LEVELS OF CARE



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MECKLENBURG COUNTY

Department of Social Services

IN-HOME AIDE SERVICES

PROCEDURE MANUAL

FOR

CONTRACT AGENCIES

Updated 7-2018

TABLE OF CONTENTS

I. INTRODUCTION Page 1

II. REFERRALS TO CONTRACT AGENCIES Page 2

III. CHANGES IN SERVICE PROVISION Page 3, 4

IV. LEVELS OF CARE Page 5-7

V. TRAINING OF IN-HOME AIDES Page 7

VI. FREQUENCY OF SUPERVISION Page 8

VII. BILLING Page 9

VIII. MONITORING Page 9

IX. CASE CONFERENCE Page 10

X. CONSUMER CONTRIBUTION Page 10

XI. CONFIDENTIALITY Page 10

XII. TERMINATION OF CASE RECORDS Page 10, 11

XV. REFERRALS TO DSS Page 11

XVI. REPORTING ABUSE, NEGLECT, EXPLOITATION Page 12

XVII. INSTRUCTIONS FOR COMPLETING Page 13

IN-HOME AIDE SERVICE PLAN

XVII. SHELTERS AND APPENDIX Page 14

INTRODUCTION

The aging population in Mecklenburg County continues to increase and there is a growing demand from the community for In-Home Aide Services. In order to meet that demand and provide services in a timely and cost efficient manner, the Mecklenburg County Board of County Commissioners has approved funding to serve the elderly and citizens with disabilities. This funding enables Mecklenburg County to contract with private home care agencies to provide In-Home Aide Services to the elderly and citizens with disabilities of Mecklenburg County.

This Procedures Manual is designed to provide guidelines to the home care agencies providing In-Home Aide Services to DSS customers through contractual agreements. We hope this information is helpful as we endeavor to provide quality services to the elderly and adults with disabilities of Mecklenburg County who choose to remain in their homes for as long as possible, rather than go into a Long-Term Care Facility or move in with other relatives.

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REFERRALS TO CONTRACT AGENCIES

Individuals may apply for In-Home Aide Services by contacting the Department of Social Services Just 1 Call (704-432-1111). A Community Social Worker (CSW) will be assigned to determine eligibility and complete an in home assessment to determine what assistance is needed. If funds are not available, the SW will screen the client for needs and assign a priority code based on his/her screening. These definitions can be found in the Family Services Manual, Volume VI, Chapter II, and Section 8100. The client may receive Case Management services from the DSS Social Worker while the client is on the Inquiry List waiting for funds to become available. When approved for vendor service, the customer’s case is assigned to a contract agency for the delivery of service.

The DSS Social Worker will notify the contract agency via the Core program by completing a Vendor Request Form when referring a new customer. The In Home Aide agency will review the service plan. When an aide is assigned, the contract agency notifies the DSS Social Worker of the starting date, the recommended level of care and recommends hours of services for the customer. The DSS Social Worker will authorize the service hours that will be provided.

The contract agency has up to eight (8) calendar days from receipt of the referral to complete the service plan, to develop the plan of care, and to start services to the customer. The contract agency will develop a plan of care with the customer indicating the number of days and hours needed by the assigned aide to complete the tasks. The contract agency also determines the specific tasks (e.g., sweep, laundry, bed bath, etc.) that will be completed within the general category identified by the social worker. The contract agency will upload into Core a signed service plan and plan of care back to DSS within five (5) calendar days of completion. The aide supervisor’s signature and date of signature must be included on the In-Home Aide Service Plan, as well as the specific service schedule and the beginning date of service. The IHA agency will also complete the MI Vendor form in CORE conforming the LOC and plan days/hours.

At the time of the home visit, the contract agency must give the customer a copy of the plan of care, and contract agency contact information.

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CHANGES IN SERVICE PROVISION

The contract agency will notify DSS immediately of any changes in service provision to the customer. This would include missed visits, customer refuses services, customer unavailable for services, hospitalizations, need to increase or decrease in frequency and number of hours, or addition of tasks, in addition to any other reporting requirements identified in the contract. The contract agency will complete a To Do to notify the social worker that there has been a change. If during the course of providing services to the customer an increase or decrease in hours is requested, authorization must be given by the supervisor before changes can be implemented. If the tasks on the service plan need to be modified and a change in the level of care is needed, an assessment will be completed by the client’s social worker, and potentially with consultation of a DSS RN, for approval before any changes will be implemented. If both the agency and the social worker determine that the level of care has changed, a revision is made to the service plan and signed by the client.

