Hi all,
I put together a question/answer list for a client who had a hard time remembering things, and expanded it into a list to help folks work with service coordinators. If it helps you, please feel free to print at will.
— Kari
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Some In Home Care Vetting questions
I’ve attached Lindquist’s 10 questions to ask before hiring a caregiver that I took from an AASC newsletter. In addition to the trainings about vetting care givers, I thought these were great questions for SC’s, as well as, for members use.
DHS Customer Service Number
Answer:
Have you tried DHS Customer Service? Their number is 517 373 0707. They can give you the name and phone number of the workers’ supervisor. I usually have success getting case workers to respond by contacting their supervisor.
Hope this helps, Andrea
Question:
I’m working with two members to get Home Help. One of them had an interview and the DHS employee said that they would get back to them with an answer. The other has not even been contacted after submitting the application. I have tried their normal DHS workers (for foodstamps and medicaid) and I did try contacting the Adult Services DHS worker that came out to interview the member. I haven’t been able to get responses from any of these workers on the progress of their cases.
Does anyone have a contact with DHS Home Help/Adult Services in Wayne county that might be able to help?
Program of All-Inclusive Care for the Elderly
Attached you will find the link to the National PACE website. There you can look at all of the services provided by PACE plus all of the national PACE sites. PACE already exists in the Detroit area (Center for Senior Independence (CSI), 7800 W. Outer Drive, Detroit, MI 48235) with areas extending out to zip codes in Highland Park, Grosse Pointes, Hamtramck, Lincoln Park, Redford, and Dearborn Heights. In January 2013, the Detroit PACE site will be opening a second center on the eastside at the Rivertown Neighborhood (see SCoop post on Rivertown Neighborhood). UMRC is looking to open a new PACE site which their catchement area will bump up to the current catchement area of CSI in Wayne County and cover the whole downriver community, including Belleville. This is expected to occur within the next year or so. In addition, there is a PACE site currently open in Battle Creek, MI, with their second site set to open in Kalamazoo in early 2013. This is a wonderful opportunity for those seniors committed to aging in place!
The website is: www.npaonline.org
Assessment of ADL’s
Assessment of ADL’s from Brenda’s SC Training:
What does ADL mean? Activities of Daily Living
We assess six areas of “ADLs”
“Frail” – Deficiency in three of six areas
“At-Risk” – Deficiency in one to two of six areas
Areas Assessed:
– Bathing
– Dressing
– Eating
– Grooming
– Home Management
– Transferring
HUD’s rational is that through identification of people with deficiencies in these areas we are able to help identify “risks” and meet those needs to help people remain living longer in the community.
HUD’s definition of “ADLs” is different than traditional ADL’s.
– ADL traditionally looks at areas of self-care tasks: Personal hygiene/grooming, Dressing, Self feeding, Transfers, Bowel & Bladder Management, Ambulation (with or without the use of an assistive device)
– IADL (Instrumental Activities of Daily Living) looks at items that are not fundamental functioning, but allow people to live independently in the community: Housework, Medication Management, Money Management, Shopping, Use of Telephone, Transportation
– HUD combines ADL’s and IADL’s in their general category of “ADL”, also fails to look at significant areas (i.e. incontinence management) and combines other areas traditionally separated (i.e. Home Management is a catch-all)
HUD considers any problem despite adaptation as a deficiency.
When do we assess ADL Status?
– On opening of a client’s case
– Within 30 days of noted change in physical or mental capabilities (do not wait until need is address to update ADL)
– Review during annual review/update of SP
Assessment:
First – how do we assess?
1) Direct questions
2) Observation (physical and environmental) – ideal to complete in apartment
3) Interview of family/caregivers
Bathing:
Does the person require assistance with any of the bathing process?
– Getting in and out of the tub?
– Washing their body? Their hair?
– Do they currently use any adaptive equipment? i.e. shower bench/chair, grab bars, handheld shower
– Do they have anyone that assists them with bathing?
– Do they avoid taking a bath because they don’t feel safe in the bathtub? i.e. bathe at sink, sponge bath, bedside bathing
Dressing:
Does the person require any assistance with dressing? i.e. applying clothes, zipping, buttoning, putting on shoes or stockings, selecting clothing items
– Can they obtain their own clothes or does someone have to buy clothes for them?
– Do they have any problem with dressing appropriately, wearing the same outfit day after day, wearing soiled/dirty clothes?
– Do they have any adaptive equipment to help them dress? i.e. zipper pulls, button fasteners
– Do they require assistance in obtaining incontinence products? Managing them?
– Do they require verbal cues to get dressed?
Eating:
Is the person able to prepare their own meals? Can they cook safely? Can they serve their own food?
– Do they require adaptive equipment? Dentures to chew, specialized utensils i.e. rocking knives, built-up handles, scoop dishes or cups, sippy cups
– Do they have any dietary restrictions? Low/no salt, diabetic diet, supplements to maintain weights, modified consistency, unable to eat orally
– Do they need someone to help them eat? Do they have difficulties chewing their food? Swallowing?
Grooming:
Does the person require assistance with personal care (nail care, toe nail care, foot care, make-up application, shaving [men and women], oral hygiene?
