Participant-Directed Core Competency Project Aging In America Conference 2011
Presenters Lori Gerhard Jim Wironen Director Director of Product Development & Consulting Services Office of Program Innovation & Demonstrations National Resource Center for Administration on Aging Participant-Directed Services Lori.Gerhard@aoa.hhs.gov James.Wironen.1@bc.edu 202-357-3443 2
AoA’s Long -Term Vision Participant-directed programs are available in every community in the nation Through various AoA programs Core Programs, ADRC, EBDP, VD-HCBS, and LTSS Core Competency drive the culture and systems changes that enable participant direction to be the primary way people access, obtain, and receive LTSS Use research to develop a LTSS system that delivers participant-directed programs 3
Chronic Care Model Community Health System Health Care Organization: Case Mgt Resources and Policies Clinical Self- Delivery Decision Information Management System Support Systems Support Design: Care Mgt Prepared, Informed, Productive Proactive Activated Interactions Practice Team Patient Improved Outcomes 4
Transitions In Health Care and LTSS Perspective of Person Primary Care Physician Hospital Rehab Center Nursing Facility AAA/ADRC 5
AAA’s/ADRC’s Key LTSS Component Home Modification Caregiver Homemaker Support Services ADRC AAA Assessment Care Service Plan/Care Plan Management Personal Care Transportation Services CDSMP 6 6
Changes in Federal Law, Regulation, and Policy 2001 New Freedom Initiative 2005 Deficit Reduction Act 2010 Affordable Care Act 2006 Reauthorization of Older Americans Act 2007 Aging and Disability Resource Center Program 2010 Affordable Care Act 2008 Veterans-Directed Home and Community -Based Services Program 7
AoA & NRCPDS Long-Term Services and Supports Workforce Participant-Directed Core Competencies Project Environmental Scan and Literature Review Stakeholder Involvement Catalog Course Develop Identify Core Curriculum to Workforce Self- Competencies Develop Core Assessment Tool Competencies 8
What is Participant Direction? Traditional Services Participant-Directed Services Makes Needs are decisions assessed based on budget Determines Hires, Provides Asked goods and manages, feedback to questions services dismisses the agency purchased workers Participant Participant Trains, or Assigned Assigns Informed of arranges for hours of hours of resources training of, services service workers Given an Evaluates option of workers agencies 9
Why Participant Direction? Comparative effectiveness research on participant-directed programs found: More positive health No increase of fraud or abuse outcomes over the traditional system Cost effective -can decrease use of more expensive services over long term Participants were up to 90% more likely to be very satisfied Significantly reduced unmet with how they led their lives personal care needs 10
Prevalence of Participant-Directed Programs AK WA ME MT ND VT MN OR NH NY WI MA ID SD MI RI WY Hawaii CT PA IA NE NJ IN OH NV IL DE WV VA CO CA KS MO MD KY DC NC TN OK AR SC AZ NM GA AL MS LA TX FL States with employer authority PD programs States with employer and budget authority PD programs States with employer authority PD programs and VD-HCBS programs States with employer, budget authority PD programs, and VD-HCBS programs 11
Department of Labor Long-Term Supports and Services Competency Model The Participant Direction Competency Model builds on the Department of Labor Long-Term Supports and Services Competency Model (LTSS-CM [ Figure 1]) . The LTSS-CM consists of a set of nine tiers of work force competencies. The nine tiers are divided into blocks representing the skills, knowledge and abilities considered essential for successful job related performance. The tiers include: • Tier 9: Management Competencies: These competencies domain are specific to supervisory and managerial occupations. • Tier 8: Occupation-Specific Requirements: This domain includes requirements such as certification, licensure, and specialized educational degrees, or physical and training requirements. • Tier 7: Occupation-Specific Technical Competencies : The detailed skills required for work in a specific occupation. • Tier 6: Occupation-Specific Knowledge Competencies: The detailed knowledge areas required for work in a specific occupation. • Tier 5: Industry-Specific Technical Competencies: Competencies included in this domain represent the knowledge, skills, abilities and other characteristics needed by all occupations within an industry segment (e.g. AAAs, ADRCs). • Tier 4: Industry-Wide Technical Competencies: Competencies included in this domain represent the knowledge, skills