If for any reason the agency is not able to serve the client, the agency must give at least ten (10) working days’ notice to the social worker and/or supervisor prior to termination of a client’s service delivery.

For the annual assessment service plan, the contract agency nurse will develop a new plan of care within thirty (30) calendar days from the date of the customer’s signature on the service plan. The nurse will sign and date, and complete the specific service schedule and beginning date of service. For the annual assessment service plan, the beginning date may be indicated as “ongoing”. Any signature on the service plan or plan of care cannot predate the date of the customer’s signature. The contract agency will upload the annual reassessment Service Plan and plan of care into CORE within five (5) calendar days of completion.

It is expected that the customer will receive the designated number of days and hours for services as shown on the service plan and that all tasks on the plan of care are completed. The contract agency must notify the customer when an aide assignment or service schedule has changed. This is particularly important for customer safety to assure the customer knows who is coming to their home.

The aide from the contract agency is expected to provide services to the customer regardless of housing conditions, unless those housing conditions are unsafe and pose safety issues for the aide and/or customer. In those situations where there is a dispute or difference of opinions about the safety of the home, a conference can be requested by any party (social worker, contract agency, program coordinator/supervisor) to discuss the situation and develop plans to address the issues.

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The contract agency should immediately notify DSS of situations which prevent the delivery of services by the In-Home aide. If intervention is needed by the customer’s social worker, the supervisor will notify the social worker and request an assessment of the customer’s situation to determine if In-Home Services are still needed or if the family needs to explore other resources. If there is a concern that makes it difficult for the IHA to complete the service plan (i.e. bedbugs, insect infestation, hording), then the IHA agency and DSS will jointly work together to resolve the issue, which may include approving for additional IHA time/tasks. The agency may suspend IHA services for 30 days, and if the situation remains unresolved, the agency may d/c the client from that service.

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LEVELS OF CARE

Contract Agencies are currently contracted to provide three levels of care to DSS customers. These levels are:

SERVICE LEVELS

Level I – Home Management

Level II – Home Management/ Personal

Care

Level III - Home Management/ Personal

Care

TASKS

Housekeeping, light meal prep,

shopping, bill paying

Partially dependent for Personal care needs; independent living skills

Significant ADL impairment and needs extensive hands-on care

Level I – Home Management

In-Home Aide Services at this level are intended to provide support to individuals/families requiring assistance with basic home management tasks, such as housekeeping, cooking, shopping, and bill paying. Individuals to be served include those who are self-directing, medically stable, and have at least one (1) instrumental activity of daily living (IADL) impairment. Personal care tasks may not be performed at this level.

Home Management Tasks

• Pay bills as directed by client

• Provide transportation for medical appointments/shopping

• Clean/care for clothing: ironing, simple mending, laundering

• Do basic housekeeping tasks: sweeping, vacuuming, dusting, mopping, and dishes

• Make un-occupied bed

• Recognize/report changes in health/environment

• Identify medications for client

• Provide companionship/emotional support

• Prepare simple meals

• Shop for food from verbal or written instruction

• Observe/report symptoms of abuse, neglect, illness, etc. to proper professionals

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Level II – Home Management/Personal Care

In-Home Aide Services at this level are intended to provide support to individuals/families requiring assistance with basic activities of daily living and home management tasks. Both home management and assistance with personal care tasks can be provided to the client when his capacities are diminished or when the client is striving to maintain or improve his own functioning. Clients to be served include those who are medically stable and partially dependent in activities of daily living (ADL) functioning (1 or 2 ADL’s) due to physical and/or mental impairment; or who have maintenance needs and/or rehabilitative potential. In addition to their personal care needs, clients/families may also require assistance with IADL activities to improve IADL functioning or to learn independent living skills; or they may have increased IADL needs (2-4) requiring additional support to maintain/achieve overall functioning.

Personal Care Tasks *Demonstrated competency verified by R.N.

• Assist ambulatory client with mobility and toileting

• Provide care for normal, unbroken skin

• Assist with personal hygiene, (mouth care, hair and scalp grooming, fingernails and

bathing; shower, tub, bed and basin) Cut/trim hair

• Shave client (electric/safety razor)

• Provide basic first aid

• * Assist with applying ace bandages, TED’s, and binders as stipulated in the In-Home Aide service plan, and under the direction of the client

• assist limited function and report self-administered medications

• * Assist with applying/removing prosthetic devices for stable clients as stipulated in the In-

Home Aide service plan, and under the direction of the client

• Assist with feeding clients with special conditions (no swallowing difficulties)

• Assist/encourage physical activity and/or prescribed exercise

• * Assist client with self-monitoring of temperature, pulse, blood pressure and weight as

stipulated in the In-Home Aide service plan, and under the direction of the client

Level III – Personal Care (Tasks subject to nurse supervision requirements for the Nursing Practice Act.)

