The September 2012 Network Insider from the Area Agency on Aging 1-B includes info on:
- Medicare Part D Assistance Days
- Fall Prevention
- Celebrate Senior Center Month
AAA1B Newsletter
DTE Assistance
From Catrina:
Below is some updated information regarding DTE assistance for individuals that are having difficulty with their account.
DTE has a new program that will start October 1, 2012. The program is Low Income Self-Sufficiency Program (LSP). The program is done according to income and each person’s payment would be calculated on an individualized basis. The payments are supposed to be very low, BUT unfortunately we cannot tell any client about the program because they feel they will have an overwhelming amount of calls. They will be identifying customers for the program. The number is 800-317-9073.
Only agencies may contact this number 866-200-0386 8:00 am-4:30pm to clarify a client’s account and request a 10 day hold on the account. An email can be sent to agencies_info@dteenergy.com to request a “HOLD”. The client is responsible for contacting billing to discuss payment arrangements. If the agency is making a request provide the following: Clients, name, address, account number.
Note: A client may contact their doctor and request a letter for a 21 day Medical Hold letter which should outline the nature of their medical condition, why they need their utilities, name, address, city, state, zip code and telephone number and submit to DTE.
If any questions please feel free to let me know,
Respectively,
Catrina Social Work Intern
Guardianship Pamphlet
From Brad Geller:
Your Rights in the Guardianship Process
Information presented by the Michigan State Court Administrative Office and the Michigan Office of Services to the Aging
Introduction
Why am I receiving this pamphlet?
You are being provided this information because someone has asked the probate court to appoint a guardian for you, or because you already have a guardian.
You have a number of rights to help ensure you only have a guardian if you need one.
What is a guardian?
A guardian is a person or company appointed by a probate court to make decisions for you if there is convincing evidence you are unable to make informed decisions for yourself.
A guardian can only be appointed if necessary to provide for your care.
What decisions can a guardian make for me?
A judge can give a guardian power to decide where you live, to make medical treatment decisions for you, to arrange services and to decide how your money is spent.
Do I lose rights if a guardian is appointed?
Yes. For instance, if a guardian is given power to decide where you live, you lose the right to make that decision for yourself.
Do all guardians have the same powers?
No. For example, a judge could grant a guardian power to make medical decisions for you, but not the power to decide where you live or to handle your money.
What are some responsibilities of a guardian if one is appointed for me?
Your guardian is required to visit you at least every three months, and to talk with you before making major decisions.
Your guardian is required to make decisions in your best interests, and to arrange appropriate medical, housing and social services so you can regain as much self-care as is possible.
The Guardianship Petition
How is a guardian appointed?
The first step is that someone interested in your welfare files a petition in probate court.
At the same time you are receiving this pamphlet, you are being given a copy of the petition.
What is the purpose of the petition?
The petition sets forth information why the petitioner believes you need a guardian.
What happens upon a petition for guardianship being filed with the court?
Court staff set a date for a court hearing. The hearing may be very soon or a few weeks away.
The judge cannot appoint a guardian for you without a hearing.
The Guardian Ad Litem
What else happens upon a petition being filed?
Court staff will send a person to your home to talk with you before the hearing date. This person, known as a guardian ad litem, is the person who handed you this pamphlet.
The guardian ad litem has no power to make decisions for you, only to collect information.
What will the guardian ad litem talk to me about?
The guardian ad litem will explain guardianship and your rights in the process.
If you do not object to guardianship, the guardian ad litem will provide information to the judge whether guardianship is appropriate and about who should serve as guardian.
Your Rights
Can I choose the person to be my guardian?
Yes, you have this right. Tell the guardian ad litem of your choice.
Do I have the right to attend the court hearing?
Yes, you always have the right to be at the hearing.
Tell the guardian ad litem if you want to attend the court hearing. Tell the guardian ad litem if you need transportation to get to the hearing, and if you need any help such as a wheelchair, a special hearing device or an interpreter in the courtroom.
What if I have signed a durable power of attorney for health care in the past?
Make sure you make the guardian ad litem aware of the document. Give him or a copy of the document if you have one.
If I do not want a guardian, what do I do?
