over 50 of IHSS workers are family members
4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D5 Claire Ramsey (2019) In - Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
37
httpswwwResourcesForIntegratedCarecom
California Long - Term Care Education Center (CLTCEC) IHSS Training
sect CLTCEC began training IHSS consumer and provider pairs in 2012 sect Began with 6 health plans across 3 counties in California as
part of a Health Care Innovations Awards grant through the Center for Medicare amp Medicaid Innovation (CMMI)
sect Continued IHSS training program with 2 health plan partners LA Care Blue Shield California
38
httpswwwResourcesForIntegratedCarecom
Basic Tenants of the IHSS Training Program
39
Voluntary participation
IHSS provider learns new skills
Honors consumer-directed model of care
Competency-based education
httpswwwResourcesForIntegratedCarecom
IHSS Training Program
sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training
and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes
if possible sect 17-week course includes additional modules on body systems and disease-
specific care sect Training modules discuss the role of the IHSS provider and integration
into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration
are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have
discussions with IHSS consumer about what was learned in class that week
40
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
Authorized Representatives for Self-Direction
sect If the person cannot maintain control of their own supports and services they may assign an Authorized Representative to act on their behalf
sect Authorized Representative A personrsquos legal guardian family member or any other person identified by the member to help manage services as defined in the care plan and supervise employees if the person is unable to do so independently sect In Ohio the Authorized Representative MAY NOT also serve
as the paid care provider for the person
16
httpswwwResourcesForIntegratedCarecom
Self - Direction Authority Employer Authority
sect Employer Authority people have decision - making authority to recruit hire train and supervise the people who furnish their services3
sect In Ohio care managers must have assessed the person and determined a need for personal care services provided by a Consumer Directed Personal Care Provider or a Choices Home Care Attendant Service Provider
sect The person assumes responsibility for being the Personal Care Providerrsquos employer including hiring training setting pay rate (within guidelines) directing care and terminating providers if necessary
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from https
17
wwwmedicaidgovmedicaidltssself-directedindexhtml
httpswwwResourcesForIntegratedCarecom
Self - Direction Authority Budget Authority
sect Budget Authority person has decision - making authority over how the Medicaid funds in a budget are spent3
sect In Ohio the care manager must have assessed the person and determined a need for sect Choices Home Care Attendant Service sect Alternative Meal Service sect Pest Control sect Home Modification Maintenance and Repair sect Home Medical Equipment Supplemental Adaptive and Assistive
Devices sect The person assumes responsibility for choosing provider for
service scheduling service and setting pay rate (within guidelines)
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from https
18
wwwmedicaidgovmedicaidltssself-directedindexhtml
httpswwwResourcesForIntegratedCarecom
Traditional Care Management vs Self-Directed Care Management
19
Traditional Care Management Self-Directed Care ManagementConsumer and Care Manager decide which services are needed based on assessment
Consumer and Care Manager decide which services are needed based on assessment
Care Manager locates providers Consumer locates providers with assistance from care manager
Provider agency decides which worker to send and when to provide careservice
Consumer determines schedule based on assessed need
Provider agency hires trains and manages employees
Consumer hires trains and manages employees
Care Manager is responsible for management of provider issues
Consumer addresses service issues directly with assistance from care manager as needed
Care Manager contacts provider with any service issues
Care Manager monitors quality of service and satisfaction
httpswwwResourcesForIntegratedCarecom
The Role of Care Management in Self-Direction
sect Care managers play important roles in supporting consumers who are self - directing through bull Education bull Facilitation bull Support
20
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Education
sect Care managers can support consumers through education to ensure that the person is sect Well - informed and capable of making decisions sect Able to understand the tasks provided by the chosen
service sect Aware of their responsibilities as the employer and the
responsibilities of the provider sect In Ohio care managers answer questions about self-
direction and provide support when needed during quarterly visits or when people experience significant changes
21
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Facilitation
sect Care Managers can facilitate self - direction by sect Providing structure for the planning process sect Empowering the person to make decisions and take
action sect Helping the person identify goals sect Working with the person to guide the selection of supports
and services sect Assisting when possible with the application process rate
negotiation and service reviews
22
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Support
sect Care Managers can support consumers by sect Providing encouragement sect Working with people to help reduce potential negative
outcomes associated with their decisions sect Helping people adapt to their role as an employer sect Educating people on the importance of a back - up plan sect Helping people implement standard employment
application processes when possible sect Helping people understand supervisory responsibilities
23
httpswwwResourcesForIntegratedCarecom
Consumer Benefits of Self-Direction
sect Consumer is in control of their own supports and services sect Flexible scheduling sect Reduces unmet needscall - offs sect Enhances feelings of safety sect Promotes independence choice and self - determination sect Returns the choice to the consumer
24
httpswwwResourcesForIntegratedCarecom
Care Management Benefits of Self-Direction
sect Reduced service gaps sect Helps arrange supports and services in ldquohard to serverdquo
areas such as rural areas with direct care worker shortages
sect Helps ensure supports and services for consumers with complex service needs such as people who need assistance with toileting hourly
sect Fewer requests for change of service providers sect Satisfaction with all services increases
25
httpswwwResourcesForIntegratedCarecom
The Role of the LTSS Coordinator in Supporting Consumer Choice
Courtland Townes Deputy Director Boston Center for Independent Living
27
httpswwwResourcesForIntegratedCarecom
Massachusetts One Care Programrsquos Independent Living LTSS Model
sect One Care is the Massachusettsrsquo Medicare - Medicaid Financial Alignment Demonstration for adults living with disabilities who are dually eligible for Medicare and Medicaid
sect One Care uses a consumer - driven interdisciplinary care team comprised of medical professionals and long - term care coordinators
sect Once enrolled members have the right to have an independent living and LTSS coordinator ( IL - LTSSC) as part of their care team
27
httpswwwResourcesForIntegratedCarecom
Supporting Consumers who Choose to Live Independently
sect IL - LTSSCs are not employed by health plans but by independent community organizations such as Independent Living Centers Recovery Learning Centers and Aging Services Access Points sect This ensures that IL - LTSSCs can advocate for the
memberrsquos needs in an unbiased manner sect An important purpose of the Independent Living planning
process is to provide consumers with opportunities to learn and develop new skills that can help them succeed in achieving and maintaining their independent living goals
28
httpswwwResourcesForIntegratedCarecom
The Role of IL-LTSSCs
sect Support consumers in developing and working toward quality of life goals for independent living wellness and recovery
sect Conduct initial assessments to help consumers identify the services they need
sect Work as a care team member providing expertise in LTSS Independent Living Philosophy and Recovery Model
sect Have experience working with people with disabilities (may include lived experience with a disability)
sect Provide expertise on community services and community service providers
29
httpswwwResourcesForIntegratedCarecom
Supporting Individuals Who are Self-Directing Personal Care Services
sect The IL - LTSSC discusses the Independent Living Philosophy framework of Consumer Direction and Control with the consumer sect ldquoIndependencerdquo is different for each consumer
sect IL-LTSSCs assist consumers in identifying short- and long-term goals and current barriers to independence sect In initial assessment in the home IL - LTSSCs help consumers
identify the services they need sect Once services are approved through the Care Management
Team the IL - LTSSC begins the necessary service coordination to put vendor services in place
sect Consumers have the right to make changes to their selected services
30
httpswwwResourcesForIntegratedCarecom
What Other Types of Supports and Services are Offered to Individuals
sect Skills training and education sect Peer support sect Non - medical transportation sect Assistive technology sect Home modifications sect Home delivered meals sect Adult day health programs sect Homemaker and companion services
31
httpswwwResourcesForIntegratedCarecom
Strength-Based Needs Assessments
sect Every person regardless of his or her personal situation has unique strengths These basic strengths can be used as a starting place to begin developing other new strengths that will support the personrsquos efforts to reach his or her goals and dreams
sect Often someone from outside the personrsquos immediate environment can best help the person identify his or her unique talents abilities and strengths
32
httpswwwResourcesForIntegratedCarecom
Utilizing a Strength-Based Approach
sect IL - LTSSCs conduct strength - based initial assessments sect Key questions for a strength - based approach to
assessments sect What is working well right now in your life sect What do you want to accomplish in the future sect What is working well that you can build on sect What are some creative ways that you or someone you know has
addressed this problem in the past
sect Instead of assuming that a person has a weakness in a particular area assume that the person has not yet had opportunities that are essential to learning developing and mastering a skill in that particular area
33
httpswwwResourcesForIntegratedCarecom
Case Study 1 ldquoKarenrdquo
sect 51 - year - old woman with history of falls and diagnoses of PTSD anxiety bipolar disorder chronic respiratory disease dizziness and unspecified psychosis
sect Extremely reliant on her brother and mother for assistance with IADLs
sect Worked with IL - LTSSC to access the following Homemaker Services Companion Services Social and Medical Transportation
sect Karen reports that these services have lessened her feelings of anxiety and stress and have allowed her to feel safer and more self-sufficient in her environment
34
httpswwwResourcesForIntegratedCarecom
Case Study 2 ldquoRicardordquo
sect 53 - year - old consumer with diagnoses of depression anxiety and cognitive disabilities
sect Experienced homelessness for approximately 5 years and had to forfeit his service animal upon entering the shelter system Left the shelter after a few months and has lived in a U - Haul van for the last 2 years
sect IL - LTSSCrsquos initial focus was on housing assistance and was able to get consumer into a one - year Single Room Occupancy (SRO) Program that will give him access to permanent housing upon successful completion of program
sect IL - LTSSC is now working with care team to obtain approval for additional supports like home - delivered meals and laundry service
35
httpswwwResourcesForIntegratedCarecom
Personal Care Attendants and the Interdisciplinary Care Team
Corinne Eldridge Executive Director California Long - Term Care Education Center
37
httpswwwResourcesForIntegratedCarecom
Californiarsquos In - Home Supportive Services (IHSS) Program
sect There are 14 million dually eligible individuals in California4
sect The IHSS program serves 564000 consumers in CA5
sect 56 are 65 years or older 37 are 18 - 64 7 are under 18 sect 50 speak a primary language other than English
sect Californiarsquos IHSS program is the oldest Personal Care Attendant program in the country
sect There are 509000 IHSS workers in CA5
sect Over 50 of IHSS workers are family members
4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D5 Claire Ramsey (2019) In - Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
37
httpswwwResourcesForIntegratedCarecom
California Long - Term Care Education Center (CLTCEC) IHSS Training
sect CLTCEC began training IHSS consumer and provider pairs in 2012 sect Began with 6 health plans across 3 counties in California as
part of a Health Care Innovations Awards grant through the Center for Medicare amp Medicaid Innovation (CMMI)
sect Continued IHSS training program with 2 health plan partners LA Care Blue Shield California
38
httpswwwResourcesForIntegratedCarecom
Basic Tenants of the IHSS Training Program
39
Voluntary participation
IHSS provider learns new skills
Honors consumer-directed model of care
Competency-based education
httpswwwResourcesForIntegratedCarecom
IHSS Training Program
sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training
and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes
if possible sect 17-week course includes additional modules on body systems and disease-
specific care sect Training modules discuss the role of the IHSS provider and integration
into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration
are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have
discussions with IHSS consumer about what was learned in class that week
40
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
Self - Direction Authority Employer Authority
sect Employer Authority people have decision - making authority to recruit hire train and supervise the people who furnish their services3
sect In Ohio care managers must have assessed the person and determined a need for personal care services provided by a Consumer Directed Personal Care Provider or a Choices Home Care Attendant Service Provider
sect The person assumes responsibility for being the Personal Care Providerrsquos employer including hiring training setting pay rate (within guidelines) directing care and terminating providers if necessary
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from https
17
wwwmedicaidgovmedicaidltssself-directedindexhtml
httpswwwResourcesForIntegratedCarecom
Self - Direction Authority Budget Authority
sect Budget Authority person has decision - making authority over how the Medicaid funds in a budget are spent3
sect In Ohio the care manager must have assessed the person and determined a need for sect Choices Home Care Attendant Service sect Alternative Meal Service sect Pest Control sect Home Modification Maintenance and Repair sect Home Medical Equipment Supplemental Adaptive and Assistive
Devices sect The person assumes responsibility for choosing provider for
service scheduling service and setting pay rate (within guidelines)
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from https
18
wwwmedicaidgovmedicaidltssself-directedindexhtml
httpswwwResourcesForIntegratedCarecom
Traditional Care Management vs Self-Directed Care Management
19
Traditional Care Management Self-Directed Care ManagementConsumer and Care Manager decide which services are needed based on assessment
Consumer and Care Manager decide which services are needed based on assessment
Care Manager locates providers Consumer locates providers with assistance from care manager
Provider agency decides which worker to send and when to provide careservice
Consumer determines schedule based on assessed need
Provider agency hires trains and manages employees
Consumer hires trains and manages employees
Care Manager is responsible for management of provider issues
Consumer addresses service issues directly with assistance from care manager as needed
Care Manager contacts provider with any service issues
Care Manager monitors quality of service and satisfaction
httpswwwResourcesForIntegratedCarecom
The Role of Care Management in Self-Direction
sect Care managers play important roles in supporting consumers who are self - directing through bull Education bull Facilitation bull Support
20
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Education
sect Care managers can support consumers through education to ensure that the person is sect Well - informed and capable of making decisions sect Able to understand the tasks provided by the chosen
service sect Aware of their responsibilities as the employer and the
responsibilities of the provider sect In Ohio care managers answer questions about self-
direction and provide support when needed during quarterly visits or when people experience significant changes
21
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Facilitation
sect Care Managers can facilitate self - direction by sect Providing structure for the planning process sect Empowering the person to make decisions and take
action sect Helping the person identify goals sect Working with the person to guide the selection of supports
and services sect Assisting when possible with the application process rate
negotiation and service reviews
22
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Support
sect Care Managers can support consumers by sect Providing encouragement sect Working with people to help reduce potential negative
outcomes associated with their decisions sect Helping people adapt to their role as an employer sect Educating people on the importance of a back - up plan sect Helping people implement standard employment
application processes when possible sect Helping people understand supervisory responsibilities
23
httpswwwResourcesForIntegratedCarecom
Consumer Benefits of Self-Direction
sect Consumer is in control of their own supports and services sect Flexible scheduling sect Reduces unmet needscall - offs sect Enhances feelings of safety sect Promotes independence choice and self - determination sect Returns the choice to the consumer
24
httpswwwResourcesForIntegratedCarecom
Care Management Benefits of Self-Direction
sect Reduced service gaps sect Helps arrange supports and services in ldquohard to serverdquo
areas such as rural areas with direct care worker shortages
sect Helps ensure supports and services for consumers with complex service needs such as people who need assistance with toileting hourly
sect Fewer requests for change of service providers sect Satisfaction with all services increases
25
httpswwwResourcesForIntegratedCarecom
The Role of the LTSS Coordinator in Supporting Consumer Choice
Courtland Townes Deputy Director Boston Center for Independent Living
27
httpswwwResourcesForIntegratedCarecom
Massachusetts One Care Programrsquos Independent Living LTSS Model
sect One Care is the Massachusettsrsquo Medicare - Medicaid Financial Alignment Demonstration for adults living with disabilities who are dually eligible for Medicare and Medicaid
sect One Care uses a consumer - driven interdisciplinary care team comprised of medical professionals and long - term care coordinators
sect Once enrolled members have the right to have an independent living and LTSS coordinator ( IL - LTSSC) as part of their care team
27
httpswwwResourcesForIntegratedCarecom
Supporting Consumers who Choose to Live Independently
sect IL - LTSSCs are not employed by health plans but by independent community organizations such as Independent Living Centers Recovery Learning Centers and Aging Services Access Points sect This ensures that IL - LTSSCs can advocate for the
memberrsquos needs in an unbiased manner sect An important purpose of the Independent Living planning
process is to provide consumers with opportunities to learn and develop new skills that can help them succeed in achieving and maintaining their independent living goals
28
httpswwwResourcesForIntegratedCarecom
The Role of IL-LTSSCs
sect Support consumers in developing and working toward quality of life goals for independent living wellness and recovery
sect Conduct initial assessments to help consumers identify the services they need
sect Work as a care team member providing expertise in LTSS Independent Living Philosophy and Recovery Model