In-Home Aide Services at this level are intended to provide substantial ADL support to clients who require assistance with health/personal care tasks. Provision of these tasks involves extensive “hands on” care and potential assistance with a wide range of health-related conditions. Individuals to be served include those who are medically stable with significant ADL

impairments (3 or more) resulting from a chronic condition; or who are medically instable due to recent illness, complications of a chronic condition, or a deteriorating condition with variable ADL and IADL needs.

Personal Care Tasks

• Assist with feeding clients with special conditions

• Give bed bath

• Make occupied bed

• Assist with mobility, gait training using assistive devices

• Assist with range of motion exercises

• Assist limited function patient with dressing

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• Apply ace bandages, TED’s, binders

• Assist with scalp care

• Take/record temperature, pulse, respirations, blood pressure, height and weight

• Observe, record and report self-administered medications

• Apply/remove prosthetic devices for stable client

• Trim toenails for clients without diabetes/peripheral vascular disease

• Empty/record drainage of catheter bag

• Shave clients with skin disorders

• Administer enemas

• Insert rectal tubes/flatus bags

• Bowel/bladder retraining

• Collect/test urine or fecal specimens

• Perineal care

• Apply condom catheters

• Chair/stretcher transfers

• Turn and position

• Safety measures (side rails, mitts, restraints)

• Change non-sterile dressings

• Force and restrict fluids

• Apply prescribed heat/cold

• Care for non-infected decubitus ulcers

• Assist clients in understanding medical orders/routines, encourage compliance

• Assist with purchase/preparation of diet food specified by professional

• Vaginal douches after instruction assist with prescribed physical/occupational therapy

• Plan menus for special diets

• Monitor dietary treatment plan, provide feedback to professional

Tasks with Special Training

(Requires Nurse Aide II registration with the NC Board of Nursing)

• Administer gastrostomy tube feedings

• Perform in and out bladder catheterizations

• Change sterile dressings

Nurse and social work service levels must match for all levels of care on the Service Plan and the 101 form, when required.

RECOMMENDED TRAINING OF IN-HOME AIDES

Aides assigned to provide services to DSS customers are expected to complete training and demonstrate skills necessary to perform tasks at the appropriate level of care per DHHS guidelines. .

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FREQUENCY OF SUPERVISION

• If aide is a new employee, supervisory home visits need to be made twice in the first month of employment. Otherwise, the frequency of aide supervision correlates to the level of tasks performed.

• All levels require a follow up home visit or telephone call to customer and aide within the first calendar week of initial service.

• Level 042 and 045- on site supervisory visit every sixty (60) calendar days. A Registered

Nurse must supervise the aides providing any level of personal care services. A supervisory

home visit or call to the aide will be made the first calendar week for newly assigned cases.

• Levels 041 - supervisory visit every ninety (90) calendar days (Home Management only cases) A supervisory home visit or call to the aide will be made the first calendar week for newly assigned cases.

• All levels must have supervisory contact during each intervening month of the home visit with customer and aide.

• Regardless of the level of care, supervision should be increased as needed to respond to capabilities of the aide and the need of the customer.

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BILLING

The contact agency will submit monthly invoices in the format specified by DSS, summarizing services rendered during the current billing period, customers served, number of service hours delivered, and the total amount of reimbursement being requested. The billing period is defined as beginning on the first (1st) of the month, and ending on the last day of the month. Invoices are due to the program coordinator/supervisor no later than 5:00 p.m. on the fifteenth (15th) of the month following the services rendered. An example of this would be that no later than 5:00 p.m. on August 15th, the invoices for the services rendered from July 1st through July 31st are sent by the contract agency and received by the program coordinator/supervisor.

For the last month of the contract year, the timeline for submitting the billing invoices to the program coordinator/supervisor changes. The billing invoices are due to the program coordinator/supervisor no later than 5:00 p.m. on July 5th, or other specified date, for services rendered from June 1st through June 30th.

All billing invoices must be submitted no later than sixty (60) calendar days from the date of service. Any billing invoices submitted by the contract agency that are over sixty (60) calendar days from the date of service will not be processed for payment.

