Empowering Homebound Veterans And their Caregivers Through Consumer Direction

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1 Empowering Homebound Veterans And their Caregivers Through Consumer Direction AIRS 2012 Training and Education Conference New Orleans, Louisiana May 20-23, 2012 Aging and Disability Track

2 Mission Statement The Agency on Aging will empower independence and enhance the quality of life and enjoyment of aging by offering a supportive network for older persons, Veterans of all ages, and family caregivers through advocacy, education, coordination, and implementation of programs and services for older adults in the trijurisdictional area.

3 How do we Define Veteran?

4 A veteran is someone, who in his/her life, wrote a blank check made payable to the United States of America for an amount "up to and including my life."

5 What do you want to learn/ take-away? 1. What is the Definition of a Homebound veteran? 2. What is Consumer Directed Care? Does it work? 3. What factors make for a successful CD program? 4. Can CD successes be copied? What are the Pitfalls? 5. What are the differences between CD care and Personal responsibility? 6. What is the role of Caregiver? 7. What does it mean to Empower?

6 Veteran Directed Home and Community Based Services Program (VDHCBS)

7 Veteran Directed is Consumer Directed Consumer Directed is a Service Model empowering participants and their families by expanding their degree of choice and control over long-term services and supports they need to live at home.* *National Resources Center for Participant-Directed Services at Boston University

8 Growing interest and demand for VDHCBS Studies support Veterans desire to receive care in their community rather than a nursing home. Significant culture change for VA

9 Collaborative Efforts Veterans Administration/Veterans Health Administration National Resource Center For Participant Directed Services Administration on Aging Aging and Disability Resource Centers Area Agency on Aging

10 VDHCBS Eligibility Veterans of All Ages Cognitive Impairment Deficiencies in ADLS & IADLS Committed to staying at home and desire Consumer Direction

11 Consumer Direction Choice = EMPOWERMENT Control = EMPOWERMENT Trust = EMPOWERMENT Confronting the Myths and Facts

12 Myths and Facts CD is just an experiment Disabled vets and their caregivers need protection and may be at greater risk. FACT- Every state including the District of Columbia has implemented a CD service program. FACT- There is no evidence that the CD model of service delivery is inherently riskier than professionally managed care.

13 Myths and Facts Younger vets want to direct their own services, not older vets. FACT-Vets of all ages-just like all consumers--are interested in CD and most have clear preferences about personal care, daily activities and where they want to live. Agency-employed providers offer higher quality services: better trained, monitored and supervised. FACT-There is no clear evidence that agency employed providers offer higher quality care than providers in CD programs regardless of mandated training.

14 Consumer Directed, Participant Directed or Veteran Directed Services?

15 CONSUMER DIRECTION EVOLMENT 1) Grant to 15 Medicaid states by RWJF 2) CMS, AoA, HHS, AARP, Substance abuse & MH Serv Admin & NASUAD 3) Veterans Administration/VHA NRCPD

16 Current Research* Cost Effective Better Quality of Care through Empowerment Preference of some people Heightened Abuse does not occur *

17 Philosophical Shift Medical Model/CM Determines needs/service Plan Oversees provisions of Services May seek participant input Establishes goals and outcomes Program parameters and standards limit flexibility Solves problems Assesses quality of services and supports Social Model/CD-SC Works w/participant to determine needs/service plan Assists participant w/ overseeing provision of services Participant involvement is critical Participant is responsible for goals and outcomes High Flexibility of services and supports Advises participant on problem solving strategies Participant assesses quality of services and supports

18 Veteran Directed Services Recruits and Manages workers Makes Decisions About needs And services Sets Tasks Trains/ arranges Worker training Veteran Caregiver/ Designate Determines flexible Work hours/ Schedule Specifies and Determines salary

19 Role of Service Coordinator Accept Goals of Consumer Direction Anyone desiring to consumer-direct should be given the opportunity Respect Individual choice Facilitate empowerment, autonomy and skills Develop strategies for success Leave competency for the legal system

20 More Goals Assess capacity to determine level of support, not program eligibility Requires buy-in at all levels Consumer direction is easy in concept, but execution may be more difficult Anything goes?...no, not quite

21 Consumer Direction and Personal Responsibility Vet/Caregiver is responsible for decision making, safety and adequacy of services Vet/Caregivers can learn from their mistakes Effectiveness and quality are measured by the vet/caregiver

22 Support System in Consumer Direction Service Coordinator Embrace the paradigm shift Explain the program Completes Enrollment Collaborates w/ the Vet and their Caregiver (or responsible designate) to complete assessment, service plan and spending plan Offer skills training Partners with the Veteran and their Caregiver

23 Support System in Consumer Direction (continued) Fiscal Employer Agent Assures that spending plan is followed Pays invoices including timesheets Figures tax liability and pays taxes Provides accounting reports

24 Support System in Consumer Direction (continued) Veteran (and Caregiver) Makes decisions based on individual budget Hires, manages and dismisses workers Sets tasks Trains/arranges for training workers Evaluates worker performance Determines goods and services to be purchased

25 Veteran Centered Planning The veteran drives decisions and invites people who they feel have important contributions to make-which often include family, friends, community members and trusted allies from the service system. The focus of the planning is defined by the vet s desired outcomes. The vet may select program supports in addition to natural supports. Planning occurs as a process that evolves over time. The focus is on Strengths and building.

26 Case Studies: 1) Young Vet/male (Parents-legal guardian) 2) Boomer Vet- 51 year old male 3) Older Vet (71 year old female spouse/- vet caregiver

27 Potential Concerns Ethical Considerations Behavior Environment Physical Medical

28 Decisions, Decisions, Decisions Vet and Caregiver responsibilities can be complex. Can be simplified to these 3 decisions 1) Find a person to hire 2) Tell them when to come 3) Tell them what to do

29 QUESTIONS??? Prince William Area Agency on Aging

30 Department of Veteran Affairs: Helpful Websites National Resource Center for Participant-Directed Services The Clearing House for Home and Community Based Services: Technical Assistance Exchange