Assisted Living - First Nations Social Development Society

1

FIRST NATIONS SOCIAL

DEVELOPMENT SOCIETY

BSDW TRAINING:

SOCIAL DEVELOPMENT POLICY AND PROCEDURES MANUAL

AANDC - BC REGION

VOLUME 2: ASSISTED LIVING PROGRAM

FNSDS.ORG

July 2014

2 FNSDS CONTACT INFORMATION

• FNSDS: (P)604-983-9820 (F)604-983-9822 (TF)1-800-991-7099

• MELENNIA POINT , EXECUTIVE DIRECTOR

-MELENNIA@FNSDS.ORG

• GINA GEORGE, FINANCE/ PWD MANAGER

-GINA@FNSDS.ORG (P)1-877-985-5565 (F)604-983-9122

• TAMI OMEASOO, PROGRAM OFFICER

-TAMI@FNSDS.ORG

• CHRIS LECHKOBIT, PROGRAM OFFICER

-CHRIS@FNSDS.ORG

• CHELSEY GEORGE, PWD ADMIN ASSISTANT

-PWDADMINASST@FNSDS.ORG

July 2014

3

MAIN OBJECTIVE AND PROGRAM

DESCRIPTION

NATIONAL SOCIAL PROGRAMS MANUAL (AANDC, JAN. 2012)

“ THE AL PROGRAM PROVIDES FUNDING FOR NON-MEDICAL SOCIAL

SUPPORT SERVICES THAT MEET THE SPECIAL NEEDS OF SENIORS,

ADULTS WITH CHRONIC ILLNESS, AND CHILDREN AND ADULTS WITH

DISABILITIES (MENTAL & PHYSICAL) WITH THE OBJECTIVE OF

MAINTAINING FUNCTIONAL INDEPENDENCE AND GREATER SELF-

RELIANCE.”

“ THE AL PROGRAM IS AVAILABLE TO ALL PERSONS RESIDING ON-

RESERVE, OR ORDINARILY RESIDENT ON-RESERVE, WHO HAVE BEEN

FORMALLY ASSESSED BY A QUALIFIED PROFESSIONAL (IN A MANNER

COMPARABLE TO THE RELEVANT PROVINCE OR TERRITORY) AS

REQUIRING NON-MEDICAL SOCIAL SUPPORT SERVICES AND WHO DO

NOT HAVE THE MEANS TO OTHERWISE OBTAIN THESE SERVICES .”

July 2014

4 FOUR MAJOR SERVICE COMPONENTS

NATIONAL SOCIAL PROGRAMS MANUAL (AANDC, JAN. 2012 )

HOMEMAKER SERVICES – PROVIDES FINANCIAL ASSISTANCE FOR NON-

MEDICAL PERSONAL CARE FOR ADULTS WHO NEED ASSISTANCE WITH

ACTIVITIES OF DAILY LIVING. SERVICES RANGE FROM HOUSEKEEPING,

MEAL PREPARATION, AND ATTENDANT CARE TO COMMUNITY

SUPPORTS, SUCH AS ADULT CARE, MEALS ON WHEELS, PSYCHO -SOCIAL

PROGRAMS, SHORT-TERM RESPITE CARE FOR CAREGIVERS, AND NON -

HEALTH TRANSPORTATION.

ADULT FAMILY CARE HOMES – PROVIDES FUNDING FOR SUPERVISION

AND CARE FOR ADULTS IN A FAMILY-LIKE SETTING WHO DO NOT

REQUIRE 24-HOUR CARE BUT ARE UNABLE TO LIVE ON THEIR OWN.

July 2014

5 FOUR MAJOR SERVICE COMPONENTS 2

INSTITUTIONAL CARE – REIMBURSES FOR SOME EXPENSES RELATED TO

TYPE I AND TYPE II CARE IN DESIGNATED FACILITIES FOR ADULTS.

ASSISTED LIVING DISABILITIES INITIATIVE, PROVIDES FUNDING TO

FIRST NATION ORGANIZATIONS FOR PROJECTS TO IMPROVE THE

COORDINATION AND ACCESSIBILITY OF EXISTING DISABILITY PROGRAMS

AND SERVICES ON RESERVES. ACTIVITIES MAY INCLUDE SUCH THINGS AS

ADVOCACY, PUBLIC AWARENESS, OR REGIONAL WORKSHOPS

• In BC this program funds the BCANDS disability case management program

July 2014

6 DEFINITIONS

NATIONAL SOCIAL PROGRAMS MANUAL (AANDC, JAN. 2012)

CONTINUING CARE – THE RANGE OF HOLISTIC MEDICAL AND SOCIAL

SUPPORT SERVICES FOR THOSE WHO DO NOT HAVE, OR WHO HAVE

LOST, SOME CAPACITY TO CARE FOR THEMSELVES .

• BC does not have a medical component of continuing care – Homemaker

Services only provides non-medical service

• For medical continuing care refer to FNHA Home and Community Care – see your Nation’s Health Dept.

DISABILITIES INITIATIVE – AN AANDC INITIATIVE TO FUND PROJECTS TO

IMPROVE THE COORDINATION AND ACCESSIBILITY OF EXISTING

DISABILITY PROGRAMS AND SERVICES ON RESERVES, SUCH AS

ADVOCACY, PUBLIC AWARENESS AND REGIONAL WORKSHOPS.

• Re: BCANDS

July 2014

7 DEFINITIONS 2

HOME SUPPORT – COMPONENT OF THE AL PROGRAM PROVIDING

HOMEMAKER SERVICES TO HELP PEOPLE WITH THEIR DAILY ACTIVITIES,

THEREBY CONTRIBUTING TO THEIR INDEPENDENCE AND TO THEIR

ABILITY TO REMAIN IN THEIR HOMES.

• Non-medical services only

INSTITUTIONAL CARE – CARE PROVIDED IN AN ADULT CARE FACILITY,

SUCH AS PERSONAL CARE HOMES, ELDERS LODGES AND SUPPORTIVE

LIVING HOMES, ETC..

