Embed Size (px)
Citation preview
The CMS Community Rule and the Raising Expectations of Direct
Support Professionals
October 27, 2014
Joseph M. MacbethExecutive Director
National Alliance for Direct Support Professionals
Actions To Complete For Compliance
441.301(c) (4) – Optimizes, but does not regiment, individual initiative, autonomy, and independence in making life choices, including but not limited to: daily activities, physical environment, and with whom to interact.
Proposed State Transition Plan Deliverables:
“Identify, develop, and distribute training tools and policy updates that are needed for compliance”
Na
tion
al A
llia
nce
fo
r D
irect
S
up
po
rt P
rofe
ssio
na
ls (
NA
DS
P)
New Federal RequirementsProviders Must Ensure that Services are
furnished:
(i) Under a written person-centered service plan (also called plan of care) that is based on a person-centered approach
• Reflect risk factors and measures in place to minimize them, including individualized back-up plans and strategies when needed.
• The individual will lead the person-centered planning process where possible
• Includes people chosen by the individual.
• Individual directs the process to the maximum extent possible,
• Reflects cultural considerations of the individual
Direct Support Professionals & the new CMS Regulations
Direct Support Professionals Must Ensure That:
• People have the freedom and support to control their own schedules and activities, and have access to food at any time.
• People are able to have visitors of their choosing at any time.
• People have the freedom to furnish and decorate their sleeping or living units
Na
tion
al A
llia
nce
fo
r D
irect
S
up
po
rt P
rofe
ssio
na
ls (
NA
DS
P)
The Emerging Role of Direct Support Professionals
Historically….
• Primarily Seen as Caretaker
• Focus on Custodial Care
• Providing Companionship
• Providing Coverage
• Primarily Focused on Health & Safety Issues
• Entry-Level Job
Now and in the Future….
• Ambassador, Mentor & Facilitator
• Culturally Competent
• Close Interactions with Families - often in Family Settings
• Supporting Informed Decisions: Assessing RISK and Facilitating Choice
• Possession of Complex Skills
Na
tion
al A
llia
nce
fo
r D
irect
S
up
po
rt P
rofe
ssio
na
ls (
NA
DS
P)
Raising the Expectations of the Direct Support Workforce
Now and in the Future….
• Creating plans with People they support
• Building meaningful friendships & relationships
• Inclusion – not recreation
• Advocating WITH – not FOR people with disabilities
• Person-Centered Identification
Na
tion
al A
llia
nce
fo
r D
irect
S
up
po
rt P
rofe
ssio
na
ls (
NA
DS
P)
Historically….
• Follow the Plan
• Filling shifts
• Rely on readily available supervision
• Community Outings
• System-Centered Identification
Building & Maintaining Friendships
Na
tion
al A
llia
nce
fo
r D
irect
S
up
po
rt P
rofe
ssio
na
ls (
NA
DS
P)
Speaking of Inclusion & Disabilities
Na
tion
al A
llia
nce
fo
r D
irect
S
up
po
rt P
rofe
ssio
na
ls (
NA
DS
P)
Direct Support Professionals
Na
tion
al A
llia
nce
fo
r D
irect
S
up
po
rt P
rofe
ssio
na
ls (
NA
DS
P)
Career Builder, 2014
The Second Fastest Growing Occupation: Personal Care Aides
• % change in employment (2012 – 2022): 48.8%
• Number employed (2012): 1,190,600
• Number employed (2022): 1,771,400
• Median annual income: $19,190 ($9.23/hour)
• Nationwide median of $34,750
• The BLS expects that over 580,000 new jobs for Personal Care Aides will be created in the decade through 2022
US Department of Labor, Bureau of Labor Statistics, 2014
Na
tion
al A
llia
nce
fo
r D
irect
S
up
po
rt P
rofe
ssio
na
ls (
NA
DS
P)
Recent Trends in Direct Support
The Third Fastest Growing Occupation: Home Health Aides
• % change in employment (2012 – 2022): 48.5%
• Number employed (2012): 875,100
• Number employed (2022): 1,299,300
• Median annual income: $20,820 ($10.01/hour)
• Nationwide median of $34,750
• The BLS expects that over 424,000 new jobs for Home Health Aides will be created in the decade through 2022
US Department of Labor, Bureau of Labor Statistics, 2014
Na
tion
al A
llia
nce
fo
r D
irect
S
up
po
rt P
rofe
ssio
na
ls (
NA
DS
P)
Recent Trends in Direct Support
The Financial Cost of Turnover
• Cost per hire• Long-term Supports and Services(2005):
$3,278 (UMN)
• Long-term Supports and Services(2011): $6,000 (PHI)
Good Turnover? Bad Hiring…
Na
tion
al A
llia
nce
fo
r D
irect
S
up
po
rt P
rofe
ssio
na
ls (
NA
DS
P)
“Decreasing turnover is about sustaining quality”
The Other Costs of TurnoverImpact on People with
Disabilities
• Services are fractured
• Personal growth is disrupted
• Activities and events are canceled
• Trusting relationships are broken
• Unsafe situations are created impacting health & safety
• Revolving door of strangers performing the most intimate interactions of daily life
Impact on Direct Support Professional Workforce
• Forced overtime
• Increased medication errors and other incidents
• Increased job stress
• Reduced productivity
• Deteriorating job satisfaction
• Burn Out
• Ultimately….More Turnover
Na
tion
al A
llia
nce
fo
r D
irect
S
up
po
rt P
rofe
ssio
na
ls (
NA
DS
P)
“Preparing” Direct Support Professionals: How Have We Done?
