What is Shared Decision Making?

Shared Decision Making is a patient-centered process that engages patients, their caregivers or other support persons, their social worker and health care team in collaborative decision making. Shared Decision Making works best with decisions, like long term care, that are preference sensitive – meaning that the patient's values and opinions affect care decisions.

Shared Decision Making is designed to increase:

• Patient knowledge
• Patient involvement in decision-making
• Consistency between decisions and patient values

Watch these videos for an overview of Shared Decision Making.
(courtesy of the Informed Medical Decisions Foundation)

For Veterans and caregivers

For clinicians

What is Long Term Care Shared Decision Making?

When Shared Decision Making is applied to Long Term Care choices, it is a process that involves the Veteran, the caregiver or other support person, the social worker, and the health care team in working together to choose long term care services and settings, or to make plans.

The goal is to obtain services and settings that best meet your long term care needs while keeping you as independent as possible.

Learn more about the Four—Step Long Term Care Shared Decision Making process.

• Step 1: Consider Needs
• Step 2: Explore Options
• Step 3: Involve Others
• Step 4: Take Action

Decision Aids can help you move through the process of selecting long term care services and settings. There is a Shared Decision Making Worksheet (for Veterans), and a Caregiver Self-Assessment.

See Personal Stories for examples of how four Veterans used Shared Decision Making to make long term care choices.

Who is involved?

The Long Term Care Shared Decision Making process should include the:

Veteran. You, the Veteran, are at the center of the process. We encourage you to involve your family caregiver or other support person, but the decision is yours. Always include your social worker and care team.

Caregiver. A caregiver is a person who is not part of your professional health care team, but who is involved in your care or daily living needs on a regular basis. Caregivers are often your spouse or adult child, but could be a close friend. This person often plays an important role in meeting your long term care needs.

Social Worker. Your social worker can play a key role in helping you plan for and select long term care services and settings. Use this online Guide to Long Term Care to get an overview of services and settings and how you might pay for them. Review and start to complete the Decision Aids. Then talk with your social worker, who can help you through this process.

Care Team. Your care team can answer questions about your physical and mental health, and how your health status could affect your choice of long term care services and settings. Remember your care team may include many providers — your primary care physician, nurse care manager, and geriatrician, mental health, and other specialists.

Shared Decision Making Worksheet (for Veterans)

Shared Decision Making Worksheet (for Veterans)

This Worksheet is your guide for the Four—Step Shared Decision Making process.

Purpose

The Shared Decision Making Worksheet    helps you work with your caregiver, social worker and care team as you think through your needs, preferences, and your options for the long term care services and settings that are best for you. 

How to Get the Worksheet

• Click on this icon    and print the Worksheet, or
• Complete the Worksheet online, then save it to your computer, then print it, or
• Save the Worksheet to your computer, then complete it, then print it.

Tips for Using the Worksheet

• Follow the Four—Step process by clicking on the left tabs.
• Use the Guide sections on Home and Community Based Services and Nursing Homes and Residential Settings to explore options.
• Use what you learned from the Worksheet in discussions with your caregiver or other support person, social worker, and other members of your health care team.

Caregiver Self-Assessment

Caregiver Self-Assessment

The Caregiver Self-Assessment is a supplement to the Shared Decision Making Worksheet.

Purpose

The Caregiver Self-Assessment helps you, the primary family caregiver or other support person, review your caregiver role and other responsibilities. This helps you decide how much ongoing care you can provide, and that affects the Veteran’s long term care choices. Remember that even when you and the Veteran do not agree, you can provide valuable suggestions and support during the long term care planning and selection process.

How to Get the Caregiver Self-Assessment

• Click on this icon    and print the Self-Assessment, or
• Complete the Self-Assessment online, then save it to your computer, then print it, or
• Save the Self-Assessment to your computer, then complete it, then print it.

Tips for Using the Self-Assessment

• Complete the four parts of the Self-Assessment.
• Use the Helpful Websites for Caregivers section of the Guide.
• Use what you learned from the Self-Assessment as you work with the Veteran and their social worker and health care team to make long term care plans and choices.

Note: Every VA medical center has at least one caregiver support coordinator. To learn more, contact a caregiver support coordinator listed on the VA caregiver support website or visit the VA social work website.

Step 1: Consider Needs

The Four—Step Shared Decision Making Process
Step 1: Consider Needs

• Use the Shared Decision Making Worksheet to guide you through the Four—Step process.
• Start by completing Step 1 of the Worksheet to get a clearer picture of your long term care needs.
• View Step 1 below.

Then ask your family caregiver or support person to complete the Caregiver Self-Assessment . It helps your caregiver to review their roles, responsibilities and stress level. And, it helps you. Then you can both take action by joining with your social worker, and your care team to make long term care choices.

Using both of these Decision Aids as you and your caregiver talk with your social worker and health care team is what makes this a shared decision making process.

Step 2: Explore Options

The Four—Step Shared Decision Making Process
Step 2: Explore Options

• Use the Shared Decision Making Worksheet to guide you through the Four—Step process.
• Now complete Step 2 of the Worksheet to explore your long term care options.
• View Step 2 below.

Use this Guide to explore your options:

• Review Home and Community Based Services and think about how those services could support you living at home.
• Review Nursing Home and Residential Settings options to think about whether or not living in a group residence is best for you.
• Visit Helpful Websites to further explore long term care services in VA and the community, and to locate services in your area.

Step 3: Involve Others

The Four—Step Shared Decision Making Process
Step 3: Involve Others

• Use the Shared Decision Making Worksheet to guide you through the Four—Step process.
• Now complete Step 3 of the Worksheet to identify who should be involved in your long term care decisions and how they can help.
• View Step 3 below.

Involve these people in your long term care planning and decisions.

Caregiver

If you have not already done so, please think again about asking your caregiver or another support person to complete the Caregiver Self-Assessment . Even though you may not always agree, your caregiver can help you explore long term care options. And, their ability to provide support affects the long term care choices you make.

Social Worker

Use your responses to Steps 1 and 2 of the Shared Decision Making Worksheet as you talk with your social worker about your long term care needs and options. Continue to use this Guide to Long Term Care to review long term care options within VA and in the larger community, and to explore how to pay for them.

Care Team

If you have questions about your health status, make an appointment to discuss that with someone on your care team. Keep in mind that a referral from your physician, or other primary care provider, is needed for some VA long term care services and settings.

Step 4: Take Action

The Four—Step Shared Decision Making Process
Step 4: Take Action

• Use the Shared Decision Making Worksheet to guide you through the Four—Step process.
• Finally, complete Step 4 of the Worksheet to identify what still needs to be done to finalize your plan.
• View Step 4 below.

Identify the action steps you need to take to finalize your long term care plan.

Remember to support your caregiver in addressing their needs.

Keep in mind that the choices you make today are not final. Your choices may change as other factors in your life change such as your health status or your caregiver's situation.

Read the Personal Stories to learn how other Veterans used the shared decision making process to make long term care choices.