Home Care Program

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Home Care Program
Executive Office of Elder
Affairs
May 2014
ELD Home Care Program
Team
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Mary DeRoo – Director of Home and Community Programs
Susan Tompkins-Hunt – Asst. Director Home and Community
Programs
Brenda Correia – Coordinator of Elder Community and
Support Programs
Sandy Brown – Clinical Assessment & Eligibility RN
CAE & Home Care RN Manager
Devon Garon– Waiver Program Manager
Shannon Philbrick –Home Care Program Coordinator
Quality Manager
Brief history
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27 Home Care Corporations (HCCs) established 1973-1975
Each with a unique geographic service area
Community based non-profits
51% of board members must be aged 60+
ASAP law passed in 1997 – c.19a§4b
Request for Responses (RFR) issued 2010; designation of 27 Aging
Services Access Points (ASAPs)
Statutory responsibilities of ASAPs:
– Information & Referral
– Clinical eligibility for Medicaid-funded institutional and community based
care
– Care management and service coordination
– Authorization and purchase of services
– Protective Services
ASAPs perform many functions
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Information and Referral
Nursing facility pre-admission screening
Functional eligibility determinations
Financial eligibility (Home Care Program)
Needs assessment
Care plan development
Authorization of services
Monitoring of service delivery
Reassessment
Protective Services
Home Care Programs
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Provide interdisciplinary care management
and in-home support services to elders in
Massachusetts.
Eligibility is based on age, residence,
income, and ability to carry out daily tasks
such as bathing, dressing and meal
preparation (functional impairment level).
Eligibility for Home Care
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Age and residence:
– 60 years of age (under 60 with a diagnosis of Alzheimer’s or related disorder)
– Resident of Massachusetts and not living in an institutional setting or Assisted Living
Residence.
Income:
– Based on a sliding scale, monthly co-payments of $9 - $140 are required for
individuals/couples with income above the Federal Poverty Level. Respite/OverIncome eligible, monthly cost sharing of 50% - 100% of the service plan cost is
required.
Functional Impairment Level (FIL):
– Require assistance with at least 2 Activities of Daily Living (ADLs) or 6-10 ADL/IADLs
(Instrumental Activities of Daily Living) and have a critical unmet need (any ADL, meal
preparation, food shopping, home health services, Respite, transportation for medical
treatments).
Exceptions to the Uniform Intake Policy:
– At Risk. Elders who are at risk due to a variety of factors, including, but not limited to
substance abuse, mental health problems or cultural and linguistic barriers.
– Protective Services. Elders who are receiving or are eligible to receive Protective
Services…
– Congregate Housing. Clients residing in a Congregate Housing Facility.
– Waiver Clients. Clients who are eligible for the Home and Community based Waiver
Program.
State Home Care Programs
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Home Care Basic - a program for
elders who:
– meet the Home Care enrollment eligibility
– require assistance with I/ADLs.
– have an Average service cost per
consumer is no more than $266/month.
(Not a per person limit.)
State Home Care Program
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Respite Over-Income – a program that
supports caregivers in meeting the needs of elders
who:
– Meet the Home Care Program eligibility criteria of
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60 years of age (under 60 with a diagnosis of Alzheimer’s or
related disorder)
Residents of Massachusetts
Functional Impairment Level (FIL)
– have an annual income over $26,562 (single) or $37,584
(couple) and are willing to pay an income-based
percentage of the cost of services (50% to 100%)
– Are not MassHealth eligible
– Are not eligible for other programs
State Home Care Programs
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Enhanced Community Options Program
(ECOP) – a subset of Home Care Basic
consumers who are:
– 60 years of age (under 60 with a diagnosis of
Alzheimer’s or related disorder)
– State Home Care Program eligible
– Meet the Clinical eligibility criteria for nursing
facility services (MH regulations 130 CMR
456.409)
– Not MassHealth Standard eligible
– Service plan cost of two times the level of services
provided through Home Care Basic Non-Waiver.
