5060-G Questions to Foster Rapport | ACCESS-TO-SERVICES-5200-MANUAL

Confirm how much time is available to talk and is client comfortable (in person)

Introduce yourself and provide a brief background/history of the work of options counseling and the agency

Review any previously received data for accuracy (address, phone, email, preferred contact method, etc)

Assure individual of confidentiality of any of the personal information shared (HIPAA)

Describe the purpose of this meeting

Get to know individual better

Answer their questions about options counseling and ADRC

Identify client’s goals (as it relates to long term services and supports)

Describe the process and about the creation of an action plan to use as a guide in moving forward.

What good things are happening in your life right now?

If struggling, prompt with a follow-up question of can you tell me one thing that you feel good about right now?

What do you enjoy doing?

Hobbies, interests, skills, talents

Something you like to do or used to like to do that brings you happiness.

What are your challenges at this time?

Things that are causing you to worry.

What do you need the most help with right now?

Prompts: do you need help with things like cooking or cleaning your house, managing your money, remembering to take medication, paying for medication, etc.

If you could have anything you want (not material goods or money), what would be three things about your life you would change right now?

Ok, more specifically, what are your hopes and goals for the future?

Prompt: where you want to live, what you would like to be doing, who you would like to be with

Are there things you have tried to do yourself to resolve a challenge you are facing?

Did any of those things work out as you would like?

What gets in the way of achieving your goals?

Have you had any hospitalizations in the past year?

Have you fallen in the past 6 months?

Who else have you worked with before?

Prompt: other professionals, family members, friends, co-workers, neighbors, church peers, physician, etc.

Get names and contact info of people who have helped in the past.

How many hours a week do you spend helping your loved one(s)?

On a scale from 1 to 10 with 1 being no stress and 10 being extremely stressed, how would you rate your current stress level?

Are you considering placing your loved one in a nursing home or other facility?

On a scale of 1 to 10 with 1 being unlikely to place in NH and 10 being going to place in NH within the next 3 months, how would you score your likelihood to place in a NH?

Are you satisfied with support you are receiving from other family members (if applicable)

Do you feel that other people understand what you are going through?

Who has been most helpful? Why/ how were they helpful?

Who else is involved with your life now?

Family members, friends, neighbors, church group, co-workers

Is there someone in particular you would consider that could be helpful in meeting your goals? (Name contact info) and may I have your permission to speak with them?

Do you have a health care POA? Financial POA?

Yes? Name and contact info

Is there anything we haven’t discussed that you want to include right now?

Let’s review what we discussed today to make sure we are on the same page about next steps:

We talked about… (Recap…​aka active listening)

Here are some of the next steps that I will follow-up with to help you explore your options towards making an informed decision.

Now let’s make a list of things you can work on in the next two weeks to move forward

Add to action plan to leave/ send a hard copy to the individual

I would like to follow-up with you in approximately 30 days to see how things are going. Would that be ok with you? Is ____________ date at say ____________ time sound good?

Add confirmed date and time to action plan sheet

I really enjoyed talking with you and look forward to follow-up with you to see how things are going.