# Presentation: 303694

## Policy and Program Options to Help People Help ThemselvesSusan C. Reinhard 

- Frontier Workshop
- Cheyenne, Wyoming
- Alzheimer’s AssociationJune 24, 2005

## Goals

**Explore policy changes needed to support consumer and family empowerment and community living**
**Stimulate new models of professional-consumer relationships**
**Focus on State Nurse Practice Policies as a framework**

## Background

**Most nurses and many health professionals, have little formal training in aging and families **
**Resistance from nurses, especially around dementia**
**Interest in Systems Change is how to support people in long term living, starting with their strengths-rural themes of self-help, self-care, self-sufficiency**

## Background

**Provide Technical Assistance to all states for some change--8 states here **
** ****Working now with respite, consumer direction, nursing home transition, and “money follows the person” grantees**
**Professionals’ changing roles in empowering people involved in all these areas **

## Change...Around the Country

**People want HCBS; Nursing home occupancy dropping **
**Baby Boomers who need care outside of home will want different kind of nursing home--Greenhouse**
**Demands for high quality, flexible services that are responsive to consumer’s direction**
**Providers challenged to respond to changing market**

## Change

**Rural state have strengths and challenges; some have innovations that are leading the way for country**
**States with the highest percent of Medicaid Dollars spent on HCBS for older adults and PWD:**
**New Mexico is #1 at 55.2%**
**Alaska is #3 at 50.9%**
**Idaho is #6 at 38.2%**

## Key Building Blocks  

## Key Concepts

_**Money Follows the Person**_** =  financing for services and supports moves with the person to the most appropriate and preferred setting.  **
**Global budgeting in Colorado**
**Legislation in North Dakota**
_**Rebalancing**_** =  reduced reliance on institutional options, increased community options.**

## Emerging Policies and Programs can Help Rural Communities

**Paying family members can help support community living**
**Oklahoma’s experience **
**Wyoming’s individual budgeting**
**Consumer direction in respite care growing **
**Legislators breaking down barriers to diversifying services that can help**
**Iowa’s Alzheimer’s Adult Day Care; had to change rules to allow NHs to diversify into this area**
**	**
**	****with services****	**
**Assisted Living, **_**Adult Foster Care**_
**Caregiver Support and** **Respite**
**Others, like Adult and Pediatric Day Health Care**

## Consumer Direction, Managing Own Care Includes

**  ****Having greater control, flexibility and choice **
**  ****Choosing preferred services **
**Designing services to meet your own schedule**
**  ****Purchasing equipment, making home modifications**

## Managing Own Care Includes

**Hiring people that you want to help you with personal care - **
**including relatives, friends, neighbors**

## Professionals are Often a Barrier to Consumer Direction

**Difficult to make professional case managers (even social workers) evolve into “support counselors”--Arkansas**
**Nurses do not want to let go of medication administration and other “nursing tasks”**
**Most tension around older adults and dementia**

## The Nurse-Consumer Relationship:  Emerging Principles and State Policies

**The Nurse-Consumer Relationship:  Emerging Principles and State Policies**

## Principles to Support Change

**Nursing practice is grounded in a philosophy of collaboration with the consumer/person.**
**Nurses emphasize strengths and abilities in developing plans for care in collaboration with consumers.**
**Nurses advocate the elimination of ageism and barriers to access to care for all persons.**
**  **

## Principles

-  **“****Health” is a broad concept that extends beyond professions’ specific scope. **
**Tasks are not necessarily “health care”**
**Includes health promotion, promotion of self-care, and care of persons with acute and chronic conditions**

## Principles

**Federal law dictates that consumers have the right to pursue community living, regardless of their age or disability.**
**Consumers have a personal responsibility for health and well-being.  Frontier stakeholders know this.**
**Consumers may desire consultation from professionals who have the knowledge and skills to provide such consultation.**

## Principles

**Nurses support consumers’ informed decision-making as consumers balance their desire for both independence and safety.**
**  **

## Principles

**In accordance with federal law and professional ethics, the professional nurse  should strive to assist the consumer to achieve the most integrated setting and least restrictive environment throughout the life span.**

## Research To Explore States’ Nurse Practice Acts

**ASPE funded “Consumer Directed Care & Nurse Practice Acts (2001)**
**ANF/ASPE funding for interviews with executives of state boards of nursing (2003)**
**Reports at www.cshp.rutgers.edu**

## Overview Findings

**Variations across and within states**
**Some states allow delegation of tube feedings but not medication administration**
**Distinguishing ways to administer meds**
**delegation**
**administration**
**supervision of self-administration**

## Range of DelegationAcross States

_**Oregon**_**: can delegate or assign (now “teach”) care tasks in community settings. Accountability language delineated.**
_**Alaska**_**:  Nurses can delegate to “providers” caring for routine, repetitive tasks (including meds, catheters, tube feedings)**
** **

## Range of Delegation

_**Montana:**_** can delegate specific task for a specific person to a specific unlicensed delegatee in the specific setting; social worker can determine consumer can direct.**
_**Nebraska**_**:  RN discretion and “health maintenance activities” are exempt if consumer directs.**
** **

## Professionals Supporting Independence

**Changing professional models**
**Collaboration and consultation with consumers and families**
**Change requires formal training, informal norms, new program designs, and new policies**
**Some states need to change laws and regulations (like Nurse Practice Acts)**

## Susan C. Reinhard

**Co-Director****Rutgers Center for State Health Policy****Director****Community Living Exchange at Rutgers****Technical Assistance for Real Systems Change****732-932-3105, ext. 230****sreinhard@ifh.rutgers.edu**