MFP: California Community Transitions

Preference

Interview

Tool

Use of the Preference Interview for

the transition of inpatient facility

residents to community living.

PREFERENCE INTERVIEW TOOL

A screening instrument used to determine a resident’s:

• Preference to transition

• Ability to transition

• Feasibility of transition

• Service needs for transition and community living

Preference Interview Training: Session Overview

• What is “Transitioning?”

• Your Role as Interviewer

• Identifying Potential Transition Participants

• Conducting the Preference Interview

• Eligibility Criteria

• Minimum Data Set (MDS)

• Referrals

Session Objectives

At the end of this training you will be able to:1. Understand your role in the process

2. Identify Potential Transition Participants

3. Determine Cognitive Impairment

4. Conduct a Preference Interviewa. With a Resident

b. With a Proxy

5. Prepare a Referral Packet

What does TRANSITIONING

mean?

Reasons people choose to transition into the community

• Individual’s right

• Promote independence

• Avoid institutional setting

Who is eligible to transition under the CCT

• Recipients of custodial & health care services for at least 6 months.

• Medi-cal recipients for at least 30 days before participation.

• People of all ages.

The road to the community

• Identify an individual’s

preference to transition.

• Assess an individual’s

service and care needs.

• Develop Comprehensive

Service Plan to meet

individual’s needs.

YourYour Role in the Transition Process

• Establish relationship with inpatient facility

administrative staff and community agencies.

• Conduct preference and stability interviews.

• Assess resident’s needs and feasibility of

transition.

• Coordinate needed services.

Identifying Transition Candidates

Minimum Data Set (MDS)• Physical and psychological profile of resident• MDS data needed to assess level of care• Two types of MDS

• Full MDS• Complete data set• Annual or “Change of Condition”

• Quarterly MDS• Subset of MDS data points• Compiled every three months

• Copy of most recent FULL MDS required• Copy of Quarterly needed if most recent MDS

Identification of Potential Transition Participants

Obtain names from:

• CCT project Team

• Nursing Facility Staff (Social Worker or Business Office)

• Referrals

Getting Started

Determine person’s cognitive level using the

MDS Recall Sub-scale. Scoring determines

who will receive the initial interview.

Determining Cognitive Impairment

MDS Recall Sub-scale1. The current season

2. Location of own room

3. Staff names and/or faces

4. Awareness of being in a nursing home

SCORING: Each correct response = 1 point

Total points:

2 – 4 administer resident interview

0 – 1 administer proxy interview

Interview Basics

Basic Interview Techniques

• Greet person warmly using a calm voice.

• Smile and speak clearly.

• Use resident’s name.

• Identify yourself and state why you are visiting.

Basic Interview Techniques (continued)

• Ask permission to speak with resident.

• Choose a quiet, private location outside of

resident’s room to meet free of distractions

(such as television or radio programs), if

possible.

• Observe and consider the person’s facial

expressions and body language.

Basic Interview Techniques (continued)

• Be aware of interviewee’s physical and/or

cognitive limitations.

• Use conversational-type interaction. Too

much social interaction can sidetrack the

interview, or misrepresent the visit as a

social call.

• State current care and services will not be

affected by anything said at this interview.

Basic Interview Techniques (continued)

• Assure resident that information given to interviewer will remain private and confidential, unless interviewer is legally required to disclose information for person’s health and safety.

• Be aware of your facial expressions and body language.

Basic Interview Techniques (continued)

• Check to make sure you and resident are comfortable before starting.

• Check partway through questions to see if resident is tiring. If resident is too tired to continue, reschedule another session to complete survey.

Background Information

A Word About HIPAA

• Resident’s personal

information is protected.

• Resident or proxy must

grant permission.

• Informed, written and

signed HIPAA consent form.

• HIPAA consent required for

outside agencies.

A Word about Housing

Demonstration Participation

Residences must adhere to the following

federal requirements:

• A single family home, duplex or condominium.

• A rental apartment with lockable entry/exit, with living, sleeping, bathing and cooking areas under participant/family’s control.

• A subsidized housing unit or apartment.

What about 24 hour care?

Is 24 hour care available in the community?

• 23/7 care is available through the NF/AH Waiver.

Preference Interview Process

Preference Interview Process

• Introduce yourself• Explain that the interview provides

an opportunity for a resident to express their preference to transition.

• Explain that resident has the right to refuse or discontinue interview at any time.

Basic Interview Techniques (continued)

• State interview does not guarantee transition to community living.

• Explain the following:-Type of questions asked.-Length of time to take.-Use of a script-You will be writing response answers on survey papers you use.

