Presentation on theme: "Executive Office of Elder Affairs"— Presentation transcript:
1 Executive Office of Elder Affairs Home Care ProgramExecutive Office of Elder AffairsMay 2014
2 ELD Home Care Program Team Mary DeRoo – Director of Home and Community ProgramsSusan Tompkins-Hunt – Asst. Director Home and Community ProgramsBrenda Correia – Coordinator of Elder Community and Support ProgramsSandy Brown – Clinical Assessment & Eligibility RNCAE & Home Care RN ManagerDevon Garon– Waiver Program ManagerShannon Philbrick –Home Care Program CoordinatorQuality Manager
3 Brief history 27 Home Care Corporations (HCCs) established 1973-1975 Each with a unique geographic service areaCommunity based non-profits51% of board members must be aged 60+ASAP law passed in 1997 – c.19a§4bRequest for Responses (RFR) issued 2010; designation of 27 Aging Services Access Points (ASAPs)Statutory responsibilities of ASAPs:Information & ReferralClinical eligibility for Medicaid-funded institutional and community based careCare management and service coordinationAuthorization and purchase of servicesProtective Services
4 ASAPs perform many functions Information and ReferralNursing facility pre-admission screeningFunctional eligibility determinationsFinancial eligibility (Home Care Program)Needs assessmentCare plan developmentAuthorization of servicesMonitoring of service deliveryReassessmentProtective Services
5 Home Care ProgramsProvide 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).
6 Eligibility for Home Care 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/Over-Income 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.
7 State Home Care Programs Home Care Basic - a program for elders who:meet the Home Care enrollment eligibilityrequire assistance with I/ADLs.have an Average service cost per consumer is no more than $266/month. (Not a per person limit.)
8 State Home Care Program Respite Over-Income – a program that supports caregivers in meeting the needs of elders who:Meet the Home Care Program eligibility criteria of60 years of age (under 60 with a diagnosis of Alzheimer’s or related disorder)Residents of MassachusettsFunctional 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 eligibleAre not eligible for other programs
9 State Home Care Programs 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 eligibleMeet the Clinical eligibility criteria for nursing facility services (MH regulations 130 CMR )Not MassHealth Standard eligibleService plan cost of two times the level of services provided through Home Care Basic Non-Waiver.
10 Home Care Non-Waiver Services Personal CareHome Health AideSupportive Home Care AideRespiteCompanionSkilled NursingAdult Day HealthBehavioral HealthChoreEnvironmental Accessibility AdaptationsGrocery Shopping/Delivery ServicesAlzheimer’s/Dementia CoachingHome Delivered MealsHomemakerLaundry ServicesMedication Dispensing SystemHome Delivery of Pre-packaged MedicationNutrition Assessment/CounselingPersonal CarePERS/Enhanced PERSSupportive Day Care ProgramsTransitional AssistanceTransportationVision RehabilitationHome Based Wandering Response Systems
11 Home & Community Based Services Waiver Programs Home Care Basic Waiver – a subset of Home Care Basic consumers who are:60 years of age or overState Home Care Program eligibleMeet the Clinical eligibility criteria for nursing facility services (MH regulations 130 CMR )MassHealth Standard eligibleIn need of and/or receiving a Waiver Service
12 Home and Community Based Services Waiver Programs CHOICES - a subset of waiver consumers who are:60 years of age or overState Home Care Program eligibleMeet the Clinical eligibility criteria for nursing facility services (MH regulations 130 CMR )MassHealth Standard eligibleIn need of and receiving a Waiver Program ServiceService plan cost of two times the level of services provided through Home Care Basic Waiver.