– Do they drool, require assistance with application of make-up, combing hear, etc.
– Do they require verbal cues for grooming? Reminds to shower?
– Are they able to maintain their hygiene? Dental, Hair, Nail
Home Management:
Does the person require any assistance with housekeeping, laundry, transportation, finances, understanding entitlement programs (i.e. Medicare benefits)
– Do they have difficulties with hearing and require modifications to their environment?
– Can they complete their housekeeping? i.e. laundry, shopping, vacuuming, scrubbing toilets, doing dishes
– Operating Home Equipment
– Are they able to sort through and management paperwork, or do they require assistance?
– Do they need assistance with obtaining transportation?
– Do they require assistance with understanding entitlement programs? Continued education, require assistance to understand
Transferring:
Can the person safely transfer from one spot to another (i.e. chair to bed, bed to chair, sitting to standing, standing to sitting, one elevation to another)?
– Does the person have an amputation that requires care? Has a prosthetic device?
– Does the person have any adaptive equipment in the home to assist with transfers? i.e. raised toilet seat, grab bars, elevating chair
– Does the individual have difficulties with falls? Does their gait place them at risk for falls? i.e. unsteady balance, shuffling, dragging limbs, swaying, limp
– Does the person have difficulties getting in and out of cars, chairs?
– Does the person require escort from the home for safety reasons?
PACE Program Expands Service Area
The Center for Senior Independence, a PACE Program, has expanded it’s service area! CSI’s purpose is to provide all inclusive care for seniors in partnership with their families and caregivers to maintain independence in the community.
Eligible participants must be 55 years or older, eligible for nursing home level care, and qualify for Medicare and/or Medicaid. They have expanded beyond Detroit to include a larger portion of Wayne County, including Dearborn Heights (got that Adrienne and Andrea!!!) and some of the downriver communities.
Please not that Brenda used to work with the CSI PACE Program (the other CSI!) and is working collaboratively with CSI and PVM to strengthen client access to the program. New Service Coordinators can talk with our more experienced Detroit-based SCs about their experiences helping residents apply for PACE.
Michigan Weatherization Assistance Program News
By admin on October 26, 2012 in Case Management, Company News, Emergency Funds, Financial, General information, Housing Programs / Services, Public Services, Resources, Welfare
The Mich Weatherization Assistance Program is operating through the Community Action Agencies. Eligible families must have income at or below 200% of the federal poverty line. contact their local CAP agency. DHS & SSI recipients automatically qualify for this no cost program. Visit the Michigan Community Action Association website for details.
Monitoring Residents/Members – Helpful Hints
Based on questions and feedback from SCs and audit staff, here are some helpful hints for monitoring clients:
1. The SC should monitor frail and at risk clients a minimum of every 30 days (note that this is more specific than “monthly”).
2. The SC should monitor all other clients a minimum of every 90 days (note that this is more specific than “quarterly”).
3. Monitoring must include direct, individualized contact. Hence, a group service log and progress note indicating that the client attended an educational workshop hosted by the SC is not sufficient. However, the SC can talk with the client individually at the event and note that direct contact in the PN, which could be considered a form of monitoring (as long a the client didn’t have follow-up needs that constituted more intensive monitoring).
4. I recommend that if you follow up with a client one month at an event (such as an educational workshop or Focus Hope delivery) or via phone, that the next month be an in-home or in-office visit.
5. Monitoring must indicate progress towards goals the client’s Initial or Updated Service Plan.
Changes to Case Management Procedures
Cheryl, Rachel and Brenda had the opportunity to discuss some of the issues that we have heard the service coordinators are encountering that impact our case management procedures. After discussion, we are going to revise our case management procedures as follows:
1) When attempting to offer services to residents/members that are either new or annually, three separate documented attempts without response will constitute a “refusal” of services. This means that you need to attempt three different types of direct contact with the resident/member and document each attempt. Only after that third unsuccessful attempt is it considered a refusal. Seperate direct attempts include telephone messages, notes under the door, or direct mailing. Once these three attempts have been made and the resident/member does not respond to you then you can document that the resident does not want services at this time in your progress notes.
2) The “Non-Participation Form” will ONLY be used when a specific service is offered and declined. The form does not need to be signed by the resident/member when you are simply offering the services of the Service Coordinator, when they are new or annually, and they decline. A specific service would be a service that is specifically being offered to the resident because of a referral from management, the FCRC, or something that the Service Coordinator deems as being an imminent/emergent need that the resident refuses. The specific service being offered can be detailed in the “comments” box. A resident/member can sign a “Non-Participation Form” and still be considered an “active client” of the Service Coordinator, still receiving OTHER services, but refuses a specific service.
3) Group Add Service Logs and Progress Notes are to be completed for ALL residents regardless of client status. Therefore, any resident that attends an educational session will be included on the group add on the Service Logs and Progress Notes.
4) Service Logs should be used on any contact with the resident/member and the Service Coordinator needs to utilize the “subcategory” when identifying the type of service provided. We are asking that all Service Coordinators make a concentrated effort to eliminate “Other” as an option and that you specifically categorize your interactions.
All of these updates go into effect today. Should you have any questions, please do not hesitate to contact us.