sect Have experience working with people with disabilities (may include lived experience with a disability)
sect Provide expertise on community services and community service providers
29
httpswwwResourcesForIntegratedCarecom
Supporting Individuals Who are Self-Directing Personal Care Services
sect The IL - LTSSC discusses the Independent Living Philosophy framework of Consumer Direction and Control with the consumer sect ldquoIndependencerdquo is different for each consumer
sect IL-LTSSCs assist consumers in identifying short- and long-term goals and current barriers to independence sect In initial assessment in the home IL - LTSSCs help consumers
identify the services they need sect Once services are approved through the Care Management
Team the IL - LTSSC begins the necessary service coordination to put vendor services in place
sect Consumers have the right to make changes to their selected services
30
httpswwwResourcesForIntegratedCarecom
What Other Types of Supports and Services are Offered to Individuals
sect Skills training and education sect Peer support sect Non - medical transportation sect Assistive technology sect Home modifications sect Home delivered meals sect Adult day health programs sect Homemaker and companion services
31
httpswwwResourcesForIntegratedCarecom
Strength-Based Needs Assessments
sect Every person regardless of his or her personal situation has unique strengths These basic strengths can be used as a starting place to begin developing other new strengths that will support the personrsquos efforts to reach his or her goals and dreams
sect Often someone from outside the personrsquos immediate environment can best help the person identify his or her unique talents abilities and strengths
32
httpswwwResourcesForIntegratedCarecom
Utilizing a Strength-Based Approach
sect IL - LTSSCs conduct strength - based initial assessments sect Key questions for a strength - based approach to
assessments sect What is working well right now in your life sect What do you want to accomplish in the future sect What is working well that you can build on sect What are some creative ways that you or someone you know has
addressed this problem in the past
sect Instead of assuming that a person has a weakness in a particular area assume that the person has not yet had opportunities that are essential to learning developing and mastering a skill in that particular area
33
httpswwwResourcesForIntegratedCarecom
Case Study 1 ldquoKarenrdquo
sect 51 - year - old woman with history of falls and diagnoses of PTSD anxiety bipolar disorder chronic respiratory disease dizziness and unspecified psychosis
sect Extremely reliant on her brother and mother for assistance with IADLs
sect Worked with IL - LTSSC to access the following Homemaker Services Companion Services Social and Medical Transportation
sect Karen reports that these services have lessened her feelings of anxiety and stress and have allowed her to feel safer and more self-sufficient in her environment
34
httpswwwResourcesForIntegratedCarecom
Case Study 2 ldquoRicardordquo
sect 53 - year - old consumer with diagnoses of depression anxiety and cognitive disabilities
sect Experienced homelessness for approximately 5 years and had to forfeit his service animal upon entering the shelter system Left the shelter after a few months and has lived in a U - Haul van for the last 2 years
sect IL - LTSSCrsquos initial focus was on housing assistance and was able to get consumer into a one - year Single Room Occupancy (SRO) Program that will give him access to permanent housing upon successful completion of program
sect IL - LTSSC is now working with care team to obtain approval for additional supports like home - delivered meals and laundry service
35
httpswwwResourcesForIntegratedCarecom
Personal Care Attendants and the Interdisciplinary Care Team
Corinne Eldridge Executive Director California Long - Term Care Education Center
37
httpswwwResourcesForIntegratedCarecom
Californiarsquos In - Home Supportive Services (IHSS) Program
sect There are 14 million dually eligible individuals in California4
sect The IHSS program serves 564000 consumers in CA5
sect 56 are 65 years or older 37 are 18 - 64 7 are under 18 sect 50 speak a primary language other than English
sect Californiarsquos IHSS program is the oldest Personal Care Attendant program in the country
sect There are 509000 IHSS workers in CA5
sect Over 50 of IHSS workers are family members
4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D5 Claire Ramsey (2019) In - Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
37
httpswwwResourcesForIntegratedCarecom
California Long - Term Care Education Center (CLTCEC) IHSS Training
sect CLTCEC began training IHSS consumer and provider pairs in 2012 sect Began with 6 health plans across 3 counties in California as
part of a Health Care Innovations Awards grant through the Center for Medicare amp Medicaid Innovation (CMMI)
sect Continued IHSS training program with 2 health plan partners LA Care Blue Shield California
38
httpswwwResourcesForIntegratedCarecom
Basic Tenants of the IHSS Training Program
39
Voluntary participation
IHSS provider learns new skills
Honors consumer-directed model of care
Competency-based education
httpswwwResourcesForIntegratedCarecom
IHSS Training Program
sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training
and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes
if possible sect 17-week course includes additional modules on body systems and disease-
specific care sect Training modules discuss the role of the IHSS provider and integration
into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration
are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have
discussions with IHSS consumer about what was learned in class that week
40
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
Self - Direction Authority Budget Authority
sect Budget Authority person has decision - making authority over how the Medicaid funds in a budget are spent3
sect In Ohio the care manager must have assessed the person and determined a need for sect Choices Home Care Attendant Service sect Alternative Meal Service sect Pest Control sect Home Modification Maintenance and Repair sect Home Medical Equipment Supplemental Adaptive and Assistive
Devices sect The person assumes responsibility for choosing provider for
service scheduling service and setting pay rate (within guidelines)
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from https
18
wwwmedicaidgovmedicaidltssself-directedindexhtml
httpswwwResourcesForIntegratedCarecom
Traditional Care Management vs Self-Directed Care Management
19
Traditional Care Management Self-Directed Care ManagementConsumer and Care Manager decide which services are needed based on assessment
Consumer and Care Manager decide which services are needed based on assessment
Care Manager locates providers Consumer locates providers with assistance from care manager
Provider agency decides which worker to send and when to provide careservice
Consumer determines schedule based on assessed need
Provider agency hires trains and manages employees
Consumer hires trains and manages employees
Care Manager is responsible for management of provider issues
Consumer addresses service issues directly with assistance from care manager as needed
Care Manager contacts provider with any service issues
Care Manager monitors quality of service and satisfaction
httpswwwResourcesForIntegratedCarecom
The Role of Care Management in Self-Direction
sect Care managers play important roles in supporting consumers who are self - directing through bull Education bull Facilitation bull Support
20
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Education
sect Care managers can support consumers through education to ensure that the person is sect Well - informed and capable of making decisions sect Able to understand the tasks provided by the chosen
service sect Aware of their responsibilities as the employer and the
responsibilities of the provider sect In Ohio care managers answer questions about self-
direction and provide support when needed during quarterly visits or when people experience significant changes
21
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Facilitation
sect Care Managers can facilitate self - direction by sect Providing structure for the planning process sect Empowering the person to make decisions and take
action sect Helping the person identify goals sect Working with the person to guide the selection of supports
and services sect Assisting when possible with the application process rate
negotiation and service reviews
22
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Support
sect Care Managers can support consumers by sect Providing encouragement sect Working with people to help reduce potential negative
outcomes associated with their decisions sect Helping people adapt to their role as an employer sect Educating people on the importance of a back - up plan sect Helping people implement standard employment
application processes when possible sect Helping people understand supervisory responsibilities
23
httpswwwResourcesForIntegratedCarecom
Consumer Benefits of Self-Direction
sect Consumer is in control of their own supports and services sect Flexible scheduling sect Reduces unmet needscall - offs sect Enhances feelings of safety sect Promotes independence choice and self - determination sect Returns the choice to the consumer
24
httpswwwResourcesForIntegratedCarecom
Care Management Benefits of Self-Direction
sect Reduced service gaps sect Helps arrange supports and services in ldquohard to serverdquo
areas such as rural areas with direct care worker shortages
sect Helps ensure supports and services for consumers with complex service needs such as people who need assistance with toileting hourly
sect Fewer requests for change of service providers sect Satisfaction with all services increases
25
httpswwwResourcesForIntegratedCarecom
The Role of the LTSS Coordinator in Supporting Consumer Choice
Courtland Townes Deputy Director Boston Center for Independent Living
27
httpswwwResourcesForIntegratedCarecom
Massachusetts One Care Programrsquos Independent Living LTSS Model
sect One Care is the Massachusettsrsquo Medicare - Medicaid Financial Alignment Demonstration for adults living with disabilities who are dually eligible for Medicare and Medicaid
sect One Care uses a consumer - driven interdisciplinary care team comprised of medical professionals and long - term care coordinators
sect Once enrolled members have the right to have an independent living and LTSS coordinator ( IL - LTSSC) as part of their care team
27
httpswwwResourcesForIntegratedCarecom
Supporting Consumers who Choose to Live Independently
sect IL - LTSSCs are not employed by health plans but by independent community organizations such as Independent Living Centers Recovery Learning Centers and Aging Services Access Points sect This ensures that IL - LTSSCs can advocate for the
memberrsquos needs in an unbiased manner sect An important purpose of the Independent Living planning
process is to provide consumers with opportunities to learn and develop new skills that can help them succeed in achieving and maintaining their independent living goals
28
httpswwwResourcesForIntegratedCarecom
The Role of IL-LTSSCs
sect Support consumers in developing and working toward quality of life goals for independent living wellness and recovery
sect Conduct initial assessments to help consumers identify the services they need
sect Work as a care team member providing expertise in LTSS Independent Living Philosophy and Recovery Model
sect Have experience working with people with disabilities (may include lived experience with a disability)
sect Provide expertise on community services and community service providers
29
httpswwwResourcesForIntegratedCarecom
Supporting Individuals Who are Self-Directing Personal Care Services
sect The IL - LTSSC discusses the Independent Living Philosophy framework of Consumer Direction and Control with the consumer sect ldquoIndependencerdquo is different for each consumer
sect IL-LTSSCs assist consumers in identifying short- and long-term goals and current barriers to independence sect In initial assessment in the home IL - LTSSCs help consumers
identify the services they need sect Once services are approved through the Care Management
Team the IL - LTSSC begins the necessary service coordination to put vendor services in place
sect Consumers have the right to make changes to their selected services
30
httpswwwResourcesForIntegratedCarecom
What Other Types of Supports and Services are Offered to Individuals
sect Skills training and education sect Peer support sect Non - medical transportation sect Assistive technology sect Home modifications sect Home delivered meals sect Adult day health programs sect Homemaker and companion services
31
httpswwwResourcesForIntegratedCarecom
Strength-Based Needs Assessments
sect Every person regardless of his or her personal situation has unique strengths These basic strengths can be used as a starting place to begin developing other new strengths that will support the personrsquos efforts to reach his or her goals and dreams
sect Often someone from outside the personrsquos immediate environment can best help the person identify his or her unique talents abilities and strengths
32
httpswwwResourcesForIntegratedCarecom
Utilizing a Strength-Based Approach
sect IL - LTSSCs conduct strength - based initial assessments sect Key questions for a strength - based approach to
assessments sect What is working well right now in your life sect What do you want to accomplish in the future sect What is working well that you can build on sect What are some creative ways that you or someone you know has
addressed this problem in the past
sect Instead of assuming that a person has a weakness in a particular area assume that the person has not yet had opportunities that are essential to learning developing and mastering a skill in that particular area
33
httpswwwResourcesForIntegratedCarecom
Case Study 1 ldquoKarenrdquo
sect 51 - year - old woman with history of falls and diagnoses of PTSD anxiety bipolar disorder chronic respiratory disease dizziness and unspecified psychosis
sect Extremely reliant on her brother and mother for assistance with IADLs
sect Worked with IL - LTSSC to access the following Homemaker Services Companion Services Social and Medical Transportation
sect Karen reports that these services have lessened her feelings of anxiety and stress and have allowed her to feel safer and more self-sufficient in her environment
34
httpswwwResourcesForIntegratedCarecom
Case Study 2 ldquoRicardordquo
sect 53 - year - old consumer with diagnoses of depression anxiety and cognitive disabilities
sect Experienced homelessness for approximately 5 years and had to forfeit his service animal upon entering the shelter system Left the shelter after a few months and has lived in a U - Haul van for the last 2 years
sect IL - LTSSCrsquos initial focus was on housing assistance and was able to get consumer into a one - year Single Room Occupancy (SRO) Program that will give him access to permanent housing upon successful completion of program
sect IL - LTSSC is now working with care team to obtain approval for additional supports like home - delivered meals and laundry service
35
httpswwwResourcesForIntegratedCarecom
Personal Care Attendants and the Interdisciplinary Care Team
Corinne Eldridge Executive Director California Long - Term Care Education Center
37
httpswwwResourcesForIntegratedCarecom
Californiarsquos In - Home Supportive Services (IHSS) Program
sect There are 14 million dually eligible individuals in California4
sect The IHSS program serves 564000 consumers in CA5
sect 56 are 65 years or older 37 are 18 - 64 7 are under 18 sect 50 speak a primary language other than English
sect Californiarsquos IHSS program is the oldest Personal Care Attendant program in the country
sect There are 509000 IHSS workers in CA5
sect Over 50 of IHSS workers are family members
4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D5 Claire Ramsey (2019) In - Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
37
httpswwwResourcesForIntegratedCarecom
California Long - Term Care Education Center (CLTCEC) IHSS Training
sect CLTCEC began training IHSS consumer and provider pairs in 2012 sect Began with 6 health plans across 3 counties in California as
part of a Health Care Innovations Awards grant through the Center for Medicare amp Medicaid Innovation (CMMI)
sect Continued IHSS training program with 2 health plan partners LA Care Blue Shield California
38
httpswwwResourcesForIntegratedCarecom
Basic Tenants of the IHSS Training Program
39
Voluntary participation
IHSS provider learns new skills
Honors consumer-directed model of care
Competency-based education
httpswwwResourcesForIntegratedCarecom
IHSS Training Program
sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training
and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes
if possible sect 17-week course includes additional modules on body systems and disease-
specific care sect Training modules discuss the role of the IHSS provider and integration
into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration
are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have
discussions with IHSS consumer about what was learned in class that week
40
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
Traditional Care Management vs Self-Directed Care Management
19
Traditional Care Management Self-Directed Care ManagementConsumer and Care Manager decide which services are needed based on assessment
Consumer and Care Manager decide which services are needed based on assessment
Care Manager locates providers Consumer locates providers with assistance from care manager
Provider agency decides which worker to send and when to provide careservice
Consumer determines schedule based on assessed need
Provider agency hires trains and manages employees
Consumer hires trains and manages employees
Care Manager is responsible for management of provider issues
Consumer addresses service issues directly with assistance from care manager as needed
Care Manager contacts provider with any service issues
Care Manager monitors quality of service and satisfaction
httpswwwResourcesForIntegratedCarecom
The Role of Care Management in Self-Direction
sect Care managers play important roles in supporting consumers who are self - directing through bull Education bull Facilitation bull Support
20
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Education
sect Care managers can support consumers through education to ensure that the person is sect Well - informed and capable of making decisions sect Able to understand the tasks provided by the chosen
service sect Aware of their responsibilities as the employer and the
responsibilities of the provider sect In Ohio care managers answer questions about self-
direction and provide support when needed during quarterly visits or when people experience significant changes
21
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Facilitation
sect Care Managers can facilitate self - direction by sect Providing structure for the planning process sect Empowering the person to make decisions and take
action sect Helping the person identify goals sect Working with the person to guide the selection of supports
and services sect Assisting when possible with the application process rate
negotiation and service reviews
22
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Support
sect Care Managers can support consumers by sect Providing encouragement sect Working with people to help reduce potential negative
outcomes associated with their decisions sect Helping people adapt to their role as an employer sect Educating people on the importance of a back - up plan sect Helping people implement standard employment
application processes when possible sect Helping people understand supervisory responsibilities
23
httpswwwResourcesForIntegratedCarecom
Consumer Benefits of Self-Direction
sect Consumer is in control of their own supports and services sect Flexible scheduling sect Reduces unmet needscall - offs sect Enhances feelings of safety sect Promotes independence choice and self - determination sect Returns the choice to the consumer
24
httpswwwResourcesForIntegratedCarecom
Care Management Benefits of Self-Direction
sect Reduced service gaps sect Helps arrange supports and services in ldquohard to serverdquo
areas such as rural areas with direct care worker shortages
sect Helps ensure supports and services for consumers with complex service needs such as people who need assistance with toileting hourly
sect Fewer requests for change of service providers sect Satisfaction with all services increases
25
httpswwwResourcesForIntegratedCarecom
The Role of the LTSS Coordinator in Supporting Consumer Choice
Courtland Townes Deputy Director Boston Center for Independent Living
27
httpswwwResourcesForIntegratedCarecom