It is very important you tell the guardian ad litem if you do not want a guardian, or if you do not want a particular person to serve as guardian, or if you want the guardian’s powers limited in any way.
What will the guardian ad litem do then?
By law, the guardian ad litem must report your wishes to the court, and court staff must appoint a lawyer to represent you. This will not cost you any money.
Hiring a Lawyer
Can I hire my own lawyer instead of having the court appoint a lawyer?
Yes. You also always have the right to hire a lawyer.
What is the role of my lawyer?
Whether the lawyer is court appointed or chosen by you, your lawyer must strongly argue for your wishes, regardless of what anyone else thinks is best for you.
Do I have the right to get a professional evaluation of my ability to make decisions?
Yes. You can choose a doctor, psychologist, nurse or social worker to do the evaluation. If you cannot afford the cost of the evaluation, the court will pay for it.
The Court Hearing
What is the purpose of the court hearing?
The person who filed the petition must present evidence and prove that you cannot make informed decisions for yourself, and that guardianship is necessary to meet your needs.
What if I disagree with the evidence presented?
You or your lawyer have a right to dispute any evidence presented, and you or your lawyer has a right to present witnesses and other evidence on your behalf.
If you have asked for a professional evaluation, you can decide whether to present the results to the judge.
Who decides whether I need a guardian?
The judge will usually make the decision whether there is clear and convincing evidence you cannot make informed decisions over one or more areas of your life. The judge will also determine whether guardianship is necessary to meet your needs.
If you have exercised your right to have a jury trial, the jury will decide those questions.
Who decides what powers the guardian will have?
The judge or jury will also determine what powers the guardian will have, based on your needs.
What if the judge or jury decides I need a guardian, but I disagree?
You have a right to appeal the decision to the Circuit Court.
How do I know what powers my guardian has?
The court order signed by the judge, and the letters of guardianship given to the guardian, must show the powers the guardian has.
You can ask court staff or the guardian for a copy of the letters of guardianship
After a Guardian is Appointed
If I have a guardian, do I lose all my rights?
No. For example, generally you maintain the right to speak your mind, to practice your religion and to see family and friends of your choice.
If a guardian is given authority to make medical treatment decisions for me, are there limits in the types of decisions the guardian can make?
Yes. For instance, a guardian does not have authority to hospitalize you for mental health treatment unless you assent.
A guardian can only authorize electroconvulsive therapy (ECT) if two psychiatrists agree it is appropriate.
Can a guardian have a do-not-resuscitate order put in my nursing home chart or hospital chart?
The law does not adequately address the powers of a guardian concerning end-of-life care.
Judges disagree whether a guardian has the power to agree to a DNR order, or to withhold or withdraw treatment that is keeping you alive.
How can I know whether my guardian has such power?
It is best to ask the judge to specify in the court order and letters of guardianship whether the guardian has this power, and in what circumstances.
If I object to a guardian’s decisions, what can I do?
You can write a letter to the probate judge, or you can file a petition with the court. There is no cost. You can ask the judge to –
- End the guardianship, or
- Limit the guardian’s powers, or
- Name another person as guardian.
Can I hire a lawyer to represent me?
Yes. You do not lose that right just because you have a guardian.
If you do not hire a lawyer, request the judge appoint one for you. The judge is required to do so.
Will there be another court hearing?
Yes. You have all the same rights you had during the first hearing.
What if I have questions about guardianship?
You can telephone the probate court.
Court staff can provide information such as rights you have under the law, the name of your guardian ad litem or lawyer, and the date of your court hearing.
What if court staff are unable to answer my questions?
If staff are unable to answer a question, they may be able to refer you to a person or agency that can answer it.
What is the name and phone number of the probate court?
10/12 MCL 700.5306a
Case Audit Follow-up for CSI SCs
I continue to be very pleased with how well you have adapted to your new positions as Service Coordinators in the past five months. This is clearly demonstrated in your audit outcomes. I have a few tips as you start to formulate your corrective action plans:
1. If you have any questions, please don’t hesitate to ask Cheryl and me.
2. Please respond immediately to Cheryl when you receive your electronic AND your written audit forms. It is your response to Cheryl that triggers your 5 day time period for submitting your Corrective Action Plan and your 30 day time period for completing your Corrective Action Plan. Cheryl will enter the dates into your audit timeline excel file in order to track your progress. You are encouraged to do the same thing in order to track on your end. Question for Cheryl: Are they days working days or calendar days? Please assume calendar days unless you hear otherwise from Cheryl.
