Empowering people with complex needs

Managing Director of Clinical Services Joi Shaw spent the early part of her career working with individuals experiencing severe mental illness, intellectual disabilities, and co-occurring substance use disorders. Understanding the complex needs of populations who require intensive services from the community and determined to enhance the lives of those who depend on government services, she explored ways to optimize programs for those they serve.

Since joining Maximus in 2014, Joi has diligently worked to grow our clinical services footprint and support more people. One of her primary sources of motivation is not just to help one person but to create a system to help the broader population of aging adults, persons with disabilities, and any adult with complex health needs.

Joi’s first role at Maximus was supervising all our PASRR operations. PASRR is a federal requirement that helps ensure people are not inappropriately placed in nursing facilities for their long-term care. It provides conflict-free evaluations for services, treatment, and placement in appropriate settings to individuals with serious mental illnesses and/or developmental disabilities.

We spoke to Joi about her inspiration and her portfolio of clinical assessment contracts across multiple states.

If I can get on my soapbox for a moment — when you’re talking about people who have lived in institutions, some community providers will say an individual has to complete 18 daily living tasks, like cleaning their floors, to move back into the community. We set such a high bar for those who need the support to live in their community. But how many of us who don’t live in an institution do all those 18 tasks every day? I know, I don’t.

We understand what people need to live the life that they want innately. It's exciting to see how our work expands people’s choices and opportunities to live that life safely in the community. And that doesn’t mean they have to clean their floors every day.

We empower people who typically haven’t had a voice in a process that can feel complex and cumbersome to them and their caregivers. We can assess people’s needs for services in a way that allows them a sense of agency — independent of service providers or influenced by a governmental payment system.

We approach an assessment through the eyes of the person we are assessing; we use evidenced-based techniques in our interaction style to meet the person’s needs. Then, a determination is made, and we write to the person we assessed. We use plain language rather than clinical language. “Your ICD-10 diagnosis code is XYZ” doesn’t mean anything to anyone who’s not a clinician. Every member of our team is trained in person-centered techniques; whether you are interacting with a team member from our helpdesk, an on-site assessor, or a member of our leadership team, that thread of person-centeredness is our foundation and runs through us all.

Everything right now is focused on “What does the data say?” We’re incorporating data analysis to reinforce our clinical approaches, determine program effectiveness, and assist states with resource allocation now and in the future. This analysis is especially important as states answer questions from families and advocacy agencies to legislators.

For example, in one state, our work includes individuals with dementia. We’re helping the state use data to track the prevalence of a particular intensity of a dementia diagnosis and its impact on activities of daily living. This, in turn, allows the state to determine the need for resources in the future.

As populations age at higher rates, we’re being thoughtful about what that looks like in each state. Many states realize costs come down when people’s needs are met in home and community-based settings rather than facilities. If states lean into this, they can save money and allow people to receive care in settings that will enable them to live longer and have a better quality of life.

Much work must be done to unblur the lines of different care settings. Assisted living is separate and distinct from a nursing facility setting. Often, nursing facilities can be seen as end-of-life care, regardless of the medical condition, instead of a rehabilitative setting with the goal of returning to a lower level of care. Rehabilitation and returning to the community are very important for people with disabilities, who die sooner in institutional settings.

Although the research shows the benefits of home and community-based settings, evaluating the level of care tools, ensuring community settings and resources, and taking a thoughtful, planned approach is no small task. But we stand ready to help states achieve these goals.