A Day in the Life of a Resident Services Coordinator: Strategies for Success

Transcription

1 A Day in the Life of a Resident Services Coordinator: Strategies for Success Nancy W. Sheehan Human Development & Family Studies University of Connecticut August 20, 2009

2 Agenda Welcome Introductions Introduction to training Objectives, Content, and Format Sheehan, HDFS, University of Connecticut, August 20, 2009

3 Overview of presentation Part I: Need for Service Coordination Part II: History of Service Coordination Programs Part III: Role and Functions of SC Part IV: Knowledge, Skills, & Strategies for Successful SC Part V: Conclusion Sheehan, HDFS, University of Connecticut, August 20, 2009

4 Learning Objectives: A Day in the Life.. Understand policy and legislative factors shaping the RSC role Describe the different types of SCPs Understand how macro and micro factors influence RSC responsibilities Explain the link between program goals and activities Describe the importance of evidence based" practice for successful role performance Share best practice strategies for enhancing residents quality of life Identify tools for effective SC Sheehan, HDFS, University of Connecticut, August 20, 2009

5 Part I: Need for Service Coordination Recognition of the need to integrate supportive services into senior housing is not a recent development What is relatively new is support for programs to bring supportive services into senior housing Prior to 1990, HUD and other housing agencies avoided the idea of linking housing and services Since 1990, increased interest in SC and growing numbers of RSCs Growth possible due to increased funding mechanisms Sheehan, HDFS, University of Connecticut, August 20, 2009

6 Part I: Need for Service Coordination Crisis is looming. Time is running out 1 1 A Quiet Crisis in America (2002): Report to Congress by the Commission on Affordable Housing and Health Facility Needs for Seniors in the 21 st Century (2002)

7 Part I: Need for Service Coordination Factors responsible for growth of SCPs: Demographic trends Changing needs of senior housing residents Pressures to improve the LTC system

8 Part I: Need for Service Coordination Demographic trends Aging of population, especially Baby Boomers Increased numbers of persons with disabilities

9 Part I: Need for Service Coordination Connecticut s Growing Elderly Population 65 years and older % 479, % 794, years and older % 79, % 132,440 Sheehan, HDFS, University of Connecticut, August 20, 2009

10 Part I: Need for Service Coordination Increased numbers of persons with chronic needs Sheehan, HDFS, University of Connecticut, August 20, 2009

11 Part I: Need for Service Coordination Changing needs of senior housing residents Approximately 2 million low income seniors living in independent, federally subsidized rental properties Elderly residents are growing older Residents are aging in place and new residents moving in at advanced ages Increased desire to age in place

12 Part I: Need for Service Coordination Changing needs of senior housing residents Median age in Section 202 properties is 76 In 2006, almost 20% of all new Section 202 residents were 80+ A large portion of residents in senior housing suffer from chronic illnesses and disabilities Greater prevalence of risk factors among senior housing residents More functional impairments More likely to live alone More hospitalizations, More likely to be at risk for needing Medicaid

13 Indicator 37 Residential Services

14 Part I: Need for Service Coordination [Factors responsible for growth of SCPs] Pressures to improve the LTC system Need to control escalating LTC costs Escalating costs Costs of nursing home care in CT increased as much as 22% from ( Annual Cost of Care Survey, Genworth Financial, 2009) Olmstead Act

15 Part I: Need for Service Coordination Many different stakeholders with different expectations: Aging experts Social service professionals Housing experts Federal and state policymakers Sheehan, HDFS, University of Connecticut, August 20, 2009

16 Part I: Need for Service Coordination Expectations from different stakeholders: To promote quality of life To enhance aging in place To deliver social services more efficiently To reduce housing $$$ (i.e., turnover) To delay or prevent institutionalization To expand community based LTC options To reduce $$$ public expenditures for LTC

17 Part II: History of Service Coordination Programs History of Service Coordination Programs SCPs have an evolving history Past developments Expansion of SC [combining SC with other types of interventions]

