Navigating the world of long-term care can be a complex and challenging proposition.

The good news is that you don’t have to do it alone

BayPath Elder Services and other ASAPs throughout Massachusetts offer Options Counseling to help guide older adults, people with disabilities and their caregivers through the process. The program, which is available through BayPath’s partnership in the MetroWest Aging and Disability Consortium, provides help to enable individuals to make informed choices about long-term settings and services, to understand the resources available to help pay for supports and services, to be referred to appropriate professionals, and to obtain assistance in connecting with resources.

In the latest edition of our Caregiving Chronicles Q&A series, we speak with BayPath Elder Services Options Counselor Susan Cote about the services she and fellow BayPath Options Counselor Courtney Cassels offer and what patients and caregivers should know about the program.

Caregiving MetroWest: What is Options Counseling?
Cote: We help people and their families understand long-term services and supports in the community that can help meet what needs they have. We help people get connected to services that would be beneficial to them.

How options counseling works is first understanding the person’s needs, and based on those needs explaining what kinds of services and supports are out there in the community that can help them meet those needs so they can stay where they want to stay. And once they have a good understanding of the options, we help with support so that they can choose direction. And once they do, we help them with the next steps to complete whatever goal they choose. And then we follow up with them about 30 days after that. So it could be one visit or five visits. It really depends on each individual case.

CGMW: How do you interact with people seeking counseling, do you meet directly with them or speak by phone?
Cote: It’s a combination. Sometimes it’s over the phone. Sometimes it’s in person. I’ve met with people in their homes, in Starbucks, Burger King, wherever it makes most sense for the person.

CGMW: Do you work directly with the person needing long-term care or the caregiver?
Cote: Our focus is to talk to the person themselves, because they’re still able to say what is best for them. We do get input from family members, but we really try to focus on the person themselves. If they’re trying to learn about services and supports for their loved one, we certainly explain what’s out there (to caregivers as well).

CGMW: Who is eligible for options counseling?
Cote: We can work with anyone over 60 or any age with a disability.

CGMW: What kind of training do you undergo to be an options counselor?
Cote: There’s a training for new options counselors. It’s a two-day training put on by EOEA, just to kind of learn the nuts and bolts. But I think understanding the resources is more of a day-by-day, ongoing thing.

CGMW: How do you let people know that this service is available?
Cote: We are constantly doing outreach. I would say a big chunk of our time is doing outreach, because it is unknown. It’s a free service for people, but a lot of people don’t know about it. So we’re out there as much as possible.

CGMW: What types of issues do you deal with and what is the process
Cote: We get a wide range, because we work with people who are both in the community and people who are in rehab or nursing homes who are going back home with more needs. I was just working with someone. She’s 54 and has cancer, and she just moved into her brother’s home. He works full-time and so does her sister, and they were getting the brunt of caring for her. So we talked about what sort of options were out there that could support the whole family. They ended up enrolling in the adult family care program here (at BayPath).

CGMW: You and Courtney are both trained SHINE (Serving the Health Information Needs of Everyone) counselors as well. Tell me a little about that program and how that complements your work as an options counselor.
Cote: It’s separate, but we found that as we were meeting with people, we were always referring people to a SHINE counselor, and it would be one extra phone call, one extra visit for them. So it just made sense. While we’re working with someone to understand their long-term service needs, questions about Medicare are going to arise. It makes sense we understand the options for Medicare as well so they don’t have to make an extra call and make an extra visit to meet with someone.

SHINE is Serving the Health Information Needs for Everyone on Medicare, but we are knowledgeable about the different MassHealth programs as well. If you have questions about Medicare, if you are becoming eligible for Medicare or if you are on Medicare, then you can make an appointment. But if someone is 60 and wants to enroll in MassHealth and not on Medicare, then they couldn’t help them. We’d refer them to someone who could help them.

CGMW: SHINE is a federally funded program through the Older Americans Act, but the Senate Appropriations Committee recently approved an appropriations bill that would eliminate all funding for the program in fiscal year 2017. Are you concerned that cut will be approved by the full Senate and House and become law and what would it mean to lose that funding?
Cote: It’s a little scary. I think they feel that SHINE is volunteer based, but to keep up with how many changes to Medicare there are throughout the year, it’s just a complicated thing to understand. So each region has a director and an assistant director, who are salaried and they put on monthly meetings for us and put on the trainings for us each year and the re-certifications each year. They make sure we have the right information for counseling people to get services.

CGMW: What else would you like people to know about Options Counseling?
Cote: People just have to make one phone call. They don’t have to go around calling 10 different places to find an answer. We can connect them to whatever they need.

If someone already has a case manager at BayPath, they’re kind of already connected. But options counselors are able to work with people who are already connected with a case manager. A case manager can explain the options, but we’re always there as a resource for the case managers. They can always come to us and we can collaborate and brainstorm.

One time I was working with a family and it was a son that called me. He was a professor at a prestigious college. He was obviously a very intelligent person. He left me a message and I called him back that day that day and he was, ‘Oh my goodness, you called me back. I’ve been talking to everyone and no one knows what to tell me.’ He was so flabbergasted on what to do with his mom. It can be overwhelming.