1. Service Coordination Quality Improvement Managed Long-Term Services and Supports Sub-Committee, MAAC January 6, 20161

2. Background DHS is committed to serving more people in the community In order to expand services in the community, quality – and participant health and welfare – must be assured Service Coordination is an important function that helps meet assurances for participant health and welfare, and quality January 6, 20162

3. Role of the Service Coordinator Role of the Service Coordinator: To assure that each participant’s assessed needs are being met – through waiver services or through non-MA services at the local level To assure that providers are providing services as ordered January 6, 20163

4. Role of the Service Coordinator (cont.) Service Coordination is a fundamental activity that can impact the success or failure of OLTL program participants to live in the community January 6, 20164

5. OLTL Program Changes and Activities Changes to OLTL programs in the last few years: Promulgation of regulations mandating conflict-free service coordination, SC and provider requirements Addition of new service coordination providers January 6, 20165

6. OLTL Program Changes and Activities OLTL activities related to Service Coordination: OLTL provided extensive training to service coordinators. In 2011, 2012 and 2013, 20 (twenty) face-to-face trainings were conducted in the field. Online training modules were provided with the expectation that agencies would use those resources for new staff. Provision of extensive technical assistance to service coordinators. January 6, 20166

7. Activities related to Participant Health and Welfare: Webinars for SCs and providers have been held focusing on how to mitigate participant health and safety risks and how to report suspected abuse and neglect. OLTL implemented the Enterprise Incident Management System. DHS Implemented of the Adult Protective Services Program. January 6, 20167 OLTL Program Changes and Activities

8. Quality Gaps and Deficiencies Through these activities, OLTL has identified gaps and deficiencies in service coordination: Lack of awareness of hospital and facility discharge requirements. Inappropriate follow-up on significant health issues. Failure to pro-actively address situations before they escalate. January 6, 20168

9. Quality Gaps and Deficiencies (cont.) Deficiencies in the Participant-Directed Model of Service Delivery Service notes fail to comprehensively document current situations as they evolve for participants, or the actions taken by the SC to address. OLTL has consistently provided extensive technical assistance in managing complicated situations. January 6, 20169

10. Extracts from Reports of Need Consumer was examined and found to have wounds up and down his back, butt, legs, and private area. Consumer was found by EMS laying in a urine soaked mattress and a caregiver was present. Consumer has open sores on her rear which are not taken care of or cleaned. These ulcers break open on the litter sheets during transport. Consumer has had several incidents with her catheter which has not been taken care of, and should have seen a doctor for. Catheter is constantly leaking. Catheter was blocked and back logged on other occasions. January 6, 201610

11. Extracts from Reports of Need Consumer has lost 60lbs in 4 months. Reporter stated that consumer has been seen on the street begging neighbors for food. Consumer states for the past week she has been laying in own urine and feces all day until 5pm when the home health worker arrives. …the home is without water and the heater is broken. Home does not have running water. Roof is covered with tarps. Water is in the home. Home is extremely cold. Coal stove in the home, but it doesn't produce enough heat. Mold in the home… January 6, 201611

12. Next Steps: OLTL is committed to providing additional training to service coordinators, both through face-to-face and on-line training OLTL has developed a participant survey tool that will help service coordinators to identify the signs of potential abuse and neglect proactively – the tool will be rolled out as funds become available January 6, 201612

13. Next Steps: OLTL believes that higher education and training standards are directly related to better documentation, participant health and safety and improved participant outcomes. CHC Requirements: SCs must be registered nurses or have a bachelor’s degree in social work, psychology or other related field and at least three years of experience in the coordination of services. SC Supervisors must be licensed social workers with at least 5 years of experience or a registered nurse with at least 5 years of experience. January 6, 201613