Massachusetts One Care Programrsquos Independent Living LTSS Model
sect One Care is the Massachusettsrsquo Medicare - Medicaid Financial Alignment Demonstration for adults living with disabilities who are dually eligible for Medicare and Medicaid
sect One Care uses a consumer - driven interdisciplinary care team comprised of medical professionals and long - term care coordinators
sect Once enrolled members have the right to have an independent living and LTSS coordinator ( IL - LTSSC) as part of their care team
27
httpswwwResourcesForIntegratedCarecom
Supporting Consumers who Choose to Live Independently
sect IL - LTSSCs are not employed by health plans but by independent community organizations such as Independent Living Centers Recovery Learning Centers and Aging Services Access Points sect This ensures that IL - LTSSCs can advocate for the
memberrsquos needs in an unbiased manner sect An important purpose of the Independent Living planning
process is to provide consumers with opportunities to learn and develop new skills that can help them succeed in achieving and maintaining their independent living goals
28
httpswwwResourcesForIntegratedCarecom
The Role of IL-LTSSCs
sect Support consumers in developing and working toward quality of life goals for independent living wellness and recovery
sect Conduct initial assessments to help consumers identify the services they need
sect Work as a care team member providing expertise in LTSS Independent Living Philosophy and Recovery Model
sect Have experience working with people with disabilities (may include lived experience with a disability)
sect Provide expertise on community services and community service providers
29
httpswwwResourcesForIntegratedCarecom
Supporting Individuals Who are Self-Directing Personal Care Services
sect The IL - LTSSC discusses the Independent Living Philosophy framework of Consumer Direction and Control with the consumer sect ldquoIndependencerdquo is different for each consumer
sect IL-LTSSCs assist consumers in identifying short- and long-term goals and current barriers to independence sect In initial assessment in the home IL - LTSSCs help consumers
identify the services they need sect Once services are approved through the Care Management
Team the IL - LTSSC begins the necessary service coordination to put vendor services in place
sect Consumers have the right to make changes to their selected services
30
httpswwwResourcesForIntegratedCarecom
What Other Types of Supports and Services are Offered to Individuals
sect Skills training and education sect Peer support sect Non - medical transportation sect Assistive technology sect Home modifications sect Home delivered meals sect Adult day health programs sect Homemaker and companion services
31
httpswwwResourcesForIntegratedCarecom
Strength-Based Needs Assessments
sect Every person regardless of his or her personal situation has unique strengths These basic strengths can be used as a starting place to begin developing other new strengths that will support the personrsquos efforts to reach his or her goals and dreams
sect Often someone from outside the personrsquos immediate environment can best help the person identify his or her unique talents abilities and strengths
32
httpswwwResourcesForIntegratedCarecom
Utilizing a Strength-Based Approach
sect IL - LTSSCs conduct strength - based initial assessments sect Key questions for a strength - based approach to
assessments sect What is working well right now in your life sect What do you want to accomplish in the future sect What is working well that you can build on sect What are some creative ways that you or someone you know has
addressed this problem in the past
sect Instead of assuming that a person has a weakness in a particular area assume that the person has not yet had opportunities that are essential to learning developing and mastering a skill in that particular area
33
httpswwwResourcesForIntegratedCarecom
Case Study 1 ldquoKarenrdquo
sect 51 - year - old woman with history of falls and diagnoses of PTSD anxiety bipolar disorder chronic respiratory disease dizziness and unspecified psychosis
sect Extremely reliant on her brother and mother for assistance with IADLs
sect Worked with IL - LTSSC to access the following Homemaker Services Companion Services Social and Medical Transportation
sect Karen reports that these services have lessened her feelings of anxiety and stress and have allowed her to feel safer and more self-sufficient in her environment
34
httpswwwResourcesForIntegratedCarecom
Case Study 2 ldquoRicardordquo
sect 53 - year - old consumer with diagnoses of depression anxiety and cognitive disabilities
sect Experienced homelessness for approximately 5 years and had to forfeit his service animal upon entering the shelter system Left the shelter after a few months and has lived in a U - Haul van for the last 2 years
sect IL - LTSSCrsquos initial focus was on housing assistance and was able to get consumer into a one - year Single Room Occupancy (SRO) Program that will give him access to permanent housing upon successful completion of program
sect IL - LTSSC is now working with care team to obtain approval for additional supports like home - delivered meals and laundry service
35
httpswwwResourcesForIntegratedCarecom
Personal Care Attendants and the Interdisciplinary Care Team
Corinne Eldridge Executive Director California Long - Term Care Education Center
37
httpswwwResourcesForIntegratedCarecom
Californiarsquos In - Home Supportive Services (IHSS) Program
sect There are 14 million dually eligible individuals in California4
sect The IHSS program serves 564000 consumers in CA5
sect 56 are 65 years or older 37 are 18 - 64 7 are under 18 sect 50 speak a primary language other than English
sect Californiarsquos IHSS program is the oldest Personal Care Attendant program in the country
sect There are 509000 IHSS workers in CA5
sect Over 50 of IHSS workers are family members
4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D5 Claire Ramsey (2019) In - Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
37
httpswwwResourcesForIntegratedCarecom
California Long - Term Care Education Center (CLTCEC) IHSS Training
sect CLTCEC began training IHSS consumer and provider pairs in 2012 sect Began with 6 health plans across 3 counties in California as
part of a Health Care Innovations Awards grant through the Center for Medicare amp Medicaid Innovation (CMMI)
sect Continued IHSS training program with 2 health plan partners LA Care Blue Shield California
38
httpswwwResourcesForIntegratedCarecom
Basic Tenants of the IHSS Training Program
39
Voluntary participation
IHSS provider learns new skills
Honors consumer-directed model of care
Competency-based education
httpswwwResourcesForIntegratedCarecom
IHSS Training Program
sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training
and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes
if possible sect 17-week course includes additional modules on body systems and disease-
specific care sect Training modules discuss the role of the IHSS provider and integration
into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration
are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have
discussions with IHSS consumer about what was learned in class that week
40
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
The Role of Care Management in Self-Direction
sect Care managers play important roles in supporting consumers who are self - directing through bull Education bull Facilitation bull Support
20
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Education
sect Care managers can support consumers through education to ensure that the person is sect Well - informed and capable of making decisions sect Able to understand the tasks provided by the chosen
service sect Aware of their responsibilities as the employer and the
responsibilities of the provider sect In Ohio care managers answer questions about self-
direction and provide support when needed during quarterly visits or when people experience significant changes
21
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Facilitation
sect Care Managers can facilitate self - direction by sect Providing structure for the planning process sect Empowering the person to make decisions and take
action sect Helping the person identify goals sect Working with the person to guide the selection of supports
and services sect Assisting when possible with the application process rate
negotiation and service reviews
22
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Support
sect Care Managers can support consumers by sect Providing encouragement sect Working with people to help reduce potential negative
outcomes associated with their decisions sect Helping people adapt to their role as an employer sect Educating people on the importance of a back - up plan sect Helping people implement standard employment
application processes when possible sect Helping people understand supervisory responsibilities
23
httpswwwResourcesForIntegratedCarecom
Consumer Benefits of Self-Direction
sect Consumer is in control of their own supports and services sect Flexible scheduling sect Reduces unmet needscall - offs sect Enhances feelings of safety sect Promotes independence choice and self - determination sect Returns the choice to the consumer
24
httpswwwResourcesForIntegratedCarecom
Care Management Benefits of Self-Direction
sect Reduced service gaps sect Helps arrange supports and services in ldquohard to serverdquo
areas such as rural areas with direct care worker shortages
sect Helps ensure supports and services for consumers with complex service needs such as people who need assistance with toileting hourly
sect Fewer requests for change of service providers sect Satisfaction with all services increases
25
httpswwwResourcesForIntegratedCarecom
The Role of the LTSS Coordinator in Supporting Consumer Choice
Courtland Townes Deputy Director Boston Center for Independent Living
27
httpswwwResourcesForIntegratedCarecom
Massachusetts One Care Programrsquos Independent Living LTSS Model
sect One Care is the Massachusettsrsquo Medicare - Medicaid Financial Alignment Demonstration for adults living with disabilities who are dually eligible for Medicare and Medicaid
sect One Care uses a consumer - driven interdisciplinary care team comprised of medical professionals and long - term care coordinators
sect Once enrolled members have the right to have an independent living and LTSS coordinator ( IL - LTSSC) as part of their care team
27
httpswwwResourcesForIntegratedCarecom
Supporting Consumers who Choose to Live Independently
sect IL - LTSSCs are not employed by health plans but by independent community organizations such as Independent Living Centers Recovery Learning Centers and Aging Services Access Points sect This ensures that IL - LTSSCs can advocate for the
memberrsquos needs in an unbiased manner sect An important purpose of the Independent Living planning
process is to provide consumers with opportunities to learn and develop new skills that can help them succeed in achieving and maintaining their independent living goals
28
httpswwwResourcesForIntegratedCarecom
The Role of IL-LTSSCs
sect Support consumers in developing and working toward quality of life goals for independent living wellness and recovery
sect Conduct initial assessments to help consumers identify the services they need
sect Work as a care team member providing expertise in LTSS Independent Living Philosophy and Recovery Model
sect Have experience working with people with disabilities (may include lived experience with a disability)
sect Provide expertise on community services and community service providers
29
httpswwwResourcesForIntegratedCarecom
Supporting Individuals Who are Self-Directing Personal Care Services
sect The IL - LTSSC discusses the Independent Living Philosophy framework of Consumer Direction and Control with the consumer sect ldquoIndependencerdquo is different for each consumer
sect IL-LTSSCs assist consumers in identifying short- and long-term goals and current barriers to independence sect In initial assessment in the home IL - LTSSCs help consumers
identify the services they need sect Once services are approved through the Care Management
Team the IL - LTSSC begins the necessary service coordination to put vendor services in place
sect Consumers have the right to make changes to their selected services
30
httpswwwResourcesForIntegratedCarecom
What Other Types of Supports and Services are Offered to Individuals
sect Skills training and education sect Peer support sect Non - medical transportation sect Assistive technology sect Home modifications sect Home delivered meals sect Adult day health programs sect Homemaker and companion services
31
httpswwwResourcesForIntegratedCarecom
Strength-Based Needs Assessments
sect Every person regardless of his or her personal situation has unique strengths These basic strengths can be used as a starting place to begin developing other new strengths that will support the personrsquos efforts to reach his or her goals and dreams
sect Often someone from outside the personrsquos immediate environment can best help the person identify his or her unique talents abilities and strengths
32
httpswwwResourcesForIntegratedCarecom
Utilizing a Strength-Based Approach
sect IL - LTSSCs conduct strength - based initial assessments sect Key questions for a strength - based approach to
assessments sect What is working well right now in your life sect What do you want to accomplish in the future sect What is working well that you can build on sect What are some creative ways that you or someone you know has
addressed this problem in the past
sect Instead of assuming that a person has a weakness in a particular area assume that the person has not yet had opportunities that are essential to learning developing and mastering a skill in that particular area
33
httpswwwResourcesForIntegratedCarecom
Case Study 1 ldquoKarenrdquo
sect 51 - year - old woman with history of falls and diagnoses of PTSD anxiety bipolar disorder chronic respiratory disease dizziness and unspecified psychosis
sect Extremely reliant on her brother and mother for assistance with IADLs
sect Worked with IL - LTSSC to access the following Homemaker Services Companion Services Social and Medical Transportation
sect Karen reports that these services have lessened her feelings of anxiety and stress and have allowed her to feel safer and more self-sufficient in her environment
34
httpswwwResourcesForIntegratedCarecom
Case Study 2 ldquoRicardordquo
sect 53 - year - old consumer with diagnoses of depression anxiety and cognitive disabilities
sect Experienced homelessness for approximately 5 years and had to forfeit his service animal upon entering the shelter system Left the shelter after a few months and has lived in a U - Haul van for the last 2 years
sect IL - LTSSCrsquos initial focus was on housing assistance and was able to get consumer into a one - year Single Room Occupancy (SRO) Program that will give him access to permanent housing upon successful completion of program
sect IL - LTSSC is now working with care team to obtain approval for additional supports like home - delivered meals and laundry service
35
httpswwwResourcesForIntegratedCarecom
Personal Care Attendants and the Interdisciplinary Care Team
Corinne Eldridge Executive Director California Long - Term Care Education Center
37
httpswwwResourcesForIntegratedCarecom
Californiarsquos In - Home Supportive Services (IHSS) Program
sect There are 14 million dually eligible individuals in California4
sect The IHSS program serves 564000 consumers in CA5
sect 56 are 65 years or older 37 are 18 - 64 7 are under 18 sect 50 speak a primary language other than English
sect Californiarsquos IHSS program is the oldest Personal Care Attendant program in the country
sect There are 509000 IHSS workers in CA5
sect Over 50 of IHSS workers are family members
4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D5 Claire Ramsey (2019) In - Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
37
httpswwwResourcesForIntegratedCarecom
California Long - Term Care Education Center (CLTCEC) IHSS Training
sect CLTCEC began training IHSS consumer and provider pairs in 2012 sect Began with 6 health plans across 3 counties in California as
part of a Health Care Innovations Awards grant through the Center for Medicare amp Medicaid Innovation (CMMI)
sect Continued IHSS training program with 2 health plan partners LA Care Blue Shield California
38
httpswwwResourcesForIntegratedCarecom
Basic Tenants of the IHSS Training Program
39
Voluntary participation
IHSS provider learns new skills
Honors consumer-directed model of care
Competency-based education
httpswwwResourcesForIntegratedCarecom
IHSS Training Program
sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training
and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes
if possible sect 17-week course includes additional modules on body systems and disease-
specific care sect Training modules discuss the role of the IHSS provider and integration
into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration
are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have
discussions with IHSS consumer about what was learned in class that week
40
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Education
sect Care managers can support consumers through education to ensure that the person is sect Well - informed and capable of making decisions sect Able to understand the tasks provided by the chosen
service sect Aware of their responsibilities as the employer and the
responsibilities of the provider sect In Ohio care managers answer questions about self-
direction and provide support when needed during quarterly visits or when people experience significant changes
21
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Facilitation
sect Care Managers can facilitate self - direction by sect Providing structure for the planning process sect Empowering the person to make decisions and take
action sect Helping the person identify goals sect Working with the person to guide the selection of supports
and services sect Assisting when possible with the application process rate
negotiation and service reviews
22
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Support
sect Care Managers can support consumers by sect Providing encouragement sect Working with people to help reduce potential negative
outcomes associated with their decisions sect Helping people adapt to their role as an employer sect Educating people on the importance of a back - up plan sect Helping people implement standard employment
application processes when possible sect Helping people understand supervisory responsibilities
23
httpswwwResourcesForIntegratedCarecom
Consumer Benefits of Self-Direction
sect Consumer is in control of their own supports and services sect Flexible scheduling sect Reduces unmet needscall - offs sect Enhances feelings of safety sect Promotes independence choice and self - determination sect Returns the choice to the consumer
24
httpswwwResourcesForIntegratedCarecom
Care Management Benefits of Self-Direction
sect Reduced service gaps sect Helps arrange supports and services in ldquohard to serverdquo
areas such as rural areas with direct care worker shortages
sect Helps ensure supports and services for consumers with complex service needs such as people who need assistance with toileting hourly
sect Fewer requests for change of service providers sect Satisfaction with all services increases
25
httpswwwResourcesForIntegratedCarecom
The Role of the LTSS Coordinator in Supporting Consumer Choice
Courtland Townes Deputy Director Boston Center for Independent Living
27
httpswwwResourcesForIntegratedCarecom
Massachusetts One Care Programrsquos Independent Living LTSS Model
sect One Care is the Massachusettsrsquo Medicare - Medicaid Financial Alignment Demonstration for adults living with disabilities who are dually eligible for Medicare and Medicaid
sect One Care uses a consumer - driven interdisciplinary care team comprised of medical professionals and long - term care coordinators
sect Once enrolled members have the right to have an independent living and LTSS coordinator ( IL - LTSSC) as part of their care team
27
httpswwwResourcesForIntegratedCarecom
Supporting Consumers who Choose to Live Independently
sect IL - LTSSCs are not employed by health plans but by independent community organizations such as Independent Living Centers Recovery Learning Centers and Aging Services Access Points sect This ensures that IL - LTSSCs can advocate for the
memberrsquos needs in an unbiased manner sect An important purpose of the Independent Living planning
process is to provide consumers with opportunities to learn and develop new skills that can help them succeed in achieving and maintaining their independent living goals
28
httpswwwResourcesForIntegratedCarecom
The Role of IL-LTSSCs
