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Special ProcessesSupplemental ResourcesTable of ContentsThis document contains the forms, tables, lists, and websites that were either displayed or referred to in the Special Processes for services training module. This document also contains additional resources to aide new WSCs in gaining the skills necessary to effectively coordinate the supports and services for individuals on their caseload. Supported Living3Medications32Supported Employment34Consumer Directed Care Plus (CDC+)36Supported LivingThrough supported living arrangements many individuals, even those with severe disabilities can live in their own homes, gain control of their lives, and become part of the community. Supported living is an opportunity for adults with developmental disabilities to choose where, how, and with whom they live. People receive personalized supports needed to maintain their own private home. Through supported living, individuals, even people with severe disabilities can receive supports to live in their own homes.In a person-centered supported living approach, each support or service is tailored to everyone’s unique preferences and requirements. Supports and services are adjusted in response to changes in life circumstances without requiring people to move to a new location or setting.People are not expected to demonstrate complete independence to participate in supported living. Instead, it is acknowledged that all adults should be able to live in their own homes in the community with whatever level of assistance is needed. An emphasis is placed on the development of non-paid supports, and people are encouraged to engage in natural, reciprocal relationships that focus on each person's abilities and unique gifts to the community.When clients are interested in moving into their own homes with supported living services, WSCs can help clients by providing information about:? types of supports and services available and needed? role of the supported living coach and other support providers who may be needed? options for living arrangements? how to plan; and? experiences of others who have received supported living services.Choosing a Supported Living Coach Choosing a Supported Living Coach who matches the needs and personality of the client is important. To select the appropriate coach, the client and legal representative, along with others the client chooses, can interview potential Supported Living Coaching providers. The WSC can facilitate the interview and provide a list of available Supported Living Coaches who the client may wish to interview. Although a set of interview questions is not required, it is one tool a WSC can provide to clients to help with this process. The following page includes some sample of interview questions for a Supported Living Coach. In addition to an interview, clients can request a copy of the Supported Living Coach’s references and resume if they desire more background information. SampleSupported Living Provider Interview FormatAgency:____________________ Interviewee:_______________________Date:______________________1.How much experience do you have working with people in supportedliving?___________________________________________________________________________________________________________________________________________________________________________________________________________________2.How many people do you currently assist?____________________________________3.What is your background/experience?________________________________________________________________________________________________________________________________________________________________________________________________________________________4.Where is your office located?__________________________________________________________________________________________________________________________________________________________________________________________________5.Do you provide the coaching service or do you have staff that work for you? Please checkone: Provide Service ? Staff provide service ?6.How many people does each person support? ___________________________7.How do I get in touch with you if I need you?Phone No.:_________________________8.How can I reach you in an emergency?Emergency Phone No.__________________________9.How long will it typically take you to respond?_______________________________________________________________________10. What happens if you or the person working for you cannot make it? What is your back upsystem?________________________________________________________________Sample Supported Living Coach Interview Page 1 of 2Supported Living Provider Interview Format (continued)11. How will you respect my choices?______________________________________________________________________________________________________________________________________12. How do you train your staff?_______________________________________________________________________________________________________________________________________________________________________________13. If I am not happy with your services or the services of your staff, what do I do?_____________________________________________________________________ _____________________________________________________________________________________________________________________________________14. How will you assist me in selecting my home? ________________________________________________________________________________________________________________________________________________________________________________________________15. What types of things will you help me with?__________________________________________________________________________________________________________________________________________________________________________________________________________________16.What are your connections in this community? _________________________________________________________________________________________________________________________________________________________________________17. How will you help me to get to know my neighbors?