Essential Elements of Self-Determination In Wisconsin

Essential Elements of Self-Determination

In Wisconsin

Excerpts from:SDS Stakeholders SeminarOctober, 24, 2006Wisconsin Dells

Updated for:

SDS NetworkJuly 11, 2011Wisconsin Dells

Key Elements of a Service System

based upon Self-Determination

2006

Clarity of Purpose

To help people• Receive the support they need,• To craft meaningful lives for

themselves in their communities,• In the company of those they

care about, in the company of those who care about them.

INDIVIDUAL Individual Self and

ConsciousnessSubjectivePersonal

Can best be known by self, and for some people by those who best know and care about the person(Family often play that role)COMMUNITY & CULTURE

Place

Culture/Values/Beliefs

Voluntary Associations

SERVICE SYSTEM - 2006Public Bureaucracies

(DHFS,DWD,DPI)

Counties and CMOs (No IRIS Yet)

Provider and Health Care

Agencies

Professionals/Paraprofessionals

Political Systems

Integrating Support & Services to People with Disabilities

Principles of Self-Determination

Authority over dollars needed for support

Freedom to live a meaningful life in the community

Support to organize resources in ways that are life enhancing and meaningful, promote valued social roles, enable and enhance connections to others

Responsibility for the wise use of public dollars

Confirmation of the important leadership that self-advocates and families must hold within the system they rely upon

High Expectations for:Regular Lives

Employment, Careers,

Retirement Contribution

and Meaning

A Home That is One’s Own

Community Inclusion

Systems Tools: An Individual BudgetWhat is it?A certain amount of funding for

support and services,

Allocated for an individual or family,

Which cannot be spent without authorization by that individual or family.

Within An Individual Budget

Needed support can be directly purchased & managed by an individual or family

(Employer Authority)

Or, all supports and services can be chosen, developed, and subject to change through the authority of the individual or family & allies.

(Budget Authority)

Budget Authority Includes• Choosing where to live, who to live

with and what to do during the day;

• Selecting and, if desired, changing agencies;

• Hiring, training, dismissing support workers;

• Proposing and negotiating new ways of obtaining support.

Independent Support Coordination

Also called support broker or personal agent,

Ideally,works for the person, not a service provider, county or managed care organization

Provides independent advice and support

May help a person…. … plan … imagine what is possible … find and organize resources … evaluate how things are

working

Financial Management ServicesCan …

Write checks to pay bills;Take care of tax withholding,pay

worker’s comp, health insurance, other benefits Some can also

Assist person to recruit, screen, hire and train his or her support workers

Act as employer of record if needed

Individualized ServicesHome … work … community

Community Connections Valued Social Roles

Presence

Participation

Contribution

Support

Safeguarding – Addressing Vulnerability

Personal

Intentional

Thoughtful

Information & Support Peer to Peer Family to Family

From the System --- Simply

Imagining Better ….

Innovation

Self-Directed Supports in Wisconsin

2011 How are we doing?

Our Laboratories Dane County

Family Care

IRIS

Dane County

Darn Good 1915(c) Waiver DD Only

# People June 1,2011

1200

Family Care Managed LTC

1915(b)(c) WaiverDDPhys DisElderly

@6000

IRIS1915(c) “SDS”

Waiver

1915(j) PC

DDPhys DisElderly

4000

Dane CountySelf Directed Support

Flow Chart

ProvidersFiscal Intermediaries

Co-EmploymentOther goods or services

Agreements

Individual and Support Broker develop person centered and

financial plan

Vouchers

Individual chooses Support

Broker

Dane CountyAdult Community Services

Fiscal Management (Direct Support Funds) Payments

Individual & Financial Plan

submitted

Individual & Financial Plan Approved

Transfer of Individual Funds

Rate set & given to individual

Specialized Transportation

Training Events

Community Organizing

Housing Counseling

Public Services

Personal Counseling

Augmentative Communication

Assistance with Self Employment

Behavior Interventions

Support Brokers

Community Nursing

Sound Response

Legal & Self Advocacy

Living arrangementsNumber Served

Number of Providers

NumberWaiting

Live with roommate (s) 670Living alone, in cluster 59Living alone, come-in support 97Living alone with behavioral support 51AFH Corporate 3-4 42 3AFH Private 42 32Out of County 4 2

Total 965 16 350

Day SupportNumber Served

Number of Providers

NumberWaiting

Supported Employment/Self-Employed 909 13Facility-Based (Sheltered/Adult Day Care) 305 3

Total 1214 14 88

Dane County How People are Supported

14

Merging Managed Care with Self-Directed Supports

SDS within Family Care

Each Family Care member may meet with their Inter-Disciplinary Team (IDT) to identify the outcomes they would like to meet use SDS

The MCO will develop a “budget allocation” for the member based upon the outcomes identified and the typical costs to meet those services through the MCO provider network

The IDT will assist the member in developing a plan and obtaining and monitoring support for SDS

A member may use SDS to manage some or nearly all of their Family Care benefit

• CMS required alternative to Family Care

• Available where Family Care is offered– Began 7/1/2008

• Comprehensive, creative “SDS” waiver

• State-Administered with two primary contracts– IRIS Independent Consultant Agency– Fiscal Services Agency

• Self-Directed PC (1915 j) added 10/09

Design Overview

• Begins with an Individual Budget Allocation (obtained though ADRC, using Wisconsin LTC Functional Screen)

• Plan developed and approved with the assistance of an IRIS Consultant and the IRIS Consultant Agency

• Ongoing support through an IRIS Consultant

• “Bills paid” by Financial Services Agency

Using IRIS

26

Overall SDSLearning

There are differences among the three laboratories that would benefit from further exploration. For example:• Dane County has by far the highest

proportion of participants in supported living and integrated employment. Why?• Family Care’s IDTs offer a strong system

of support. Can that system enhance creativity and flexibility over time? • IRIS has a high proportion of people

employing support directly. What are the strengths and concerns about that over time?

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Overall SDSLearning

• All three laboratories, in general, have:• maintained or increased quality;• increased choice, empowerment and

inclusion through SDS;• been cost-effective;• grown rapidly and become a popular

choice• seen less creativity and innovation

than might have been expected.Challenges remain ... And there is no

reason they cannot be successfully addressed.