NORTH CAROLINA OPTIONS COUNSELING STANDARDS(Revised)
Introductory Note
Background
Options Counseling Goals
Goals of the Standards
Standards Revision Process
Definitions
Options Counseling Standards:
I: Service Definition, Population, Outreach, and Provider Agency
II: Initiating Options Counseling
III: Components of Options Counseling
IV: Staffing
V: Certification and Recertification
VI: Partnerships
VII: Continuous Quality Improvement, Evaluation and
Outcomes
Appendices
A. Options Counseling Action Plan
B. Initial Application for Options Counseling Certification
C. Final Application for Options Counseling Certification
D. Options Counseling Recertification Form
E. Options Counseling Performance Validation Checklist
F. Samples of Consent for the Release of Confidential Information
G. Initiating the Options Counseling Process (flow chart)
H. Options Counseling Documentation Sheets
I. Documentation Guide
Introductory Note
These Standards are the framework of Options Counseling. They are your reference and guide to providing this service in a consistent, high-quality manner across the state. It is vital that you read the Standards, understand them, and become familiar with their content. This is your “rule book” for conducting Options Counseling. If you have a question about any part of the Options Counseling service, your first action is to consult the Standards.
Background
The U.S. Administration for Community Living (ACL), formerly known as the Administration on Aging, the Centers for Medicare & Medicaid Services (CMS) and the Veterans Health Administration (VHA) are committed to supporting states' efforts to develop and sustain a person-centered, self-directed national long term supports and services system. For over a decade,ACL, CMS and VHA have created multiple funding opportunities for states to significantly strengthen and expand their person-centered access programs to help people learn about and access the long term services and supports (LTSS) that best meet their needs.
In 2010, ACL funded Aging and Disability Resource Center (ADRC)* programs in 20 states, including North Carolina, towork with ACL and each other in a collaborative process to develop national minimum standards. These standards guide how Options Counseling is delivered, who delivers it, under what circumstances, and how outcomes are tracked across the ADRC network. Through the grant, states also designed, implemented and tested draft standards for Options Counseling. In keeping with federal expectations, North Carolina has developed this set of standards for Options Counseling.
These Federal partners have the goal of further developing ADRC programs to serve as high-performing national models for providing LTSS Options Counseling to all state residents with LTSS needs.
* In North Carolina, ADRCs are known as Community Resource Connections for Aging and Disabilities (CRCs)
Options Counseling Goals
The primary goals of Options Counseling are to facilitate informed decision-making about Long-Term Services and Supports (LTSS) and serve a key role in the streamlined access to supports. Options Counselingsupports the broader system goals of rebalancing LTSS and may help to prevent or delay premature institutionalization.
Options Counseling plays a pivotal role in supporting many federal initiatives and programs that encourage community living.These includeVeteran-Directed Home and Community-Based Services, other participant-directed programs, care transitions interventions, and Medicaid waiver and other programs such as Money Follows the Person.
Goals of the Standards
The purpose of these standards is to:
- provide a clear definition of Options Counseling;
- establish a framework for agencies that provide the service; and
- promote consistency and quality of Options Counseling provided.
Standards Revision Process
At a minimum, a full review of the Options Counseling Standards will be conducted every two years.
The Standards Committee will be comprised of representatives from the Division of Aging and Adult Services (DAAS), experienced certified Options Counselors, and other individuals with related knowledge and expertise.
Changes that may be needed include:
- Revisions mandated by Federal or State policy changes
- Revisions in wording to clarify or strengthena Standardor related criteria.
- Addition of Standards or related criteria that are not in the current document.
- Deletion of a current Standard or related criteria
The Standards Committee will conduct the following review process:
1)The committee will conveneto discuss any proposed additions, revisions, and/or deletions to the Standards. Guidelines for making changes to the Standards are as follows:
- The Standards should reflect current Options Counseling practice;
- The Standards should not create an undue hardship in order to meetthe desired outcome;
- The Standards should be achievable by all agencies providing the service.
2)The committee will draft any revised/new Standard and associated criteria.
3) If a Standard is new or there is a substantive change in an existing
Standard, the draft will be posted on the DAAS website and the
Options Counselor listserv. Options Counselors will receive notification
of the posting and will have 30 days to review and submit
comments to the Standards Committee.
4) If a Standard is being considered for deletion, a notice will be posted
on the DAAS websiteand the Options Counselor listserv. Options
Counselors will receive notification of the posting and will have 30
days to review and submit comments to the Standards Committee.
5) Feedback will be evaluated by the StandardsCommittee and
incorporated as appropriate.
6) The Standards Committee makes the final decision regarding any
change and theStandard is adopted or deleted.
7) Technical assistance related to any new requirements will
be provided, as needed,to all certified Options Counselorsand their
supervisors to ensurecompliance.