July 2014

8 DEFINITIONS: ORDINARILY RESIDENT

NATIONAL SOCIAL PROGRAMS MANUAL (AANDC, JAN. 2012 )

ORDINARILY RESIDENT ON RESERVE - FOR THE PURPOSE OF PROVIDING

INCOME ASSISTANCE AND ASSISTED LIVING PROGRAMS AND SERVICES,

“ORDINARILY RESIDENT” MEANS THAT AN INDIVIDUAL CLIENT:

-LIVES AT A PERMANENT ADDRESS ON-RESERVE MORE THAN 50% OF

THE TIME; OR,

-IN THE CASE OF CHILDREN IN JOINT CUSTODY, LIVES MORE THAN 50%

OF THE TIME ON-RESERVE;

-DOES NOT HAVE A PRIMARY RESIDENCE OFF-RESERVE;

-IS AN INDIVIDUAL WHO IS OFF-RESERVE FOR THE PURPOSE OF

OBTAINING CARE NOT AVAILABLE ON-RESERVE OR WHO IS OFF-RESERVE

FOR THE PRIMARY PURPOSE OF ACCESSING SOCIAL SERVICES BECAUSE

THERE IS NO REASONABLY COMPARABLE SERVICE AVAILABLE ON -

RESERVE

July 2014

9

AANDC BC REGION

VOLUME 2: ASSISTED LIVING PROGRAM

THERE ARE THREE MAIN SERVICE COMPONENTS TO ASSISTED LIVING IN

BC. WE WILL LOOK AT THESE COMPONENTS WITH A PROGRAM

SUMMARY (PRINCIPLE AND ELIGIBILITY), PROCEDURAL GUIDE, REVIEWS,

AND POLICY SUMMARY. THE MANUAL - VOLUME 2, ALSO HAS A

INTRODUCTION CHAPTER.

CHAPTER 1, INTRODUCTION

CHAPTER 2, HOMEMAKER SERVICES

CHAPTER 3, ADULT INSTITUTIONAL CARE SERVICES

CHAPTER 4, ADULT FAMILY CARE HOMES

July 2014

10

CHAPTER 2 HOMEMAKER SERVICES

PRINCIPLE (2.1)

VOLUME 2: ASSISTED LIVING PROGRAM (AANDC, JUNE. 2011)

“HOMEMAKER SERVICES MEANS THE MINIMUM SET OF HOUSEHOLD

TASKS REQUIRED TO MAINTAIN A SAFE AND SUPPORTIVE ENVIRONMENT

FOR THE CLIENT. SERVICES MAY INCLUDE: CLEANING, LAUNDRY AND

MEAL PREPARATION AND BY EXCEPTION, TRANSPORTATION, BANKING

OR SHOPPING. SERVICES DO NOT INCLUDE MAJOR HOME REPAIRS.

• HOMEMAKER SERVICES IS A FIXED BUDGET PROGRAM – CARE IS

NEEDED WHEN APPROVING AND ASSIGNING SERVICES

July 2014

11

CHAPTER 2 HOMEMAKER SERVICES

PRINCIPLE 2 (2.1)


“ THE OBJECTIVE OF THE HOMEMAKER SERVICES PROGRAM IS TO

SUPPORT AND ENHANCE THE DIGNITY AND INDEPENDENCE OF

PHYSICALLY DISABLED, MENTALLY DISABLED OR ELDERLY ADULTS , AND

TO ASSIST THEM TO REMAIN IN THEIR OWN COMMUNITIES WITH

FAMILY AND FRIENDS, THEREBY AVOIDING INSTITUTIONALIZATION.”

• NON-MEDICAL SERVICES ONLY – MEDICAL IS HOMECARE

• HOMEMAKERS ASSIST DOMESTICALLY BUT ARE NOT MAIDS!

July 2014

12

CHAPTER 2 HOMEMAKER SERVICES:

PRINCIPLE 3 (2.1)

VOLUME 2: ASSISTED LIVING PROGRAM (AANDC, JUNE. 2011 )

“HOMEMAKER SERVICES ARE INTENDED TO:

• ASSIST CLIENTS TO LIVE IN THEIR OWN HOMES AS LONG AS IT IS

PRACTICAL AND IN THE BEST INTERESTS OF THE CLIENTS AND THEIR

FAMILIES;

• SUPPLEMENT, BUT NOT REPLACE, THE CARE PROVIDED BY FAMILIES,

OTHER UNPAID CAREGIVERS AND COMMUNITIES;

• PROMOTE THE INDEPENDENCE AND WELL-BEING OF CLIENTS, THEIR

FAMILIES AND OTHER UNPAID CAREGIVERS; AND,

• PROVIDE RESPITE CARE TO THE FAMILY MEMBER OR OTHER

CAREGIVER ORDINARILY CARING FOR THE PERSON IN THE PERSON’S

HOME.“

* RESPITE FOR FAMILIES PROVIDING CARE IS POSSIBLE!

July 2014

13


ELIGIBILITY (2.1)


AGE: MUST BE 19 OR OLDER

RESIDENCY: MUST BE RESIDENT ON RESERVE AT TIME OF APPLICATION

HEALTH: FOR PERSONS WHO CANNOT LIVE INDEPENDENTLY DUE TO

HEALTH ISSUES THAT DO NOT REQUIRE ACUTE OR REHABILITATION CARE

• OF AT LEAST THREE MONTHS DURATION; AND,

• DUE TO A PROGRESSIVE AND /OR CHRONIC CONDITION.

July 2014

14


ELIGIBILITY 2 (2.1)

ACCESS TO SERVICES IS BASED ON:

1) THE CLIENT’S HEALTH AND FUNCTIONAL STATUS; AND,

2) THE AVAILABILITY OF FAMILY AND OTHER COMMUNITY SUPPORTS.

• PRIORITY FOR SERVICE PROVISION IS TO BE GIVEN TO CLIENTS WHO

HAVE BEEN ASSESSED AS HAVING THE HIGHEST CARE NEEDS OR THOSE

WHO ARE LIVING WITH THE HIGHEST LEVELS OF RISK

* CLIENT DOES NOT HAVE TO BE ELIGIBLE FOR SOCIAL ASSISTANCE TO

RECEIVE ASSISTED LIVING SERVICES, ALTHOUGH USER FEES APPLY.