Home Care Non-Waiver
Services
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Personal Care
Home Health Aide
Supportive Home Care Aide
Respite
Companion
Skilled Nursing
Adult Day Health
Behavioral Health
Chore
Environmental Accessibility
Adaptations
Grocery Shopping/Delivery
Services
Alzheimer’s/Dementia Coaching
Home Delivered Meals
Homemaker
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Laundry Services
Medication Dispensing System
Home Delivery of Prepackaged Medication
Nutrition
Assessment/Counseling
Personal Care
PERS/Enhanced PERS
Supportive Day Care Programs
Transitional Assistance
Transportation
Vision Rehabilitation
Home Based Wandering
Response Systems
Home & Community Based
Services Waiver Programs
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Home Care Basic Waiver – a subset of
Home Care Basic consumers who are:
– 60 years of age or over
– State Home Care Program eligible
– Meet the Clinical eligibility criteria for nursing
facility services (MH regulations 130 CMR
456.409)
– MassHealth Standard eligible
– In need of and/or receiving a Waiver Service
Home and Community Based
Services Waiver Programs
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CHOICES - a subset of waiver consumers who are:
– 60 years of age or over
– State Home Care Program eligible
– Meet the Clinical eligibility criteria for nursing
facility services (MH regulations 130 CMR
456.409)
– MassHealth Standard eligible
– In need of and receiving a Waiver Program
Service
– Service plan cost of two times the level of services
provided through Home Care Basic Waiver.
Frail Elder Waiver (FEW)
Expanded Income Eligibility
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Frail Elder Waiver (FEW) Expanded Income
Eligibility for MassHealth Standard:
-Elders who meet all Waiver program eligibility criteria except
for MassHealth Standard eligibility:
With income at or below 300% SSI FBR
($2,163/month in 2014)
Have countable assets below $2,000
-Can apply for MassHealth Standard using the FEW expanded
income eligibility rule
Home Care Waiver Services
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Personal Care
Home Health Aide
Supportive Home Care Aide
Homemaker
Respite
Companion
Skilled Nursing
Chore
Environmental Accessibility
Adaptations
Grocery Shopping/Delivery
Services
Home Delivered Meals
Laundry Services
Supportive Day Program
Transitional Assistance
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Non- Medical Transportation
Home Based Wandering
Response Systems
Alzheimer’s/Dementia Coaching
Home Delivery of Pre-packaged
Medication
Medication Dispensing System
Occupational Therapy
Services not available through
the waiver program, available
through the MassHealth State
Plan:
– PERS
– Transportation for medical
– ADH
Care Planning/Care Management
– Care Manager completes an initial on-site
assessment (OSA) to determine consumer
eligibility
– Initial Service Plan is created with consumer to
address identified unmet needs.
– visit schedule of an OSA at least every six
months dependent upon program enrollment
and need
– Annual re-determination of home care program
eligibility
– review of care plan/service plan at least annually
– Annual re-determination of personal care needs,
as well as clinical eligibility for waiver and ECOP
by ASAP RN
Service delivery options
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Traditional service providers
– ASAP contracted service providers
Consumer Directed Care – a service delivery option for non-waiver enrolled
consumers in accordance with EOEA PI-09-08
– Consumer can choose to recruit, train and hire their own worker for
personal assistance services
– ASAP authorizes an average number of hours per week and is responsible
for the overall management of program service costs within the limits for
HCB-NW and ECOP program
– Services Offered
 Homemaking
 Personal Care
 Home Health Aide
 Transportation
 Chore
 Companion
 Other assistance with I/ADLs
– Services provided must meet needs identified in the assessment process or
otherwise identified as necessary for the health, welfare and community
independence of the consumer.
Wait Lists
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Currently, there are no wait lists
for:
–Home Care Programs
–ECOP (Enhanced Community Options
Program)
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No Expectation for a wait list through
Fiscal Year 2014
Wait Lists and Exceptions
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Effective September 8, 2009, ASAPs were required to establish
a Home Care Program waiting list. Applicants are screened at
intake to determine whether the applicant meets one of the following
exceptions:
– Eligible for Enhanced Community Options Program (ECOP) or Medical Frail
Elder Home and Community Based Services Waiver;
– Active or triaged Protective Services consumers in need of Home Care
Program Services
– Elders being discharged from nursing facilities and hospitals, including
chronic and rehabilitation hospitals who need Home Care Program Services
in order to return to the community;
– Elders enrolled in hospice care who require Home Care Program Services.
