1. Abstract # 0000 Case Presentation B - Policy Impact on Home-Bound Clients Angela Betts Social Work Department University of TN at Chattanooga Case Presentation B - Policy Impact on Home-Bound Clients Angela Betts Social Work Department University of TN at Chattanooga Policies that effect home-bound clients Agency: If a client is unable to leave their home and they have no support system that can assist them in picking up their food and clothing from The Caring Place, a social worker or volunteer will deliver one bag of groceries and clothing appropriate for the individual. State/National: The definition of homebound as it relates to Medicare is as follows: (1) the beneficiary has been certified by one physician as an individual who has a permanent and severe, disabling condition that is not expected to improve; (2) the beneficiary is dependent upon assistance from another individual with at least 3 out of the 5 activities of daily living for the rest of the beneficiary's life; (3) the beneficiary requires skilled nursing services for the rest of the beneficiary's life and the skilled nursing is more than medication management; (4) an attendant is required to visit the beneficiary on a daily basis to monitor and treat the beneficiary's medical condition or to assist the beneficiary with activities of daily living; (5) the beneficiary requires technological assistance or the assistance of another person to leave the home; and (6) the beneficiary does not regularly work in a paid position full-time or part-time outside the home. (c) Global: Criteria to participate in the residential training for disabled adults are as follows: UK resident, Physical and or sensory disability or learning difficulty, Age 18 or over, Can’t access suitable local training, and are unemployed and have the potential to take up employment, including supported employment. The Vienna International Plan of Action on Aging states: “Housing for the elderly must be viewed as more than mere shelter. In addition to the physical, it has psychological and social significance which should be taken into account.” The following goals should be considered: Helping the aging and disabled to live in their homes as long as possible, give a variety of housing options to take into account the diversity within the aging process, Coordinating policies on housing with other social services, and Apply special measures to allow the aged to move freely. Policies that effect home-bound clients Agency: If a client is unable to leave their home and they have no support system that can assist them in picking up their food and clothing from The Caring Place, a social worker or volunteer will deliver one bag of groceries and clothing appropriate for the individual. State/National: The definition of homebound as it relates to Medicare is as follows: (1) the beneficiary has been certified by one physician as an individual who has a permanent and severe, disabling condition that is not expected to improve; (2) the beneficiary is dependent upon assistance from another individual with at least 3 out of the 5 activities of daily living for the rest of the beneficiary's life; (3) the beneficiary requires skilled nursing services for the rest of the beneficiary's life and the skilled nursing is more than medication management; (4) an attendant is required to visit the beneficiary on a daily basis to monitor and treat the beneficiary's medical condition or to assist the beneficiary with activities of daily living; (5) the beneficiary requires technological assistance or the assistance of another person to leave the home; and (6) the beneficiary does not regularly work in a paid position full-time or part-time outside the home. (c) Global: Criteria to participate in the residential training for disabled adults are as follows: UK resident, Physical and or sensory disability or learning difficulty, Age 18 or over, Can’t access suitable local training, and are unemployed and have the potential to take up employment, including supported employment. The Vienna International Plan of Action on Aging states: “Housing for the elderly must be viewed as more than mere shelter. In addition to the physical, it has psychological and social significance which should be taken into account.” The following goals should be considered: Helping the aging and disabled to live in their homes as long as possible, give a variety of housing options to take into account the diversity within the aging process, Coordinating policies on housing with other social services, and Apply special measures to allow the aged to move freely. Evaluation of Policies Agency: The mission of The Caring Place is to “address basic spiritual, physical, and social needs of the disadvantaged in Bradley County, Tennessee.” The agency strives to enable client to meet their own needs when possible and give a hands-on approach when needed. When a client is home-bound and has a limited support system it becomes necessary for the social worker to be a direct support by making home deliveries of food, clothing, and social work support. Evaluation of Policies Agency: The mission of The Caring Place is to “address basic