July 2014

15


ELIGIBILITY 3 (2.1)

FAMILY MEMBERS EXCLUDED FROM PROVIDING HOMEMAKER

SERVICES:

WITHIN THE LIMITS OF THEIR MEANS AND CAPACITY, INDIVIDUALS AND

THEIR RELATIVES HAVE PRIMARY RESPONSIBILITY FOR HOME

MANAGEMENT AND SUPPORTS. PAYMENT MAY NOT BE ISSUED WHERE A

FAMILY MEMBER CAN BE EXPECTED TO PROVIDE HOMEMAKING SERVICE

• THIS ALSO MEANS THAT FAMILY MEMBERS WHO RESIDE WITH THE

APPLICANT CANNOT BE PAID TO PROVIDE HOMEMAKER SERVICES IN

THEIR OWN HOME

July 2014

16


APPLICATION PROCEDURES (2.2)


THERE ARE 7 STEPS TO TAKE WHEN SETTING UP A HOMEMAKER

SERVICE:

1) CLIENT ENQUIRES ABOUT HOMEMAKER SERVICES OR IS REFERRED TO

BSDW IN THE COMMUNITY WHERE THEY LIVE

2) BSDW PROVIDES FORM SA-215 HOMEMAKER SERVICES APPLICATION

TO CLIENT AND INFORMS CLIENT TO COMPLETE SECTION A AND B TO

START THEIR FILE

July 2014

17


APPLICATION PROCEDURES 2 (2.2)


3) ONCE CLIENT COMPLETES THEIR SECTIONS AND RETURNS SA-215

AND BSDW ARRANGES FOR AN ASSESSOR TO VISIT THE CLIENT TO

DETERMINE CLIENT’S CARE REQUIREMENTS

* THE ASSESSOR MAY BE A PUBLIC HEALTH NURSE, A COMMUNITY

HEALTH NURSE, A COMMUNITY HEALTH REPRESENTATIVE OR OTHER

PERSON CAPABLE OF MAKING AN ACCURATE ASSESSMENT OF THE

APPLICANT’S CARE NEEDS.

July 2014

18




4) THE ASSESSOR VISITS AS ARRANGED AND COMPLETES FORM 901-30

HOMEMAKER SERVICES EVALUATION FORM

5) AFTER THE ASSESSMENT, THE ASSESSOR AND BSDW MEET TO REVIEW

THE APPLICATION AND MAKE A DECISION ON APPROPRIATE PROVISION

OF HOMEMAKER SERVICE. IF APPROVED, BSDW STARTS MAKING

ARRANGEMENTS WITH CLIENT TO SET UP CARE AS ASSESSED

July 2014

19




6) BSDW COMPLETES SECTION C OF SA-215 HOMEMAKER SERVICES

APPLICATION BASED ON THE ASSESSMENT

7) BSDW MEETS WITH APPLICANT TO EXPLAIN THE TERMS OF SERVICE

AND COMPLETE SECTION D OF SA-215 HOMEMAKER SERVICES

APPLICATION. BSDW MUST ENSURE CLIENT UNDERSTANDS THE

PURPOSE AND CONTENT OF THE FORM, PARTICULARLY AROUND

PAYMENT

July 2014

20


REVIEWS (2.5)


“REVIEWS ARE DOCUMENTED FOLLOW-UP VISITS FOR THE PURPOSE OF

RE-EVALUATING THE CLIENT’S HEALTH STATUS AND CARE

REQUIREMENTS.”

• MUST BE IN-PERSON WITH ASSESSOR AND BSDW

• MUST BE AT LEAST EVERY 6 MONTHS, OR AT THE REQUEST OF THE

CLIENT OR RECOMMENDATION OF THE HOMEMAKER

* ALL FORMS MUST BE RE-DONE (SA-215 AND 901-30)

ROLE OF THE ASSESSOR:

• FOLLOWS UP ON CLIENT’S HEALTH AND CIRCUMSTANCES TO

DETERMINE IF THE ASSESSMENT IS STILL VALID – I.E. SA-215 FORM

• TO RECORD ANY CHANGES IN CLIENT’S HEALTH AND CIRCUMSTANCES

TO INFORM CHANGES TO CARE AND SERVICE PLANS

July 2014

21


REVIEWS CONTINUED (2.5)

ROLE OF THE BSDW:

• REVIEWS NEW SA-215 HOMEMAKER SERVICES APPLICATION TO

DETERMINE IF FINANCIAL ARRANGEMENTS SHOULD CHANGE

• MAKES THE DECISION TO CONTINUE OR DISCONTINUE HOMEMAKER

SERVICES AS PER THE ASSESSOR’S REVIEW

REVIEW COMPONENTS:

• HOME VISIT

• DISCUSSION WITH CLIENT, FAMILY AND HEALTHCARE PROFESSIONALS

ABOUT CLIENT’S HEALTH AND CIRCUMSTANCES

• EXAMINATION OF RECORD OF CARE

• CONTACT SERVICE PROVIDERS REGARDING PLAN AND ANY CHANGES

• DOCUMENTATION AND UPDATING CLIENT’S FILE

July 2014

22


ADDITIONAL POLICIES


2.6 MONTHLY REPORTS: REPORTING IS NOW DONE QUARTERLY OR

ANNUALLY VIA THE ASSISTED LIVING REPORT DCI455937 – DISREGARD

DIRECTION TO THE SDSFR (SA-700) IN POLICY

2.3 SERVICE PROVIDER RATES AND PAYMENT METHODS

• RATES: PREVAILING RATE OF CONTRACTED AGENCY, COMPARABLE

RATES NEGOTIATED WITH QUALIFIED PROVIDER, MINIMUM WAGE IF

NO LOCAL AGENCY OR QUALIFIED PROVIDER EXISTS

• METHODS: ADMINISTERING AUTHORITY PAYS HOMEMAKER DIRECTLY;

OR IF CLIENT IS RESPONSIBLE FOR A PORTION OF THE CHARGE, THEY

ALSO PAY DIRECTLY

* HOMEMAKER IS RESPONSIBLE FOR PREPARING A STATEMENT OF

ACCOUNT THAT IS VALIDATED BY CLIENT PRIOR TO PAYMENT

July 2014

23


ADDITIONAL POLICIES 2

2.7 OTHER SUPPORT SERVICES: WITHIN BUDGET LIMITATIONS AND

AVAILABLE RESOURCES, ASSISTED LIVING MAY HAVE OTHER PROGRAMS

DESIGNED TO PROMOTE THE INDEPENDENCE OF THE CLIENT

• I.E. COUNSELLING, MEALS, PSYCHO-SOCIAL, NON-MEDICAL, ETC.