___________________________________________________________________________________________________________________________________________________________________18. Can you provide at least 3 references of people you are currently serving whoI may contact? Yes________ No _________Sample Supported Living Provider Interview Form Page 2 of 2Choosing Housing for Supported LivingThe WSC is the client’s primary contact to access services and supports. The Supported Living Coach helps the client survey a prospective home to ensure that it is safe to inhabit. To ensure that the housing selected by the client meets housing standards, the Supported Living Coach completes the Housing Survey form. The Supported Living Coach forwards the Housing Survey to the WSC for review. Before clients move into their own home, the WSC must visit the home to ensure health and safety standards are met and that the home meets acceptable standards as outlined in the Housing Survey. This should occur before the client signs the lease agreement. The survey must be updated quarterly by the Supported Living Coach and made available for review by the WSC at the time of quarterly home visit. This quarterly update must include a review of the individual’s current health, safety, and well-being. It is the WSC’s responsibility to update the survey on a quarterly basis in the absence of a Supported Living Coach.The Housing Survey form is on the next page. SUPPORTED LIVING SERVICES INITIAL HOUSING SURVEYNAME __________________________________________________ ADDRESS________________________________________________ _________________________________________________________ DATE OF SURVEY__________________________________________ MOVE IN DATE_____________________________________________ (If before date of survey, explanation must be included) ___________ Individual’s name is on the lease/mortgage ____________ Copy of the lease has been placed in individual’s records at HSNF office. ____________ The dwelling is located in an area which accounts for no more than 10 percent of the houses or 10 percent of the units in an apartment complex. ____________ No more than two other people who have developmental disabilities reside in the home ____________ Flush toilet in separate bathroom, in working condition ____________ Fixed basins (kitchen and bathrooms) with hot & cold water, in working condition ____________ Shower or tub with hot and cold water in working condition ____________ Bathroom has at least one opening window or exhaust ventilation ____________ Water from hot water heater not more than 120 F ____________ Non-skid surfaces are present in all bath tubs and shower stall floors. (Removable rubber mats or adhesive strips are acceptable). ____________ Suitable place to store, prepare, and serve food in a sanitary manner ____________ Garbage can/bin Initial Housing survey (cont) _____________ Stove or range of appropriate size, in operating condition _____________ Refrigerator of appropriate size, in operating condition _____________ Kitchen sink with hot and cold water _____________ A portable fire extinguisher is located in the kitchen _____________ Sink drains into approved public or private system _____________ Separate living room and at least one bedroom _____________ Safe heating and cooling that reaches all rooms (unvented room heaters that burn gas, oil, kerosene not acceptable) _____________ One operative window in each living and sleeping room _____________ Window dressings are adequate to maintain privacy _____________ At least two electric outlets in the living area, kitchen, and each bedroom _____________ At least one smoke detector is mounted in an appropriate location and functions (fresh batteries) _____________ No serious defects in interior/exterior walls, ceiling, or floor; floor should not move when walking _____________ No visible safety hazards are apparent, including empty light sockets, frayed cords or wires, or discoloration around electrical sockets _____________ Roof structure is firm _____________ No danger of tripping in stairways, halls, porches, walkways _____________ Free of dangerous levels of air pollution from carbon monoxide, sewer gas, fuel gas, dust, etc. ____________ Air circulation adequate throughout ____________ Water supply free of contamination ____________ Alternate means (doorway for individuals using a wheelchair) of escape available in case of a fire ____________ Handicap facilities are available and accessible for individuals using a wheelchair ____________ If required, grab bars are mounted in appropriate locations ____________ Free of lead base paint 3 ___________ Elevator is safe, operating condition (if applicable) ___________ Free of rodent infestation ___________ Neighborhood free of health hazards such as dangerous walk steps, poor drainage, sewage hazards, abnormal air pollution, excessive accumulation of trash, rodent infestation, or fire hazards ___________ Unit able to be used freely and maintained without unauthorized use by other individuals Any other comments regarding the individual’s housing that should be considered: Waivers requested (if any)_____________________________________________ Date waiver requested __________ Date waiver approval received ____________ (copy of approval must be attached) Supported Living Coach Signature______________________________________ Date __________ Support Coordinator Signature _________________________________________ Date __________Financial Planning and Supported Living An important aspect of transitioning into supported living is financial planning. A Supported Living Coach will work with the client to complete the Financial Profile form. The Financial Profile is an analysis of household costs and revenue sources associated with maintaining a balanced monthly budget. The Financial Profile is used to substantiate the need for a monthly subsidy or initial startup costs from APD, should they be needed. In-home subsidies may be one-time startup or ongoing, depending on the financial needs of the client. The Individual Financial Profile is the source of information for determining strategies for assisting the person with money management. The supported living provider helps the individual complete the Financial Profile and submits it to the WSC for review within ten (10) days of housing selection. Subject to the availability of funds and other criteria, APD can approve an in-home subsidy, which provides financial assistance to help someone to live in their own home. If