1. Module 2: Home- and Community- Based Services Aging Services of Minnesota Older Adult Services Orientation Manual © Aging Services of Minnesota 2014 1

2. Home and Community Settings Private homesTownhomesSenior patio homesMultifamily senior rental housing © Aging Services of Minnesota 2014 2

3. Services Offered Services offered in home and community settings are diverse, catering to varying levels of care © Aging Services of Minnesota 2014 3 Informal Community Supports Home Management Services Respite Care Adult Day Services Home Care Services Medicare Home Health Care Services Hospice

4. Community Supports Informal Caregivers Caregivers can include a friend, spouse, or other family member Essential role – providing 75% of all care to older adults Services range from basic companionship to complex medical tasks © Aging Services of Minnesota 2014 4 46% of informal caregivers provide medical/nursing services to older adults

5. Community Supports Other Services © Aging Services of Minnesota 2014 5 Block nurse program Faith community nursing Volunteer companions Volunteer transportation

6. Home Management Services Services of a non-technical nature that emphasize the daily needs of individual users Requires registration with the Minnesota Department of Health © Aging Services of Minnesota 2014 6 Housekeeping Shopping Meal preparation

7. Respite Care Provides informal caregivers (such as a spouse or family member) a temporary relief from caregiving © Aging Services of Minnesota 2014 7 Duration can range from hours to weeks Respite care can be provided in: the home, care centers, housing with services, or adult day center

8. Adult Day Services Services provided in a group setting Services may include activities and socialization, meals, baths, health care services, and social services by staff in a licensed setting. Most adult day service centers operate 10 to 12 hours per day On average participants attend for 3 to 6 hours several days a week © Aging Services of Minnesota 2014 8

9. Home Care Home care agencies must be licensed by the Minnesota Department of Health. They can provide personal care, health care, and home management services. Services are provided in any home setting including Housing with Services establishments © Aging Services of Minnesota 2014 9

10. Home Care Licensing Historical classes of home care licenses © Aging Services of Minnesota 2014 10 Class A professional home care agency license May provide all home care services, at least one of which is nursing, physical therapy, speech therapy, occupational therapy, nutritional services, medical social services, home health aide tasks, or the provision of medical supplies and equipment when accompanied by the provision of a home care service Class A agencies may be Medicare-certified Class B paraprofessional agency license Personal care services, homemaker services, and home management tasks in a persons home Class F home care provider license Nursing, personal care and home management services provided in a persons home or registered HWS establishment

11. Home Care Licensing Minnesota Home Care Law © Aging Services of Minnesota 2014 11 Minnesota Department of Health recommended home care provider licensing regulation changes to 2012 Legislature Legislature passed changes into law Transition period started July 1, 2013 2012 2013 Transition period continues 2014 Full implementation by July 2015 All providers must be licensed under the new law 2015 Key change: Streamlined 4 license distinctions into 2 (basic or comprehensive) based on the level of services being provided

12. Home Care Provider Basic Assistive tasks provided by trained, unlicensed personnel that include: Assisting with dressing, self-feeding, oral hygiene, hair care, grooming, toileting, and bathing Standby assistance Verbal or visual reminders to take regularly scheduled medication Verbal or visual reminders to the client to perform regularly scheduled treatments and exercises Preparing modified diets ordered by a licensed health professional Assisting with laundry, housekeeping, meal preparation, shopping, or other household chores and services © Aging Services of Minnesota 2014 12

13. Home Care Provider Comprehensive Home care services that may include any of the basic home care services and one or more of the following: Services of an advanced practice nurse, registered nurse, licensed practical nurse, physical therapist, respiratory therapist, occupational therapist, speech-language pathologist, dietitian or nutritionist, or social worker Tasks delegated by a registered nurse, a licensed health professional to trained, unlicensed staff Medication management services Hands-on assistance with transfers and mobility Assisting clients with eating when the clients have complicating eating problems © Aging Services of Minnesota 2014 13

14. Home Care Licensing Law Timeline of Key Dates Change of ownership applications required to pay an application fee $2,100 for a provider operating at the Basic Level fee or $4,200 for a provider operating at the Comprehensive Level New providers applying for licensure will apply for Basic or Comprehensive license, pay the new fees, and abide by new licensing laws (will be inspected by Minnesota Department of Health within 14 months) All providers licensed by Minnesota Department of Health prior to January 1, 2014, will transition to the new set of requirements upon their regular license renewal date © Aging Services of Minnesota 2014 14

15. Home Health Care Home health care differs from home care in that it: © Aging Services of Minnesota 2014 15 Requires Medicare certification from the Centers for Medicare and Medicaid Services (must also be licensed under Minnesota state statutes) 1 Home health care provides seniors and people with disabilities with short-term skilled nursing, rehabilitative, and therapeutic home health care services 2 Is the only level of home care reimbursable by Medicare 3

16. Home Health Care Eligibility Adults over age 65 are eligible to receive Home Health Care if services are: © Aging Services of Minnesota 2014 16 Provided by a Medicare certified home health care agency Under the care of a doctor Require a skilled level of care provided by a nurse or physical therapist Short-term or intermittent Provided while homebound (as defined by Centers for Medicare and Medicaid Services)

17. Home Health Care Services Provided Examples of services a Medicare-certified home health care agency may provide include: Physical therapy Skilled assessments and teaching Occupational or speech therapy Wound care Pain management Home health aide services Medical social services © Aging Services of Minnesota 2014 17

18. Hospice Care Hospice defined: Family-oriented; designed to meet spiritual, emotional, and physical needs during the end of life Supportive and palliative care provided but does not provide treatment to underlying conditions Hospice requirements: Hospice providers must be licensed under Minnesota state statues Medicare Eligibility – when a physician gives a prognosis of six months or less to live © Aging Services of Minnesota 2014 18

19. Hospice Care Services Provided Services provided include: Bereavement and emotional support for family Counseling Dietary and other counseling Home health aide and homemaker services Medical social services Medical supplies and equipment Nursing services Outpatient drugs for symptom and pain control Physical, occupational, and speech therapy Physician services Short-term inpatient care Spiritual care © Aging Services of Minnesota 2014 19

20. Acknowledgements This resource was made possible by funding from the Ronald Patterson Governance Fund of the Aging Services of Minnesota Foundation Developed by Health Dimensions Group, Minneapolis, MN © Aging Services of Minnesota 2014 20