A Story
Rodrigo
Martinez and his wife Juanita live in an apartment complex in the city. Two
years ago, Mr. Martinez had a mild stroke but it did not affect his daily life.
However, two months ago he had his second stroke which was more severe. He had
a short stay in the hospital followed by in-patient rehabilitation before he
returned home. Mr. Martinez now has weakness in his right side, creating
problems with his speech, mobility and use of his right arm. He cannot manage
the stairs to his second-floor apartment without a lot of effort and assistance
by a neighbor or his son who lives nearby. His wife has health problems of her
own, being diagnosed with COPD and hypertension, so she is unable to help him
as much as he needs. He worries about what would happen if he had another
stroke or his wife became sicker, and he wonders how he would get out of the
building if there was a fire.
Mr. and Mrs.
Martinez had always thought that when they got older, they would move to an
apartment building for seniors in their neighborhood where they could also get
services, but they thought they still had time so they never got around to it.
Now they are on a long waiting list and it is expected to be a year before an
apartment is available. No one has told him that he might be able to move
higher on the waiting list because of his needs.
Mr. Martinez
receives assistance from an in-home aide but the one that is assigned to him
does not speak Spanish and he does not know enough English to tell her how he wants
things done. She comes too late to help him get cleaned up and dressed before
his breakfast, which has always been his routine. The agency has told him that
they have no one else to assign, and he has been told that there are no other
agencies in that area that accept Medicaid. There is a friend in his apartment
complex that would be happy to provide assistance but the agency will not hire
her because she does not have the required education or training.
Mr. Martinez
is receiving services and supports that are not person-centered. The system
does not have an array of service choices appropriate to his needs and he is
unable to direct the services that he receives. The agency is not able to
respond to his concerns, there is no flexibility to change services or staff,
and there is not an advocate to help him understand his choices, navigate the
system and plan for the future.
What makes Supports and Services person-centered?
Person-centered
supports and services are designed so that the person being supported has full authority
and control over the services provided. The person is in charge of what
services are provided, how they are delivered, who provides them, and when and
where they occur. Schedules and staffing patterns are responsive to the
person’s individual needs and routines, and are flexible to change or expand as
the person has new experiences or circumstances change. Persons receiving
services have mechanisms to voice their concerns about staffing and services,
with the expectation that those concerns will be addressed. They can freely
select among providers and can change providers when needed or when they are
unsatisfied.
A
person-centered service system has an array of accessible, available and
appropriate choices from which individuals can choose. Services are coordinated
within the community so that transitions can be made in services or providers
as circumstances change. Communities have systems for people to become informed
of the available options including eligibility criteria, types of services and
locations. Information is available through service coordinators, the internet,
other media, and aging and disability agencies, and is easy to obtain and
understand.
Supports are
available in an emergency. Individuals are assisted in making plans for crises,
such as unexpected illnesses or death, financial changes, natural disasters,
extreme weather or loss of power. People have assistance in developing advance
directives and durable powers of attorney to advocate for their needs when they
are unable to do so.
In a
person-centered service system, Mr. Martinez would have access to an advocate
(perhaps a service coordinator or system navigator) who would help him
understand the available services and agencies. He would be assisted to
advocate for an apartment in the senior complex more quickly, to understand if
there are other agencies accepting Medicaid and to advocate for an in-home aide
that better meets his needs. His provider agency would customize his services
by hiring and assigning a person who speaks his first language (perhaps by
assisting his trusted neighbor to meet the hiring criteria) and who can provide
services based on his schedule. Mr. Martinez and his wife would also be
assisted to plan for an emergency and to help them better plan for the future
through advance directives and a power of attorney.
Resources
The
following websites contain information from agencies and organizations that are
working to provide more person-centered supports and services to older adults:
The Council
on Quality and Leadership--www.thecouncil.org/pceduideforolderadults.aspx
The Learning
Community for Person-Centered Practices--http://www.learningcommunity.us/aging.htm
Helen
Sanderson Associates--http://www.helensandersonassociates.co.uk/reading-room/who-/older-people.aspx