sect Support consumers in developing and working toward quality of life goals for independent living wellness and recovery
sect Conduct initial assessments to help consumers identify the services they need
sect Work as a care team member providing expertise in LTSS Independent Living Philosophy and Recovery Model
sect Have experience working with people with disabilities (may include lived experience with a disability)
sect Provide expertise on community services and community service providers
29
httpswwwResourcesForIntegratedCarecom
Supporting Individuals Who are Self-Directing Personal Care Services
sect The IL - LTSSC discusses the Independent Living Philosophy framework of Consumer Direction and Control with the consumer sect ldquoIndependencerdquo is different for each consumer
sect IL-LTSSCs assist consumers in identifying short- and long-term goals and current barriers to independence sect In initial assessment in the home IL - LTSSCs help consumers
identify the services they need sect Once services are approved through the Care Management
Team the IL - LTSSC begins the necessary service coordination to put vendor services in place
sect Consumers have the right to make changes to their selected services
30
httpswwwResourcesForIntegratedCarecom
What Other Types of Supports and Services are Offered to Individuals
sect Skills training and education sect Peer support sect Non - medical transportation sect Assistive technology sect Home modifications sect Home delivered meals sect Adult day health programs sect Homemaker and companion services
31
httpswwwResourcesForIntegratedCarecom
Strength-Based Needs Assessments
sect Every person regardless of his or her personal situation has unique strengths These basic strengths can be used as a starting place to begin developing other new strengths that will support the personrsquos efforts to reach his or her goals and dreams
sect Often someone from outside the personrsquos immediate environment can best help the person identify his or her unique talents abilities and strengths
32
httpswwwResourcesForIntegratedCarecom
Utilizing a Strength-Based Approach
sect IL - LTSSCs conduct strength - based initial assessments sect Key questions for a strength - based approach to
assessments sect What is working well right now in your life sect What do you want to accomplish in the future sect What is working well that you can build on sect What are some creative ways that you or someone you know has
addressed this problem in the past
sect Instead of assuming that a person has a weakness in a particular area assume that the person has not yet had opportunities that are essential to learning developing and mastering a skill in that particular area
33
httpswwwResourcesForIntegratedCarecom
Case Study 1 ldquoKarenrdquo
sect 51 - year - old woman with history of falls and diagnoses of PTSD anxiety bipolar disorder chronic respiratory disease dizziness and unspecified psychosis
sect Extremely reliant on her brother and mother for assistance with IADLs
sect Worked with IL - LTSSC to access the following Homemaker Services Companion Services Social and Medical Transportation
sect Karen reports that these services have lessened her feelings of anxiety and stress and have allowed her to feel safer and more self-sufficient in her environment
34
httpswwwResourcesForIntegratedCarecom
Case Study 2 ldquoRicardordquo
sect 53 - year - old consumer with diagnoses of depression anxiety and cognitive disabilities
sect Experienced homelessness for approximately 5 years and had to forfeit his service animal upon entering the shelter system Left the shelter after a few months and has lived in a U - Haul van for the last 2 years
sect IL - LTSSCrsquos initial focus was on housing assistance and was able to get consumer into a one - year Single Room Occupancy (SRO) Program that will give him access to permanent housing upon successful completion of program
sect IL - LTSSC is now working with care team to obtain approval for additional supports like home - delivered meals and laundry service
35
httpswwwResourcesForIntegratedCarecom
Personal Care Attendants and the Interdisciplinary Care Team
Corinne Eldridge Executive Director California Long - Term Care Education Center
37
httpswwwResourcesForIntegratedCarecom
Californiarsquos In - Home Supportive Services (IHSS) Program
sect There are 14 million dually eligible individuals in California4
sect The IHSS program serves 564000 consumers in CA5
sect 56 are 65 years or older 37 are 18 - 64 7 are under 18 sect 50 speak a primary language other than English
sect Californiarsquos IHSS program is the oldest Personal Care Attendant program in the country
sect There are 509000 IHSS workers in CA5
sect Over 50 of IHSS workers are family members
4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D5 Claire Ramsey (2019) In - Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
37
httpswwwResourcesForIntegratedCarecom
California Long - Term Care Education Center (CLTCEC) IHSS Training
sect CLTCEC began training IHSS consumer and provider pairs in 2012 sect Began with 6 health plans across 3 counties in California as
part of a Health Care Innovations Awards grant through the Center for Medicare amp Medicaid Innovation (CMMI)
sect Continued IHSS training program with 2 health plan partners LA Care Blue Shield California
38
httpswwwResourcesForIntegratedCarecom
Basic Tenants of the IHSS Training Program
39
Voluntary participation
IHSS provider learns new skills
Honors consumer-directed model of care
Competency-based education
httpswwwResourcesForIntegratedCarecom
IHSS Training Program
sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training
and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes
if possible sect 17-week course includes additional modules on body systems and disease-
specific care sect Training modules discuss the role of the IHSS provider and integration
into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration
are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have
discussions with IHSS consumer about what was learned in class that week
40
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Facilitation
sect Care Managers can facilitate self - direction by sect Providing structure for the planning process sect Empowering the person to make decisions and take
action sect Helping the person identify goals sect Working with the person to guide the selection of supports
and services sect Assisting when possible with the application process rate
negotiation and service reviews
22
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Support
sect Care Managers can support consumers by sect Providing encouragement sect Working with people to help reduce potential negative
outcomes associated with their decisions sect Helping people adapt to their role as an employer sect Educating people on the importance of a back - up plan sect Helping people implement standard employment
application processes when possible sect Helping people understand supervisory responsibilities
23
httpswwwResourcesForIntegratedCarecom
Consumer Benefits of Self-Direction
sect Consumer is in control of their own supports and services sect Flexible scheduling sect Reduces unmet needscall - offs sect Enhances feelings of safety sect Promotes independence choice and self - determination sect Returns the choice to the consumer
24
httpswwwResourcesForIntegratedCarecom
Care Management Benefits of Self-Direction
sect Reduced service gaps sect Helps arrange supports and services in ldquohard to serverdquo
areas such as rural areas with direct care worker shortages
sect Helps ensure supports and services for consumers with complex service needs such as people who need assistance with toileting hourly
sect Fewer requests for change of service providers sect Satisfaction with all services increases
25
httpswwwResourcesForIntegratedCarecom
The Role of the LTSS Coordinator in Supporting Consumer Choice
Courtland Townes Deputy Director Boston Center for Independent Living
27
httpswwwResourcesForIntegratedCarecom
Massachusetts One Care Programrsquos Independent Living LTSS Model
sect One Care is the Massachusettsrsquo Medicare - Medicaid Financial Alignment Demonstration for adults living with disabilities who are dually eligible for Medicare and Medicaid
sect One Care uses a consumer - driven interdisciplinary care team comprised of medical professionals and long - term care coordinators
sect Once enrolled members have the right to have an independent living and LTSS coordinator ( IL - LTSSC) as part of their care team
27
httpswwwResourcesForIntegratedCarecom
Supporting Consumers who Choose to Live Independently
sect IL - LTSSCs are not employed by health plans but by independent community organizations such as Independent Living Centers Recovery Learning Centers and Aging Services Access Points sect This ensures that IL - LTSSCs can advocate for the
memberrsquos needs in an unbiased manner sect An important purpose of the Independent Living planning
process is to provide consumers with opportunities to learn and develop new skills that can help them succeed in achieving and maintaining their independent living goals
28
httpswwwResourcesForIntegratedCarecom
The Role of IL-LTSSCs
sect Support consumers in developing and working toward quality of life goals for independent living wellness and recovery
sect Conduct initial assessments to help consumers identify the services they need
sect Work as a care team member providing expertise in LTSS Independent Living Philosophy and Recovery Model
sect Have experience working with people with disabilities (may include lived experience with a disability)
sect Provide expertise on community services and community service providers
29
httpswwwResourcesForIntegratedCarecom
Supporting Individuals Who are Self-Directing Personal Care Services
sect The IL - LTSSC discusses the Independent Living Philosophy framework of Consumer Direction and Control with the consumer sect ldquoIndependencerdquo is different for each consumer
sect IL-LTSSCs assist consumers in identifying short- and long-term goals and current barriers to independence sect In initial assessment in the home IL - LTSSCs help consumers
identify the services they need sect Once services are approved through the Care Management
Team the IL - LTSSC begins the necessary service coordination to put vendor services in place
sect Consumers have the right to make changes to their selected services
30
httpswwwResourcesForIntegratedCarecom
What Other Types of Supports and Services are Offered to Individuals
sect Skills training and education sect Peer support sect Non - medical transportation sect Assistive technology sect Home modifications sect Home delivered meals sect Adult day health programs sect Homemaker and companion services
31
httpswwwResourcesForIntegratedCarecom
Strength-Based Needs Assessments
sect Every person regardless of his or her personal situation has unique strengths These basic strengths can be used as a starting place to begin developing other new strengths that will support the personrsquos efforts to reach his or her goals and dreams
sect Often someone from outside the personrsquos immediate environment can best help the person identify his or her unique talents abilities and strengths
32
httpswwwResourcesForIntegratedCarecom
Utilizing a Strength-Based Approach
sect IL - LTSSCs conduct strength - based initial assessments sect Key questions for a strength - based approach to
assessments sect What is working well right now in your life sect What do you want to accomplish in the future sect What is working well that you can build on sect What are some creative ways that you or someone you know has
addressed this problem in the past
sect Instead of assuming that a person has a weakness in a particular area assume that the person has not yet had opportunities that are essential to learning developing and mastering a skill in that particular area
33
httpswwwResourcesForIntegratedCarecom
Case Study 1 ldquoKarenrdquo
sect 51 - year - old woman with history of falls and diagnoses of PTSD anxiety bipolar disorder chronic respiratory disease dizziness and unspecified psychosis
sect Extremely reliant on her brother and mother for assistance with IADLs
sect Worked with IL - LTSSC to access the following Homemaker Services Companion Services Social and Medical Transportation
sect Karen reports that these services have lessened her feelings of anxiety and stress and have allowed her to feel safer and more self-sufficient in her environment
34
httpswwwResourcesForIntegratedCarecom
Case Study 2 ldquoRicardordquo
sect 53 - year - old consumer with diagnoses of depression anxiety and cognitive disabilities
sect Experienced homelessness for approximately 5 years and had to forfeit his service animal upon entering the shelter system Left the shelter after a few months and has lived in a U - Haul van for the last 2 years
sect IL - LTSSCrsquos initial focus was on housing assistance and was able to get consumer into a one - year Single Room Occupancy (SRO) Program that will give him access to permanent housing upon successful completion of program
sect IL - LTSSC is now working with care team to obtain approval for additional supports like home - delivered meals and laundry service
35
httpswwwResourcesForIntegratedCarecom
Personal Care Attendants and the Interdisciplinary Care Team
Corinne Eldridge Executive Director California Long - Term Care Education Center
37
httpswwwResourcesForIntegratedCarecom
Californiarsquos In - Home Supportive Services (IHSS) Program
sect There are 14 million dually eligible individuals in California4
sect The IHSS program serves 564000 consumers in CA5
sect 56 are 65 years or older 37 are 18 - 64 7 are under 18 sect 50 speak a primary language other than English
sect Californiarsquos IHSS program is the oldest Personal Care Attendant program in the country
sect There are 509000 IHSS workers in CA5
sect Over 50 of IHSS workers are family members
4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D5 Claire Ramsey (2019) In - Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
37
httpswwwResourcesForIntegratedCarecom
California Long - Term Care Education Center (CLTCEC) IHSS Training
sect CLTCEC began training IHSS consumer and provider pairs in 2012 sect Began with 6 health plans across 3 counties in California as
part of a Health Care Innovations Awards grant through the Center for Medicare amp Medicaid Innovation (CMMI)
sect Continued IHSS training program with 2 health plan partners LA Care Blue Shield California
38
httpswwwResourcesForIntegratedCarecom
Basic Tenants of the IHSS Training Program
39
Voluntary participation
IHSS provider learns new skills
Honors consumer-directed model of care
Competency-based education
httpswwwResourcesForIntegratedCarecom
IHSS Training Program
sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training
and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes
if possible sect 17-week course includes additional modules on body systems and disease-
specific care sect Training modules discuss the role of the IHSS provider and integration
into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration
are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have
discussions with IHSS consumer about what was learned in class that week
40
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
Care Management and Self-Direction Support
sect Care Managers can support consumers by sect Providing encouragement sect Working with people to help reduce potential negative
outcomes associated with their decisions sect Helping people adapt to their role as an employer sect Educating people on the importance of a back - up plan sect Helping people implement standard employment
application processes when possible sect Helping people understand supervisory responsibilities
23
httpswwwResourcesForIntegratedCarecom
Consumer Benefits of Self-Direction
sect Consumer is in control of their own supports and services sect Flexible scheduling sect Reduces unmet needscall - offs sect Enhances feelings of safety sect Promotes independence choice and self - determination sect Returns the choice to the consumer
24
httpswwwResourcesForIntegratedCarecom
Care Management Benefits of Self-Direction
sect Reduced service gaps sect Helps arrange supports and services in ldquohard to serverdquo
areas such as rural areas with direct care worker shortages
sect Helps ensure supports and services for consumers with complex service needs such as people who need assistance with toileting hourly
sect Fewer requests for change of service providers sect Satisfaction with all services increases
25
httpswwwResourcesForIntegratedCarecom
The Role of the LTSS Coordinator in Supporting Consumer Choice
Courtland Townes Deputy Director Boston Center for Independent Living
27
httpswwwResourcesForIntegratedCarecom
Massachusetts One Care Programrsquos Independent Living LTSS Model
sect One Care is the Massachusettsrsquo Medicare - Medicaid Financial Alignment Demonstration for adults living with disabilities who are dually eligible for Medicare and Medicaid
sect One Care uses a consumer - driven interdisciplinary care team comprised of medical professionals and long - term care coordinators
sect Once enrolled members have the right to have an independent living and LTSS coordinator ( IL - LTSSC) as part of their care team
27
httpswwwResourcesForIntegratedCarecom
Supporting Consumers who Choose to Live Independently
sect IL - LTSSCs are not employed by health plans but by independent community organizations such as Independent Living Centers Recovery Learning Centers and Aging Services Access Points sect This ensures that IL - LTSSCs can advocate for the
memberrsquos needs in an unbiased manner sect An important purpose of the Independent Living planning
process is to provide consumers with opportunities to learn and develop new skills that can help them succeed in achieving and maintaining their independent living goals
28
httpswwwResourcesForIntegratedCarecom
The Role of IL-LTSSCs
sect Support consumers in developing and working toward quality of life goals for independent living wellness and recovery
sect Conduct initial assessments to help consumers identify the services they need
sect Work as a care team member providing expertise in LTSS Independent Living Philosophy and Recovery Model
sect Have experience working with people with disabilities (may include lived experience with a disability)
sect Provide expertise on community services and community service providers
29
httpswwwResourcesForIntegratedCarecom
Supporting Individuals Who are Self-Directing Personal Care Services
sect The IL - LTSSC discusses the Independent Living Philosophy framework of Consumer Direction and Control with the consumer sect ldquoIndependencerdquo is different for each consumer
sect IL-LTSSCs assist consumers in identifying short- and long-term goals and current barriers to independence sect In initial assessment in the home IL - LTSSCs help consumers
identify the services they need sect Once services are approved through the Care Management
Team the IL - LTSSC begins the necessary service coordination to put vendor services in place
sect Consumers have the right to make changes to their selected services
30
httpswwwResourcesForIntegratedCarecom
What Other Types of Supports and Services are Offered to Individuals
sect Skills training and education sect Peer support sect Non - medical transportation sect Assistive technology sect Home modifications sect Home delivered meals sect Adult day health programs sect Homemaker and companion services
31
httpswwwResourcesForIntegratedCarecom
Strength-Based Needs Assessments
sect Every person regardless of his or her personal situation has unique strengths These basic strengths can be used as a starting place to begin developing other new strengths that will support the personrsquos efforts to reach his or her goals and dreams
sect Often someone from outside the personrsquos immediate environment can best help the person identify his or her unique talents abilities and strengths
32
httpswwwResourcesForIntegratedCarecom
Utilizing a Strength-Based Approach
sect IL - LTSSCs conduct strength - based initial assessments sect Key questions for a strength - based approach to
assessments sect What is working well right now in your life sect What do you want to accomplish in the future sect What is working well that you can build on sect What are some creative ways that you or someone you know has
addressed this problem in the past
sect Instead of assuming that a person has a weakness in a particular area assume that the person has not yet had opportunities that are essential to learning developing and mastering a skill in that particular area
33
httpswwwResourcesForIntegratedCarecom
Case Study 1 ldquoKarenrdquo
sect 51 - year - old woman with history of falls and diagnoses of PTSD anxiety bipolar disorder chronic respiratory disease dizziness and unspecified psychosis
sect Extremely reliant on her brother and mother for assistance with IADLs