Definitions
Action Plan – A plan outlining goals, action steps, timelines, resources needed, responsible parties, and referrals made in the Options Counseling process that are needed by the individual and/or counselor to attain supports that meet the goals and preferences of the individual. This plan is time-limited and is directed and developed by the individual with support from the Options Counselor as needed.
ADRC/CRC -A network of agencies and organizations working together to create a coordinated system of information and access for all persons seeking long-term services and supports. Using a “no wrong door” approach, the goal is to minimize confusion, enhance individual choice, and support informed decision-making.
Affiliated – Has a formal relationship with the named agency such as the funding of services, contractual agreements, interagency agreements or other circumstances as deemed appropriate by the Division of Aging and Adult Services.
Care/Case Management – A long-term service designed to help the individual who has complex care needs achieve an agreed upon goal. It assists with assessment of an individual’s needs and with arrangement and monitoring of services.
Caregiver - A family member, partner, friend, or neighbor who supports an individual. Caregivers may also be the individuals seeking Options Counseling for their own supports.
Conflict of Interest - Any relationship, real or apparent, which jeopardizes the fair and objective administration of the Options Counseling service.
Decision Support – A process of examining and selecting various options available to the individual. It includes information and education to support an individual as he or she weighs options. It includes exploration of an individual’s perceptions about the pros and cons, and dialogue about how those perceptions influence potential decisions. The use of planning tools is a common method to assist the individual in the decision making process.
Follow up – A scheduled contact with the individual to determine what progress toward goals and steps within the action plan has occurred.
Information and Assistance (I&A) – Informs individuals about programs and services and how to access them, identifying types of resources, providing referrals and service coordination as needed.
Legal Representative – A person who is a guardian or otherwise legally authorized to represent the individual.
Long-Term Services and Supports (LTSS) – Ongoing assistance with Activities of Daily Living (ADLs) or Instrumental Activities of Daily Living (IADLs) forindividuals who cannot perform these activities on their own.
Options Counselor –Facilitates a decision support process to help individuals make informed choices about long-term services and supports. The counselor must successfully complete the Options Counseling certification processand maintain a valid certification issued by the Division of Aging and Adult Services.(See Certification on page 20.)
Person-Centered Planning Approach (PCP) – A process that is driven by the individual, and may also include a representative whom the person has freely chosen or is legally authorized. The PCP approach identifies the strengths, preferences, needs, formal and informal supports, and desired outcomes of the individual.
Standards for Options Counseling
I. Service Definition, Population, Outreach, and Provider Agency
Standard 1.1Definition ofOptions Counseling
Options Counseling is an interactive process where individuals receive guidance as theymake informed choices about long-term services and supports. The process is directed bythe individual or his/herlegal representative, but may includeothers the individualor legal representative chooses to be present for the discussions. Regardless of representation, the individual to be served through Options Counseling shall be involved in the process to the greatest extent possible.
Options Counseling includes the following steps:
1)conduct a personal interviewto discover strengths, values, and preferences of the individual and screen for eligibility for private pay and publicly-funded programs;
2)facilitate the decision-support process which explores resources and service options, and support the individual in weighing pros and cons;
3)develop anActionPlan and provide assistance in applying for and accessing support options when requested;
4)provide quality assurance and follow-up to ensure that decisions and supports are working for the individual.
Guidance:
A personal interview, which includes a “one-on-one” conversation with the individual, and as requested or desired, a representative, family members, or other supporters, that would facilitate an initial screen to determine if the person needs LTSS. If so, then a comprehensive person-centered planning process starts to occur to identify the individual’s strengths, values, and preferences. This process will include the identification of all current supports, both formal and informal, and incorporate as appropriate the use of screening and assessment tools that may be required by various programs.
A facilitated decision-support process that helps individuals and their families weigh the pros/cons of various options, including exploration of self-directed options and leads to:
1)identifying the desired and available options (including informal supports, emergency supports, funding sources, etc.);
2)assisting individuals and families in determining how best to pay for and arrange the delivery of services, including helping individuals to assess sufficiency of their own resources, and their eligibility for enrollment in public programssuch asMedicaid, Medicare, and Veterans’ benefits.
Development of anaction plan and connecting people to the identified services and supports
The individual develops a person-centered action planwith help from the Options Counselor as needed. The plan outlines the:
1)immediate next steps to be taken in the decision-making process; and
2)mix of informal supports, community resources, and publicly-and privately funded services the individual elects to use based on his or her own preferences andneeds, and also on the eligibility criteria and availability of the services.
In Options Counseling, the individual self-advocates to the greatest extent possible. However, assistance from the Options Counselor, when needed, is available. This may include helping complete an application and/or making referrals.
Quality Assurance & Follow-up to:
1)assure the supports meet the individual’s preferences;
2)gather and act on consumer feedback on services and the delivery systems;
3)determine if planned services are activated, assist with changes in the plan as necessary, and monitor the effectiveness of the service;
4)input data into reporting systems that monitor program performance,
customer satisfaction, trends, and preferences.