spiritual, physical, and social needs of the disadvantaged in Bradley County, Tennessee.” The agency strives to enable client to meet their own needs when possible and give a hands-on approach when needed. When a client is home-bound and has a limited support system it becomes necessary for the social worker to be a direct support by making home deliveries of food, clothing, and social work support. Compare and Contrast The four mentioned policies have a common trend – they all have an effect on individuals who are unable to leave their home without assistance. All of the policies describe ways to help homebound clients meet their basic human needs. However, each of the policies lay out very different ways to better the client’s life. When comparing the issue of homebound clients in the United States with those in other parts of the world, there is one main difference that is clear between the United States and the UK. In the UK, clients who are disabled are encouraged to contribute to the work force in ways that will use their skills and not be hindered by their physical or mental handicap. Medicare policy in the United States says that if a person works full time, or part-time outside of the home, they loose the rights to federal healthcare. The United Nations notes a commonality among many nations of the world including the United States that our policies that effect the aging populations are not being written with the help of older adults, but rather take into account the needs of younger society and making it easier for them to care for older adults. Compare and Contrast The four mentioned policies have a common trend – they all have an effect on individuals who are unable to leave their home without assistance. All of the policies describe ways to help homebound clients meet their basic human needs. However, each of the policies lay out very different ways to better the client’s life. When comparing the issue of homebound clients in the United States with those in other parts of the world, there is one main difference that is clear between the United States and the UK. In the UK, clients who are disabled are encouraged to contribute to the work force in ways that will use their skills and not be hindered by their physical or mental handicap. Medicare policy in the United States says that if a person works full time, or part-time outside of the home, they loose the rights to federal healthcare. The United Nations notes a commonality among many nations of the world including the United States that our policies that effect the aging populations are not being written with the help of older adults, but rather take into account the needs of younger society and making it easier for them to care for older adults. Plan of Action To meet the needs of homebound clients more effectively, there needs to be an inclusion of the effected clients in policy writing. Encourage the United States to follow the example of the UK to develop training programs for homebound clients to enable them to still earn an income and contribute to society. Plan of Action To meet the needs of homebound clients more effectively, there needs to be an inclusion of the effected clients in policy writing. Encourage the United States to follow the example of the UK to develop training programs for homebound clients to enable them to still earn an income and contribute to society. Linkages between Policy and Practice The link between agency policies and practice are directly related in many agencies, but state, national, and international policies are more distant to many clients. It is important for social workers to understand the policies such as Medicare that effect clients because we need to know what services are available to those we are working with. Understanding international policy can enable social workers to utilize their eclectic nature to create policies that can truly better the lives of their clients. Linkages between Policy and Practice The link between agency policies and practice are directly related in many agencies, but state, national, and international policies are more distant to many clients. It is important for social workers to understand the policies such as Medicare that effect clients because we need to know what services are available to those we are working with. Understanding international policy can enable social workers to utilize their eclectic nature to create policies that can truly better the lives of their clients. Social work Roles and Tasks The social worker should include homebound clients when developing agency policies. Interview homebound clients about their current needs and what they feel the agency could do differently to better meet their needs. Meetings pertaining to policy changes should keep in mind how these changes will impact homebound clients. Social work Roles and Tasks The social worker should include homebound clients when developing agency policies. Interview homebound clients about their current needs and what they feel the agency could do differently to better meet their needs. Meetings pertaining to policy changes should keep in mind how these changes will impact