sect Worked with IL - LTSSC to access the following Homemaker Services Companion Services Social and Medical Transportation
sect Karen reports that these services have lessened her feelings of anxiety and stress and have allowed her to feel safer and more self-sufficient in her environment
34
httpswwwResourcesForIntegratedCarecom
Case Study 2 ldquoRicardordquo
sect 53 - year - old consumer with diagnoses of depression anxiety and cognitive disabilities
sect Experienced homelessness for approximately 5 years and had to forfeit his service animal upon entering the shelter system Left the shelter after a few months and has lived in a U - Haul van for the last 2 years
sect IL - LTSSCrsquos initial focus was on housing assistance and was able to get consumer into a one - year Single Room Occupancy (SRO) Program that will give him access to permanent housing upon successful completion of program
sect IL - LTSSC is now working with care team to obtain approval for additional supports like home - delivered meals and laundry service
35
httpswwwResourcesForIntegratedCarecom
Personal Care Attendants and the Interdisciplinary Care Team
Corinne Eldridge Executive Director California Long - Term Care Education Center
37
httpswwwResourcesForIntegratedCarecom
Californiarsquos In - Home Supportive Services (IHSS) Program
sect There are 14 million dually eligible individuals in California4
sect The IHSS program serves 564000 consumers in CA5
sect 56 are 65 years or older 37 are 18 - 64 7 are under 18 sect 50 speak a primary language other than English
sect Californiarsquos IHSS program is the oldest Personal Care Attendant program in the country
sect There are 509000 IHSS workers in CA5
sect Over 50 of IHSS workers are family members
4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D5 Claire Ramsey (2019) In - Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
37
httpswwwResourcesForIntegratedCarecom
California Long - Term Care Education Center (CLTCEC) IHSS Training
sect CLTCEC began training IHSS consumer and provider pairs in 2012 sect Began with 6 health plans across 3 counties in California as
part of a Health Care Innovations Awards grant through the Center for Medicare amp Medicaid Innovation (CMMI)
sect Continued IHSS training program with 2 health plan partners LA Care Blue Shield California
38
httpswwwResourcesForIntegratedCarecom
Basic Tenants of the IHSS Training Program
39
Voluntary participation
IHSS provider learns new skills
Honors consumer-directed model of care
Competency-based education
httpswwwResourcesForIntegratedCarecom
IHSS Training Program
sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training
and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes
if possible sect 17-week course includes additional modules on body systems and disease-
specific care sect Training modules discuss the role of the IHSS provider and integration
into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration
are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have
discussions with IHSS consumer about what was learned in class that week
40
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
Consumer Benefits of Self-Direction
sect Consumer is in control of their own supports and services sect Flexible scheduling sect Reduces unmet needscall - offs sect Enhances feelings of safety sect Promotes independence choice and self - determination sect Returns the choice to the consumer
24
httpswwwResourcesForIntegratedCarecom
Care Management Benefits of Self-Direction
sect Reduced service gaps sect Helps arrange supports and services in ldquohard to serverdquo
areas such as rural areas with direct care worker shortages
sect Helps ensure supports and services for consumers with complex service needs such as people who need assistance with toileting hourly
sect Fewer requests for change of service providers sect Satisfaction with all services increases
25
httpswwwResourcesForIntegratedCarecom
The Role of the LTSS Coordinator in Supporting Consumer Choice
Courtland Townes Deputy Director Boston Center for Independent Living
27
httpswwwResourcesForIntegratedCarecom
Massachusetts One Care Programrsquos Independent Living LTSS Model
sect One Care is the Massachusettsrsquo Medicare - Medicaid Financial Alignment Demonstration for adults living with disabilities who are dually eligible for Medicare and Medicaid
sect One Care uses a consumer - driven interdisciplinary care team comprised of medical professionals and long - term care coordinators
sect Once enrolled members have the right to have an independent living and LTSS coordinator ( IL - LTSSC) as part of their care team
27
httpswwwResourcesForIntegratedCarecom
Supporting Consumers who Choose to Live Independently
sect IL - LTSSCs are not employed by health plans but by independent community organizations such as Independent Living Centers Recovery Learning Centers and Aging Services Access Points sect This ensures that IL - LTSSCs can advocate for the
memberrsquos needs in an unbiased manner sect An important purpose of the Independent Living planning
process is to provide consumers with opportunities to learn and develop new skills that can help them succeed in achieving and maintaining their independent living goals
28
httpswwwResourcesForIntegratedCarecom
The Role of IL-LTSSCs
sect Support consumers in developing and working toward quality of life goals for independent living wellness and recovery
sect Conduct initial assessments to help consumers identify the services they need
sect Work as a care team member providing expertise in LTSS Independent Living Philosophy and Recovery Model
sect Have experience working with people with disabilities (may include lived experience with a disability)
sect Provide expertise on community services and community service providers
29
httpswwwResourcesForIntegratedCarecom
Supporting Individuals Who are Self-Directing Personal Care Services
sect The IL - LTSSC discusses the Independent Living Philosophy framework of Consumer Direction and Control with the consumer sect ldquoIndependencerdquo is different for each consumer
sect IL-LTSSCs assist consumers in identifying short- and long-term goals and current barriers to independence sect In initial assessment in the home IL - LTSSCs help consumers
identify the services they need sect Once services are approved through the Care Management
Team the IL - LTSSC begins the necessary service coordination to put vendor services in place
sect Consumers have the right to make changes to their selected services
30
httpswwwResourcesForIntegratedCarecom
What Other Types of Supports and Services are Offered to Individuals
sect Skills training and education sect Peer support sect Non - medical transportation sect Assistive technology sect Home modifications sect Home delivered meals sect Adult day health programs sect Homemaker and companion services
31
httpswwwResourcesForIntegratedCarecom
Strength-Based Needs Assessments
sect Every person regardless of his or her personal situation has unique strengths These basic strengths can be used as a starting place to begin developing other new strengths that will support the personrsquos efforts to reach his or her goals and dreams
sect Often someone from outside the personrsquos immediate environment can best help the person identify his or her unique talents abilities and strengths
32
httpswwwResourcesForIntegratedCarecom
Utilizing a Strength-Based Approach
sect IL - LTSSCs conduct strength - based initial assessments sect Key questions for a strength - based approach to
assessments sect What is working well right now in your life sect What do you want to accomplish in the future sect What is working well that you can build on sect What are some creative ways that you or someone you know has
addressed this problem in the past
sect Instead of assuming that a person has a weakness in a particular area assume that the person has not yet had opportunities that are essential to learning developing and mastering a skill in that particular area
33
httpswwwResourcesForIntegratedCarecom
Case Study 1 ldquoKarenrdquo
sect 51 - year - old woman with history of falls and diagnoses of PTSD anxiety bipolar disorder chronic respiratory disease dizziness and unspecified psychosis
sect Extremely reliant on her brother and mother for assistance with IADLs
sect Worked with IL - LTSSC to access the following Homemaker Services Companion Services Social and Medical Transportation
sect Karen reports that these services have lessened her feelings of anxiety and stress and have allowed her to feel safer and more self-sufficient in her environment
34
httpswwwResourcesForIntegratedCarecom
Case Study 2 ldquoRicardordquo
sect 53 - year - old consumer with diagnoses of depression anxiety and cognitive disabilities
sect Experienced homelessness for approximately 5 years and had to forfeit his service animal upon entering the shelter system Left the shelter after a few months and has lived in a U - Haul van for the last 2 years
sect IL - LTSSCrsquos initial focus was on housing assistance and was able to get consumer into a one - year Single Room Occupancy (SRO) Program that will give him access to permanent housing upon successful completion of program
sect IL - LTSSC is now working with care team to obtain approval for additional supports like home - delivered meals and laundry service
35
httpswwwResourcesForIntegratedCarecom
Personal Care Attendants and the Interdisciplinary Care Team
Corinne Eldridge Executive Director California Long - Term Care Education Center
37
httpswwwResourcesForIntegratedCarecom
Californiarsquos In - Home Supportive Services (IHSS) Program
sect There are 14 million dually eligible individuals in California4
sect The IHSS program serves 564000 consumers in CA5
sect 56 are 65 years or older 37 are 18 - 64 7 are under 18 sect 50 speak a primary language other than English
sect Californiarsquos IHSS program is the oldest Personal Care Attendant program in the country
sect There are 509000 IHSS workers in CA5
sect Over 50 of IHSS workers are family members
4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D5 Claire Ramsey (2019) In - Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
37
httpswwwResourcesForIntegratedCarecom
California Long - Term Care Education Center (CLTCEC) IHSS Training
sect CLTCEC began training IHSS consumer and provider pairs in 2012 sect Began with 6 health plans across 3 counties in California as
part of a Health Care Innovations Awards grant through the Center for Medicare amp Medicaid Innovation (CMMI)
sect Continued IHSS training program with 2 health plan partners LA Care Blue Shield California
38
httpswwwResourcesForIntegratedCarecom
Basic Tenants of the IHSS Training Program
39
Voluntary participation
IHSS provider learns new skills
Honors consumer-directed model of care
Competency-based education
httpswwwResourcesForIntegratedCarecom
IHSS Training Program
sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training
and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes
if possible sect 17-week course includes additional modules on body systems and disease-
specific care sect Training modules discuss the role of the IHSS provider and integration
into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration
are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have
discussions with IHSS consumer about what was learned in class that week
40
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
Care Management Benefits of Self-Direction
sect Reduced service gaps sect Helps arrange supports and services in ldquohard to serverdquo
areas such as rural areas with direct care worker shortages
sect Helps ensure supports and services for consumers with complex service needs such as people who need assistance with toileting hourly
sect Fewer requests for change of service providers sect Satisfaction with all services increases
25
httpswwwResourcesForIntegratedCarecom
The Role of the LTSS Coordinator in Supporting Consumer Choice
Courtland Townes Deputy Director Boston Center for Independent Living
27
httpswwwResourcesForIntegratedCarecom
Massachusetts One Care Programrsquos Independent Living LTSS Model
sect One Care is the Massachusettsrsquo Medicare - Medicaid Financial Alignment Demonstration for adults living with disabilities who are dually eligible for Medicare and Medicaid
sect One Care uses a consumer - driven interdisciplinary care team comprised of medical professionals and long - term care coordinators
sect Once enrolled members have the right to have an independent living and LTSS coordinator ( IL - LTSSC) as part of their care team
27
httpswwwResourcesForIntegratedCarecom
Supporting Consumers who Choose to Live Independently
sect IL - LTSSCs are not employed by health plans but by independent community organizations such as Independent Living Centers Recovery Learning Centers and Aging Services Access Points sect This ensures that IL - LTSSCs can advocate for the
memberrsquos needs in an unbiased manner sect An important purpose of the Independent Living planning
process is to provide consumers with opportunities to learn and develop new skills that can help them succeed in achieving and maintaining their independent living goals
28
httpswwwResourcesForIntegratedCarecom
The Role of IL-LTSSCs
sect Support consumers in developing and working toward quality of life goals for independent living wellness and recovery
sect Conduct initial assessments to help consumers identify the services they need
sect Work as a care team member providing expertise in LTSS Independent Living Philosophy and Recovery Model
sect Have experience working with people with disabilities (may include lived experience with a disability)
sect Provide expertise on community services and community service providers
29
httpswwwResourcesForIntegratedCarecom
Supporting Individuals Who are Self-Directing Personal Care Services
sect The IL - LTSSC discusses the Independent Living Philosophy framework of Consumer Direction and Control with the consumer sect ldquoIndependencerdquo is different for each consumer
sect IL-LTSSCs assist consumers in identifying short- and long-term goals and current barriers to independence sect In initial assessment in the home IL - LTSSCs help consumers
identify the services they need sect Once services are approved through the Care Management
Team the IL - LTSSC begins the necessary service coordination to put vendor services in place
sect Consumers have the right to make changes to their selected services
30
httpswwwResourcesForIntegratedCarecom
What Other Types of Supports and Services are Offered to Individuals
sect Skills training and education sect Peer support sect Non - medical transportation sect Assistive technology sect Home modifications sect Home delivered meals sect Adult day health programs sect Homemaker and companion services
31
httpswwwResourcesForIntegratedCarecom
Strength-Based Needs Assessments
sect Every person regardless of his or her personal situation has unique strengths These basic strengths can be used as a starting place to begin developing other new strengths that will support the personrsquos efforts to reach his or her goals and dreams
sect Often someone from outside the personrsquos immediate environment can best help the person identify his or her unique talents abilities and strengths
32
httpswwwResourcesForIntegratedCarecom
Utilizing a Strength-Based Approach
sect IL - LTSSCs conduct strength - based initial assessments sect Key questions for a strength - based approach to
assessments sect What is working well right now in your life sect What do you want to accomplish in the future sect What is working well that you can build on sect What are some creative ways that you or someone you know has
addressed this problem in the past
sect Instead of assuming that a person has a weakness in a particular area assume that the person has not yet had opportunities that are essential to learning developing and mastering a skill in that particular area
33
httpswwwResourcesForIntegratedCarecom
Case Study 1 ldquoKarenrdquo
sect 51 - year - old woman with history of falls and diagnoses of PTSD anxiety bipolar disorder chronic respiratory disease dizziness and unspecified psychosis
sect Extremely reliant on her brother and mother for assistance with IADLs
sect Worked with IL - LTSSC to access the following Homemaker Services Companion Services Social and Medical Transportation
sect Karen reports that these services have lessened her feelings of anxiety and stress and have allowed her to feel safer and more self-sufficient in her environment
34
httpswwwResourcesForIntegratedCarecom
Case Study 2 ldquoRicardordquo
sect 53 - year - old consumer with diagnoses of depression anxiety and cognitive disabilities
sect Experienced homelessness for approximately 5 years and had to forfeit his service animal upon entering the shelter system Left the shelter after a few months and has lived in a U - Haul van for the last 2 years
sect IL - LTSSCrsquos initial focus was on housing assistance and was able to get consumer into a one - year Single Room Occupancy (SRO) Program that will give him access to permanent housing upon successful completion of program
sect IL - LTSSC is now working with care team to obtain approval for additional supports like home - delivered meals and laundry service
35
httpswwwResourcesForIntegratedCarecom
Personal Care Attendants and the Interdisciplinary Care Team
Corinne Eldridge Executive Director California Long - Term Care Education Center
37
httpswwwResourcesForIntegratedCarecom
Californiarsquos In - Home Supportive Services (IHSS) Program
sect There are 14 million dually eligible individuals in California4
sect The IHSS program serves 564000 consumers in CA5
sect 56 are 65 years or older 37 are 18 - 64 7 are under 18 sect 50 speak a primary language other than English
sect Californiarsquos IHSS program is the oldest Personal Care Attendant program in the country
sect There are 509000 IHSS workers in CA5
sect Over 50 of IHSS workers are family members
4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D5 Claire Ramsey (2019) In - Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
37
httpswwwResourcesForIntegratedCarecom
California Long - Term Care Education Center (CLTCEC) IHSS Training
sect CLTCEC began training IHSS consumer and provider pairs in 2012 sect Began with 6 health plans across 3 counties in California as
part of a Health Care Innovations Awards grant through the Center for Medicare amp Medicaid Innovation (CMMI)
sect Continued IHSS training program with 2 health plan partners LA Care Blue Shield California
38
httpswwwResourcesForIntegratedCarecom
Basic Tenants of the IHSS Training Program
39
Voluntary participation
IHSS provider learns new skills
Honors consumer-directed model of care
Competency-based education
httpswwwResourcesForIntegratedCarecom
IHSS Training Program
sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training
and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes
if possible sect 17-week course includes additional modules on body systems and disease-
specific care sect Training modules discuss the role of the IHSS provider and integration
into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration
are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have
discussions with IHSS consumer about what was learned in class that week
40
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
The Role of the LTSS Coordinator in Supporting Consumer Choice
Courtland Townes Deputy Director Boston Center for Independent Living
27
httpswwwResourcesForIntegratedCarecom
Massachusetts One Care Programrsquos Independent Living LTSS Model
sect One Care is the Massachusettsrsquo Medicare - Medicaid Financial Alignment Demonstration for adults living with disabilities who are dually eligible for Medicare and Medicaid
sect One Care uses a consumer - driven interdisciplinary care team comprised of medical professionals and long - term care coordinators
sect Once enrolled members have the right to have an independent living and LTSS coordinator ( IL - LTSSC) as part of their care team
27
httpswwwResourcesForIntegratedCarecom
Supporting Consumers who Choose to Live Independently
sect IL - LTSSCs are not employed by health plans but by independent community organizations such as Independent Living Centers Recovery Learning Centers and Aging Services Access Points sect This ensures that IL - LTSSCs can advocate for the
memberrsquos needs in an unbiased manner sect An important purpose of the Independent Living planning
process is to provide consumers with opportunities to learn and develop new skills that can help them succeed in achieving and maintaining their independent living goals
28
httpswwwResourcesForIntegratedCarecom
The Role of IL-LTSSCs
sect Support consumers in developing and working toward quality of life goals for independent living wellness and recovery
sect Conduct initial assessments to help consumers identify the services they need