“Tell me and I will forget.
Teach me and I might remember.
Involve me and I will learn”.
- Chinese Proverb
Na
tion
al A
llia
nce
fo
r D
irect
S
up
po
rt P
rofe
ssio
na
ls (
NA
DS
P)
Invest in Direct Support Professionals
Na
tion
al A
llia
nce
fo
r D
irect
S
up
po
rt P
rofe
ssio
na
ls (
NA
DS
P)
Where is Quality Defined?
“It is defined at the point of interaction between the staff member and the individual
with a developmental disability.”
John F. Kennedy, Jr. (1995)
Chair, President’s Committee on Mental Retardation Developmental Disabilities
Na
tion
al A
llia
nce
fo
r D
irect
S
up
po
rt P
rofe
ssio
na
ls (
NA
DS
P)
Where are those at the point of interaction of service delivery typically found on organizational charts?
Typical Organizational Chart
Executive & Admin Staff
Clinical, Middle Management & Other Support Staff
Na
tion
al A
llia
nce
fo
r D
irect
S
up
po
rt P
rofe
ssio
na
ls (
NA
DS
P)
Direct Support Professionals
Clinical, Middle Management & Other Support Staff
Executive & Admin Staff
Future Organizational Chart
Knowledge
SkillsValues
Unethical Practice
Ineffective Practice
Uninformed of Best Practice
QualitySupport
QualityIntersection
(NADSP Code of Ethics) (OPWDD Core Competencies)
(Training Based on Research)
Na
tion
al A
llia
nce
fo
r D
irect
S
up
po
rt P
rofe
ssio
na
ls (
NA
DS
P)
The Five Elements of a Profession
Code of
Ethics
Body of
KnowledgeUniversal
Skill Standards
License,Certificate or
Credential
Affiliation withProfessional Organization
90,000 in NYS90,000 in NYS
Direct Support Professionals
Approximately 4 Million Cross-SectorPHI, 2012
Na
tion
al A
llia
nce
fo
r D
irect
S
up
po
rt P
rofe
ssio
na
ls (
NA
DS
P)
A Day In the Life of a DSP…
“Not Ready for Apartment Living”
A DSP with Good Intentions and the absence of a Code of
Ethics
Na
tion
al A
llia
nce
fo
r D
irect
S
up
po
rt P
rofe
ssio
na
ls (
NA
DS
P)
Direct Support Professionals and the Media
Media and Public Policy in New York State…
Na
tion
al A
llia
nce
fo
r D
irect
S
up
po
rt P
rofe
ssio
na
ls (
NA
DS
P)
And finally, the big one…
“At state-run homes, abuse and impunity”
National Alliance for Direct Support Professionals (NADSP)
The New York Times, New YorkMarch 12, 2011
Which led to…..
Legislation Establishes Justice Center for the Protection of People with Special Needs to Prevent, Investigate and Prosecute Abuse and Neglect of Vulnerable New Yorkers
“Legislative Leaders Announce Agreement on Legislation to Protect People with Special Needs and Disabilities”
(New York Times, June 18, 2012)
Na
tion
al A
llia
nce
fo
r D
irect
S
up
po
rt P
rofe
ssio
na
ls (
NA
DS
P)
Which is sort of like…
Closing the Barn Door after the horse has bolted.
Legislation that focuses on Prosecution is NOT considering
Prevention & Building Excellence
Na
tion
al A
llia
nce
fo
r D
irect
S
up
po
rt P
rofe
ssio
na
ls (
NA
DS
P)
But it also led to this….