a client will need an in-home subsidy from APD, the Financial Profile is required for submission and approval before the person signs the lease agreement. The Financial Profile form is located on the next page. Financial ProfileDate |Name| Address|Number of roommates sharing expenses| |Personal Supports Y or NSavings Account balance |as of:Checking Account balance |as of:Monthly Income ReceivedStaff Person Assisting in Profile Completion|EmploymentSSISocial Security Representative PayeeVA Benefits Food StampsOther (specify)Total Monthly Income:Projected Monthly ExpensesSee Attachment “A” for Personal Supports/RoommatesHousingRent/Room & BoardUtilitiesTelephone Cable TVGarbageLawn ServiceOther (specify) Housing Subtotal:|FOOD/HOUSEHOLDTRANSPORTATIONPersonalEntertainmentClothingPersonal ItemsHealth RelatedInsurancePaid RoommatePaid NeighborSpending Money @ $ /week:Laundry Money :Other (specify): Personal Subtotal:| Total Monthly Expenses:|Comparison of Monthly Income with Projected Monthly ExpensesTotal Monthly: |Total Monthly Expenses: | Monthly Income minus Monthly Expenses: |To meet projected expenses, present monthly income will be: |Sufficient| |Insufficient|Start -up ExpensesComparison of Share Start-up Expenses for Personal Supports/RoommatesPersonal SupportsIndividualRoommate 1Roommate 2Total ExpensesA.First month rentB.Last month rentC.Security depositD.Electric DepositE.Electric hook-upF.Telephone depositG.Telephone hook-upH.Cable installationI.FurnishingsJ.Household suppliesK.Pantry stocksL.Moving costsM. Other (specify)Total Start-Up ExpensesComparison of Available Funds with Projected Start-up Expenses for IndividualSavings Account Balance:Checking Account Balance:Subtotal-Funds Savings and CheckingBalance:Amount needed to meet any financial obligations prior to move: |Subtotal-Funds available (Savings and Checking minus financial obligations)|Amount to remain in savings account for emergencies, etc. (living expensesFor 2 months is suggested):Subtotal-Funds available minus Emergency Funds:Total Start-up Expenses|Total Start-up funds requested|A positive total represents surplus savings for the individual and no start-up grant should be needed.Negative total represents the maximum amount of start-up funds by the individual.Individual Start-up and Monthly Subsidy Recommendations____Based on the figures above, a start-up grant of ___________ is recommended for ____________20__ (year)____Based on the figures above, a monthly subsidy of _________ to commence in _________20__ (year) is recommended____ Based on the figures above, monthly income and other personal financial resources are sufficient to meet both start-up and monthly. No financial assistance is requested at this time.Signatures:Individual:______________________/Guardian:_______________________________Supported Living Provider:_________________________________________________ Date Submitted to Support Coordinator:______________Support Coordinator ______________________________________ Date returned to Supported Living Provider: ____________Guardian/Advocate _______________________________________________________District/Region Office: Start-up Grant ____ Denied ____ Approved for $ __________ Monthly Subsidy _____ Denied _____ Approved for $___________ Authorizing signature______________________________________________ATTACHMENT “A”Comparison of Shared Monthly Expenses For Personal Supports/RoommatePersonal Supports will pay $____________toward rent (an equal proportion of rent and utilities)The individual/roommate(s) is/are responsible for the balance of the rent and all of the utilities.Receipts and expense forms will be maintained.Personal SupportsIndividualRoommate 1Roommate 2Total ExpensesHOUSING:1.Rent/Room &Board2.Utilities3.Telephone4.Cable TV5.Garbage6.Lawn ServiceOther (specify)HOUSING Subtotal:FOOD/HOUSEHOLDTotal Monthly Shared Expenses:NOTE TO SUPPORT COORDINATOR: Please return pages 1 and 2 (with your signature) to the Supported Living provider as soon as possible. Pages 1-3 are to be submitted to the Regional Office. Return page 3 to the Supported Living Provider after the Regional Office has approved or denied start-up subsidy request.AHCA Form 5000-3557, September 2015 (incorporated by reference in Rule 59G-13.070)Health and Safety Checklist The supported living provider assists the individual in completing the Health and Safety Checklist, which is intended to assess potential health and safety concerns in the home. When helping a client transition into supported living, the WSC will, along with the client and supported living provider, review the Health and Safety Checklist, Financial Profile, and supported living provider’s implementation plan to help the client have a smooth transition into their new home. During the required quarterly meeting for supported living clients, the WSC will review the Health and Safety Checklist with the Housing Survey to determine if there is a need for follow-up with unresolved issues or if changes are needed.The Health and Safety Checklist is on the next page.Health and Safety ChecklistName:Address:City: | State: |Zip:Phone: |EMAIL:Support Coordinator:Agency:Address:City: |State: |Zip:Phone:Date of Review: |The neighborhood is free from disturbing noises, reverberations, and health hazards such as adverse environmental conditions, dangerous walks and steps, instability, flooding, poor drainage, septic tank backups, sewage hazards or mudslides, abnormal air pollution, smoke or dust, excessive accumulation of trash, or fire hazards Y N N/ANo danger of tripping in stairways, halls, porches, or walkways Y N N/AResidence is free of vermin, rodents, or insect infestations Y N N/AResidence is free of maintenance issues such as a leaky roof, loose door knobs, torn screens, etc. No major defects in the walls, ceiling, or floors (floors do not move when walking) Y N N/AResidence is free of unpleasant odors such as urine, sewage, or mold Y N N/A There are no visible safety hazards such as empty light sockets, frayed electrical cords, discoloration or exposed wires at electrical outlets, or excessive use of extension cords Y N N/AIf dwelling was built before 1978 and houses children 7 years or younger, there has been an inspection for lead based paints Y N N/ADoors open, latch, and lock properly. Exterior doors have deadbolts. Locks