18 Part II: History of Service Coordination Programs History of SCPs RWJ Demonstration Program 1989 RWJ: Living at Home Program: SSSHP 1990 AoA funds Elderly Supportive Services Program (ESSP) in Connecticut 1990 HUD promotes SC across Assisted Housing Inventory 1990 Congress authorizes SC in Section 202 Cranston Gonzales National Affordable Housing Act 1991 Congress broadens SC to multifamily assisted housing and public housing (Housing and Community Development Act of 1992) 1993 Congress funds and extends program to Section 8, 221(d)(3), HUD awards SC grants to public housing 1997 HUD issues Management Agent Handbook for SCPs 1997 HUD authorizes SC funding through operating budgets and residual receipts 1 Adapted from Maine State Housing Authority (2003). Opening Doors to Services in Housing, Accessed on June 12, at ResidentServicesCoordination.pdf Sheehan, HDFS, University of Connecticut, August 20, 2009

19 S Part II: History of Service Coordination Programs Connecticut 1959 First state funded elderly housing authorized 1961 Elderly housing to include younger persons with disabilities 1980s Trends impacting resident population in state elderly/disabled housing 1998 PA : Elderly Rental Registry & Counselor Program (aka) RSC Program 2005 PA : An Act Concerning the Training and Responsibilities of RSC (Roles expanded and redefined) 2009 DECD funds about 70 LHAs and/or non profits to provide the RSC program ($1.3 million a year)

20 Part II: History of Service Coordination Programs

21 Part II: History of Service Coordination Programs Expansion of SC [combining SC with other types of interventions] Range of partnerships to offer on site health and wellness services» Hospitals and health systems, physician practices, Health professional schools, HMOs, Home health agencies, AAAs

22 Part II: Public Policy Trends in Senior Housing Sheehan, HDFS, University of Connecticut, August 20, 2009

23 Part III: Roles and Functions of SC Service coordination can enchant, surprise, discourage, and frustrate you. Some nights the challenge will keep you awake; other nights the satisfaction will help you sleep Susan Lanspery, n.d. Service Coordination Guide, HUD Contract No. DU100C , Task Order No. 4, National Neighborhood Networks.

24 Part III: Roles and Functions of SC Efforts to define the RSC role Role in the context of SCP goals The link between goals and outcome measures

25 Part III: Roles and Functions of SC The Professional Service Coordinator Core area of training for SCs serving projects with elderly or people with disabilities

26 Part III: Roles and Functions of SC Efforts to define the role: What the RSC role is What the RSC does What the RSC does not do What the RSC program offers to management and residents

27 Part III: Roles and Functions of SC Reasons why it is important to define role Many different meanings (means different things to different people) Different types of supportive housing use term to refer to different roles and sets of functions Avoid confusion when the role is introduced Clear expectations are critical for evaluating performance

28 Part III: Roles and Functions of SC Early discussions of the RSC role attempted to: (1) Expose misperceptions (2) Compare RSC role to other roles

29 Part III: Roles and Functions of SC Discussions of the RSC role: (1)Debunk misperceptions surrounding the role RSC just links residents up with services RSC is a troubleshooter for management Anyone who works well with elderly persons is qualified to be RSC [Anyone who works well with children is qualified to be a RCS] Other misperceptions????

30 Part III: Roles and Functions of SC (2) Compare RSC role to other roles How are you different from a Geriatric Social Worker? How are you different from a case manager? How are you different from an activities director?

31 Part III: Roles and Functions of SC (2) Distinguish RSC role from other roles: the Resident Services Coordinator is not a social worker, not a case management specialist, and not an activities director. The distinction between the RSC role and other human service roles, such as social worker, case manager, and activities director, is complicated by the fact that the RSC performs certain functions similar to those of a social worker, case manager, and at times, activities director. (Sheehan, 1992, p. 26)

32 Part III: Roles and Functions of SC RSC versus Case Manager? Case/care managers: Focus on meeting individual s needs (medical orientation) Often operate within constraints of service programs Often act as gatekeepers Professionals responsible (Doing for individual) Professionals seen as experts

33 Part III: Roles and Functions of SC RSC versus Case Manager? RSCs: Community orientation (i.e., group focus) Problem prevention Early intervention Emphasis on empowerment Power resides in community Community is the expert

34 Part III: Roles and Functions of SC RSCs versus Activity Directors How do you distinguish your role from Activity Director role?

