Perspectives of the Community Choice Counselors: Report on a Focus Group
EXECUTIVE SUMMARY
OVERVIEW
As part of its evalutation of the New Jersey Senior Initiatives, Rutgers Center for State Health Policy conducted two focus group sessions in November 2000 with counselors for the Community Choice Counseling program. A total of 38 Community Choice Counselors attended, addressing the perception of their roles, changes in program elements, and implementation issues. The sessions were conducted simultaneously, designed as a follow-up to the original focus group discussion with ten counselors on September 13, 1999.
PURPOSE
The focus groups had a dual purpose: 1) to understand program functioning from the point of view of the counselors and 2) to utilize this information to help focus future research on the program and the Senior Initiatives more generally.
METHOD
The focus groups were conducted on November 21, 2000 with 38 counselors. To guide the discus-sion, counselors were presented with a written list of questions, developed with feedback from program management, as well as the previous focus group discussion conducted on September 13, 1999. While these questions helped guide the discussions, counselors were given the opportunity to discuss other topics as well.
CONCLUSIONS
The Community Choice Counselors take pride in their roles and see their efforts as useful. Moreover, they play several crucial roles: facilitator, patient advocate, and catalyst for their clients. Counselors also perceive themselves as being able to provide not only support but also empowerment to their clients.
Although counselors see themselves as helping seniors return to the community, the discussions of hope and idealism so prominent in the initial focus group were replaced with discussions of process and change. For instance, the counselors now do a pre-admission screening for sub-: acute clients that was not a routine function of their job one year ago. This shift in policy has enlarged their jobs and multiplied paperwork; counselors feel they have less time available to spend on patient discharge planning and follow-up.
In addition to the shift in the scope of work, clients have changed as well. As the program has grown, the "clients' are not only nursing home residents and their families, but also nursing home staff as well. Counselors indicated that nursing homes see them as both an informational source and a discharge planning resource. The number of informational requests by staff social workers, however, varies by facility depending upon the training and experience of the social worker. The response of families has improved, as more people are aware of the program.
Assisting seniors to return to the community is often contingent upon the behaviors of external entities such as nursing homes, assisted living residences (ALRs), other senior housing, and county agencies. Placing nursing home residents in ALRs continues to be a challenge regardless of county, due to the small number of ALRs, long waiting lists, and very low reimbursement rates. Placement in senior subsidized housing is also difficult. The tension between county workers and the counselors seems to have decreased. However, many of the counselors commented on the shortage of county workers, as well as the scarcity of providers and caregivers to supply the services that clients need. The counselors' general frustration with the perceived lack of resources continues to be an underlying theme.