National Alliance for Direct Support Professionals
The Measure of a Society: Protection of Vulnerable Persons in Residential Facilities Against Abuse & Neglect . Clarence J. Sundram, 2012
“Direct Support jobs are compensated poorly, with many workers living at or near the poverty level or forced to work multiple jobs to make ends meet. One might summarize the job description of the direct support worker as requiring the wisdom of Solomon, the patience of Job and the caring of Florence Nightingale… While much is said about the value of these direct support jobs, the traditional hallmarks of value are often missing – qualifying credentials, adequate pay, career ladders, attention to working conditions, adequate training, managerial and supervisory support and so on…”
Na
tion
al A
llia
nce
fo
r D
irect
S
up
po
rt P
rofe
ssio
na
ls (
NA
DS
P)
A Day In the Life of a DSP…
“Take Me Out to the Ball Game”
A Nice Afternoon
Na
tion
al A
llia
nce
fo
r D
irect
S
up
po
rt P
rofe
ssio
na
ls (
NA
DS
P)
CHOICE
C -CitizenH -Harm/RiskO -OpportunitiesI -Informed DecisionC -CommunityE -Experience
Na
tion
al A
llia
nce
fo
r D
irect
S
up
po
rt P
rofe
ssio
na
ls (
NA
DS
P)
CHOICE
Na
tion
al A
llia
nce
fo
r D
irect
S
up
po
rt P
rofe
ssio
na
ls (
NA
DS
P)
EXPERIENCESomething we get just after we needed it…
We all learn by experience-usually, its bad experience…
People we support need opportunities to EXPERIENCE different options in order to establish a preference.
Those options may and will include some degree of risk!
Na
tion
al A
llia
nce
fo
r D
irect
S
up
po
rt P
rofe
ssio
na
ls (
NA
DS
P)
Five Steps to the Decision Making Process
1-Define the problem/situation
2-Gather information and resources
3-List Options/Choices & Evaluate
4-Consider Outcomes (Risk/Reward)
5-Make a decision & plan of action-Reflect on the decision
Na
tion
al A
llia
nce
fo
r D
irect
S
up
po
rt P
rofe
ssio
na
ls (
NA
DS
P)
ED: Nearly 25 Years Later
Working on writing his autobiography
Getting tattoos
Jumping out of airplanes
Living his life, on his terms
Na
tion
al A
llia
nce
fo
r D
irect
S
up
po
rt P
rofe
ssio
na
ls (
NA
DS
P)
“The System opens the door to community; direct support professionals help people go through that door.
Direct Support Professional’s Role in Informed Decision Making
DSPs will be critical in supporting people in learning to make Informed Decisions
DSPs must learn about Person-Centered Planning, Risk Planning, Code of Ethics, Social Capital, the Informed Decision Making Process and more……
Na
tion
al A
llia
nce
fo
r D
irect
S
up
po
rt P
rofe
ssio
na
ls (
NA
DS
P)
OPWDD Regional Centers for Workforce Development (RCWT)
Na
tion
al A
llia
nce
fo
r D
irect
S
up
po
rt P
rofe
ssio
na
ls (
NA
DS
P)
OPWDD Regional Centers for Workforce Development (RCWT)
OPWDD Core Competencies
“The core competencies are not a training program; they represent the day-to-day valuable work that DSPs perform when serving individuals with developmental disabilities. Coupled with the recently adopted National Alliance of Direct Support Professionals’ Code of Ethics, the standardized DSP competencies will help set standards for quality supports and services; provide guidance for DSPs; promote professionalism; standardize DSP skills; improve service provision; and save training costs”.
Commissioner Courtney Burke
Na
tion
al A
llia
nce
fo
r D
irect
S
up
po
rt P
rofe
ssio
na
ls (
NA
DS
P)
OPWDD Regional Centers for Workforce Development (RCWT)
Code of Ethics for Direct Support Professionals
“The Code of Ethics developed through the National Alliance for Direct Support Professionals (NADSP) guides DSPs through the ethical dilemmas they face daily and encourages the highest professional ideals. Direct support staff, agency leaders, policymakers, and people receiving services are urged to read the code and to consider ways that these ethical statements can be incorporated into daily practice. This code is not the handbook of the profession, but rather a roadmap to assist in staying the course of securing freedom, justice, and equality for all”.