35 Part III: Roles and Functions of SC Practical steps for introducing/clarifying RSC role Clear precise job description for RSC role Compare RSC job description with other management company employees to identify any overlap in formal duties and determine appropriate assignment of these responsibilities Meet with other employees to achieve consensus on RSC functions and tasks Establish clear supervisory arrangements and expectations Finalize job description Sign Memorandum of Understanding (MOU)

36 Part III: Roles and Functions of SC Connecticut DECD: By law, housing authorities must use the [RSC] funding to: 1. hire a resident service coordinator to assist residents maintain an independent living status; 2. assess the individual needs of residents for the purpose of establishing and maintaining support services; 3. Maintain regular contact with residents; 4. monitor the delivery of support services to residents; 5. advocate changes in services sought or required by residents; and 6. provide mediation and conflict resolution services (Legislative Program Review & Investigations Committee, December, 2004). Sheehan, HDFS, University of Connecticut, August 20, 2009

37 Part III: Roles and Functions of SC Objective of the position: Job Description: Service Coordinator Elderly Facilities HUD Financed (Sample) American Association of Service Coordinators 1 The Service Coordinator (SC) must work from an empowerment model. The goal of the program is self actualization of residents. Residents should do as much as they are capable of doing themselves. The SC works in conjunction with the property manager. The SC and manager maintain a mutually respectful, collaborative relationship. 1 Reprinted with permission, AASC, August 2, 2009

38 Part III: Roles and Functions of SC Functions: Job Description: Service Coordinator Elderly Facilities HUD Financed (Sample) American Association of Service Coordinators 1 1. Provides general service management which includes intake, education (services available and application procedures) and referral of residents to service providers in the general community. These social services may include meals on wheels, transportation, home health aides, homemakers, financial assistance, counseling, preventative health screening, and other needed services. 2. Develops a Resource Directory 3. Sponsors educational events which may include subject relating to health care, agency support, life skills, referral sources, etc.

39 Functions (continued): Part III: Roles and Functions of SC Job Description: Service Coordinator Elderly Facilities HUD Financed (Sample) American Association of Service Coordinators 1 4. Facilitates the formation of Resident Associations within the property if the residents are interested. The formation of these groups assists the residents in planning social events, organizing activities and discussing life issues. 5. Monitors the ongoing provision of services from community agencies and keeps the case management and provider agency current with the progress of the individual. Manages the provision of supportive services where appropriate. 6. Serves as a liaison to community agencies, networks with community providers and seeks out new services available to residents. 7. Assists the residents in building informal support networks with other residents, family and friends.

40 Part III: Roles and Functions of SC Service Coordinators fulfill the following roles: Investigator Educator Community Builder Advocate/Liaison Service Facilitator

41 Additional Tasks: [Fulfill educational requirements as outlined by HUD] Inform residents about benefits Help residents interpret mail; may fill out forms that they cannot fill out themselves; arrange utility, phone, medical, and other payment schedules; address errors or misunderstanding s related to SS earnings, insurance billing, or death or survivor s benefits; make funeral arrangement for a loved one; connect with hospice and bereavement counseling or supportive services; and solve other bureaucratic problems.. Part III: Roles and Functions of SC

42 Part III: Roles and Functions of SC List of tasks is extensive!!!!!!!! Questions: How do you prioritize? How do the goals of your SCP help you to prioritize? What outcomes document your success?