that are present can be easily manipulated by the consumer Y N N/AThere is at least one window in each living and sleeping area. Windows have screens and locks that are easily manipulated by the consumer. Windows have adequate coverings to provide with needed privacy Y N N/ABathroom has at least one opening window or exhaust fan Y N N/AFloor coverings are appropriate, acceptable, and safe (there is no danger of tripping) Y N N/AQUARTERLY HOME SAFETY, AND HEALTH REVIEW, page 2Consumer Name:Date of review: There are at least two electrical outlets (one can be overhead) in the living area, kitchen, and each bedroom Y N N/AThere is a ceiling or wall mounted light fixture in the kitchen and bathroom Y N N/AThere is adequate lighting throughout the residence to carry out normal activities Y N N/AThere is adequate and functional heating and cooling with adequate ventilation (unvented room heaters that burn gas, oil, or kerosene are not acceptable) Y N N/AThe residence is free from dangerous levels of air pollution from carbon monoxide, sewer gas, fuel gas, dust etc. Y N N/APlumbing is in good working order with a flushing toilet in a private bathroom with a fixed basin and tub or shower, both with hot (not over 120 degrees F) and cold water. Kitchen sink is present with both hot (not over 120 degrees F) and cold water Y N N/AWater supply is free from contaminants Y N N/ANonskid surfaces are present in all bath tubs and showers. If tub/shower does not have a nonskid surface, removable rubber mats or adhesive strips are acceptable Y N N/A If appropriate, the grab bars are mounted in appropriate locations Y N N/A Kitchen has suitable space to store, prepare, and serve food in a sanitary manner. Stove and refrigerator are present and in working condition (all burners on gas stove function, pilot lights are lit, and no gas odor is present). Y N N/AGarbage can/bin is present Y N N/AFirst aid kit is complete and available Y N N/AAt least one smoke detector is mounted in an appropriate place and functions Y N N/AA portable fire extinguisher is located in the kitchen and can demonstrate knowledge and ability to use it Y N N/AConsumer can identify closest fire exit and alternative exit and can identify procedures to follow in case of a fire Y N N/AConsumer has a plan in place to deal with hurricanes and other natural disasters Y N N/A Consumer understands causes and prevention of AIDS and other sexually transmitted diseases Y N N/AReview with consumer “Notice of On Call System” form Y N N/AConsumer has emergency numbers readily accessible Y N N/AReview with consumer “Grievance Procedure” form Y N N/AConsumer expresses satisfaction with service as currently provided Y N N/AQUARTERLY HOME SAFETY, AND HEALTH REVIEW, Page 3Consumer Name:Date of Review:Provide an explanation of an “N/A” responses:Provide an explanation of a “No” responses. Include a specific plan to address with a target completion date:QUARTERLY HOME SAFETY, AND HEALTH REVIEW, Page 4Consumer Name:Date of Review:CURRENT MEDICAL PROVIDERS:(Provide the address and contact information for new providers only)Physician:Specialty:Address:City | State: |Zip:Phone: |Fax:Physician:Specialty:Address:City | State: |Zip:Phone: |Fax:Physician:Specialty:Address:City | State: |Zip:Phone: |Fax:Physician:Specialty:Address:City | State: |Zip:Phone: |Fax:CURRENT MEDICATIONS:Name: |Dosage: |Frequency:Prescribing Physician:Reason for Medication:Name: |Dosage: |Frequency:Prescribing Physician:Reason for Medication:QUARTERLY HOME SAFETY, AND HEALTH REVIEW, Page 5Consumer Name:Date of Review:Name: |Dosage: |Frequency:Prescribing Physician:Reason for Medication:Name: |Dosage: |Frequency:Prescribing Physician:Reason for Medication:Name: |Dosage: |Frequency:Prescribing Physician:Reason for Medication:(Provide address and contact information for pharmacist only if new provider)Pharmacist:Pharmacy:Address:City: |State: |Zip:Phone: |Fax:MEDICAL VISITS:ExaminationsRecommended FrequencyLast AppointmentNext AppointmentPhysicalAnnualDentalSemi-AnnualEye examAnnual (Bi-annual if no glassesTetanusEvery 10 yearsProstrate (Male)AnnualPap Test (FemaleAnnualMammogram (Female)AnnualMEDICAL VISITS (Continued):Other Examinations:Date:Reason for visit:QUARTERLY HOME SAFETY, AND HEALTH REVIEW, Page 6Consumer Name:Date of Review:MEDICAL VISITS (Continued):Other Examinations:Date:Reason for VisitRELATIONSHIP MAP (USE OF NATURAL AND GENERIC SUPPORTS)Name: |Relationship:Address: |Phone:Type of Support:Name: |Relationship:Address: |Phone:Type of Support:Name: |Relationship:Address: |Phone:Type of Support:Name: |Relationship:Address: |Phone:Type of Support:Name: |Relationship:Address: |Phone:Type of Support:SL Coach Signature/Date:Consumer Signature/Date:Roles and Responsibilities in Supported LivingRegardless of where the client lives, WSCs are responsible for helping the client identify services and supports necessary to ensure health and safety and coordinating those supports. This is particularly critical for individuals in supported living since they may be moving from a family home where there were natural supports readily available or a licensed facility with around the clock supervision. Working TogetherTips for Collaboration Between Waiver Support Coordinators and Supported Living CoachesBe Partners: Work together to support the client in achieving his or her goals.Be Flexible and Creative: Preferences and needs will vary from person to person as will the roles of providers. Together, search for non-traditional resolutions to problems and creative ways to establish and maintain support arrangements. Maintain as much flexibility as possible within the parameters of state and federal laws, rules, regulations, and guidelines.Work it Out: Address and discuss areas of uncertainty. Identify possible areas of duplication and how they will be handled. Example: The Waiver Support Coordinator and the Supported Living Coach work hand-in-hand to ensure people maintain eligibility for benefits (such as Social Security, Medicaid, etc.). There should be a clear understanding between all parties so that efforts are not duplicated, or necessary activities overlooked.Write it Down: The Support Plan is the guiding document for supports and services authorized on the cost plan. The expectations of the Supported Living Coach, Waiver Support Coordinator and