National Alliance for Direct Support Professionals
Na
tion
al A
llia
nce
fo
r D
irect
S
up
po
rt P
rofe
ssio
na
ls (
NA
DS
P)
NY State OPWDD Direct Support Core Competencies
A. Supporting a person’s unique capacities, personality and potential
B. Getting to know the person through assessment and discovery
C. Promoting advocacy with the individual
D. Facilitating personal growth and development
E. Facilitation of supports and services
F. Building and maintaining relationships
G. Creating meaningful communication
H. Developing professional relationships
I. Exhibiting professional behaviorJ. Showing respect for diversity ad
inclusionK. Creating meaningful
documentation records
L. Education, training and self-development activities
M. Organizational participation
N. Exhibiting ethical behavior on the job
O. Promoting positive behavior and supports
P. Supporting Health and Wellness
Q. Preventing, recognizing and reporting abuse
R. Supporting crisis prevention, intervention and resolution
S. Supporting safety
T. Ensuring safety of individuals during environmental emergencies
U. Supporting people to live in a home of their own choice
V. Supporting ACTIVE participation in the community
W. Supporting employment, educational and career goal attainment
Na
tion
al A
llia
nce
fo
r D
irect
S
up
po
rt P
rofe
ssio
na
ls (
NA
DS
P)
The NADSP Code of EthicsDeveloped by NADSP in 2001
Adopted by New York in 2012
Adopted by New Hampshire in 2014
Universally Accepted
Na
tion
al A
llia
nce
fo
r D
irect
S
up
po
rt P
rofe
ssio
na
ls(
NA
DS
P)
WHY must we consider Ethics in the role of Direct Support Professionals?
Every day Direct Support Professionals help make decisions
with the people they support.
Decisions based on what one thinks is ok, good or right will lead
to a slippery slope into possible unethical practice.
Na
tion
al A
llia
nce
fo
r D
irect
S
up
po
rt P
rofe
ssio
na
ls (
NA
DS
P)
Code of Ethics Word Cloud
Na
tion
al A
llia
nce
fo
r D
irect
S
up
po
rt P
rofe
ssio
na
ls (
NA
DS
P)
OPWDD Regional Centers for Workforce Development (RCWT)
Rolling Out the Code of Ethics and Core Competencies
• “The Why and The How” Seminars: A Series of Two Day Sessions in each RCWT
• Building Workforce Champions and Skill Mentors in Regions and Provider Organization
• Baseline and Periodic Surveys to Measure Organizational Buy-In and Implementation
• Website and Resource Sharing Network• Technical Assistance• Engaging Other Stakeholders (Families and People with
Disabilities)
Na
tion
al A
llia
nce
fo
r D
irect
S
up
po
rt P
rofe
ssio
na
ls (
NA
DS
P)
OPWDD Regional Centers for Workforce Development (RCWT)
Region 1 Contact - Katie O’Donnell, Finger Lakes Collaborative: [email protected]
Region 2 (North) Contact – Suzanne Lavigne, Citizen Advocates: [email protected]
Region 2 (South), 3, 4 & 5 Contact – Kirsten Sanchirico, NYSACRA: [email protected]
OPWDD Contact: Regis Obijiski, Deputy Director of Workforce Transformation: [email protected]
Na
tion
al A
llia
nce
fo
r D
irect
S
up
po
rt P
rofe
ssio
na
ls (
NA
DS
P)
OPWDD Regional Centers for Workforce Development (RCWT)
Please Join Part Two of this Webinar
November 13th @ 3:00
Implementing a Comprehensive Direct Support Development Initiative: Monarch of North Carolina's – 2014 Moving Mountains Award
Peggy Terhune, PhD, CEO and President, Monarch of North Carolina
Dr. Terhune will share Monarch's comprehensive initiatives in direct support professional workforce development. Monarch, a statewide provider of cross-sector services in North Carolina that has been accredited by The Council on Quality and Leadership - CQL for many years is the 2014 Moving Mountains Award Winner. Topics will include Monarch's recruitment & retention strategies, staff development & career ladder opportunities, recognition strategies and organizational culture - all of which lead to quality outcomes for people receiving services by the organization. This webinar will discuss how other organizations can begin to transform the expectations and responsibilities of its direct support workforce.
Na
tion
al A
llia
nce
fo
r D
irect
S
up
po
rt P
rofe
ssio
na
ls (
NA
DS
P)
Join Our Membership at www.nadsp.org!
Customized Trainings, One-Day Workshops and Culture of Direct Support Competency Technical Assistance
Join us on Facebook!
YES, We’re on YouTube
Follow us on Twitter @NADSPINC
Na
tion
al A
llia
nce
fo
r D
irect
S
up
po
rt P
rofe
ssio
na
ls (
NA
DS
P)