3. You should write your Corrective Action Plan on the electronic Audit Report Form and submit electronically to Cheryl within the timeframe listed above. You do note need to write a separate Corrective Action Plan on each individual client form.
4. You only need to write a Corrective Action Plan for items with a double asterix (**). Other comments are there just for your information.
5. A Corrective Action Plan should correct what can be physically corrected (ie obtain the missing physician’s name) AND what you plan to do in the future to reduce the potential to make the same mistake again (ie plan to use AASC Online or Zimbra calendar to prompt reminders to obtain missing information from client).
6. Please schedule an appointment with me, if you haven’t already, to review your Corrective Action Plans. This can be in-person or via phone depending on your preference.
7. If you are missing pieces of information on your intake or assessment forms (ie physician’s name, race, etc.), you may hand write it into your hard file and indicate that you have also updated the information in your electronic file (initial and date this note). You do not need to reprint the entire intake or assessment form.
8. Visual Review.
a. Many of the issues identified with the Visual Review are issues that we need to work out with CSI regarding signage and keypad entry into the buildings. I have shared the visual review forms with your liaison and Sharon already. Please review them with your liaisons at your monthly meeting.
b. I have told CSI that you will be regularly brining brochures and updated print outs of your AASC Online resource directories to your monthly meetings to share with the FCRC chairs for their FCRC binders. Please ask your FCRC chairs where these binders are kept and tell your auditor when she returns for her re-inspection.
We are assessing where we are seeing consistent challenges with case files, and we will be planning trainings and clarifying our case management procedures accordingly. Two important upcoming dates to remember are:
1. October 2nd. After we conclude our Co-op 102 training, there will be 3 afternoon sessions provided for all SCs by Hannan, including:
a. Working with clients with emergent situations that may include APS or 911 calls, other referal options, or that you may be able to de-escalate because they don’t quite reach the threshhold of an APS referal (by Brenda Carney and Ann Kraemer).
b. Presentation of Hannan’s Professional Development Program by Ann Kraemer.
c. Presentation and Q&A regarding clarifications to Case Management procedures by Cheryl Bukoff. Some of you may have case file “ordering” issues that will be resolved with this clarification. In these situations, it is not a need for “Corrective Action” because you technically meet the letter of our current case management procedures, but that you should consider updating the way you order your files once it is clarified for you. We’ll discuss this.
2. October 23rd, 12noon, ADL Assessment Training by Brenda Carney. A number of SCs have client-cases where there is inconsistency with how we have determined challenges with ADLs. After the training, you will likely see a need to conduct an Updated ADL Assessment and corresponding Updated Service Plan.
Once again, great job and congratulations with finishing your first audit. I hope it was a good learning experience and I look forward to your feedback.
Sincerely,
Rachel
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.
University of Michigan School of Information Communications Inquiry
As you may recall from our earlier conference call discussion regarding communication needs of service coordinators, a team of University of Michigan School of Information Masters students is conducting an analysis and presenting recommendations regarding the Hannan Service Coordination Program’s communication system this semester.
Diana Bachman, team liaison, is very pleased to be working with the Luella Hannan Memorial Foundation for their School of Information “Contextual Inquiry” project. The team has five members total:
Diana Bachman
Paul Belser
Yanni Gu
Weichao Li
Meng Xia
Diana has “read only” access to SCoop for the semester, and the team will be looking at our organizational communications structure and policies. The team will interview 10 of us regarding how we communicate, including four PVM SCs (two in Metro and two in Detroit) and four CSI SCs (including one in Kalamazoo). The team will not have access to any client files or documents, but will be signing a confidentiality agreement regarding any Hannan, PVM or CSI information they utilize during their study.
We are excited to have their assistance helping us develop our communications systems. Please help make the team feel welcome, and if you have any questions, please don’t hesitate to contact me directly.