as other providers should be clearly specified in the Support Plan. The Support Plan changes and is revised over the course of the year as the needs and desires of the individual change. It is a fluid document reflecting the person’s desired outcomes, scope of service, and current municate: Be sure the client knows who to contact for assistance in certain situations and with certain tasks (i.e. Medicaid problems, emergency assistance, etc.).The Assignment of Duties and Responsibilities for Serving Clients in Supported Living is a tool that the WSC can use to help make sure that the details of supports and services are carefully considered and that each support team member acknowledges and accepts responsibility for ensuring the client’s health and safety needs are met. The Assignment of Duties and Responsibilities for Serving Clients in Supported Living can be found on the next page. Agency for Persons with Disabilities – Best Practice ChecklistAssignment of Duties and Responsibilities for Serving Clients in Supported LivingJune 2017Consumer: _____________________ Address: __________________________________ Phone#: __________________Support Coordinator/Contact Info: _____________________________________________________________________Supported Living Coach/Contact Info: ___________________________________________________________________Personal Support Provider/Contact Info: _________________________________________________________________Other Support Team Member/Contact Info: ______________________________________________________________Other Support Team Member/Contact Info: ______________________________________________________________Other Support Team Member/Contact Info: ______________________________________________________________Support Coordinators are responsible for helping the client identify services and supports necessary to ensure health and safety as well as coordinating supports and services identified by the client and the support team. This tool can be used to help ensure that the details of supports and services are carefully considered and that each support team member acknowledges and accepts responsibility in ensuring the client’s health and safety needs are met. Meetings to review these duties and responsibilities should be held prior to the client moving into SL and at least annually, but as often as quarterly, thereafter. All support team members should initial/date acknowledgement of assigned duties and be furnished a copy of the completed form. When completing the assignments the support coordinator will indicate with a “1” the person with primary responsibility and indicate with a “2” the person who has back-up responsibility for each task.PLANNING and ARRANGING MOVE TO SUPPORTED LIVINGSCSLCPSOTHER -SPECIFYIdentify supports/services needed to live in supported living.Identify natural and community supports.Assist consumer to apply for food stamps, housing subsidies, etc.Assist consumer to choose paid providers.Ensure funding is in place for paid plete Functional Assessment.Assist consumer to locate safe, affordable housingComplete Housing Survey.Review Housing Survey prior to move.Assist consumer to sign lease agreement.Maintain copy of lease agreement.Arrange for PS, EAA, DME, CMS, nursing, behavioral services, meaningful day activity etc. to be in place the day of the move.Ensure electric, gas, water, phone deposits are paid and services connected prior to move date.Assist consumer to select/obtain furnishings, household items and food.Assist consumer to open bank account.Assist consumer to secure ID card.Assist client to report change of address to SSA, ACCESS, post office, etc.Arrange medical providers if move to new community.SCSLCPSOTHER -SPECIFYObtain copies of medical records if move to new community.Ensure supply of meds and new prescription if move to new communityMake arrangements for actual move.Assist consumer to pack belongings.Move belongings.Assist client to unpack/arrange belongings and furnishings.Ensure all belongings are made readily accessible to consumer.Program phone, provide emergency numbers, train consumer how to access in case of emergencyTest and train in use of smoke detectors/fire extinguishers.Obtain/maintain extra keys.Show client around new neighborhood.Assist client to meet new neighbors.Review community safety precautions.Update data base with change of address/program component.Other:Other:Other:DISASTER PREPAREDNESSSCSLCPSOTHER -SPECIFYComplete Disaster Plan for Persons in Supported Living.Provide copies of Disaster Plan to consumer, support team members, APD.Register for Special Needs Shelter, if plete Emergency Communicator and ensure it is kept current.Ensure that specified shelter in place supplies are kept stocked in the home.Build specified disaster drive-away kit and ensure it is kept stocked.Ensure Emergency Communicator is stored in disaster drive-away kit.Provide training in these specific areas of disaster preparedness: Specify- Specify-Other:FINANCIALSCSLCPSOTHER -SPECIFYAssist client to ensure all applicable public benefits are in place.Identify rep payee if applicable.Serve as fiscal agent if applicable.Assist client to open/review and sort mail and bills.Assist client to budget money for payment of bills.Assist client with banking.Assist client to pay bills.Assist client to write checks.Assist client to write entries in check register.Assist client to reconcile checkbook with monthly bank statement.Assist client to obtain spending money.Assist client to keep track of how spending money is used.Review bills for late payments and/or added charges/feesReview mail for unexpected bills. SCSLCPSOTHER -SPECIFYAssist client to review checkbook and bank statements for unusual purchases/charges.Maintain required receipts for SLS.Submit required receipts with SLS invoice.Assist client to obtain credit report at least once per year.Assist client to save copies of pay stubs for all earned incomeAssist client to report all earned income to SSA.Assist client to file tax return.Provide training to client in these specific financial-related areas: Specify - Specify- Specify-Other:Other:HEALTHSCSLCPSOTHER -SPECIFYServe as health care coordinator if applicable.Assist client to fill prescriptions and obtain refills.Determine client’s need for assistance with med administration.Obtain