sect Work as a care team member providing expertise in LTSS Independent Living Philosophy and Recovery Model
sect Have experience working with people with disabilities (may include lived experience with a disability)
sect Provide expertise on community services and community service providers
29
httpswwwResourcesForIntegratedCarecom
Supporting Individuals Who are Self-Directing Personal Care Services
sect The IL - LTSSC discusses the Independent Living Philosophy framework of Consumer Direction and Control with the consumer sect ldquoIndependencerdquo is different for each consumer
sect IL-LTSSCs assist consumers in identifying short- and long-term goals and current barriers to independence sect In initial assessment in the home IL - LTSSCs help consumers
identify the services they need sect Once services are approved through the Care Management
Team the IL - LTSSC begins the necessary service coordination to put vendor services in place
sect Consumers have the right to make changes to their selected services
30
httpswwwResourcesForIntegratedCarecom
What Other Types of Supports and Services are Offered to Individuals
sect Skills training and education sect Peer support sect Non - medical transportation sect Assistive technology sect Home modifications sect Home delivered meals sect Adult day health programs sect Homemaker and companion services
31
httpswwwResourcesForIntegratedCarecom
Strength-Based Needs Assessments
sect Every person regardless of his or her personal situation has unique strengths These basic strengths can be used as a starting place to begin developing other new strengths that will support the personrsquos efforts to reach his or her goals and dreams
sect Often someone from outside the personrsquos immediate environment can best help the person identify his or her unique talents abilities and strengths
32
httpswwwResourcesForIntegratedCarecom
Utilizing a Strength-Based Approach
sect IL - LTSSCs conduct strength - based initial assessments sect Key questions for a strength - based approach to
assessments sect What is working well right now in your life sect What do you want to accomplish in the future sect What is working well that you can build on sect What are some creative ways that you or someone you know has
addressed this problem in the past
sect Instead of assuming that a person has a weakness in a particular area assume that the person has not yet had opportunities that are essential to learning developing and mastering a skill in that particular area
33
httpswwwResourcesForIntegratedCarecom
Case Study 1 ldquoKarenrdquo
sect 51 - year - old woman with history of falls and diagnoses of PTSD anxiety bipolar disorder chronic respiratory disease dizziness and unspecified psychosis
sect Extremely reliant on her brother and mother for assistance with IADLs
sect Worked with IL - LTSSC to access the following Homemaker Services Companion Services Social and Medical Transportation
sect Karen reports that these services have lessened her feelings of anxiety and stress and have allowed her to feel safer and more self-sufficient in her environment
34
httpswwwResourcesForIntegratedCarecom
Case Study 2 ldquoRicardordquo
sect 53 - year - old consumer with diagnoses of depression anxiety and cognitive disabilities
sect Experienced homelessness for approximately 5 years and had to forfeit his service animal upon entering the shelter system Left the shelter after a few months and has lived in a U - Haul van for the last 2 years
sect IL - LTSSCrsquos initial focus was on housing assistance and was able to get consumer into a one - year Single Room Occupancy (SRO) Program that will give him access to permanent housing upon successful completion of program
sect IL - LTSSC is now working with care team to obtain approval for additional supports like home - delivered meals and laundry service
35
httpswwwResourcesForIntegratedCarecom
Personal Care Attendants and the Interdisciplinary Care Team
Corinne Eldridge Executive Director California Long - Term Care Education Center
37
httpswwwResourcesForIntegratedCarecom
Californiarsquos In - Home Supportive Services (IHSS) Program
sect There are 14 million dually eligible individuals in California4
sect The IHSS program serves 564000 consumers in CA5
sect 56 are 65 years or older 37 are 18 - 64 7 are under 18 sect 50 speak a primary language other than English
sect Californiarsquos IHSS program is the oldest Personal Care Attendant program in the country
sect There are 509000 IHSS workers in CA5
sect Over 50 of IHSS workers are family members
4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D5 Claire Ramsey (2019) In - Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
37
httpswwwResourcesForIntegratedCarecom
California Long - Term Care Education Center (CLTCEC) IHSS Training
sect CLTCEC began training IHSS consumer and provider pairs in 2012 sect Began with 6 health plans across 3 counties in California as
part of a Health Care Innovations Awards grant through the Center for Medicare amp Medicaid Innovation (CMMI)
sect Continued IHSS training program with 2 health plan partners LA Care Blue Shield California
38
httpswwwResourcesForIntegratedCarecom
Basic Tenants of the IHSS Training Program
39
Voluntary participation
IHSS provider learns new skills
Honors consumer-directed model of care
Competency-based education
httpswwwResourcesForIntegratedCarecom
IHSS Training Program
sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training
and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes
if possible sect 17-week course includes additional modules on body systems and disease-
specific care sect Training modules discuss the role of the IHSS provider and integration
into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration
are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have
discussions with IHSS consumer about what was learned in class that week
40
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
Massachusetts One Care Programrsquos Independent Living LTSS Model
sect One Care is the Massachusettsrsquo Medicare - Medicaid Financial Alignment Demonstration for adults living with disabilities who are dually eligible for Medicare and Medicaid
sect One Care uses a consumer - driven interdisciplinary care team comprised of medical professionals and long - term care coordinators
sect Once enrolled members have the right to have an independent living and LTSS coordinator ( IL - LTSSC) as part of their care team
27
httpswwwResourcesForIntegratedCarecom
Supporting Consumers who Choose to Live Independently
sect IL - LTSSCs are not employed by health plans but by independent community organizations such as Independent Living Centers Recovery Learning Centers and Aging Services Access Points sect This ensures that IL - LTSSCs can advocate for the
memberrsquos needs in an unbiased manner sect An important purpose of the Independent Living planning
process is to provide consumers with opportunities to learn and develop new skills that can help them succeed in achieving and maintaining their independent living goals
28
httpswwwResourcesForIntegratedCarecom
The Role of IL-LTSSCs
sect Support consumers in developing and working toward quality of life goals for independent living wellness and recovery
sect Conduct initial assessments to help consumers identify the services they need
sect Work as a care team member providing expertise in LTSS Independent Living Philosophy and Recovery Model
sect Have experience working with people with disabilities (may include lived experience with a disability)
sect Provide expertise on community services and community service providers
29
httpswwwResourcesForIntegratedCarecom
Supporting Individuals Who are Self-Directing Personal Care Services
sect The IL - LTSSC discusses the Independent Living Philosophy framework of Consumer Direction and Control with the consumer sect ldquoIndependencerdquo is different for each consumer
sect IL-LTSSCs assist consumers in identifying short- and long-term goals and current barriers to independence sect In initial assessment in the home IL - LTSSCs help consumers
identify the services they need sect Once services are approved through the Care Management
Team the IL - LTSSC begins the necessary service coordination to put vendor services in place
sect Consumers have the right to make changes to their selected services
30
httpswwwResourcesForIntegratedCarecom
What Other Types of Supports and Services are Offered to Individuals
sect Skills training and education sect Peer support sect Non - medical transportation sect Assistive technology sect Home modifications sect Home delivered meals sect Adult day health programs sect Homemaker and companion services
31
httpswwwResourcesForIntegratedCarecom
Strength-Based Needs Assessments
sect Every person regardless of his or her personal situation has unique strengths These basic strengths can be used as a starting place to begin developing other new strengths that will support the personrsquos efforts to reach his or her goals and dreams
sect Often someone from outside the personrsquos immediate environment can best help the person identify his or her unique talents abilities and strengths
32
httpswwwResourcesForIntegratedCarecom
Utilizing a Strength-Based Approach
sect IL - LTSSCs conduct strength - based initial assessments sect Key questions for a strength - based approach to
assessments sect What is working well right now in your life sect What do you want to accomplish in the future sect What is working well that you can build on sect What are some creative ways that you or someone you know has
addressed this problem in the past
sect Instead of assuming that a person has a weakness in a particular area assume that the person has not yet had opportunities that are essential to learning developing and mastering a skill in that particular area
33
httpswwwResourcesForIntegratedCarecom
Case Study 1 ldquoKarenrdquo
sect 51 - year - old woman with history of falls and diagnoses of PTSD anxiety bipolar disorder chronic respiratory disease dizziness and unspecified psychosis
sect Extremely reliant on her brother and mother for assistance with IADLs
sect Worked with IL - LTSSC to access the following Homemaker Services Companion Services Social and Medical Transportation
sect Karen reports that these services have lessened her feelings of anxiety and stress and have allowed her to feel safer and more self-sufficient in her environment
34
httpswwwResourcesForIntegratedCarecom
Case Study 2 ldquoRicardordquo
sect 53 - year - old consumer with diagnoses of depression anxiety and cognitive disabilities
sect Experienced homelessness for approximately 5 years and had to forfeit his service animal upon entering the shelter system Left the shelter after a few months and has lived in a U - Haul van for the last 2 years
sect IL - LTSSCrsquos initial focus was on housing assistance and was able to get consumer into a one - year Single Room Occupancy (SRO) Program that will give him access to permanent housing upon successful completion of program
sect IL - LTSSC is now working with care team to obtain approval for additional supports like home - delivered meals and laundry service
35
httpswwwResourcesForIntegratedCarecom
Personal Care Attendants and the Interdisciplinary Care Team
Corinne Eldridge Executive Director California Long - Term Care Education Center
37
httpswwwResourcesForIntegratedCarecom
Californiarsquos In - Home Supportive Services (IHSS) Program
sect There are 14 million dually eligible individuals in California4
sect The IHSS program serves 564000 consumers in CA5
sect 56 are 65 years or older 37 are 18 - 64 7 are under 18 sect 50 speak a primary language other than English
sect Californiarsquos IHSS program is the oldest Personal Care Attendant program in the country
sect There are 509000 IHSS workers in CA5
sect Over 50 of IHSS workers are family members
4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D5 Claire Ramsey (2019) In - Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
37
httpswwwResourcesForIntegratedCarecom
California Long - Term Care Education Center (CLTCEC) IHSS Training
sect CLTCEC began training IHSS consumer and provider pairs in 2012 sect Began with 6 health plans across 3 counties in California as
part of a Health Care Innovations Awards grant through the Center for Medicare amp Medicaid Innovation (CMMI)
sect Continued IHSS training program with 2 health plan partners LA Care Blue Shield California
38
httpswwwResourcesForIntegratedCarecom
Basic Tenants of the IHSS Training Program
39
Voluntary participation
IHSS provider learns new skills
Honors consumer-directed model of care
Competency-based education
httpswwwResourcesForIntegratedCarecom
IHSS Training Program
sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training
and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes
if possible sect 17-week course includes additional modules on body systems and disease-
specific care sect Training modules discuss the role of the IHSS provider and integration
into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration
are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have
discussions with IHSS consumer about what was learned in class that week
40
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
Supporting Consumers who Choose to Live Independently
sect IL - LTSSCs are not employed by health plans but by independent community organizations such as Independent Living Centers Recovery Learning Centers and Aging Services Access Points sect This ensures that IL - LTSSCs can advocate for the
memberrsquos needs in an unbiased manner sect An important purpose of the Independent Living planning
process is to provide consumers with opportunities to learn and develop new skills that can help them succeed in achieving and maintaining their independent living goals
28
httpswwwResourcesForIntegratedCarecom
The Role of IL-LTSSCs
sect Support consumers in developing and working toward quality of life goals for independent living wellness and recovery
sect Conduct initial assessments to help consumers identify the services they need
sect Work as a care team member providing expertise in LTSS Independent Living Philosophy and Recovery Model
sect Have experience working with people with disabilities (may include lived experience with a disability)
sect Provide expertise on community services and community service providers
29
httpswwwResourcesForIntegratedCarecom
Supporting Individuals Who are Self-Directing Personal Care Services
sect The IL - LTSSC discusses the Independent Living Philosophy framework of Consumer Direction and Control with the consumer sect ldquoIndependencerdquo is different for each consumer
sect IL-LTSSCs assist consumers in identifying short- and long-term goals and current barriers to independence sect In initial assessment in the home IL - LTSSCs help consumers
identify the services they need sect Once services are approved through the Care Management
Team the IL - LTSSC begins the necessary service coordination to put vendor services in place
sect Consumers have the right to make changes to their selected services
30
httpswwwResourcesForIntegratedCarecom
What Other Types of Supports and Services are Offered to Individuals
sect Skills training and education sect Peer support sect Non - medical transportation sect Assistive technology sect Home modifications sect Home delivered meals sect Adult day health programs sect Homemaker and companion services
31
httpswwwResourcesForIntegratedCarecom
Strength-Based Needs Assessments
sect Every person regardless of his or her personal situation has unique strengths These basic strengths can be used as a starting place to begin developing other new strengths that will support the personrsquos efforts to reach his or her goals and dreams
sect Often someone from outside the personrsquos immediate environment can best help the person identify his or her unique talents abilities and strengths
32
httpswwwResourcesForIntegratedCarecom
Utilizing a Strength-Based Approach
sect IL - LTSSCs conduct strength - based initial assessments sect Key questions for a strength - based approach to
assessments sect What is working well right now in your life sect What do you want to accomplish in the future sect What is working well that you can build on sect What are some creative ways that you or someone you know has
addressed this problem in the past
sect Instead of assuming that a person has a weakness in a particular area assume that the person has not yet had opportunities that are essential to learning developing and mastering a skill in that particular area
33
httpswwwResourcesForIntegratedCarecom
Case Study 1 ldquoKarenrdquo
sect 51 - year - old woman with history of falls and diagnoses of PTSD anxiety bipolar disorder chronic respiratory disease dizziness and unspecified psychosis
sect Extremely reliant on her brother and mother for assistance with IADLs
sect Worked with IL - LTSSC to access the following Homemaker Services Companion Services Social and Medical Transportation
sect Karen reports that these services have lessened her feelings of anxiety and stress and have allowed her to feel safer and more self-sufficient in her environment
34
httpswwwResourcesForIntegratedCarecom
Case Study 2 ldquoRicardordquo
sect 53 - year - old consumer with diagnoses of depression anxiety and cognitive disabilities
sect Experienced homelessness for approximately 5 years and had to forfeit his service animal upon entering the shelter system Left the shelter after a few months and has lived in a U - Haul van for the last 2 years
sect IL - LTSSCrsquos initial focus was on housing assistance and was able to get consumer into a one - year Single Room Occupancy (SRO) Program that will give him access to permanent housing upon successful completion of program
sect IL - LTSSC is now working with care team to obtain approval for additional supports like home - delivered meals and laundry service
35
httpswwwResourcesForIntegratedCarecom
Personal Care Attendants and the Interdisciplinary Care Team
Corinne Eldridge Executive Director California Long - Term Care Education Center
37
httpswwwResourcesForIntegratedCarecom
Californiarsquos In - Home Supportive Services (IHSS) Program
sect There are 14 million dually eligible individuals in California4
sect The IHSS program serves 564000 consumers in CA5
sect 56 are 65 years or older 37 are 18 - 64 7 are under 18 sect 50 speak a primary language other than English
sect Californiarsquos IHSS program is the oldest Personal Care Attendant program in the country
sect There are 509000 IHSS workers in CA5
sect Over 50 of IHSS workers are family members
4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D5 Claire Ramsey (2019) In - Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
37
httpswwwResourcesForIntegratedCarecom
California Long - Term Care Education Center (CLTCEC) IHSS Training
sect CLTCEC began training IHSS consumer and provider pairs in 2012 sect Began with 6 health plans across 3 counties in California as
part of a Health Care Innovations Awards grant through the Center for Medicare amp Medicaid Innovation (CMMI)
sect Continued IHSS training program with 2 health plan partners LA Care Blue Shield California
38
httpswwwResourcesForIntegratedCarecom
Basic Tenants of the IHSS Training Program
39
Voluntary participation
IHSS provider learns new skills
Honors consumer-directed model of care
Competency-based education
httpswwwResourcesForIntegratedCarecom
IHSS Training Program
sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training
and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes
if possible sect 17-week course includes additional modules on body systems and disease-
specific care sect Training modules discuss the role of the IHSS provider and integration
into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration
are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have
discussions with IHSS consumer about what was learned in class that week
40
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
The Role of IL-LTSSCs
sect Support consumers in developing and working toward quality of life goals for independent living wellness and recovery
sect Conduct initial assessments to help consumers identify the services they need
sect Work as a care team member providing expertise in LTSS Independent Living Philosophy and Recovery Model
sect Have experience working with people with disabilities (may include lived experience with a disability)
sect Provide expertise on community services and community service providers
29
httpswwwResourcesForIntegratedCarecom
Supporting Individuals Who are Self-Directing Personal Care Services
sect The IL - LTSSC discusses the Independent Living Philosophy framework of Consumer Direction and Control with the consumer sect ldquoIndependencerdquo is different for each consumer
sect IL-LTSSCs assist consumers in identifying short- and long-term goals and current barriers to independence sect In initial assessment in the home IL - LTSSCs help consumers
