Staff Training Manual
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The ABCs of the CRC
Serving Beaufort, Bertie, Hertford, Martin and Pitt CountyStaff Training Manual1WelcomeStaff Training for CRCan innovative network thatwill help you better connect withand serve consumers
CRC Mission & VisionMission: To be a consumer-centered network providing easy access to aging and disability information and services in Beaufort, Bertie, Hertford, Martin and Pitt County.Vision: Service access without confusion for all consumers.
3LTC System Challenges Fragmented Institutional bias Lacks focus on consumerConfusingIncrease in population = $$$$$
CRC Reform Strategy
Purpose and Background of Aging and Disability Community Resource Connections
Aging and Disability Community Resource Connections every community in the nation highly visible and trusted people of all incomes and ages information on the full range of long term support options point of entry for streamlined access to services
Purpose and Background of Community Resource Connections 6Maturity, Growth, and Expansion of CRCs Federal CRC initiative began in 2003 with three core functionsAwareness, Assistance, and AccessSet of core expectations has grown over timeInformation, referral, and awarenessOptions counseling, advice, and assistanceStreamlined eligibility determinations for public programsIntervene in critical pathways to institutionalizationPerson-centered transitionsQuality assurance and continuous improvementAoA and CMS view CRCs as the platform to:Catalyze broader systems change Promote participant-directionBuild stronger partnerships across siloed LTSS systemIntervene during care transitions from hospitals and other acute care settingsAssist with institutional transitionsImplement new initiatives (e.g., Veteran Directed Home and Community Based Services)Seamless system from consumer perspectiveHigh level of visibility and trustProactive intervention into LTC pathways Integration of aging and disability service systemsFormal partnerships across aging, disability and MedicaidAll income levels served More a process than an entity
Defining Characteristics of CRCs
How CRCs Operate Home and Community Based ServicesNursing Homes/InstitutionsOptions CounselingHealthPromotionEmployment ServicesPeer CounselingPrivate ServicesPublic ProgramsOne-Stop Access8Key Partners 8Area Agencies on Aging Centers for Independent Living Public & private aging and disability service providers State Health Insurance Assistance Program (SHIIP) Long term supports and service providers (e.g., home health agencies, nursing facilities) Critical pathway providers (e.g., hospital discharge planners, physicians) Adult Protective Services Medicaid
Effective CRC Partnerships Regular communication Written agreements Written referral protocols Co-location of staff Regular cross-training of staff Compatible IT systems I&R resources are shared Collaboration on client services Client data are shared Joint marketing and outreach activitiesEvery Community? ADRC Coverage June 201125-50% of state populationHawaiiAlaskaMTIDWACOWYNVCANMAZMNKSTXIAWIILKYTNINOHMIALMSARLAFLSCWVVANCPAVTRIMENHORUTSDNDMOOKNENYCTMADCDEGuamNorthernMariana Islands1-25% of state population100% of state population75-99% of state population0% of state populationGA50-75% of state populationPuerto RicoMD1111Overview of CRCs: Operational Components Information & Awareness
Person-Centered Hospital Discharge Planning (Care Transitions)
Quality Assurance & Evaluation
Open one door, make every connection
Overview of CRCs: Operational Components
CRCs Provide Decision Support
. . . an interactive decision-support process whereby consumers, family members and/or significant others are supported in their deliberations to determine appropriate long-term support choices in the context of the consumers needs, preferences, values, and individual circumstances
Options Counseling Overview of CRCs: Operational Components Options counseling provides consumers with the tools and knowledge they need to choose the best path for themselves.
Options Counseling -- from the consumers perspective
Go somewhere else no wrong door or one stop shop access to services and supports Call another organization or agency seamless referral to other agencies; consumers do not need to make another phone call Repeat same information over and over information systems designed so that information collected at the initial point of contact populates multiple forms Worry about getting lost in the system. follow-up after referrals are made
Overview of CRCs : Operational ComponentsStreamlined Access
Person-Centered Hospital Discharge Planning (Care Transitions)
Create linkages that ensure people have the information -- to make informed decisions -- to understand their support options as they pass through critical health and LTC transition points -- hospital discharge -- nursing or rehab facility admission or discharge nComponents
Quality Assurance and Evaluation
Measure: consumer outcomes system efficiencies costs
Use results: improve services identify and meet needs strengthen programs
Quality Assurance and EvaluationConsumers have consistently reported high levels of satisfaction with CRCs Services ResponsivenessStaff knowledgeInformationCapacity to make informed decisions
I never knew that this could be so easy and pleasant. I was expecting something far more bureaucratic and difficult.
The CRC Is NOTa separate physical location, a change to existing service eligibility criteria, or a change or replacement of services.
20How does the CRC work?Referral ProcessPerson-Centered Follow-upEvaluation/Customer Satisfaction21Now What?
Is this contact a CRC consumer?Age 60 or aboveAge 18 or over and disabledIf the answer is no, stop intake form and mark as a contact60+ or DisabledAm I an agency that provides any CRC services?Do I provide information and assistance?Do I provide options counseling?Do I conduct assessments?Do I provide follow-up?
If Your Answer Is YesDetermine customer needs and desiresDevelop a person-centered plan of actionExplain the CRC and discuss confidentialityComplete the Intake/Referral ToolContact the customer to determine if needs were metDetermine next steps
If Some Answers Were NoHandle the immediate requestExplain the CRC, discuss confidentiality, and get permission to refer Complete the Intake/Referral Tool Refer to a CRC PartnerFollow up to ensure needs are metReferralIf the answer is No!!!!
Let your partner know you received the referralPerson-Centered Follow-upKeep the consumer (or his/her caregiver) updated on progress of requestsAs deliverables occur, ensure it/they meet(s) expectationsWhen complete contact consumer to confirm that initial request satisfied and determine any additional needsEnlist consumers willingness to provide satisfaction feedback to CRC
Evaluation/Customer SatisfactionContact consumer (or consumers representative)Inquire as to adequacy of product or service deliveredAsk if she/he has any recommendations to improve the process, service, product or experience Ask if there is any further information or assistance needed at this time SART REPORT Semi-Annual Reporting Tool
Network Data = SustainabilityKeeping Track of DataRefer to SART DefinitionsPlan a system to count contactsPlan a system to count clients/consumersSubmit data to CRC Coordinator via email by the 15th of each month. Were Still EvolvingThis is a Process in progressThe Network is ExpandingIncreased Understanding of Partner Capabilities = A Stronger Network = Enhanced Consumer Service Quality =Cost-Effective Resource Allocation