annual Authorization of Med Administration from client’s physician.Identify trained and validated medication administration assistance providers as appropriate.Obtain “Informed Consent for Medication Administration” as appropriate.Obtain from physician specific instructions for OTC and prescribed PRN meds.Set up monthly MAR .Maintain copies of all prescription orders.Update MAR as med changes occur.Correctly complete MAR as meds are administered.Review MAR for accuracy and correct/timely administration.Count controlled medications at ____________intervalsEnsure meds are correctly stored.Dispose of expired and/or discontinued meds in accordance with approved protocolsComplete and submit Medication Error Reports.Track and report to person responsible for refills at least 5 days prior to running out.Track and report to SC whenever there is less than a two day supply of meds on site.Set up and maintain system to ensure all prescriptions are timely filled.Ensure meds are properly prepared/labelled/transported for dispensing by meaningful day activity provider.Assist client to schedule all medical, lab and dental appointmentsAssist client to arrange transportation to medical, lab, therapy and dental appointments. Assist client to communicate with health care providers at routine medical, lab, therapy and dental appointments.Assist client to communicate with health care providers at non-routine/specialist appointments.SCSLCPSOTHER -SPECIFYObtain reports from all medical/lab/hospital/therapy services.Obtain from physician specific instructions regarding recommendations and restrictions for diet and exercise.Provide follow-up to ensure client understands and follows physician orders.Report results of all medical, lab, dental appointments to SC.Provide to SC physician recommendations/restrictions related to diet and exerciseEnsure results and recommendations from all medical, lab, dental services are effectively communicated with support team members as appropriate.Maintain accurate and current record of all medical services – medical, lab, dental, therapy, emergency, hospital, etc.Update SP, Implementation plan to reflect changing health care needsEnsure support team members are informed and kept current regarding health care needs.Arrange for training for responsible staff with regard to carrying out orders and recommendations from physicians, therapists, etc. Update Emergency Communicator with current medical information (see Disaster Planning)Maintain in the home a current accurate list of all medical, dental and pharmacy providers with contact informationIdentify how the consumer communicates health issues, including subtle signs.Observe daily for signs/symptoms of ill health, pain, discomfort, unusual behavior, etc. Report to health care coordinator whenever there are signs/symptoms of ill health, pain, discomfort, unusual behavior (note: this does not negate the responsibility for all providers to immediately calling 911 in the event of emergency/acute need).Contact Region to request medical case manager consult as appropriate.Contact Region to request participation in consumer staffing as appropriate.Provide training to consumer in these specific health-related areas: Specify- Specify- Specify-Other:Other:PERSONAL CARE NEEDSSCSLCPSOTHER -SPECIFYProvide assistance with eating, toileting, hygiene, oral hygiene and bathing as needed.Provide assistance with grooming including hair styling, nail care, shaving and make-up as needed.Provide assistance with transfers, positioning and ambulation as needed.Provide assistance with clothing selection and dressing as needed.Assist consumer to engage in physician-recommended exercise routine.Assist consumer to follow physician recommended diet.Carry out orders from physicians and therapists with regards to positioning, range of motion, exercise, etc.Assist consumer to schedule and access barber, beauty salon as neededSCSLCPSOTHER -SPECIFYAssist client to utilize durable medical equipment, adaptive equipment and personal technology needed for ambulation, positioning, communication, environmental control, etc.Assist client to maintain and clean durable medical equipment, adaptive equipment and personal technology needed for ambulation, positioning, communication, environmental control, etc.Provide training to consumer in these specific personal care areas: Specify- Specify- Specify- Specify- Specify - Specify-Other:Other:HOUSEHOLD CARE and MAINTENANCESCSLCPSOTHER -SPECIFYAssist with meal planning.Assist with meal preparation.Assist with cleaning and maintaining all areas of the home including walls, floors, appliances, counters, storage areas, bathroom fixtures, furnishings, etc.Assist the client to keep the living areas safe and free from clutter and safety hazards.Ensure that outdated and/or spoiled food is discarded from refrigerator, freezer and kitchen cabinets.Ensure that garbage is placed in outside receptacles daily.Ensure that that discarded/unusable household items are properly disposed of.Assist with laundry, clothing care, clothing maintenance and clothing storageAssist with changing light bulbs, water filters, A/C filters, etc.Arrange for routine pest control. Arrange for lawn care as appropriate.Identify and report needed home repairs.Contact landlord regarding home repair and maintenance needs.Provide training to consumer in these specific areas of household care and maintenance: Specify- Specify- Specify- Specify- Specify-Other:Other:SHOPPINGSCSLCPSOTHER -SPECIFYAssist client to prepare grocery list, including foods to meet special dietary needs. SCSLCPSOTHER -SPECIFYAssist client to shop for groceries.Assist client to put away/properly store food items.Assist client to prepare list of needed personal items.Assist client to shop for personal items.Assist client to put away/store personal items.Assist client to prepare list of needed household items.Assist client to shop for household items.Assist client to put away/store household items.Assist client to plan for clothing, non-routine and major purchases.Assist client to shop for clothing, non-routine and major purchases.Provide training to client in these specific areas related to shopping: Specify- Specify-Other:Other:MISCELLANEOUS SCSLCPSOTHER -SPECIFYAssist client to participate in recreational opportunities in the home.Assist client to