Services may be provided on the designated Mecklenburg County holidays, but is not required. If services are needed and provided, the agency may bill accordingly.

If there is a discrepancy in the amount billed by the contract agency as compared to number of days and hours authorized by DSS, then DSS will notify the contract agency that payment is being withheld until documentation is provided to dispute such claim. If adjustments need to be made, the contract agency will be notified of any adjustments made, or to adjust their next invoice as necessary.

MONITORING

DSS will conduct yearly reviews of service provision by the contract agency. The program coordinator/supervisor and/or Q & T Specialist will monitor documents to ensure that the contract agency is following the terms of the contract agreement and AAA/DAAS requirements. Monitoring documents that DSS customers are being served in accordance with the service plan and receiving assistance with all assigned tasks. Monitoring also documents that customers are receiving quality services and adjusts service delivery as appropriate.

Monitoring will be completed through use of the monitoring tools, which are included in the forms section of the manual.

For time slip audits, the documentation in the file must reflect the actual time it takes for the In-Home aide to complete the authorized / assigned tasks. If at anytime the tasks billed by the contract agency are not justified by the documentation, which includes signed IHA timeslips, then the contract agency will be assessed a penalty of $25.00 for each occurrence and overpayment will be recouped. Penalty payments and overpayment will be deducted from the next monthly billing.

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CASE CONFERENCE

In certain situations, it may become necessary to have a case conference where there is a question as to the appropriateness of In-Home Aide Services. These situations may involve customers who are bedridden with little or no social support system or situation in which there are safety issues for the customer or aide. Although the customer has a right to self-determination, DSS needs to ensure that the customer is not being supported in an environment that may prove to be unsafe for their well being.

The case conference can be initiated by any of the parties working with the customer, including the contract agency. Present at the staffing will be the social worker, the social worker’s supervisor, and the In-Home aide (if possible), and the In-Home aide’s supervisor. The parties involved in the case conference will make recommendations as to the continued need to service the customer in his/her present environment with In-Home Aide Services, or whether the customer needs to consider other options for his/her care.

CONSUMER CONTRIBUTION

Some customers receiving In-Home Aide Services are eligible for cost sharing under state funding policies. These policies require that the cost sharing program be explained to customers, and a suggested contribution based on the customer’s income be calculated. The program asks customers to make a contribution towards the cost of providing In-Home Aide Services. The social worker assigned to the customer has responsibility for discussing cost sharing and explaining how contributions may be made. If the customer is unable to contribute to the cost of the service, services will still continue to be provided to the customer. Contract Agencies have no responsibility for asking customers to participate in the cost of providing services.

CONFIDENTIALITY

The contract agency is expected to comply with DSS confidentiality regulations with regard to protection of customer information. Any information about a customer must be kept in strict confidence and used only in the capacity of specified responsibilities. The information should not be released to any person not authorized to receive the information. The contract agency needs to ensure that all employees assisting with DSS customers agree to keep information in strict confidence and use the information only in the performance of his/her duties.

TERMINATION OF CASE RECORDS

When it becomes necessary to end In-Home Aide Services for a customer due to notification from the social worker that services are no longer needed, DSS will notify the contract agency to close its case record on the customer. The contract agency must maintain all program records for a period of seven (7) years from the date of final payment for inspection by DSS, the Area Agency on Aging, the Division of Social Services or any of their duly authorized representatives.

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In the situation whereas the Contract is terminated OR the Agency is no longer in business, copies

of the DSS client records must be made available to the Department. Forms which are to be

provided include: Client Service Plans; IHA Timesheets; CNA Competencies; and verifications of RN supervision of CNA.

REFERRALS TO DSS

Contract agencies may become aware of situations in which a person may be eligible for, or may wish to request services from the Department of Social Services. If so the contract agency or the person needing services may make a referral to DSS by calling Just 1 Call (704) 432-1111. The caller will be asked by the Just One Call Social Worker to give a description of the services or type of assistance being requested and if it needs to be screened for APS services.

If the service being requested is offered through DSS, the social worker will contact the applicant and schedule a home visit to complete the social work assessment. If the applicant is eligible for DSS In-Home Aide Services and funds are available, the social worker will develop a service plan with the applicant for the provision of services, and establish goals for solving problem areas. The social worker continues to monitor the service plan to ensure that services are meeting the needs of the customer.

Services offered for adults through DSS include:

← Community Social Work Services – provides assistance with obtaining medical care,

Accessing community resources, case management; long term planning; crisis intervention.