* ADMINISTERING AUTHORITY MUST CONTACT THE FSO REGARDING

ANY REPORTING REQUIREMENTS

2.4 CLIENT USER CHARGES: DEPENDING ON INCOME, CLIENTS MAY BE

RESPONSIBLE FOR A PORTION OF THEIR USER FEE. ALL EARNED AND

UNEARNED INCOME MUST BE ACCOUNTED, AS WELL AS ASSETS.

• CLIENT DOES NOT HAVE TO PAY IF THEY RECEIVE ANY OF:

GIS/OAS/WIDOW’S PENSIONS

• AANDC INCOME ASSISTANCE, PPMB OR PWD

• A WAR VETERAN’S ALLOWANCE

July 2014

24


CLIENT USER CHARGES PROCEDURES


• IT IS EASIEST TO FOLLOW THE INSTRUCTIONS ON FORM SA215 –

HOMEMAKER SERVICES APPLICATION THAN USE PROCEDURES IN 2.4

CLIENT-USER CHARGES

1) ADD CLIENT’S (AND SPOUSE) NET INCOME ON TAX RETURN -LINE 236

2) MINUS THE TAX PAID AS REPORTED ON LINE 435 OF TAX RETURN

3) MINUS THE ANNUAL EARNED INCOME UP TO $15000 MAX –LINES

101, 104, 135, 137, 139, 141, 143

July 2014

25


CLIENT USER CHARGES PROCEDURES 2


4) MINUS THE “ALLOWABLE DEDUCTION FOR CALCULATION OF THE

CLIENT’S REMAINING ANNUAL INCOME” THAT CORRESPONDS WITH THE

CLIENT’S FAMILY UNIT SIZE.”

5) MULTIPLY THE REMAINING ANNUAL INCOME BY 0.00138889 TO GET

CLIENT’S MAXIMUM DAILY USER CHARGE

6) CALCULATE CLIENT’S RESPONSIBILITY FOR PAYMENT

July 2014

26

CHAPTER 3 ADULT INSTITUTIONAL CARE:

PRINCIPLE (3.1)


“ THE ADULT INSTITUTIONAL CARE SERVICES PROGRAM PROVIDES

ASSISTANCE TO ELIGIBLE RESIDENTS LIVING ON -RESERVE WHO, BY

REASON OF INCAPACITY, REQUIRE PLACEMENT IN A LICENSED

CONTINUING CARE FACILITY.

ELIGIBILITY CRITERIA ARE SET BY THE PROVINCIAL MINISTRY OF HEALT H

SERVICES AND DIAND, BC REGION.

• THIS MEANS THAT ASSESSMENTS ARE CONTINGENT UPON THE LOCAL

HEALTH AUTHORITY.

July 2014

27


PRINCIPLE (3.1)


IT IS THE RESPONSIBILITY OF THE LOCAL HEALTH AUTHORITY TO

DETERMINE THE NATURE, AMOUNT, COST AND DURATION OF THE

SERVICE TO BE PROVIDED TO THE CLIENT.

• THE HEALTH AUTHORITY MAKES THE PLACEMENT AND

RECOMMENDATIONS ON CARE.

• AANDC WILL NOT NORMALLY AUTHORIZE CARE ARRANGEMENTS

THAT ARE NOT THOSE RECOMMENDED BY THE HEALTH AUTHORITY

ADMINISTERING AUTHORITIES WILL BE REIMBURSED BY DIAND FOR

CLIENTS PLACED IN DESIGNATED CONTINUING CARE FACILITIES, SUBJECT

TO THE CLIENTS MEETING THE ELIGIBILITY CRITERIA.”

July 2014

28


ELIGIBILITY (3.1)




HEALTH: FOR PERSONS WHO CANNOT LIVE INDEPENDENTLY DUE TO

HEALTH ISSUES THAT DO NOT REQUIRE ACUTE OR REHABILITATION CARE

• OF AT LEAST THREE MONTHS DURATION; AND,

• DUE TO A PROGRESSIVE AND /OR CHRONIC CONDITION.

* TO PROVIDE SERVICES APPROPRIATE TO CLIENTS’ LONG TERM NEEDS

* CLIENT DOES NOT HAVE TO BE ELIGIBLE FOR SOCIAL ASSISTANCE TO

RECEIVE ASSISTED LIVING SERVICES, ALTHOUGH USER FEES APPLY.

July 2014

29


APPLICATION PROCEDURES (3.2)


1) REFERRAL IS MADE TO BSDW AND FILE IS OPENED

2) BSDW ASKS CLIENT TO COMPLETE SA-115 MEDICAL RELEASE AND

REPORT

3) BSDW CONTACTS LOCAL HOME AND COMMUNITY CARE AT THE

HEALTH AUTHORITY (I.E. VIHA, INTERIOR HEALTH) AND REQUESTS AN

ASSESSMENT

• YOUR NATION’S LOCAL COMMUNITY NURSE OR OTHER EMPLOYEES

CANNOT ACT AS THE ASSESSOR

• THE ASSESSOR MUST BE EMPLOYED BY THE LOCAL HEALTH

AUTHORITY AS A HOME AND COMMUNITY CARE MANAGER AND

THEY WILL BRING ALL REQUIRED FORMS

July 2014

30



4) ASSESSOR VISITS CLIENT, COMPLETES FORMS, DISCUSSES CARE

NEEDS AND ALTERNATIVES.

5) ASSESSOR MAKES RECOMMENDATION ABOUT CLIENT’S ELIGIBILITY,

LEVEL OF CARE, SERVICE DELIVERY PLAN, INSTITUTIONAL PLACEMENT

• RECOMMENDATION IS OUTLINED ON FORM LTC 1 APPLICATION AND

ASSESSMENT

• HOWEVER SOME HEALTH AUTHORITIES WILL ONLY USE ONE OF LTC 1,

HLTH 1.1, OR THE INTER SYSTEM (I.E. INTER-RAI, INTER-HDS, ETC.)