Sincerely,
Rachel
Medicaid Spend down aka Medicaid deductible
Medicaid Spend down also referred to as Medicaid deductibles are not bills that have been paid by the beneficiary. However, they are bills that have been received from any medical appointment and it includes prescription drug costs. Copies of these bills must be submitted to the DHS Specialist monthly. When the bills are received by the DHS Specialist, they keep a talley and their system will generate a report letting them know what beneficiaries have/have not met the Spend down/Deductible. If the deductible is not met for 3 consecutive months, the beneficiary will receive a letter informing them that their Medicaid benefits have been suspended. If this happens, they must reapply. The Spend down/Deductible amounts are set by the DHS system and it is based on the information entered on behalf of the beneficiary. The DHS Specialist DOES NOT PERSONALLY SET THE AMOUNT!
A. Smith, Dearborn Heights Co-op
Nursing Home Payment
The question was asked, when will a nursing home start “taking” a person’s social security check when they are receiving services at the nursing home … and is there anything that can be done to stop this?
Ann Kraemer states, “I want to reinforce that nursing homes don’t “start taking” resident’s social security. As Brenda notes [below], Medicare & other insurance programs pay for some of the person’s stay in a nursing home. If the resident’s Medicare days run out, (ref Brenda’s reference to the 21-100 days Medicare & related insurance limitations) then the resident has to pay for his/her stay in the nursing home. Residents typically “turn over” their social security checks to the nursing home for a portion of their payment. Keep in mind that nursing homes charge on the average $6-7,000/month so most nursing home residents are looking for ways to pay that tab when their health insurance won’t pay.”
Brenda Carney adds, “For traditional Medicare, Medicare pays 100% of the first 20 days, and then a daily co-payment thereafter for days 21 – 100, as long as they meet the criteria for Medicare Skilled Care. If they have a secondary insurance (besides Medicaid), they may pick-up some to all of the daily co-payment. If their secondary insurance is Medicaid, then at day 21 they start charging the daily co-payment until all but $60 of their social security check is depleted then Medicaid kicks in. If they DO NOT have Medicaid, then the co-payment starts at day 21 and continues until discharge from Medicare. Therefore, it is HIGHLY recommended that they apply for Medicaid should they not have any savings (over $2000) as it could cost them A LOT. Nursing Home Medicaid is different than community Medicaid, so it is worthwhile applying for …
Having said ALL of this, there is a Special Director or Olmstead exception that they can apply for which will possibly waive part to all off the monthly payment to the nursing home out of the Social Security check. Below is a link that explains this application process. The nursing home social worker should be able to assist with this process. They have to provide supports for all NECESSARY bills that they need to maintain their apartment while they are in the nursing home. It does not include Cable TV, etc. I have applied for this on behalf of a resident successfully and partially successfully. Do not anticipate that the entire social security check will be preserved.
http://www.mplp.org/Issues/mplpissue.2010-05-05.9554801510
As for food stamps and SSI, while you are in a nursing home, these items are items that can be cut. However, it does not consistently happen, depending on how long the individual is in the nursing home and the speediness at which the billing office at the nursing home submits and the State changes the resident’s status as Nursing Home in the State computer. There is no work around that I know of … and cannot be applied for until after they are discharged from the nursing home. There is a code in the State Medicaid system that needs to have them reflected as being community living for them to be eligible for Food Stamps and SSI. Conversely, it can take a while when the person is OUT of the nursing home to resume these services as it depends on the speed of the billing office at the nursing home to submit and DHS to change the State database.”
Corporation for National and Community Service RSVP Programs
The Corporation for National and Community Service is currently seeking applications in the 2013 Retired and Senior Volunteer Program (RSVP) competition. RSVP grants provide support to community service programs that utilize volunteers 55 years of age and older in meeting local and community needs through service. Focus areas for the grants include education, healthy futures, veterans and military families, environmental stewardship, economic opportunity, and disaster services.
The application deadline is October 11, 2012. For more information on this opportunity, visit: http://1.usa.gov/QG418F.
ACA Moon Festival at Hannan House
The Association of Chinese Americans is hosting a Moon Festival event at Hannan House on Thursday, September 27th, 11am-1:30pm. 4750 Woodward. Donations welcome. RSVP by 9/25/12 to ACA staff at 313-831-1790.
Event includes the origin of the Mid-Autumn Festival, Moon Cake Making Demonstration, and Lunch.