43 Part III: Roles and Functions of SC Service Coordination exists in context

44 Contextual factors SC Philosophy Funding Source Type of setting Property manager Housing resources Partners Resident Profile Knowledge, skills of RSC Family involvement Social climate Trust of residents

45 Part III: Roles and Functions of SC SCP Philosophy Different approaches reflect: Different philosophies regarding aging in place Different SC approach Different goals for SCP Problem: Different models use the same terms RSC and coordination to reflect different underlying assumptions and approaches

46 Part III: Roles and Functions of SC Early approaches distinguished among different types of SCPs However, over time many differences have been ignored

47 Part III: Roles and Functions of SC Different SC approaches: Consumer driven Empowerment Individual social service delivery Concierge

48 Part III: Roles and Functions of SC RWJ: Supportive Services in Senior Housing Program (SSPSH) Consumer driven model Marketing: Key to success Marketing to: HFA staff Residents

49 Part III: Roles and Functions of SC SSPSH Tools Research skills Resident surveys Focus groups Resident organizations Organized voices for residents preference for developing, marketing, and evaluating services Resident advisory councils convened for SSPSH

50 Part III: Roles and Functions of SC Elderly Supportive Services Program (ESSP) Initiative of: CHFA, DOA &University of Connecticut Key features: Promotes competence and skill (empowerment) Respects self determination Prolongs ability to live in housing Provides monitoring for frail residents Both individual and group needs Serves frail and non frail residents Both group and individual orientation Combines coordination, advocacy, and skill building

51 Part III: Roles and Functions of SC Individual service needs Needs driven Individually oriented Clinical approach Emphasizes disability Removes some control May create dependency Serves restricted number

52 Part III: Roles and Functions of SC A social service coordinator is little like having your own concierge. The seniors will come to them and say, I need this and the social service coordinator figures out how to take care of it. (Taken from: Linking Seniors to Resources: Social Service Coordinators Make Life Easier for Residents at LSSI S Senior Buildings, Eye of LSSI: A Look at Lutheran Social Service of Illinois, Spring 2006). Sheehan, HDFS, University of Connecticut, August 20, 2009

53 Part III: Roles and Functions of SC RSCs in Connecticut Asked: Which tasks RSCs were required to do While some common tasks, a good deal of variability

54 Part III: Roles and Functions of SC Required Task Percent of RSCs Link residents with services 93.7% Disseminate information about services 92.1% Organize social, recreational programs 84.1% Mediate disputes among residents 82.5% Assess all residents seeking RSC help 76.2% Counsel residents 73.0% Service brokering with community agencies 68.3% Assess all residents referred by management 66.7% Form and strengthen resident organizations 63.5% Develop directory of community services 61.9% Mediate disputes between residents and management 60.3% Mediate disputes between residents and family 58.7% Assess all housing applicants 52.4% Assess all residents on a regular basis 50.8%

55 Part III: Roles and Functions of SC Significant differences: Part time/hourly versus full time Housing based versus social service agency Prior experience working with elderly Continuing education

56 Part III: Roles and Functions of SC Job related stress related to: Responsible for too many residents Lack of peer support Unresponsive service providers Management s lack of understanding of role More experienced RSCs rated as a more serious problem RSCs engaged in Continuing Education rated as a more serious problem Confidentiality issues More serious resident problems More hours worked Management not understanding role

57 Part III: Roles and Functions of SC Qualitative analysis: Common problems: (1) Mental health challenges and (2) Inadequate resources and support Diverging perspectives: (1) Aging in place, confidentiality, and resident self determination (2) Definition of role

58 Part IV: Knowledge, Skills & Strategies for Successful SC Evidence based outcomes from RSC Programs Few empirical studies of SC programs Most research descriptive or process oriented research Consequently, little empirical evidence of the outcomes of SCPs

59 Part IV: Knowledge, Skills & Strategies for Successful SC RSC outcome measures? What evidence do you have confirming the effectiveness of the RSC program? Has the average age at move out increased dramatically? Is the major reason for vacancy turnover death? If residents relocate to nursing homes, what is their average age? Coalition for Senior Housing of Massachusetts (2007). Aging in place successfully with affordable housing and services.