6) REFERRAL MAY BE MADE TO AN ASSESSMENT TEAM FOR REVIEW

BEFORE SERVICE LEVEL AND CARE PLAN IS FINALIZED

July 2014

31



7) IF THE CLIENT IS DETERMINED AS REQUIRING PLACEMENT IN A

CONTINUING CARE FACILITY AT INTERMEDIATE LEVELS 1, 2, OR 3, THE

ASSESSOR WILL VISIT CLIENT AND EXPLAIN THE DECISION AND PLAN

FOR CARE.

• IF THE CLIENT AND/OR FAMILY DOES NOT AGREE, AANDC LIKELY WILL

NOT PAY FOR THEIR PREFERRED PLACEMENT.

8) POST-ASSESSMENT, BSDW SENDS A COPY OF SA-115 MEDICAL

RELEASE AND REPORT TO THE LOCAL HEALTH AUTHORITY AND

REQUESTS A COPY OF CLIENT’S LTC 1 APPLICATION AND ASSESSMENT

AND HLTH 1.6 FINANCIAL PROFILE AND CALCULATIONS FORMS

July 2014

32



9) IF CLIENT CANNOT PAY THEIR USER CHARGES, BSDW WILL ASSESS FOR

INCOME ASSISTANCE ELIGIBILITY.

IF CLIENT RECEIVES ANY OF THE FOLLOWING THEY DO NOT PAY. THE

WHOLE USER CHARGE IS PAID BY THROUGH SOCIAL ASSISTANCE

• CLIENT DOES NOT HAVE TO PAY IF THEY RECEIVE ANY OF:

GIS/OAS/WIDOW’S PENSIONS

• AANDC INCOME ASSISTANCE, PPMB OR PWD

• A WAR VETERAN’S ALLOWANCE

July 2014

33



10) PRIOR TO ADMISSION TO A DESIGNATED CONTINUING CARE

FACILITY, THE BAND SOCIAL DEVELOPMENT WORKER WILL:

• ASK THE ADMINISTRATOR OF THE CARE FACILITY TO COMPLETE PART

A OF THE ADULT INSTITUTIONAL CARE & FAMILY CARE HOMES CLIENT

ADMISSION FORM, INDICATING THE FACILITY’S PER DIEM COST

• ASK THE APPLICANT OR AN INDIVIDUAL WITH POWER OF ATTORNEY

TO COMPLETE PART B OF THE ADULT INSTITUTIONAL CARE & FAMILY

CARE HOMES CLIENT ADMISSION FORM, ACKNOWLEDGING CLIENT

USER CHARGES. IF THIS IS $0, STILL ENTER $0 AS THE VALUE

• BSDW COMPLETES PART C OF THE ADULT INSTITUTIONAL CARE &

FAMILY CARE HOMES CLIENT ADMISSION FORM, TO CONFIRM

CLIENT’S RESIDENCY AND ADMINISTERING AUTHORITY’S PAYMENT

July 2014

34



11) THE ADMINISTERING AUTHORITY WILL FAX A COPY OF THE

COMPLETED:

• ADULT INSTITUTIONAL CARE & ADULT FAMILY CARE HOMES CLIENT

ADMISSION FORM,

• THE PROVINCIAL APPLICATION AND ASSESSMENT (LTC 1) FORM AND

• THE PROVINCIAL FINANCIAL PROFILE AND CALCULATIONS (HLTH 1.6)

FORM,

ATTENTION: AANDC, BC REGION DATA SERVICES UNIT AND THE LOCAL

FUNDING SERVICES OFFICER. THE DEDICATED REPORTING FAX NUMBER

IS 604-775-7400.

July 2014

35



12) AANDC WILL SEND A CONFIRMATION LETTER TO THE

ADMINISTERING AUTHORITY INDICATING APPROVAL OR DENIAL. IF

APPROVED, THE LETTER WILL STATE THE PAYMENT START DATE

• NOTE THAT CLIENTS LIKELY WILL NOT BE REIMBURSED IF ENTERING A

CARE FACILITY BEFORE APPROVAL.

• TO DO SO MAY ALSO COMPLICATE THE ASSESSMENT PROCESS. –

CLIENT MAY NOT BE PLACED IN THE SAME FACILITY AFTER THEIR

ASSESSMENT

July 2014

36



13) BSDW WILL ENSURE THE CLIENT’S FILE IS COMPLETE, INCLUDING:

• DIAND MEDICAL RELEASE AND REPORT (SA 115 )

• PROVINCIAL APPLICATION AND ASSESSMENT (LTC 1) FORM

• PROVINCIAL MINI MENTAL STATUS EXAMINATION (MMSE) FORM

• A PROVINCIAL FINANCIAL PROFILE AND CALCULATIONS (HLTH 1.6)

FORM

• DIAND ADULT INSTITUTIONAL CARE & ADULT FAMILY CARE HOMES

CLIENT ADMISSION FORM

• DIAND, BC REGION’S CONFIRMATION LETTER TO THE ADMINISTERING

AUTHORITY THAT THE CLIENT’S ADMISSION FORM HAS BEEN

APPROVED FOR FUNDING

• CASE NOTES

• OTHER DOCUMENTATION AS REQUIRED

July 2014

37



14) BSDW REQUIREMENTS:

• SUBMIT AN ASSISTED LIVING REPORT AS PER THE ADMINISTERING

AUTHORITY’S FUNDING AGREEMENT

• REPORT ANY RATE CHANGES FROM THE LOCAL HEALTH AUTHORITY

ON THE ASSISTED LIVING REPORT. MUST ATTACH A COPY OF THE

RATE CHANGE NOTIFICATION

• REPORT THE END OF CARE DATE ON THE ASSISTED LIVING REPORT

• CONTINUE TO MONITOR CLIENT’S ELIGIBILITY AND FUNDABILITY FOR

CLIENT USER CHARGES

* BSDW FACILITATES THE PROCESS, MONITORS CLIENT ELIGIBILITY, AND

KEEPS THE FILE UP TO DATE

July 2014

38


REVIEWS (3.2)


REVIEWS MAY BE REQUESTED BY:

• THE CLIENT

• A SERVICE PROVIDER

• A FAMILY MEMBER

• A PHYSICIAN

• A HEALTH CARE PROFESSIONAL

* REVIEWS ARE CONDUCTED BY THE LOCAL HEALTH AUTHORITY’S HOME

AND COMMUNITY CASE MANAGER AS WITH THE ORIGINAL ASSESSMENT

July 2014

39


ADDITIONAL POLICIES


3.3 RESPONSIBILITY OF THE ADMINISTERING AUTHORITY

JURISDICTION: ENSURE CLIENT FALLS WITHIN RESIDENCY OR

ORDINARILY RESIDENT REQUIREMENTS

SUPPORT SERVICES: MUST PROVIDE PRIOR TO ADMISSION:

• INCREASED AVAILABLE AND FLEXIBLE COMMUNITY HEALTH

SUPPORTS AND HOMEMAKER SERVICES

• CRISIS MANAGEMENT PLANNING

• PREPARATION AND COUNSELLING FOR ADMISSION

*UPON ADMISSION, MUST PROVIDE ADMINISTRATOR OF FACILITY:

- CONTRIBUTION RATES FOR AA AND CLIENT, BILLING PROCEDURES, AND

CONTACT INFO OF WORKER FOR REQUIRED FOLLOW -UP SERVICES

July 2014

40



3.4 LEVELS OF CARE

* AANDC STILL USES OLD BC REGIMES OF LEVELS OF CARE. AANDC HAS

AN AGREEMENT WITH BC MINISTRY OF HEALTH TO STILL USE THIS

REGIME FOR ON-RESERVE CLIENTS DURING ASSESSMENTS

• PERSONAL LEVEL OF CARE: PERSON IS INDEPENDENTLY MOBILE,

REQUIRES MINIMAL ASSISTANCE AND WITH COMMUNITY SUPPORTS,

SHOULD NOT REQUIRE INSTITUTIONAL PLACEMENT

• INTERMEDIATE CARE LEVELS: RECOGNIZES A NEED FOR CARE

PLANNING AND SUPERVISION BY HEALTH CARE PROFESSIONALS

• EXTENDED CARE LEVELS: RECOGNIZES A SEVERE CHRONIC DISABILITY

WITH RESULTING FUNCTIONAL DEFICIT THAT REQUIRES 24 HOUR

CARE BUT NOT THE RESOURCES OF AN ACUTE CARE HOSPITAL

July 2014

41



3.7 RESPONSIBILITY FOR PAYMENT OF… PER DIEM

FACILITY PER DIEM COSTS ARE ESTABLISHED BY THE LOCAL HEALTH

AUTHORITY

INTERMEDIATE LEVELS OF CARE: AANDC IS RESPONSIBLE FOR ANY

CHARGES NOT BILLED TO THE USER

EXTENDED CARE LEVEL: COVERED BY PROVINCE OR FIRST NATIONS

HEALTH AUTHORITY – NON-INSURED HEALTH BENEFITS

RESIDENTS ON DESIGNATED COMMERCIAL PROPERTIES: NON-STATUS

CLIENTS ON DESIGNATED COMMERCIAL PROPERTY APPLY TO MSDSI

July 2014

42



3.8 FINANCIAL EXEMPTIONS AND ALLOWANCES

ELIGIBILITY IS BASED ON CONTINUING FINANCIAL ELIGIBILITY FOR

SOCIAL ASSISTANCE

EARNED INCOME: RESIDENTS OF CARE FACILITIES ARE ELIGIBLE FOR

EARNINGS EXEMPTIONS RELEVANT TO THEIR IA CLIENT CLASS

INCENTIVE/CVS: RESIDENTS OF CARE FACILITIES ARE ELIGIBLE

COMFORTS AND CLOTHING ALLOWANCE: ELIGIBLE FOR RESIDENTS OF

CARE FACILITIES WITH NO OTHER MEANS OF PROVIDING FOR PERSONAL

AND RECREATIONAL NEEDS

July 2014

43



3.9 OTHER SERVICES

MEDICAL SERVICES:

• STATUS PERSONS ARE COVERED THROUGH NON-INSURED HEALTH

BENEFITS, ANY REQUEST OR BILLING SHOULD BE DIRECTED TO FNHA

• IF CLIENT MEETS INCOME ASSISTANCE ELIGIBILITY, NON -STATUS

PERSONS ARE COVERED BY AANDC VIA VOLUME 1, INCOME

ASSISTANCE – CHAPTER 10 NON-STATUS HEALTH BENEFITS

TEMPORARY ABSENCE:

• IF A CLIENT RESIDES IN A CARE FACILITY AND IS HOSPITALIZED, THE

ADMINISTERING AUTHORITY CAN CONTINUE TO PAY FOR RESIDENCE

AT THE FACILITY IF IT IS EXPECTED THAT CLIENT WILL RETURN

• IF A CLIENT RESIDING IN A CARE FACILITY IS VISITING FRIENDS OR

FAMILY, IT IS APPROPRIATE TO CONTINUE PAYMENT.

July 2014

44


PER DIEM/ USER CHARGES


3.5 CONTINUING CARE FACILITY PER DIEM COSTS

A CARE FACILITY MUST BE LICENSED BY THE PROVINCE UNDER THE

COMMUNITY CARE AND ASSISTED LIVING ACT

PER DIEM COST RATES ARE SET BY THE LOCAL HEALTH AUTHORITY FOR

THE VARIOUS LEVELS OF CARE

* DOES NOT COVER PERSONAL ITEMS (SEE COMFORT ALLOWANCE)

3.6 CLIENT USER CHARGES

CLIENTS WHO CAN AFFORD TO PAY MUST CONTRIBUTE

THE LOCAL HEALTH AUTHORITY CALCULATES USER CHARGES BASED ON

CLIENT INCOME

July 2014

45

CHAPTER 4 ADULT FAMILY CARE HOMES:

PRINCIPLE (4.1)


“ THE OBJECTIVE OF A FAMILY CARE HOME IS TO PROVIDE A PROTECTIVE

AND SUPPORTIVE ENVIRONMENT WITHIN A PRIVATE FAMILY HOME TO

ELIGIBLE ON-RESERVE ELDERLY OR DISABLED PERSONS AS AN

ALTERNATIVE TO ADMISSION TO A LONG TERM CARE INSTITUTION .

