Hiring Your Own Workers

October 8, 2004

Aging and Adult Services & Minnesota Department of Human Services

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Consumer Directed Supports

Started with the Self Determination Movement – Freedom – to live a meaningful life in the community – Support – to organize resources in ways that are life enhancing and meaningful – Authority – over dollars needed for support – Responsibility – for wise use of public dollars – Confirmation – of the important leadership that self-advocates must hold in a newly designed system 2

Self Direction

Self-direction has been defined as a “philosophy and orientation to the delivery of home and community-based long-term care services whereby informed individuals assess their service needs, determine how and by whom these needs should be met, and monitor the quality of services received.” (NCOA, 2000) 3

Features of Consumer-directed Model of Service

 Individual decides who, when, where, and what LTC services are delivered  Emphasizes the individual as opposed to medical or social work professionals  Individuals can have an active role in managing their services; can be dual employer  Allows funds to follow the individual rather than the service provider.

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Public and Private Options

 “Consumer-directed services” is the term used when clients in publicly funded programs use the option to hire their own workers and get the bookkeeping and counseling help they need to do this.

 This same method can be used by persons who are not on public programs and want to pay workers directly to help them, rather than going through home health or other agencies.

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Consumer Directed Supports

Is cost effective because -do not always have to purchase through the medical system.

-can purchase more support for the money.

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Client Support Services

 Fiscal Entity Services – Fiscal Intermediary – Employer of Record  Counseling (flexible case management) Services – Planning – Budget Management – Coordinating Services 7

Support Brokers or Agents

 Assist clients with: – developing and revising their plans – managing their budget; purchasing – locating, hiring and managing support staff – coordinating services and paperwork for medical care, social services, etc.

 Those with specific expertise may also assist by developing specialized support methods and strategies. 8

Fiscal Intermediary Services

 Assist with employment functions, including, – Payroll – Taxes – Availability of “group” insurance – May serve as employer of record 9

For Older Persons (60+) and Adults with Physical Disabilities     Retain freedom – No need to “trade” freedom for support Retain Authority – The right to make decisions about their lives – The right to choose who their needs are addressed Continue to assume responsibility – For decisions made as to self-care – As managing employer (at minimum) Receive Support – Developing plan, hiring and directing staff 10

CMS Waiver Amendments

 Effective October 1, 2004  All five Medicaid Waivers  Provision of payment of spouses and parents of minor children  Includes – personal assistance, – environmental modifications and provisions, – treatment and training and – self direction support activities. 11

Rolling Out Consumer Direction Across Aging Services  Elderly Waiver  Alternative Care Program  Title III E Caregiver Support  Private Pay  State Grants – Respite – Service Development 12

Infrastructure Will Benefit Everyone

 Counseling/supportive services to assist with planning and coordination of services  Fiscal Support Entities – Provide employer-related functions the consumer does not want to assume 13

Questions?

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