60 Part IV: Knowledge, Skills & Strategies for Successful SC Property managers satisfaction with provision of SC Survey of property managers at Section 202 and Section 8 housing Overall, property managers expressed high levels of satisfaction with SCP 1 Multifamily Property Managers Satisfaction with Service Coordination (U.S. HUD, Office of Policy Development and Research, 2009)

61 Part IV: Knowledge, Skills & Strategies for Successful SC HUD Survey (continued) Strong belief that SC improves tenants quality of life Lengthens tenure: Average length of occupancy 6 months longer By forestalling or preventing unnecessary institutionalization, service coordination programs help to promote independent living, improve residents quality of life, and ultimately save taxpayer dollars.

62 Part IV: Knowledge, Skills & Strategies for Successful SC Increasing attention paid to the essential knowledge and skills for successful SC Growing emphasis on background qualifications for SCs and training requirements

63 Part IV: Knowledge, Skills & Strategies for Successful SC Professional Service Coordinator (PSC) Certificate Program ( Ohio State University Medical Center and The American Association of Service Coordinators Training: Consists of core and elective modules which must be completed within 3 years after admission to program Curriculum reflects the core values of the service coordination profession service, social justice, dignity and worth of the person, importance of human relationships, integrity, and competence. Sheehan, HDFS, University of Connecticut, August 20, 2009

64 Part IV: Knowledge, Skills & Strategies for Successful SC Program Requirements: Eight core modules Six elective modules Comprehensive examination Additional: 12 hours CE every year to maintain Certification Admission requirements: American Association of Service Coordinators (AASC) membership BA/BA or five years experience in social service or related field Sheehan, HDFS, University of Connecticut, August 20, 2009

65 Part IV: Knowledge, Skills & Strategies for Successful SC Core modules: 1. Communication 2. Diverse Lives, Diverse Needs 3. Documentation 4. Federal Programs 5. Professional Conduct and Ethics 6. Role of the Service Coordinator 7. Substance Abuse: Realities and Hope 8. Supervision & Program Outcomes (Quality Assurance) Sheehan, HDFS, University of Connecticut, August 20, 2009

66 Elective modules Aging, Memory and Alzheimer s Disease Elder Mistreatment: Defining, Understanding and Responding Embracing Life s Transitions: Decisions, Choices & Connections End of Life Care: Perspectives, Decision Making and Resources Health Literacy Legal Issues Legal Issues Life Management for the Service Coordinator Life s Losses: Bereavement, Grief, and Coping Local Network of Support Low Literacy: It s Time To Take It Seriously! Medication Use and the Older Population Mental Health Issues: Symptom Recognition, Intervention and Referral Navigating Medicare Physical Disabilities Program Funding Social Change What is Healthy Aging? You Can t Tell By Looking!: Communiicating with Persons with Low Literacy Skills Sheehan, HDFS, University of Connecticut, August 20, 2009

67 Part IV: Knowledge, Skills & Strategies for Successful SC Research Skills What do residents really need? 1 Resident Satisfaction Surveys Focus Groups Stone, A. (2009). Getting to the heart of consumers needs and wants starts with conducting quality research but ends with searching for critical details. Assisted Living Federation News. Sheehan, HDFS, University of Connecticut, August 20, 2009

68 Part IV: Knowledge, Skills & Strategies for Successful SC Understanding the importance of the social Climate Residents health and well being

69 Physical features Comfort, security, staff facilities Aggregate resident & staff characteristics Number, gender, social resources, functional ability, staff resident ratio Social Climate Interpersonal support and self direction Policies & Services Autonomy, policy clarity, socialrecreational activities Timko & Moos (1990), Model of Determinants of Social Climate

70 Part V: Conclusion It takes a special person to be an effective social services coordinator. One must have patience and be an astute listener, communicator, researcher, and observer. Of equal importance are ethics and willingness to take initiative (Taken from: Linking Seniors to Resources: Social Service Coordinators Make Life Easier for Residents at LSSI S Senior Buildings, Eye of LSSI: A Look at Lutheran Social Service of Illinois, Spring 2006). Sheehan, HDFS, University of Connecticut, August 20, 2009