FAMILY CARE HOMES ARE SINGLE FAMILY RESIDENCES LOCATED ON -

RESERVE, INTENDED FOR ON-RESERVE ADULTS WHO REQUIRE 24 HOUR

SUPERVISION OUTSIDE THEIR OWN HOME, AND WHO CHOOSE TO

REMAIN IN THEIR HOME COMMUNITIES. THE FAMILY CARE HOME

PROVIDES A HOMELIKE ATMOSPHERE, MEALS, AND OTHER

HOUSEKEEPING SERVICES, ALONG WITH CARING SUPPORT AND

ASSISTANCE WITH THE ACTIVITIES OF DAILY LIVING TO THE ELDERLY OR

DISABLED CLIENT.”

July 2014

46


PRINCIPLE 2 (4.1)

• SCREENING, MONITORING AND APPROVAL IS THE RESPONSIBILITY OF

THE ADMINISTERING AUTHORITY; HOWEVER, AANDC MUST GIVE

AGREEMENT BEFORE TO ENSURE FUNDING IS AVAILABLE

• AANDC WILL REIMBURSE PER DIEM AND RESPITE COSTS BASED ON

CLIENT’S ASSESSED LEVEL OF CARE BY THE LOCAL HEALTH

AUTHORITY

* NOTE: OPERATION OF HOME IS CLIENT SPECIFIC AND PLACEMENT

DEPENDS ON MATCH OF OPERATOR AND CLIENT

* NOTE: AANDC DOES NOT GUARANTEE OCCUPANCY OF THE HOME

ELIGIBILITY:



July 2014

47


ROLES AND RESPONSIBILITIES (4.1)


THE ADMINISTERING AUTHORITY:

• APPROVES FAMILY CARE HOME BASED ON INFORMATION PROVIDED

DURING THE SCREENING PROCESS

• ENSURES THAT THE SERVICE PROVIDER AGREEMENT IS COMPLETED

AND SIGNED BY FAMILY CARE HOME OPERATOR

• PROVIDES ONGOING MONITORING OF THE HOME

• ENSURES COLLECTION OF CLIENT DAILY USER FEE

• REIMBURSES THE OPERATOR BASED ON SUBMITTED CLAIMS FOR THE

NUMBER OF DAYS OF OCCUPANCY AT THE RATE ESTABLISHED FOR

THE CLIENT’S ASSESSED LEVEL OF CARE

July 2014

48


ROLES AND RESPONSIBILITIES 2 (4.1)

THE BAND SOCIAL DEVELOPMENT WORKER:

• COMPLETES THE FAMILY CARE HOME OPERATOR APPROVAL FORM

(DK02-01) AND ADULT FAMILY CARE HOME APPROVAL CHECKLIST

(DK02-02)

• IDENTIFIES ELIGIBLE CLIENTS, AND MATCHES CLIENT AND FAMILY

CARE HOME OPERATOR

• COMPLETES NEEDS TEST, MONITORS CARE OF INDIVIDUAL AND

SERVES AS LINK BETWEEN CLIENT, FAMILY, AND SERVICE PROVIDER

July 2014

49


ROLES AND RESPONSIBILITIES 3 (4.1)

THE CONTINUING CARE CASE MANAGER:

• PROVIDES ASSESSMENT AND ESTABLISHES LEVEL OF CARE OF

PROSPECTIVE CLIENT

• MAY ASSIST ADMINISTERING AUTHORITY PERSONNEL TO COMPLETE

THE FAMILY CARE HOME OPERATOR APPROVAL FORM (DK02-01) AND

ADULT FAMILY CARE HOME APPROVAL CHECKLIST (DK02-02)

• IN COOPERATION WITH BAND SOCIAL DEVELOPMENT WORKER, MAY

ASSIST IN THE ASSESSMENT OF THE COMPATIBILITY OF HOME AND

PROSPECTIVE CLIENT

• MAY ASSIST WITH ONGOING MONITORING, AS APPROPRIATE

AANDC:

• PROVIDES AGREEMENT TO PROCEED BASED ON AVAILABLE FUNDING

• APPROVES REIMBURSEMENT OF PER DIEM AND CHARGES

July 2014

50


PROCEDURES (4.2)


4.2 RECRUITMENT AND SCREENING

• OPERATORS ARE RECRUITED TO MATCH WITH CLIENTS

• BSDW COMPLETES FORM DK02-01 FAMILY CARE HOME OPERATOR

APPROVAL FORM AS PART OF SCREENING PROCESSES

OPERATOR SCREENING COVERS:

• REFERENCES

• TRAINING/ EXPERIENCE

• PERSONAL SUITABILITY

• FINANCIAL

• CRIMINAL RECORD SEARCH

- HEALTH

- TRANSPORTATION

July 2014

51


PROCEDURES 2 (4.3)

4.3 APPROVAL OF HOMES

THE FOLLOWING DOCUMENTATION MUST BE COMPLETED:

• FAMILY CARE HOME OPERATOR APPROVAL FORM (DK02-01)

• ADULT FAMILY CARE HOME APPROVAL CHECKLIST (DK02-02)

• LETTERS OF REFERENCE

• CRIMINAL RECORD SEARCHES

• FAMILY CARE HOME SERVICE PROVIDER AGREEMENT (DK02-04)

* REMEMBER THAT APPROVAL IS BASED ON AVAILABLE FUNDING

* REQUIRES A SERVICE PROVIDER AGREEMENT FOR OPERATOR AND A

COMPREHENSIVE FUNDING AGREEMENT BETWEEN AANDC AND THE

ADMINISTERING AUTHORITY, WHICH AANDC MAY TERMINATE

July 2014

52


PROCEDURES 3 (4.3)

BASED ON FORM DK02-02 ADULT FAMILY CARE HOME APPROVAL

CHECKLIST THE HOME MUST BE ACCEPTABLE IN THE FOLLOWING AREAS:

• FIRE SAFETY

• OUTDOOR ENVIRONMENT

• GENERAL SAFETY

• GENERAL CLEANLINESS

• LIVING SPACE

• BASIC NUTRITION, FOOD PREPARATION, AND MEAL PLANNING

• WASHING AND TOILET FACILITIES

• BEDROOMS

• FURNISHINGS

• INSURANCE

July 2014

53


PROCEDURES 4 (4.5)