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All eligible applicants who meet one of the exception criteria
described above shall be enrolled in the Home Care Program.
All other applicants must be placed on the Home Care Program
waiting list.
Referral sources must be informed at the time of referral that the
applicant may be enrolled in a program or placed on the waiting list, as
appropriate.
ASAPs should offer information regarding other community sources of
assistance that may be available to the applicant.
Wait List Priority Levels
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Criteria for the assignment of priority levels. Priority levels are based
on the need for services.
– Priority Level 1: The applicant has no informal support or other formal
support and has at least one of the following Critical Unmet Needs:
 Personal Care
 Home health services
 Transportation to medical treatments
 Grocery shopping
– Priority Level 2: The applicant has limited formal and/or informal supports
(inadequate to meet demonstrated need) or the caregiver requires respite to
continue involvement and the applicant has at least one of the following
Critical Unmet Needs:
 Personal Care
 Home health services
 Transportation to medical treatments
– Priority Level 3: The applicant has limited formal/informal supports and a
Critical Unmet Need of grocery shopping.
– Priority Level 4: The applicant has a Critical Unmet Need of meal
preparation.
Family Caregiver Support
Program
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National Program implemented by Elder
Affairs through ASAPs
Funded primarily with Federal Title III-E
funds; with limited state and local agency
funds
Program with a multi-faceted approach
that supports the Caregiver.
Caregiver Specialist
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Caregiver Specialist focuses on supporting
the Caregiver
– Conducts caregiver assessments
– Develops a caregiver action plan
– Provides personal assistance in connecting
caregivers with resources and services which may
include
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Respite care options
Supplemental Services
– One-on-one counseling & coaching
– Identified training in group settings or for
individuals
– Facilitates family meetings
Who is eligible to be a
Caregiver
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A family or informal caregiver who is
– caring for an elder 60 or older, or someone with
Alzheimer’s
– a grandparent aged 55 or older caring for a child
age 18 or younger
– over the age of 55 caring for a disabled
individual between the ages of 18-59; cannot be
the parent
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Contact the Massachusetts Family Caregiver Support Program:
Local ASAP 1-800-AGE-INFO or www.mass.gov/caregiver
Other Community Options
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Veteran’s Independence Plus (VIP)
Certified Home Health Agency
– Optional for consumers with Medicare A
coverage, as well as other insurers
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Private Pay Home Care
– Optional for all consumers
Veteran’s Independence Plus
Program (VIP)
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VIP Program serves
– veterans of any age
– at risk of nursing home admission
– Supports family Caregivers
VIP Program qualifications
– receive primary care at Bedford or Boston VAMC
(Veteran’s Administration Medical Center)
– have a VA primary care team
– meet the eligibility criteria for home and community based
services as determined by VA
– Receive a referral to VIP Program from the VA Medical
Center
ASAP Case Manage (Care Advisor) VIP enrollees
Certified Home Health Agency
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CHHA’s are home care providers certified by
Federal Medicare Program
– Provide and bill for services
– Meet requirements for patient care and management
– CHHA’s provide:
 In-home assessment
 Developed plan of care
 Skilled care health services for 60 day increments
Qualifying for Certified Home
Health Care (CHHA)
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To qualify for Medicare home health coverage, a
person must:
– Need skilled care (SN, OT, PT)
– Have a physician’s order for care and have seen by the
physician ordering care either within 90 days before care
or 30 days after starting care
– Be homebound, i.e. unable to seek medical attention
without “severe taxing effort”
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Discharge from an acute or rehabilitation/hospital is
not necessary
Family members or others can refer to CHHA
– Physician’s order for care is required (see above)
Private Home Care
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Private pay home care services can be purchased in hourly
blocks of time or as overnight or live in services
Private pay home care companies provide a broad range of
services
Private pay home care services are not subject to eligibility
rules and restrictions, or ASAP/EOEA monitoring requirements
Private pay home care companies can be a company within a
Certified Home Health Agency, but not always
For more information contact local ASAP or ILC
Information and Referral
Contact the local ASAP or ILC
1-800-AGE-INFO
www.800ageinfo.com
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