13 Frail Elder Waiver (FEW) Expanded Income Eligibility 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
14 Home Care Waiver Services Personal CareHome Health AideSupportive Home Care AideHomemakerRespiteCompanionSkilled NursingChoreEnvironmental Accessibility AdaptationsGrocery Shopping/Delivery ServicesHome Delivered MealsLaundry ServicesSupportive Day ProgramTransitional AssistanceNon- Medical TransportationHome Based Wandering Response SystemsAlzheimer’s/Dementia CoachingHome Delivery of Pre-packaged MedicationMedication Dispensing SystemOccupational TherapyServices not available through the waiver program, available through the MassHealth State Plan:PERSTransportation for medicalADH
15 Care Planning/Care Management Care Manager completes an initial on-site assessment (OSA) to determine consumer eligibilityInitial 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 needAnnual re-determination of home care program eligibilityreview of care plan/service plan at least annuallyAnnual re-determination of personal care needs, as well as clinical eligibility for waiver and ECOP by ASAP RN
16 Service delivery options Traditional service providersASAP contracted service providersConsumer Directed Care – a service delivery option for non-waiver enrolled consumers in accordance with EOEA PI-09-08Consumer can choose to recruit, train and hire their own worker for personal assistance servicesASAP 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 programServices OfferedHomemakingPersonal CareHome Health AideTransportationChoreCompanionOther assistance with I/ADLsServices provided must meet needs identified in the assessment process or otherwise identified as necessary for the health, welfare and community independence of the consumer.
17 Wait Lists Currently, there are no wait lists for: Home Care Programs ECOP (Enhanced Community Options Program)No Expectation for a wait list through Fiscal Year 2014
18 Wait Lists and Exceptions 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 ServicesElders 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.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.
19 Wait List Priority Levels 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 CareHome health servicesTransportation to medical treatmentsGrocery shoppingPriority 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: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.
20 Family Caregiver Support Program National Program implemented by Elder Affairs through ASAPsFunded primarily with Federal Title III-E funds; with limited state and local agency fundsProgram with a multi-faceted approach that supports the Caregiver.
21 Caregiver SpecialistCaregiver Specialist focuses on supporting the CaregiverConducts caregiver assessmentsDevelops a caregiver action planProvides personal assistance in connecting caregivers with resources and services which may includeRespite care optionsSupplemental ServicesOne-on-one counseling & coachingIdentified training in group settings or for individualsFacilitates family meetings
22 Who is eligible to be a Caregiver A family or informal caregiver who iscaring for an elder 60 or older, or someone with Alzheimer’sa grandparent aged 55 or older caring for a child age 18 or youngerover the age of 55 caring for a disabled individual between the ages of 18-59; cannot be the parentContact the Massachusetts Family Caregiver Support Program: Local ASAP AGE-INFO or
23 Other Community Options Veteran’s Independence Plus (VIP)Certified Home Health AgencyOptional for consumers with Medicare A coverage, as well as other insurersPrivate Pay Home CareOptional for all consumers
24 Veteran’s Independence Plus Program (VIP) VIP Program servesveterans of any ageat risk of nursing home admissionSupports family CaregiversVIP Program qualificationsreceive primary care at Bedford or Boston VAMC (Veteran’s Administration Medical Center)have a VA primary care teammeet the eligibility criteria for home and community based services as determined by VAReceive a referral to VIP Program from the VA Medical CenterASAP Case Manage (Care Advisor) VIP enrollees
25 Certified Home Health Agency CHHA’s are home care providers certified by Federal Medicare ProgramProvide and bill for servicesMeet requirements for patient care and managementCHHA’s provide:In-home assessmentDeveloped plan of careSkilled care health services for 60 day increments
26 Qualifying for Certified Home Health Care (CHHA) 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 careBe homebound, i.e. unable to seek medical attention without “severe taxing effort”Discharge from an acute or rehabilitation/hospital is not necessaryFamily members or others can refer to CHHAPhysician’s order for care is required (see above)
27 Private Home Care For more information contact local ASAP or ILC Private pay home care services can be purchased in hourly blocks of time or as overnight or live in servicesPrivate pay home care companies provide a broad range of servicesPrivate pay home care services are not subject to eligibility rules and restrictions, or ASAP/EOEA monitoring requirementsPrivate pay home care companies can be a company within a Certified Home Health Agency, but not alwaysFor more information contact local ASAP or ILC
28 Information and Referral Contact the local ASAP or ILC AGE-INFO