← In-Home Aide Services and Adult Day Care Services – provides vendor services in an effort to keep clients aging in place

← Adult Protective Services – offers protection plans for the elderly and/or persons with disabilities who are abused, neglected, or exploited;

← Senior Nutrition – provides meals and opportunities for socialization for the elderly;

← Transportation – provides transportation to places such as Senior Citizen’s Nutrition sites, adult day care centers and medical appointments.

← Guardianship – acts as a court appointed guardian for adults who have been adjudicated incompetent by the courts and have no one else to serve in that role.

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REPORTING ABUSE, NEGLECT, OR EXPLOITATION

Contract agencies must report immediately any allegations that an adult with disabilities has been abused or neglected (by self or caretaker), or exploited to the Mecklenburg County DSS.

An adult with a disability is anyone over age 18 and physically or mentally incapacitated by their disability.

Abuse is defined as the willful infliction of physical pain, injury, mental anguish, unreasonable confinement or willful deprivation by a caretaker of services, which are necessary to maintain mental and physical health.

Self neglect involves an adult with disabilities living alone and without a caretaker and who is not able to provide necessary services to maintain his/her mental and physical health.

Caretaker neglect is defined as the failure of the caretaker to provide services necessary to avoid physical harm, mental anguish or mental illness to the disabled adult.

Exploitation is the illegal or improper use of an adult with a disability or his resources for another’s profit or advantage.

All allegations of abuse, neglect or exploitation must be reported to DSS by calling the Just 1 Call number at (704) 432-1111. Information needed at the time of referral is:

◆ Name and address of customer

◆ Age or date of birth

◆ Caregiver’s name (if any)

◆ An explanation of the situation and why you feel the person needs protection

◆ Mental or physical condition of the adult

◆ Names of others who may help provide information regarding the situation (if available)

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INSTRUCTIONS FOR COMPLETING IN-HOME AIDE SERVICE PLAN

The DSS social worker is responsible for completing the social work assessment to determine the customer’s need for In-Home Aide Services. The social worker then initiates the In-Home Aide Service Plan, which includes support information and general tasks need to be completed and the clients ADL/IADL limitations.

The IHA agency will indicate the Specific service schedule, which should include the number of days per week the service will be given and the number of hours per day needed to complete the tasks, which are authorized by the DSS supervisor. The contract agency must notify the DSS Social Worker of the date when services will begin for the customer, prior to the actual provision of services.

If the contract agency notifies the social worker that more time is needed for tasks to be completed, the Social Worker will evaluate to determine if the increase can be authorized. If the increase is not authorized, the DSS Social Worker will notify the contract agency of the reason for the denial.

The contract agency is responsible for ensuring that the customer has a copy of the contract agency’s plan of care, which lists the specific tasks that will be performed. Contract agencies must notify the Social Worker of the frequency of service provision and the number of hours per visit that has been recommended for the customer in order to obtain authorization prior to the delivery of services. If during the course of service, the agreed upon time/tasks cannot be met by the agency over a period of 5 calendar days, the agency will inform the DSS SW. The SW and agency will evaluate any trends and adjust as needed.

Personal Care tasks: Allowed 3 time/week unless client is incontinent or bedbound, or otherwise discussed and agreed upon. This will be implemented for new clients admitted after July 1, 2016

Home Management: Cleaning will be done 1/week with some exceptions (client is blind, has severe allergies). IHA is not to clean up after pets in client’s home. Paying bills will be limited to assisting the clients in writing checks, purchasing money orders, mailing payments. Aide will not go out and pay bill in person. These will be implemented for new clients and existing clients at time of annual assessment.

Shopping: Aides will not transport clients, but may assist with essential errands, such as grocery shopping and retrieving medications. Aides may assist clients in preparation of a grocery list and can purchase items at the nearest grocery store. The payment must be in cash or check. This task may be performed 1/week. Aides may pick up prescription(s) for a client. The payment must be with cash or check. This task may be performed no more than 2/month with minimal exceptions. This will be implemented at time of annual assessment.

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Shelters: The Agencies will provide IHA staff when necessary for any Mecklenburg County Special Needs Shelter when called upon. The Agency will invoice DSS on a separate tab on their invoice sheet and DSS will authorize payment at the contracted rate.

APPENDIX FORMS

IN-HOME AIDE MONITORING TOOLS

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NC DAAS IN-HOME AIDE MANUAL services/in-home-aides

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