access recreational opportunities in the community.Assist client to maintain contact with family.Assist client to access church services and activities.Assist client to access social functions/opportunities based on interests/preferences.Arrange training re: behavior services plan as applicable.Implement behavior service plan.Collect and report data related to behavior services plan.Other:Other:Other:I have reviewed and understand my responsibilities/assignments. I have received a copy of the completed/updated document._________________________ ______________ _____________ _____________ _____________ ____________Support Coordinator Dates/Updates_________________________ ______________ _____________ _____________ _____________ ____________Supported Living Coach Dates/Updates_________________________ ______________ _____________ _____________ _____________ ____________Personal Support Staff Dates/Updates_________________________ ______________ _____________ _____________ _____________ ____________Personal Support Staff Dates/Updates_________________________ ______________ _____________ ______________ _____________ ____________ Other (specify role) Date/Updates Supported Living Quarterly MeetingArranging the Supported Living Quarterly meeting is one of the required contacts for WSCs when serving clients in supported living settings. The WSC must attend the Supported Living Quarterly meeting with the client and the meeting must be at the client’s home. The WSC is required to invite the Supported Living Coach and Personal Supports providers. Required Activities During the Supported Living Quarterly MeetingWSC reviews client’s progress towards achieving support plan goals and determine if services are provided in accordance with the person-centered support plan.WSC reviews the Health and Safety Checklist and the Housing Survey to determine if there are any unresolved issues or areas requiring follow-up.If the client is receiving assistance with financial management from the Supported Living Coach, the WSC will review financial information, benefits, and health care information.If the client receives an in-home subsidy, the WSC will review the Financial Profile form to verify continued accuracy. The WSC must document the meeting in case notes. The WSC must notify the APD Regional Office of any unresolved issues within three (3) calendar days. The Supported Living Quarterly Checklist is a tool that can assist a WSC in conducting a thorough quarterly visit to ensure continued health and safety standards are being met. The Supported Living Quarterly Checklist can be found as an attachment to this document. MedicationsWSCs are required to maintain current information about the medications taken by clients in the support plan. WSCs need to know which medications a client takes and how the medication is administered. Some clients have their medications administered by service providers. Medication Administration for APD clients is governed by Rule Chapter 65G-7, F.A.C. A copy of this rule is provided for reference as an attachment to this document. WSCs must know this rule, its requirements, forms associated with the rule, and how it impacts medication administration. The provisions and requirements of 65G-7 can affect how and where services are provided to clients.The Medication Administration rule allows direct service providers who do not have a professional license (are not nurses, doctors, etc.) to administer medications and enteral formula (tube feeding). However, those individuals must complete required training and validation of their skills. When selecting Personal Supports, choosing a licensed facilities, or selecting other providers, consider whether the individual requires assistance or supervision with medication administration. If so, the provider must be trained and validated to administer medications in accordance with the Medication Administration Rule. The provider must have a validation certificate that is updated in accordance with the rule. If the WSC is unable to locate providers who meet the requirements to administer medications, they may contact the APD Regional Office. Please note, that when family members and friends assist a client with medications without compensation, they do not have to meet the rule requirements. Also, if a client resides in an Assisted Living Facility, the medication administration rule is not applicable while the client is at the Assisted Living Facility. However, it may be applicable when the client is receiving other waiver services in the community. Important FormsInformed Consent for Medication Administration WSCs may be involved in helping the client and legal representative understand the Informed Consent for Medication Administration form. Providers must a signed copy of the Informed Consent for Medication Administration form from the client and the client’s legal representative before assisting him or her with medications. When signing this form, the client acknowledges that they will receive medication assistance from an unlicensed direct services provider. The WSC may need to help obtain this form as it must be updated annually or when there is any change in facility provider or other provider agency.Authorization for Medication AdministrationAll clients must have an Authorization for Medication Administration form signed by the client’s physician, physician assistance, or advanced registered nurse practitioner on file. This form documents a client’s level of ability and need for assistance with medication.This document must be updated annually and upon any change in the client’s need for assistance. The WSC is responsible for assuring that all providers that assist a client with medications have an up-to-date copy of the authorization. This form documents the client’s need for assistance with medication administration or ability to self-administer medication without supervision. The WSC must maintain this form in the client’s central record. The Authorization for Medication Administration form must also be maintained at the client’s residence. When conducting visits in the client’s home, check that an up-to-date copy of the Authorization for Medication Administration form is available. The Authorization for Medication Administration form must be updated annually. However, sometimes a physician