and abilities needed by all occupations within an industry (e.g. LTSS). • Tier 3: Workplace Competencies : Competencies included in this domain represent those skills and abilities that allow individuals to function in an organizational setting. As with the Academic Competencies, these are generally applicable to a large number of occupations and industries on a national level. • Tier 2: Academic Competencies: Basic academic skills of reading, writing, etc apply to all organizations represented by a single industry or industry association nationwide. • Tier 1: Personal Effectiveness Competencies: These competencies are the base tier because they are essential for all life roles not exclusive to the competencies needed for a successful career or role in the workplace. Figure 1: Long-Term Supports and Services Competency Model 12
Relationship of Participant Direction Core Competencies Project to Other Participant-Directed Activities DHHS: AoA-NRCPDS: Consumer Direction Core Competencies Project Identify the competencies necessary to assist and support participants in managing their services effectively through informed decision-making DHHS: DHHS: AoA DHHS: DHHS: Office of DHHS: Veterans Health DHHS Office of ADRC CMS Minority Health SAMHSA Administration Disability Supports Options Supports DHHS Supports Taxonomy Supports National Supports Complements Supports the Veteran- Counseling Provisions of Patient Standards on Culturally and Community Living developing recovery Directed Home and National Protection and Affordable Linguistically Appropriate Initiative Activities competencies Community-Based Standards Project Care Act Services (CLAS) for individuals Services Program working in (VD-HCBS) behavioral health care project Develop Section 2402(a): Information and The CLAS standards are Affirming the Identifying VD-HCBS is a national Common framework assistance in support primarily directed at right of persons competencies program that minimum establishing principles of participant organizations, but with disabilities to needed of staff to purchases a package standards to and process elements direction (supports individuals are also obtain services in operationalize of participant- guide how supporting participant brokerage) encouraged to use the the “most guiding principles directed services options direction; the standards, to make their integrated setting of recovery from an entity in the counseling is Community Living practices more culturally appropriate” to (including being Aging Network; delivered Assistance Services and and linguistically meet their needs person-driven) in through VD-HCBS, Supports (CLASS) accessible: the Participant everyday practice Veterans decide for Program; Community Direction Core Competencies themselves what mix First Choice (Section Project supports of services and goods 1915(k)), and revisions Standards 1 (respectful will best meet their in the 1915(i) authority; and appropriate care), 3 needs to live Money Follows the (ongoing training and independently in the Person (MFP) ; Aging education), 6 (oral community and Disability communication), 7 Resource Centers (written (ADRCs); Care communication), and 12 Transitions; Health (participatory, Homes collaborative partnerships) 13
Relationship of Participant Direction Core Competencies Project to Other Participant-Directed Activities DHHS: AoA-NRCPDS: Consumer Direction Core Competencies Project Identify the competencies necessary to assist and support participants in managing their services effectively through informed decision-making The National Association of State Directors of National Council on National Association of World Institute on Developmental Independent Living States United for Aging Disability (WID) Disabilities Services (NCIL) and Disability (NASUAD) (NASDDDS) The National Core Indicators Strengthening the Aging Network Strategic Plan Health Access Initiative Project (SAN) Develop a standard set of Develop a measurement system Special initiative aimed at Trains doctors and medical performance measures used by that demonstrates NCIL’s increasing the capacity of state staff in culturally competent states to manage quality, set effectiveness in its mission agencies across the country to health care and in how to benchmarks, compare findings through efficient utilization of enhance their ability to play make services and with other states, and compare resources leadership roles in the equipment accessible with national findings development and implementation of cutting edge long term services and supports (LTSS) systems 14
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