Preference Interview Process (Continued)

Restate the following information:

• Right to refuse or discontinue interview

• Confidential and private

• No guaranteed outcomes

Interview with Resident

In person In person

• Meet with them at the facilityMeet with them at the facility

• Use script Use script

• Attempt contact at different times Attempt contact at different times during dayduring day

• Log all attemptsLog all attempts

• No more than 5 attemptsNo more than 5 attempts

Interview with Proxy• In person – meet at nursing home.In person – meet at nursing home.• By telephone - initiate call.By telephone - initiate call.• Process:Process:

– Use script Use script – Attempt contact at different times Attempt contact at different times

during dayduring day– Leave detailed messageLeave detailed message– Log all attemptsLog all attempts– No more than 3 attemptsNo more than 3 attempts

Preference Interview:

A look at the Questions

Interview Overview

Interview is designed to be conducted as a conversation. Areas are queried:

• History

• Ability

• Preference

• Self-Assessment

• Feasibility

Question 1: History

• What led to resident’s current stay in nursing home?• Medical health change• Post-surgery rehabilitation• Change in physical status• Long illness• Need 24 hour care• Money problems

• Provide insight into support network

Question 2: Ability to Transfer

• Initial perception of resident’s ability to transfer.

• What are the reasons for this perception?

Question 3: Preference to Transfer

• Does resident WANT to leave nursing home?

• Reasons for wanting to remain in nursing home.

• Distinction between Ability and Desire.

Question 4: Living Options

• Present alternative living options in

community.

• Provide education about options.

• Enables informed decision.

Question 5: Service Options

• Present list of services available in community

• Educate about wide range of services

• Enable informed decision

• Re-assess decision to leave nursing home• “YES” continue with interview• “NO” end interview

Question 6: Housing and Support

• Feasibility of transition • Housing options

• Existing housing options• Affordability• Adequate support

network• Alternatives

• Private home• Senior apartment

Questions 7–26: Service Needs Assessment• Activities of Daily

Living (ADLs)• Transfer• Mobility• Toileting• Hygiene• Grooming• Dressing

• Instrumental Activities of Daily Living (IADLs)• Communication• Meals• Medication• Housekeeping• Shopping• Transportation• Finances

Service Needs Assessments• Systematically Identifies

Needs• Influence Decision to

Transition • Research vs. Operational

Format• Research limited probing

• Outside agency assessment (IHSS)

• Operational format more in depth

• Provide better sense of resident need from start

Questions 7-19:Activities of Daily Living• Determine if nursing services are needed

• Risk of overestimation of ability or unrecognized assistance• Tasks broken down into smaller components• Survey resident’s room for assistive devices• Performance of task in last 7-14 days• Don’t take “NO” for an answer

Question 7: Transfer Assistance

• Help getting out of bed?• Set up only (positioning of side rails,

wheelchair)• Supervision • Limited assistance (non or light - weight

bearing support)• Extensive/total assistance (significant or

total weight bearing support)

• Probe all responses

Questions 8 – 9: Meal Assistance

• Help getting started to eat?

• Cutting up food

• Opening cartons

• Getting silverware

• Help eating?• Food Intake

assistance• Use of special

utensils and/or cup

Question 10: Bed Mobility

• Resident need assistance to turn in bed?

• Bed rails count as assistance

Question 11: Toileting Assistance

• Sensitive subject

• Help getting to toilet?• Adult briefs or pads?• How often briefs or pads?• Help changing briefs or pads?

• Use of briefs/pads ≠ inability to use toilet

Question 12: Toileting Assistance Frequency• How often assistance is required during

day• Getting to the toilet• Changing adult brief/pad

• Identify points in day assistance received• Morning (before/after breakfast)• Afternoon (before/after lunch, before dinner)• Evening (after dinner, before bed)

Questions 13 & 14: Grooming and Hygiene

• Assistance with morning grooming• Brush teeth• Wash face• Comb hair

• Assistance with bathing• Shower • Bath

• Level of assistance• Set-up only (i.e.,

toiletries laid out)

• Supervision

• Limited (resident performs most activities)

• Extensive/Total (resident dependent on nurse aides for most or all activities)

Questions 15, 16 & 17: Mobility

• Help walking: Inside/Outside

• Specify type of assistance• Cane• Walker• Safety rails• Wheelchair: Inside/Outside

Questions 18 & 19: Dressing

• Assistance to dress and undress

• Able to put on/remove:• Shoes/socks

• Reach feet• Tie laces

• Shirt/dress• Buttons• Zippers

• Pants• Bend• Pull• Fasten

Question 20-26: Instrumental Activities of Daily Living (IADLs)

• Auxiliary services needed to function in community

• IADLs currently performed by Nursing Home or family

• Probe responses

Question 20: Communication

• Help using telephone?Help using telephone?– Volume increaseVolume increase– Large numbersLarge numbers– Dialing assistanceDialing assistance

• Does resident use an amplifier?Does resident use an amplifier?