identify the services they need sect Once services are approved through the Care Management
Team the IL - LTSSC begins the necessary service coordination to put vendor services in place
sect Consumers have the right to make changes to their selected services
30
httpswwwResourcesForIntegratedCarecom
What Other Types of Supports and Services are Offered to Individuals
sect Skills training and education sect Peer support sect Non - medical transportation sect Assistive technology sect Home modifications sect Home delivered meals sect Adult day health programs sect Homemaker and companion services
31
httpswwwResourcesForIntegratedCarecom
Strength-Based Needs Assessments
sect Every person regardless of his or her personal situation has unique strengths These basic strengths can be used as a starting place to begin developing other new strengths that will support the personrsquos efforts to reach his or her goals and dreams
sect Often someone from outside the personrsquos immediate environment can best help the person identify his or her unique talents abilities and strengths
32
httpswwwResourcesForIntegratedCarecom
Utilizing a Strength-Based Approach
sect IL - LTSSCs conduct strength - based initial assessments sect Key questions for a strength - based approach to
assessments sect What is working well right now in your life sect What do you want to accomplish in the future sect What is working well that you can build on sect What are some creative ways that you or someone you know has
addressed this problem in the past
sect Instead of assuming that a person has a weakness in a particular area assume that the person has not yet had opportunities that are essential to learning developing and mastering a skill in that particular area
33
httpswwwResourcesForIntegratedCarecom
Case Study 1 ldquoKarenrdquo
sect 51 - year - old woman with history of falls and diagnoses of PTSD anxiety bipolar disorder chronic respiratory disease dizziness and unspecified psychosis
sect Extremely reliant on her brother and mother for assistance with IADLs
sect Worked with IL - LTSSC to access the following Homemaker Services Companion Services Social and Medical Transportation
sect Karen reports that these services have lessened her feelings of anxiety and stress and have allowed her to feel safer and more self-sufficient in her environment
34
httpswwwResourcesForIntegratedCarecom
Case Study 2 ldquoRicardordquo
sect 53 - year - old consumer with diagnoses of depression anxiety and cognitive disabilities
sect Experienced homelessness for approximately 5 years and had to forfeit his service animal upon entering the shelter system Left the shelter after a few months and has lived in a U - Haul van for the last 2 years
sect IL - LTSSCrsquos initial focus was on housing assistance and was able to get consumer into a one - year Single Room Occupancy (SRO) Program that will give him access to permanent housing upon successful completion of program
sect IL - LTSSC is now working with care team to obtain approval for additional supports like home - delivered meals and laundry service
35
httpswwwResourcesForIntegratedCarecom
Personal Care Attendants and the Interdisciplinary Care Team
Corinne Eldridge Executive Director California Long - Term Care Education Center
37
httpswwwResourcesForIntegratedCarecom
Californiarsquos In - Home Supportive Services (IHSS) Program
sect There are 14 million dually eligible individuals in California4
sect The IHSS program serves 564000 consumers in CA5
sect 56 are 65 years or older 37 are 18 - 64 7 are under 18 sect 50 speak a primary language other than English
sect Californiarsquos IHSS program is the oldest Personal Care Attendant program in the country
sect There are 509000 IHSS workers in CA5
sect Over 50 of IHSS workers are family members
4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D5 Claire Ramsey (2019) In - Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
37
httpswwwResourcesForIntegratedCarecom
California Long - Term Care Education Center (CLTCEC) IHSS Training
sect CLTCEC began training IHSS consumer and provider pairs in 2012 sect Began with 6 health plans across 3 counties in California as
part of a Health Care Innovations Awards grant through the Center for Medicare amp Medicaid Innovation (CMMI)
sect Continued IHSS training program with 2 health plan partners LA Care Blue Shield California
38
httpswwwResourcesForIntegratedCarecom
Basic Tenants of the IHSS Training Program
39
Voluntary participation
IHSS provider learns new skills
Honors consumer-directed model of care
Competency-based education
httpswwwResourcesForIntegratedCarecom
IHSS Training Program
sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training
and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes
if possible sect 17-week course includes additional modules on body systems and disease-
specific care sect Training modules discuss the role of the IHSS provider and integration
into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration
are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have
discussions with IHSS consumer about what was learned in class that week
40
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
Supporting Individuals Who are Self-Directing Personal Care Services
sect The IL - LTSSC discusses the Independent Living Philosophy framework of Consumer Direction and Control with the consumer sect ldquoIndependencerdquo is different for each consumer
sect IL-LTSSCs assist consumers in identifying short- and long-term goals and current barriers to independence sect In initial assessment in the home IL - LTSSCs help consumers
identify the services they need sect Once services are approved through the Care Management
Team the IL - LTSSC begins the necessary service coordination to put vendor services in place
sect Consumers have the right to make changes to their selected services
30
httpswwwResourcesForIntegratedCarecom
What Other Types of Supports and Services are Offered to Individuals
sect Skills training and education sect Peer support sect Non - medical transportation sect Assistive technology sect Home modifications sect Home delivered meals sect Adult day health programs sect Homemaker and companion services
31
httpswwwResourcesForIntegratedCarecom
Strength-Based Needs Assessments
sect Every person regardless of his or her personal situation has unique strengths These basic strengths can be used as a starting place to begin developing other new strengths that will support the personrsquos efforts to reach his or her goals and dreams
sect Often someone from outside the personrsquos immediate environment can best help the person identify his or her unique talents abilities and strengths
32
httpswwwResourcesForIntegratedCarecom
Utilizing a Strength-Based Approach
sect IL - LTSSCs conduct strength - based initial assessments sect Key questions for a strength - based approach to
assessments sect What is working well right now in your life sect What do you want to accomplish in the future sect What is working well that you can build on sect What are some creative ways that you or someone you know has
addressed this problem in the past
sect Instead of assuming that a person has a weakness in a particular area assume that the person has not yet had opportunities that are essential to learning developing and mastering a skill in that particular area
33
httpswwwResourcesForIntegratedCarecom
Case Study 1 ldquoKarenrdquo
sect 51 - year - old woman with history of falls and diagnoses of PTSD anxiety bipolar disorder chronic respiratory disease dizziness and unspecified psychosis
sect Extremely reliant on her brother and mother for assistance with IADLs
sect Worked with IL - LTSSC to access the following Homemaker Services Companion Services Social and Medical Transportation
sect Karen reports that these services have lessened her feelings of anxiety and stress and have allowed her to feel safer and more self-sufficient in her environment
34
httpswwwResourcesForIntegratedCarecom
Case Study 2 ldquoRicardordquo
sect 53 - year - old consumer with diagnoses of depression anxiety and cognitive disabilities
sect Experienced homelessness for approximately 5 years and had to forfeit his service animal upon entering the shelter system Left the shelter after a few months and has lived in a U - Haul van for the last 2 years
sect IL - LTSSCrsquos initial focus was on housing assistance and was able to get consumer into a one - year Single Room Occupancy (SRO) Program that will give him access to permanent housing upon successful completion of program
sect IL - LTSSC is now working with care team to obtain approval for additional supports like home - delivered meals and laundry service
35
httpswwwResourcesForIntegratedCarecom
Personal Care Attendants and the Interdisciplinary Care Team
Corinne Eldridge Executive Director California Long - Term Care Education Center
37
httpswwwResourcesForIntegratedCarecom
Californiarsquos In - Home Supportive Services (IHSS) Program
sect There are 14 million dually eligible individuals in California4
sect The IHSS program serves 564000 consumers in CA5
sect 56 are 65 years or older 37 are 18 - 64 7 are under 18 sect 50 speak a primary language other than English
sect Californiarsquos IHSS program is the oldest Personal Care Attendant program in the country
sect There are 509000 IHSS workers in CA5
sect Over 50 of IHSS workers are family members
4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D5 Claire Ramsey (2019) In - Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
37
httpswwwResourcesForIntegratedCarecom
California Long - Term Care Education Center (CLTCEC) IHSS Training
sect CLTCEC began training IHSS consumer and provider pairs in 2012 sect Began with 6 health plans across 3 counties in California as
part of a Health Care Innovations Awards grant through the Center for Medicare amp Medicaid Innovation (CMMI)
sect Continued IHSS training program with 2 health plan partners LA Care Blue Shield California
38
httpswwwResourcesForIntegratedCarecom
Basic Tenants of the IHSS Training Program
39
Voluntary participation
IHSS provider learns new skills
Honors consumer-directed model of care
Competency-based education
httpswwwResourcesForIntegratedCarecom
IHSS Training Program
sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training
and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes
if possible sect 17-week course includes additional modules on body systems and disease-
specific care sect Training modules discuss the role of the IHSS provider and integration
into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration
are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have
discussions with IHSS consumer about what was learned in class that week
40
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
What Other Types of Supports and Services are Offered to Individuals
sect Skills training and education sect Peer support sect Non - medical transportation sect Assistive technology sect Home modifications sect Home delivered meals sect Adult day health programs sect Homemaker and companion services
31
httpswwwResourcesForIntegratedCarecom
Strength-Based Needs Assessments
sect Every person regardless of his or her personal situation has unique strengths These basic strengths can be used as a starting place to begin developing other new strengths that will support the personrsquos efforts to reach his or her goals and dreams
sect Often someone from outside the personrsquos immediate environment can best help the person identify his or her unique talents abilities and strengths
32
httpswwwResourcesForIntegratedCarecom
Utilizing a Strength-Based Approach
sect IL - LTSSCs conduct strength - based initial assessments sect Key questions for a strength - based approach to
assessments sect What is working well right now in your life sect What do you want to accomplish in the future sect What is working well that you can build on sect What are some creative ways that you or someone you know has
addressed this problem in the past
sect Instead of assuming that a person has a weakness in a particular area assume that the person has not yet had opportunities that are essential to learning developing and mastering a skill in that particular area
33
httpswwwResourcesForIntegratedCarecom
Case Study 1 ldquoKarenrdquo
sect 51 - year - old woman with history of falls and diagnoses of PTSD anxiety bipolar disorder chronic respiratory disease dizziness and unspecified psychosis
sect Extremely reliant on her brother and mother for assistance with IADLs
sect Worked with IL - LTSSC to access the following Homemaker Services Companion Services Social and Medical Transportation
sect Karen reports that these services have lessened her feelings of anxiety and stress and have allowed her to feel safer and more self-sufficient in her environment
34
httpswwwResourcesForIntegratedCarecom
Case Study 2 ldquoRicardordquo
sect 53 - year - old consumer with diagnoses of depression anxiety and cognitive disabilities
sect Experienced homelessness for approximately 5 years and had to forfeit his service animal upon entering the shelter system Left the shelter after a few months and has lived in a U - Haul van for the last 2 years
sect IL - LTSSCrsquos initial focus was on housing assistance and was able to get consumer into a one - year Single Room Occupancy (SRO) Program that will give him access to permanent housing upon successful completion of program
sect IL - LTSSC is now working with care team to obtain approval for additional supports like home - delivered meals and laundry service
35
httpswwwResourcesForIntegratedCarecom
Personal Care Attendants and the Interdisciplinary Care Team
Corinne Eldridge Executive Director California Long - Term Care Education Center
37
httpswwwResourcesForIntegratedCarecom
Californiarsquos In - Home Supportive Services (IHSS) Program
sect There are 14 million dually eligible individuals in California4
sect The IHSS program serves 564000 consumers in CA5
sect 56 are 65 years or older 37 are 18 - 64 7 are under 18 sect 50 speak a primary language other than English
sect Californiarsquos IHSS program is the oldest Personal Care Attendant program in the country
sect There are 509000 IHSS workers in CA5
sect Over 50 of IHSS workers are family members
4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D5 Claire Ramsey (2019) In - Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
37
httpswwwResourcesForIntegratedCarecom
California Long - Term Care Education Center (CLTCEC) IHSS Training
sect CLTCEC began training IHSS consumer and provider pairs in 2012 sect Began with 6 health plans across 3 counties in California as
part of a Health Care Innovations Awards grant through the Center for Medicare amp Medicaid Innovation (CMMI)
sect Continued IHSS training program with 2 health plan partners LA Care Blue Shield California
38
httpswwwResourcesForIntegratedCarecom
Basic Tenants of the IHSS Training Program
39
Voluntary participation
IHSS provider learns new skills
Honors consumer-directed model of care
Competency-based education
httpswwwResourcesForIntegratedCarecom
IHSS Training Program
sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training
and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes
if possible sect 17-week course includes additional modules on body systems and disease-
specific care sect Training modules discuss the role of the IHSS provider and integration
into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration
are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have
discussions with IHSS consumer about what was learned in class that week
40
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
Strength-Based Needs Assessments
sect Every person regardless of his or her personal situation has unique strengths These basic strengths can be used as a starting place to begin developing other new strengths that will support the personrsquos efforts to reach his or her goals and dreams
sect Often someone from outside the personrsquos immediate environment can best help the person identify his or her unique talents abilities and strengths
32
httpswwwResourcesForIntegratedCarecom
Utilizing a Strength-Based Approach
sect IL - LTSSCs conduct strength - based initial assessments sect Key questions for a strength - based approach to
assessments sect What is working well right now in your life sect What do you want to accomplish in the future sect What is working well that you can build on sect What are some creative ways that you or someone you know has
addressed this problem in the past
sect Instead of assuming that a person has a weakness in a particular area assume that the person has not yet had opportunities that are essential to learning developing and mastering a skill in that particular area
33
httpswwwResourcesForIntegratedCarecom
Case Study 1 ldquoKarenrdquo
sect 51 - year - old woman with history of falls and diagnoses of PTSD anxiety bipolar disorder chronic respiratory disease dizziness and unspecified psychosis
sect Extremely reliant on her brother and mother for assistance with IADLs
sect Worked with IL - LTSSC to access the following Homemaker Services Companion Services Social and Medical Transportation
sect Karen reports that these services have lessened her feelings of anxiety and stress and have allowed her to feel safer and more self-sufficient in her environment
34
httpswwwResourcesForIntegratedCarecom
Case Study 2 ldquoRicardordquo
sect 53 - year - old consumer with diagnoses of depression anxiety and cognitive disabilities
sect Experienced homelessness for approximately 5 years and had to forfeit his service animal upon entering the shelter system Left the shelter after a few months and has lived in a U - Haul van for the last 2 years
sect IL - LTSSCrsquos initial focus was on housing assistance and was able to get consumer into a one - year Single Room Occupancy (SRO) Program that will give him access to permanent housing upon successful completion of program
sect IL - LTSSC is now working with care team to obtain approval for additional supports like home - delivered meals and laundry service
35
httpswwwResourcesForIntegratedCarecom
Personal Care Attendants and the Interdisciplinary Care Team
Corinne Eldridge Executive Director California Long - Term Care Education Center
37
httpswwwResourcesForIntegratedCarecom
Californiarsquos In - Home Supportive Services (IHSS) Program
sect There are 14 million dually eligible individuals in California4
sect The IHSS program serves 564000 consumers in CA5
sect 56 are 65 years or older 37 are 18 - 64 7 are under 18 sect 50 speak a primary language other than English
sect Californiarsquos IHSS program is the oldest Personal Care Attendant program in the country
sect There are 509000 IHSS workers in CA5
sect Over 50 of IHSS workers are family members
4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D5 Claire Ramsey (2019) In - Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
37
httpswwwResourcesForIntegratedCarecom
California Long - Term Care Education Center (CLTCEC) IHSS Training
sect CLTCEC began training IHSS consumer and provider pairs in 2012 sect Began with 6 health plans across 3 counties in California as
part of a Health Care Innovations Awards grant through the Center for Medicare amp Medicaid Innovation (CMMI)
sect Continued IHSS training program with 2 health plan partners LA Care Blue Shield California
38
httpswwwResourcesForIntegratedCarecom
Basic Tenants of the IHSS Training Program
39
Voluntary participation
IHSS provider learns new skills
Honors consumer-directed model of care
Competency-based education
httpswwwResourcesForIntegratedCarecom
IHSS Training Program
sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training
and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes
if possible sect 17-week course includes additional modules on body systems and disease-
specific care sect Training modules discuss the role of the IHSS provider and integration
into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration
are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have
discussions with IHSS consumer about what was learned in class that week
40
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
Utilizing a Strength-Based Approach
sect IL - LTSSCs conduct strength - based initial assessments sect Key questions for a strength - based approach to
assessments sect What is working well right now in your life sect What do you want to accomplish in the future sect What is working well that you can build on sect What are some creative ways that you or someone you know has
addressed this problem in the past
sect Instead of assuming that a person has a weakness in a particular area assume that the person has not yet had opportunities that are essential to learning developing and mastering a skill in that particular area
33
httpswwwResourcesForIntegratedCarecom
Case Study 1 ldquoKarenrdquo