or other medical professional treating the client needs to update the form before the annual update. If a medical professional makes changes to the Authorization for Medication Administration form when a WSC is not present, providers must notify the WSC so that they can update the client’s record. WSCs should be mindful to see if changes occurred with the form when contacting clients after medical appointments. Why is the Authorization so important to the WSC??It tells the WSC about the client’s ability with medication administration. This information allows the WSC to ensure that chosen providers can meet the needs of the client.?If the client needs medication assistance around the clock, the client’s residential providers must have validated Medication Assistance Providers working around the clock.?If the client has a medication during daytime activities and requires assistance, the chosen day activity must have a Medication Assistance Provider available. ?If a client needs medication assistance and is fed through a Gastrostomy Tube (GT, aka PEG, JG tube or Mickey button), the WSC must make sure that unlicensed service providers working with the client are Medication Assistance Providers who have had further training and validation in Prescribed Enteral Formula Administration (PEFA). Supported EmploymentAPD is committed to increasing opportunities for clients to work in competitive integrated employment at or above minimum wage. WSCs are critical in helping clients understand the choice to work and how to achieve employment goals by creating a pathway to competitive employment. WSCs can help all clients, even those with the most challenging issues to have a job.The term, competitive integrated employment is defined in federal regulations. It means that the individual holds a job and is paid at least minimum wage or a salary that is customary for others who hold the same job and have similar experience. The individual is able to access the same benefits as other employees. The job is at a location where they interact with others who do not have disabilities in the community. As appropriate, the individual has the same opportunities for career advancement as other individuals without disabilities with similar jobs. Person-Centered Conversations About WorkingPerson-centered conversations about working are more than just asking a client if he or she wants a job. It is about finding out what is important to the individual. WSCs should find out where the client sees themselves in the future and help them develop a plan to get there. WSCs can learn about past experiences, fears, or barriers that the client has experienced related to working and help identify ways to overcome obstacles. Some individuals may not be ready to go to work immediately, and the WSC can help plan a path for readiness through post-secondary education, pre-vocational training, or vocational training. The plan is about identifying a target and creating opportunities. Asking an individual if they want to work is more than just referring the client for services through Vocational Rehabilitation or helping the client locate a job coach. The WSC should help the client and their circles of supports plan for all aspects of working. This includes transportation, back up plans, and ensuring that the individual is safe when they are working. Additionally, it is important for WSCs to help APD clients plan for and understand how working impacts Medicaid and other governmental benefits. Understanding Social Security Work Incentives is one way that a WSC can assist clients in this arena. WSCs can gain information on Social Security Work Incentives by completing required training on this topic. When clients have a job, WSCs are responsible for checking in with individual to see how the job is going. Find out if the person likes the job. Have they had a promotion, pay increase, or benefits changes? Do they need more training?There is no right, wrong, or one-size fits all conversation about employment. However, it is critical for WSCs to help clients and their families realize that competitive integrated employment at or above minimum wage is a possibility. Vocational Rehabilitation Referral The Division of Vocational Rehabilitation (VR) is the state agency responsible for helping individuals find competitive integrated employment. Since the waiver is the payer of last resort, the client must try to access employment services from VR before receiving waiver-funded supported employment services. For clients who are ready to work, the WSC should first initiate a referral to VR. Once VR services have ended or if the client is denied services through VR, the WSC can help the individual access Supported Employment services through the waiver. Helping Clients with VR ReferralsClients may be interested in learning more about how VR can meet their needs. WSCs can assist clients in viewing the VR orientation video that is posted on the VR website. Here is a link to the video: will need to sign an attestation of watching the orientation video. WSCs can help clients access the VR Attestation Form at this link: has offices around the state that service as points of contacts for individuals seeking VR services. WSCs can help clients connect with these offices at this link: interested in obtaining competitive integrated employment as part of their goals on their Person-Centered Support Plan must have their WSC complete a referral packet for VR services. The referral must include a complete referral form with the client’s demographic information and contact information of the person filling out the referral, recent pertinent assessments, a copy of the Person-Centered Support Plan with the client’s employment goals, and any other information related to employment exploration. The Referral to Vocational Rehabilitation form may be found on VR’s website at this link: (English) and (Spanish)Consumer Directed Care Plus (CDC+)Waiver Support Coordinators must first be certified to provide CDC+ Consultant services before serving a client in the CDC+ program. More information about the process and training requirements to become a CDC+ Consultant can be found online at the following link: Administration RuleSupported Living Quarterly Checklist ................
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