Question 21: Meal Preparation

• Help cooking or preparing meals?• In their own household• Use or operate appliances, i.e., microwave

Question 22: Medication Management

• Help with medications?

• Read labels

• Open packaging/

• bottles

Question 23: Housework

• Help with housework?

• Laundry

• Washing dishes

• Stand for extended period of time

• Cleaning house

• Bend over

Question 24: Shopping

• Help with shopping?

• Type of help?• Reach

shelves• Place things

in basket

Question 25: Transportation

• Help with transportation?

• Type of transportation

• Frequency of transportation

Question 26: Financial Management

• Help managing money or finances?• Paying bills

• Balancing checkbook

• Tracking bank accounts

Question 27: Feasibility

• If needed services are available in community, is resident able to leave nursing home?

• Response determines course of action

Where to after question 27?

• Interviewee’s response determines next step in identifying transition candidates

• Primary Interview with Resident• YES or NO

• Conduct second preference interview in 2 weeks• Primary Interview with Proxy

• YES• Conduct second preference interview in 2 weeks

• NO• Final response• No transition

Interviewer’s Perception of

Resident’s responses

Questions 28 & 29: Impressions

• Interviewer’s perception

• Post-interview

• Measure interviewer’s confidence in resident’s response• Understanding of what services are needed

process (Question 28)• Level of motivation to relocate (Question 29)

• Optional

Stability of Preference to Transition

Stability of Preference to Transition

Determination of preference stability is evaluated twice using the Preference Interview both times.

1st interview: Preference is assessed and information is shared on transition issues and services.

2nd interview: Preference is assessed and how transition issues and services will affect them in a potential transition.

Determining Resident’s Stability Of Preference to Transition

Stable if:• Resident responded

YES to question 5.• Resident responded

YES to question 27.

Not Stable if:• Resident responded

NO to question 5 .• Resident responded

No to question 27.

Second Interview

Repeat Preference Interview with Primary Interviewee 2 weeks after primary interview

Second Interview (Continued)

• Primary interviewee determines who secondary interviewee will be:• If primary interviewee is RESIDENT, then

secondary conducted with potential caregiver.• If primary interviewee is PROXY, then

secondary conducted with resident.

• Permission is required.

Two Interviews – Now What?

Do findings show:

Preference Stability• Initial preference does not change over time.• Measure desire and commitment to transition.

Transition Eligibility• Permission to refer• HIPAA consent

Preference Interview Findings

Person is a candidate for transition if:

Agreement among resident, proxy, and/or family regarding transition preference shows stability.

Resident or Proxy responded YES on two consecutive interviews:

• Primary = YES• Secondary = YES

PREFERENCE = YES

Ask resident’s permission to refer for possible transition and participation in demonstration.

Obtain signature on Participant Information Form to review process.

Person is a possible candidate for transition if:

A third interview may be needed to discuss transition issues and confirm findings.

Resident responded YES on 2nd interview• Primary = NO• Secondary = YES

Person is not a candidate for transition if:

Resident responded No to 2nd interview

• Primary = Yes

• Secondary = No

Leave contact information with resident/ support person in case future contact is requested.

Transitioning Referral Packet

• MDS copy(s)

• Permission to Refer

• HIPAA consent form

• Copies of Interviews

• Resident Summary

Permission to Refer

• Once the preference to transition to community is established, interviewee must provide written, informed permission to have information forwarded to transitioning agency.

• Permission to Refer form is standardized notice signed by interviewee.

• Presented to interviewee once stability interviews are complete.

Resident Summary

• Demographics: Name, DOB and AGE• Significant considerations

• Physical (i.e., wheelchair)• Medical• Psychological

• Consent status• Proxy name and contact information• Potential caregiver name and contact information• Housing information

• Housing preferences• Desired locations• Amount willing/able to pay

• Interviewer impressions (Questions 28 & 29)

Final Note:Inter-Rater Reliability

• Agreement between interviewers• Necessary• Establish reliability among all

interviewers• Pair up interviewers• One interviewer conducts interview• Other interviewer audits• Minimum 80% agreement

Interview Practice

• Role play: – Interviewer– Resident– Inter-rater reliability test

Questions and Discussions