4.5 PLACEMENT OF CLIENT

MUST BE LESS THAN 3 CLIENTS PER HOME TO COMPLY WITH THE

COMMUNITY CARE AND ASSISTED LIVING ACT

• MOST HOMES WILL ONLY HAVE 1 CLIENT, HOWEVER 2 MAY BE

CONSIDERED IF IT WOULD BE BENEFICIAL TO THE CLIENT AND THE

OPERATOR IS DEEMED CAPABLE OF CARING FOR 2 CLIENTS AND BOTH

CLIENTS AGREE

• CLIENTS CANNOT BE PLACED WITH AN IMMEDIATE FAMILY MEMBER

CONSIDERATIONS:

LIFESTYLES AND COMPATIBILITY

BEHAVIOURAL PROBLEMS (CLIENT)

SAFEKEEPING AND FINANCIAL AFFAIRS

RIGHT TO REFUSE PLACEMENT

July 2014

54


OPERATION OF HOME (4.6)


4.6 OPERATION OF HOME

• ADMINISTERING AUTHORITY IS RESPONSIBLE FOR ENSURING THAT

OPERATORS DELIVER HIGH QUALITY SERVICE AND SUPPORTING THEM

• BSDW SHALL VISIT THE HOME MONTHLY TO ENSURE OPERATOR

ADHERES TO THEIR RESPONSIBILITY

• IF THE ADMINISTERING AUTHORITY SUSPECTS RISK TO THE CLIENT

THEY MUST IMMEDIATELY TAKE STEPS TO RESOLVE THE SITUATION

July 2014

55


OPERATION OF HOME 2 (4.6)


TEMPORARY CLIENT ABSENCES: IF CLIENT IS HOSPITALIZED, THE

ADMINISTERING AUTHORITY MAY CONTINUE TO PAY THE PER DIEM IF

THE CLIENT IS REASONABLY EXPECTED TO RETURN

• UP TO 30 DAYS PER CALENDER YEAR. ANYTHING OVER 3 DAYS MUST

BE APPROVED BY FSO.

• DAYS WITH UNAUTHORIZED ABSENCES WILL NOT BE REIMBURSED

FUNDED RESPITE: CAN BE IN-HOME, OUT-OF-HOME, ADULT DAY CARE

• THIS IS FUNDED WITH A SPECIAL QUARTERLY ADJUSTMENT FROM

AANDC THAT ALLOWS THE ADMINISTERING AUTHORITY TO

PURCHASE RESPITE.

July 2014

56



OPERATORS RESPONSIBILITY: (MUST NOT BE CHARGED TO CLIENT)

• MEDICATION

• MEALS/ THERAPEUTIC DIETS

• DIET SUPPLEMENTS

• LAUNDRY SERVICE

• GENERAL HYGIENE SUPPLIES

• MEDICAL SUPPLIES

• INCONTINENCE CARE

• PHYSICAL, SOCIAL AND RECREATIONAL ACTIVITIES

• TRANSPORTATION

* THIS IS NOT EXHAUSTIVE AND OTHER RESPONSIBILITIES MAY OCCUR

July 2014

57



CLIENT RESPONSIBILITY

• PERSONAL HYGIENE AND GROOMING SUPPLIES

• PERSONAL DRY CLEANING

• PERSONAL PHONE AND TV

• PERSONAL NEWSPAPER, PERIODICALS, AND SMOKING MATERIALS

• TRANSPORTATION (FOR INDIVIDUAL PURPOSES)

• EXTRA CRAFT SUPPLIES AND ACTIVITIES

• PERSONAL EQUIPMENT (MEDICAL)

* CLIENT IS RESPONSIBLE FOR PAYMENT OF ALL ITEMS AND SERVICES

NOT INCLUDED IN THE REIMBURSEMENT RATE. OPERATOR CANNOT

CHARGE AND ADMINISTRATION FEE FOR THESE ITEMS

* NOTE: THIS IS NOT AN EXHAUSTIVE LIST

July 2014

58


CLOSURE OF HOME (4.7)

4.7 CLOSURE OF HOME: IMPOSED CLOSURE MAY BE FOR 2 REASONS:

• CLIENT AT RISK

• Administering Authority notified of possible risk. If risk is assessed as real,

Chief and Council is notified and Client is immediately removed

• Notify FSO immediately to stop the comprehensive funding agreement

• UNSATISFACTORY SERVICE

1) BSDW TELLS OPERATOR OF AREAS TO IMPROVE WITH DEADLINE

2) WRITTEN NOTIFICATION GIVEN WITHIN 3 DAYS

3) BSDW VISITS HOME TO ENSURE IMPROVEMENT

4) WITHOUT IMPROVEMENT, BSDW GIVES LAST WRITTEN WARNING

5) ADMINISTERING AUTHORITY NOTIFIED FOR INVESTIGATION

6) BSDW AND AA AGREE, OPERATOR IS GIVEN 14 DAYS NOTICE TO CLOSE

July 2014

59


FINANCIAL REQUIREMENTS (4.4)

4.4 FINANCIAL REQUIREMENTS

PER DIEM RATES:

• BASED ON CLIENTS ASSESSED LEVEL OF CARE DETERMINED BY THE

LOCAL HEALTH AUTHORITY

• RATES ARE BASED ON LOCAL HEALTH AUTHORITIES’ SCHEDULE

• BILLING IS PRO-RATED ON NUMBER OF CARE DAYS PROVIDED

• BASED ON COMPREHENSIVE FUNDING AGREEMENT AND

AUTHORIZED BY AANDC FUNDING SERVICES OFFICER

July 2014

60


FINANCIAL REQUIREMENTS 2 (4.4)

4.4 FINANCIAL REQUIREMENTS

ELIGIBILITY IS BASED ON CONTINUING FINANCIAL ELIGIBILITY FOR

SOCIAL ASSISTANCE

EARNED INCOME: RESIDENTS OF HOMES ARE ELIGIBLE FOR EARNINGS

EXEMPTIONS RELEVANT TO THEIR IA CLIENT CLASS

INCENTIVE/CVS: RESIDENTS OF CARE HOMES ARE ELIGIBLE FOR THE CVS

COMFORTS AND CLOTHING ALLOWANCE: ELIGIBLE FOR RESIDENTS OF

CARE FACILITIES WITH NO OTHER MEANS OF PROVIDING FOR PERSONAL

AND RECREATIONAL NEEDS

July 2014

Assisted Living - First Nations Social Development Society

Related documents

Products

Support

Assisted Living - First Nations Social Development Society

Related documents

Add this document to collection(s)

Add this document to saved

Suggest us how to improve StudyLib