homebound clients. Bibliography Donelson, S.M., Murtaugh, C.M., Feldman, P.H.,Hijjazi, K., Bruno, L., Zeppie, S., Neder, S.K., Quint, E., Huang, L., & Clark, A. (2001). Clarifying the definition of homebound and medical necessity using OASIS data: final report. U.S. Department of Health and Human Services. http://aspe.hhs.gov/daltcp/Reports/OASISes.htm Gottlich, V. (2008). Long awaited homebound study issued secretary recommends keeping current standard. National Senior Citizens Law Center.http://medicareadvocacy.org/Archives/ArchivedPages/WAUpda te_HomeboundStudy Residential training for disabled adults. DirectGov. http://www.direct.gov.uk/ en/DisabledPeople/Employmentsupport/WorkSchemesAndProgram Implications of an aging society, (2006). http://www.un.org/esa/socdev/ ageing/policy.html Terry, R.A., The caring place mission statement. Vienna international plan of action on aging, (2006). United Nations Programme on Ageing. http://un.org/esa/socdev/ageing/vienna _inlplanofaction3a3/html United Nations principles for older persons, (2006). United Nations Programme on Ageing. http://www.un.org/socdev/ageing/un_principles.html Bibliography Donelson, S.M., Murtaugh, C.M., Feldman, P.H.,Hijjazi, K., Bruno, L., Zeppie, S., Neder, S.K., Quint, E., Huang, L., & Clark, A. (2001). Clarifying the definition of homebound and medical necessity using OASIS data: final report. U.S. Department of Health and Human Services. http://aspe.hhs.gov/daltcp/Reports/OASISes.htm Gottlich, V. (2008). Long awaited homebound study issued secretary recommends keeping current standard. National Senior Citizens Law Center.http://medicareadvocacy.org/Archives/ArchivedPages/WAUpda te_HomeboundStudy Residential training for disabled adults. DirectGov. http://www.direct.gov.uk/ en/DisabledPeople/Employmentsupport/WorkSchemesAndProgram Implications of an aging society, (2006). http://www.un.org/esa/socdev/ ageing/policy.html Terry, R.A., The caring place mission statement. Vienna international plan of action on aging, (2006). United Nations Programme on Ageing. http://un.org/esa/socdev/ageing/vienna _inlplanofaction3a3/html United Nations principles for older persons, (2006). United Nations Programme on Ageing. http://www.un.org/socdev/ageing/un_principles.html Home-Bound Clients in the United States: Home-Bound Clients around the world Evaluation of Policies cont. State/National: Medicare’s definition of a homebound client decides who is eligible for in-home services to be paid through national and state government funds. The social security act sections 1814 and 1835 as amended by section 4615 state that to be eligible for Medicare an individuals must meet qualifications to be considered homebound. Therefore, to receive needed services from the United States government individuals must meet all six criteria listed within the Medicare eligibility policy. Global: In the UK there is a program that has been developed as a government funded service that enables individuals who would be unable to acquire a job through traditional means. This program allows adults with disabilities to be trained for a job that is within their skill level and not be influenced by their disability. For homebound clients this would consist of work that can be done from their home. Embedded within the United Nations Programme on Ageing it was recommended that the policies pertaining to the aging population be rethought. In the past policies in this area have been mostly written out of considerations for the younger society instead of the desires of older adults. The recommendations brought to light through the Vienna International Plan of Action on Aging have been composed to bring the focus of certain policies back to the needs of the aged throughout our world. Evaluation of Policies cont. State/National: Medicare’s definition of a homebound client decides who is eligible for in-home services to be paid through national and state government funds. The social security act sections 1814 and 1835 as amended by section 4615 state that to be eligible for Medicare an individuals must meet qualifications to be considered homebound. Therefore, to receive needed services from the United States government individuals must meet all six criteria listed within the Medicare eligibility policy. Global: In the UK there is a program that has been developed as a government funded service that enables individuals who would be unable to acquire a job through traditional means. This program allows adults with disabilities to be trained for a job that is within their skill level and not be influenced by their disability. For homebound clients this would consist of work that can be done from their home. Embedded within the United Nations Programme on Ageing it was recommended that the policies pertaining to the aging population be rethought. In the past policies in this area have been mostly written out of considerations for the younger society instead of the desires of older adults. The recommendations brought to light through the Vienna International Plan of Action on Aging have been composed to bring the focus of certain policies back to the needs of the aged throughout our world.