sect 51 - year - old woman with history of falls and diagnoses of PTSD anxiety bipolar disorder chronic respiratory disease dizziness and unspecified psychosis
sect Extremely reliant on her brother and mother for assistance with IADLs
sect Worked with IL - LTSSC to access the following Homemaker Services Companion Services Social and Medical Transportation
sect Karen reports that these services have lessened her feelings of anxiety and stress and have allowed her to feel safer and more self-sufficient in her environment
34
httpswwwResourcesForIntegratedCarecom
Case Study 2 ldquoRicardordquo
sect 53 - year - old consumer with diagnoses of depression anxiety and cognitive disabilities
sect Experienced homelessness for approximately 5 years and had to forfeit his service animal upon entering the shelter system Left the shelter after a few months and has lived in a U - Haul van for the last 2 years
sect IL - LTSSCrsquos initial focus was on housing assistance and was able to get consumer into a one - year Single Room Occupancy (SRO) Program that will give him access to permanent housing upon successful completion of program
sect IL - LTSSC is now working with care team to obtain approval for additional supports like home - delivered meals and laundry service
35
httpswwwResourcesForIntegratedCarecom
Personal Care Attendants and the Interdisciplinary Care Team
Corinne Eldridge Executive Director California Long - Term Care Education Center
37
httpswwwResourcesForIntegratedCarecom
Californiarsquos In - Home Supportive Services (IHSS) Program
sect There are 14 million dually eligible individuals in California4
sect The IHSS program serves 564000 consumers in CA5
sect 56 are 65 years or older 37 are 18 - 64 7 are under 18 sect 50 speak a primary language other than English
sect Californiarsquos IHSS program is the oldest Personal Care Attendant program in the country
sect There are 509000 IHSS workers in CA5
sect Over 50 of IHSS workers are family members
4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D5 Claire Ramsey (2019) In - Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
37
httpswwwResourcesForIntegratedCarecom
California Long - Term Care Education Center (CLTCEC) IHSS Training
sect CLTCEC began training IHSS consumer and provider pairs in 2012 sect Began with 6 health plans across 3 counties in California as
part of a Health Care Innovations Awards grant through the Center for Medicare amp Medicaid Innovation (CMMI)
sect Continued IHSS training program with 2 health plan partners LA Care Blue Shield California
38
httpswwwResourcesForIntegratedCarecom
Basic Tenants of the IHSS Training Program
39
Voluntary participation
IHSS provider learns new skills
Honors consumer-directed model of care
Competency-based education
httpswwwResourcesForIntegratedCarecom
IHSS Training Program
sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training
and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes
if possible sect 17-week course includes additional modules on body systems and disease-
specific care sect Training modules discuss the role of the IHSS provider and integration
into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration
are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have
discussions with IHSS consumer about what was learned in class that week
40
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
Case Study 1 ldquoKarenrdquo
sect 51 - year - old woman with history of falls and diagnoses of PTSD anxiety bipolar disorder chronic respiratory disease dizziness and unspecified psychosis
sect Extremely reliant on her brother and mother for assistance with IADLs
sect Worked with IL - LTSSC to access the following Homemaker Services Companion Services Social and Medical Transportation
sect Karen reports that these services have lessened her feelings of anxiety and stress and have allowed her to feel safer and more self-sufficient in her environment
34
httpswwwResourcesForIntegratedCarecom
Case Study 2 ldquoRicardordquo
sect 53 - year - old consumer with diagnoses of depression anxiety and cognitive disabilities
sect Experienced homelessness for approximately 5 years and had to forfeit his service animal upon entering the shelter system Left the shelter after a few months and has lived in a U - Haul van for the last 2 years
sect IL - LTSSCrsquos initial focus was on housing assistance and was able to get consumer into a one - year Single Room Occupancy (SRO) Program that will give him access to permanent housing upon successful completion of program
sect IL - LTSSC is now working with care team to obtain approval for additional supports like home - delivered meals and laundry service
35
httpswwwResourcesForIntegratedCarecom
Personal Care Attendants and the Interdisciplinary Care Team
Corinne Eldridge Executive Director California Long - Term Care Education Center
37
httpswwwResourcesForIntegratedCarecom
Californiarsquos In - Home Supportive Services (IHSS) Program
sect There are 14 million dually eligible individuals in California4
sect The IHSS program serves 564000 consumers in CA5
sect 56 are 65 years or older 37 are 18 - 64 7 are under 18 sect 50 speak a primary language other than English
sect Californiarsquos IHSS program is the oldest Personal Care Attendant program in the country
sect There are 509000 IHSS workers in CA5
sect Over 50 of IHSS workers are family members
4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D5 Claire Ramsey (2019) In - Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
37
httpswwwResourcesForIntegratedCarecom
California Long - Term Care Education Center (CLTCEC) IHSS Training
sect CLTCEC began training IHSS consumer and provider pairs in 2012 sect Began with 6 health plans across 3 counties in California as
part of a Health Care Innovations Awards grant through the Center for Medicare amp Medicaid Innovation (CMMI)
sect Continued IHSS training program with 2 health plan partners LA Care Blue Shield California
38
httpswwwResourcesForIntegratedCarecom
Basic Tenants of the IHSS Training Program
39
Voluntary participation
IHSS provider learns new skills
Honors consumer-directed model of care
Competency-based education
httpswwwResourcesForIntegratedCarecom
IHSS Training Program
sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training
and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes
if possible sect 17-week course includes additional modules on body systems and disease-
specific care sect Training modules discuss the role of the IHSS provider and integration
into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration
are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have
discussions with IHSS consumer about what was learned in class that week
40
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
Case Study 2 ldquoRicardordquo
sect 53 - year - old consumer with diagnoses of depression anxiety and cognitive disabilities
sect Experienced homelessness for approximately 5 years and had to forfeit his service animal upon entering the shelter system Left the shelter after a few months and has lived in a U - Haul van for the last 2 years
sect IL - LTSSCrsquos initial focus was on housing assistance and was able to get consumer into a one - year Single Room Occupancy (SRO) Program that will give him access to permanent housing upon successful completion of program
sect IL - LTSSC is now working with care team to obtain approval for additional supports like home - delivered meals and laundry service
35
httpswwwResourcesForIntegratedCarecom
Personal Care Attendants and the Interdisciplinary Care Team
Corinne Eldridge Executive Director California Long - Term Care Education Center
37
httpswwwResourcesForIntegratedCarecom
Californiarsquos In - Home Supportive Services (IHSS) Program
sect There are 14 million dually eligible individuals in California4
sect The IHSS program serves 564000 consumers in CA5
sect 56 are 65 years or older 37 are 18 - 64 7 are under 18 sect 50 speak a primary language other than English
sect Californiarsquos IHSS program is the oldest Personal Care Attendant program in the country
sect There are 509000 IHSS workers in CA5
sect Over 50 of IHSS workers are family members
4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D5 Claire Ramsey (2019) In - Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
37
httpswwwResourcesForIntegratedCarecom
California Long - Term Care Education Center (CLTCEC) IHSS Training
sect CLTCEC began training IHSS consumer and provider pairs in 2012 sect Began with 6 health plans across 3 counties in California as
part of a Health Care Innovations Awards grant through the Center for Medicare amp Medicaid Innovation (CMMI)
sect Continued IHSS training program with 2 health plan partners LA Care Blue Shield California
38
httpswwwResourcesForIntegratedCarecom
Basic Tenants of the IHSS Training Program
39
Voluntary participation
IHSS provider learns new skills
Honors consumer-directed model of care
Competency-based education
httpswwwResourcesForIntegratedCarecom
IHSS Training Program
sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training
and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes
if possible sect 17-week course includes additional modules on body systems and disease-
specific care sect Training modules discuss the role of the IHSS provider and integration
into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration
are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have
discussions with IHSS consumer about what was learned in class that week
40
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
Personal Care Attendants and the Interdisciplinary Care Team
Corinne Eldridge Executive Director California Long - Term Care Education Center
37
httpswwwResourcesForIntegratedCarecom
Californiarsquos In - Home Supportive Services (IHSS) Program
sect There are 14 million dually eligible individuals in California4
sect The IHSS program serves 564000 consumers in CA5
sect 56 are 65 years or older 37 are 18 - 64 7 are under 18 sect 50 speak a primary language other than English
sect Californiarsquos IHSS program is the oldest Personal Care Attendant program in the country
sect There are 509000 IHSS workers in CA5
sect Over 50 of IHSS workers are family members
4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D5 Claire Ramsey (2019) In - Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
37
httpswwwResourcesForIntegratedCarecom
California Long - Term Care Education Center (CLTCEC) IHSS Training
sect CLTCEC began training IHSS consumer and provider pairs in 2012 sect Began with 6 health plans across 3 counties in California as
part of a Health Care Innovations Awards grant through the Center for Medicare amp Medicaid Innovation (CMMI)
sect Continued IHSS training program with 2 health plan partners LA Care Blue Shield California
38
httpswwwResourcesForIntegratedCarecom
Basic Tenants of the IHSS Training Program
39
Voluntary participation
IHSS provider learns new skills
Honors consumer-directed model of care
Competency-based education
httpswwwResourcesForIntegratedCarecom
IHSS Training Program
sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training
and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes
if possible sect 17-week course includes additional modules on body systems and disease-
specific care sect Training modules discuss the role of the IHSS provider and integration
into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration
are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have
discussions with IHSS consumer about what was learned in class that week
40
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
Californiarsquos In - Home Supportive Services (IHSS) Program
sect There are 14 million dually eligible individuals in California4
sect The IHSS program serves 564000 consumers in CA5
sect 56 are 65 years or older 37 are 18 - 64 7 are under 18 sect 50 speak a primary language other than English
sect Californiarsquos IHSS program is the oldest Personal Care Attendant program in the country
sect There are 509000 IHSS workers in CA5
sect Over 50 of IHSS workers are family members
4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D5 Claire Ramsey (2019) In - Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
37
httpswwwResourcesForIntegratedCarecom
California Long - Term Care Education Center (CLTCEC) IHSS Training
sect CLTCEC began training IHSS consumer and provider pairs in 2012 sect Began with 6 health plans across 3 counties in California as
part of a Health Care Innovations Awards grant through the Center for Medicare amp Medicaid Innovation (CMMI)
sect Continued IHSS training program with 2 health plan partners LA Care Blue Shield California
38
httpswwwResourcesForIntegratedCarecom
Basic Tenants of the IHSS Training Program
39
Voluntary participation
IHSS provider learns new skills
Honors consumer-directed model of care
Competency-based education
httpswwwResourcesForIntegratedCarecom
IHSS Training Program
sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training
and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes
if possible sect 17-week course includes additional modules on body systems and disease-
specific care sect Training modules discuss the role of the IHSS provider and integration
into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration
are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have
discussions with IHSS consumer about what was learned in class that week
40
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
California Long - Term Care Education Center (CLTCEC) IHSS Training
sect CLTCEC began training IHSS consumer and provider pairs in 2012 sect Began with 6 health plans across 3 counties in California as
part of a Health Care Innovations Awards grant through the Center for Medicare amp Medicaid Innovation (CMMI)
sect Continued IHSS training program with 2 health plan partners LA Care Blue Shield California
38
httpswwwResourcesForIntegratedCarecom
Basic Tenants of the IHSS Training Program
39
Voluntary participation
IHSS provider learns new skills
Honors consumer-directed model of care
Competency-based education
httpswwwResourcesForIntegratedCarecom
IHSS Training Program
sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training
and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes
if possible sect 17-week course includes additional modules on body systems and disease-
specific care sect Training modules discuss the role of the IHSS provider and integration
into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration
are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have
discussions with IHSS consumer about what was learned in class that week
40
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
Basic Tenants of the IHSS Training Program
39
Voluntary participation
IHSS provider learns new skills
Honors consumer-directed model of care
Competency-based education
httpswwwResourcesForIntegratedCarecom
IHSS Training Program
sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training
and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes
if possible sect 17-week course includes additional modules on body systems and disease-
specific care sect Training modules discuss the role of the IHSS provider and integration
into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration
are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have
discussions with IHSS consumer about what was learned in class that week
40
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
IHSS Training Program
sect IHSS provider training courses last 10 or 17 weeks sect Opportunity for consumers and providers to learn about benefits of training
and develop a sense of shared purpose sect Identifies rights roles and responsibilities of consumers and IHSS providers sect IHSS provider attends all classes consumer attends specific relevant classes
if possible sect 17-week course includes additional modules on body systems and disease-
specific care sect Training modules discuss the role of the IHSS provider and integration
into the consumerrsquos care team sect We always emphasize that provider roles and extent of care team integration
are choices that the consumer makessect Take home assignments (homework) encourage IHSS providers to have
discussions with IHSS consumer about what was learned in class that week
40
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
Five Key Roles of an IHSS Provider
41
Monitor
Communicator
Coach
Navigator
Care Aide
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
IHSS Providers Play Valuable Roles on Care Teamssect IHSS providers can act as an extra set of eyes and
ears sect Notice important information about the day - to - day
health of the consumer and any changes in diet mood skin health energy and many other important factors and bring them to the consumerrsquos attention
sect The doctor sees the consumer only occasionally the provider sees the consumer regularly is close to the consumer and has valuable insight
sect The consumer and the provider are a team and work together with the rest of the care team to obtain the best possible care for the consumer
42
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
Successful Care Team Integration
sect ldquoSuccessfulrdquo care team integration varies from consumer to consumer and from health plan to health plan but may include sect The consumerrsquos care team knows the IHSS provider
sect The care managers and clinicians can see in their EMR that the care recipient has an IHSS provider who they have given permission to be part of hisher care team
sect The IHSS provider is invited to interdisciplinary care team meetings
43
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
IHSS Training Program Successes
sect CLTEC has trained over 1884 IHSS providers through the LA Care Program
sect After Year 1 sect 95 of IHSS providers reported more confidence in ability to talk to
consumerrsquos care team
sect 96 of consumers who responded to the survey reported that communication with their IHSS provider improved
44
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
Making it Work Voices of a Consumer and IHSS Provider
Carole Stewart and Maida CastellanosIHSS Consumer and Personal Care Attendant
47
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
Questions
46
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
Thank You for Attending
sect The video replay slide presentation and a summary of the QampA will be available at httpswwwresourcesforintegratedcarecom
sect If you are applying for CNE or NASW CE you must complete the post-test in order to receive credit httpswwwsurveymonkeycomrselfdirectionpost
sect For more information about obtaining CEUs or CMEs via CMSrsquo Learning Management System please visit httpsresourcesforintegratedcarecomsitesdefaultfilesGCC_Self_Direction_for_Dually_Eligible_Individuals_Utilizing_LTSS_Prewebinar_Continuing_Education_Credit_Guidepdf
sect Questions Please email RIClewincom
sect Follow us on Twitter at Integrate_Care to learn about upcoming webinars and new products
49
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
Webinar Evaluation Form
sect Your feedback is very important Please take a moment to complete a brief evaluation on the quality of the webinar The survey will automatically appear on the screen approximately a minute after the conclusion of the presentation
sect We would also like to invite you to provide feedback on other RIC products as well as suggestions to inform the development of potential new resources httpswwwresearchnetrMVGNWVJ
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
Resources
sect Applied Self - Direction httpwwwappliedselfdirectioncom
sect Supported Decision Makinghttpwwwsupporteddecisionmakingorg
sect Training for Homecare Workers httpswwwcdcgovnioshdocs2015-102defaulthtml
sect Training Tips amp Videos httpscltcecorg
sect Direct Service Workforce Core Competencies httpswwwmedicaidgovmedicaidltssdownloadsworkforcedsw-core-competencies-final-set-2014pdf
49
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50
httpswwwResourcesForIntegratedCarecom
Sources
1 Applied Self Direction (2018) What is Self-Direction Retrieved from httpwwwappliedselfdirectioncomwhat-self-direction
2 Family Caregiver Alliance (2013) The National Resource Center for Participant - Directed Services Retrieved from httpswwwcaregiverorgnational-resource-center-participant-
3 MedicaidGov ( nd ) Self-Directed Services Retrieved from directed-services
httpswwwmedicaidgovmedicaidltssself-directedindexhtml4 Kaiser Family Foundation Number of Dual Eligible Beneficiaries Retrieved from
httpswwwkfforgmedicaidstate-indicatordual-eligible-beneficiariescurrentTimeframe=0ampselectedRows=7B22states227B22california227B7D7D7DampsortModel=7B22colId2222Location2222sort2222asc227D
5 Claire Ramsey (2019) In-Home Supportive Services (IHSS) A Guide for Advocates Justice in Aging Retrieved from httpswwwjusticeinagingorgwp-contentuploads201906Final_IHSS-Adocate-Manualpdf
50