Standard 1.2 Target Population
Any individual in need of weighing options regarding future long-term services and supports. This service is recommended for individuals whose changing health, support system or life circumstances place them at risk for loss of independence. The serviceis also very appropriate for people who are transitioning from hospital and institutional settings back to community settings.
Guidance:
Options Counseling can also be offered to caregivers to assist them in making choices about the level of care they can offer, finding support for their caregiving efforts, and communicating with the care recipient. In this situation, the person-centered, decision-support process is focused on the caregiver’s needs. A separate Options Counseling process may take place with a focus on the care recipient’s needs. These would be documented as two separate Options Counseling events.
Standard 1.3 Marketing/Outreach
The provider agency must promote the Options Counseling service to individuals, service providers, community groups, employers and public officials to create awareness about and promote appropriate utilization of the service.
Standard 1.4 Provider Agency
Providers of Options Counseling shall be affiliated with:
- an ADRC network, or
- an Area Agency on Aging, or
- other agencies as identified by the Division of Aging and Adult Services.
II. Initiating Options Counseling
Standard 2.1 Activation/Initial Contact
Provider agenciesshall implement a process for receiving initial inquiries related to Options Counseling.
Guidance:
A variety of circumstances may activate Options Counseling. Activation triggers might include when an individual:
1)presents with an unmet need for which there is more than one service alternative;
2)has had recent change in life situation;
3)has long term services and supports needs but unsure about the process to access them;
4)is requesting transition assistance;
5)is admitted to the hospital;
6)lacks awareness of existing community resources and supports;
7)has multiple needs, behavioral health needs or a chronic illness;
8)or person acting on his or her behalf, and has the legal authority to make requests or indicates an interest in receiving information or advice concerning long-term services and supports options;or
9)is referred by a hospital, nursing home, assisted living home, home and community-based waiver services provider, or other agency.
Appendix F – “Initiating the OC Process” outlines when it may be appropriate to refer an individual to Options Counseling.
Standard 2.2 Delivery Setting/Method
a.Every attempt shall be made to deliver Options Counseling in the setting and by the method desired by the individual. Settings and methods of service delivery may include:
1)the individual’s place of residence;
2)a nursing home, hospital, or rehabilitation center;
3)office or satellite office;
4)by phone; *
5)by e-mail; *
6)by video conferencing technology or other electronic method.
* Phone and email shall not be relied upon as the sole mechanisms for
communication in the Options Counseling process, unless preferred by
the individual needing services and documented in the individual’s file.
b.At least one in-person meeting is required unless declined by the individual and documented in the individual’s file.
Guidance:
These are not exclusive settings andmethods of communication. The Options Counseling process can involve a combination of the settings and methods outlined.
Standard 2.3 Documentation
Each provider agencyshall maintain a system to document individual Options Counseling contacts. Documentation may be in a paper and/or electronic format.Documentation shall includeat a minimum:
1)name of individual(s) receiving Options Counseling;
2)contact setting and/or method;
3)a summary of eachcontact that includes a clear picture of the individual’s situation, what was discussed, and what was decided. At some point within the entire body of documented contacts the following are addressed:
- the individual’s preferences and needs with ongoing notation on how they are addressed;
- options/information discussed; and
- options selected
4)date, time spent with or onbehalf of the individual;
5)counselor’s initials orsignature and date;
6)a summary or a copy of any written Action Plan resulting from the contact(s) thatidentifies and weighs options and available resources, or anotation that the individual declined development of an Action Plan; and
7)a record of follow-up activities, unless declined by the individual. Follow-up documentation shall include at a minimum:
- an outline of the individual’s current situation
- outcomes since last contact
- whether steps in the Action Plan occurred, if not, why
- any next steps needed
Guidance:
See Appendix G – “Options Counseling Documentation Sheets” and
Appendix H – “Documentation Guide”
Standard 2.4 Confidentiality and Security of Personal Identifying Information (PII)
(Adapted from Home and Community Care Block Grant Manual)
2.4-1Confidentiality
a.Information obtained through the Options Counseling processshall not be disclosed in a way that identifies the individual without the informed consent of theindividual or legal representative unless the disclosure is required by courtorder, or for program monitoring by authorized Federal, State, local orother designated monitoring agencies.
b.Any agency whose staff conducts Options Counseling shall assure that all authorized persons are informed ofthe confidential nature of the individual’s information and shall disseminatethe agency’s written policy to and provide training for all persons with access tothat information.
c. If the Options Counselor receives information from another agency or individual, then suchinformation shall be treated as any other information generated through the Options Counseling process and disclosure
thereof will be governed by any condition imposed by the furnishing agency orindividual.
2.4-2 Records
a.All individual information obtained throughOptions Counseling is the property ofthe respective agency. Employees of the agency shall protect and preserve suchinformation from dissemination except as indicated by the policies establishedin this section.