Personal Care Services. Service Specific Operational Procedures

Transcription

1 Personal Care Services Service Specific Operational Procedures

2 Designed for: R.N. Field Supervisors Of Personal Care Provider Agencies

3 Goals Provide R. N. Field Supervisors with the information they need to. Understand Home and Community Based Service Network Negotiate PCA s communication network Meet PCA Contract Requirements

4 Philadelphia Corporation for Aging What is PCA? Private, not for profit, area agency on aging for Philadelphia County. Serves Philadelphia s over 60 population as well as some disabled consumers under 60.

5 PCA s Mission Planning Advocacy Program Development Service coordination and provision Accountable administration of public and private funds

6 Of all the states, Pennsylvania has the third highest percentage of elderly residents. There are approximately 2.5 million Pennsylvanians over the age of 60, with more than 302,000 over the age of 85. One in five older Pennsylvanians lives in or near poverty and more than 200,000 are identified as members of a minority group. Department of Aging Website

7 PCA LTC Departments LTC Long Term Care LTCA Long Term Care Access LTCO Long Term Care Options OAPS Older Adult Protective Services FCSP Family Caregiver Support Program CLO Community Living Options

8 Consumer Referral Process Hospitals Community Agencies PCA Call Center Long Term Care Access

9 Long Term Care Access Assessor visits consumer wherever consumer is located.(community or facility) Level and locus of care are determined. Consumer preferences are established. Community Based Care Options

10 The Consumer s level of care and financial eligibility will determine which program they will qualify for Waiver requires Nursing Facility Clinical Eligibility and DPW income level and asset requirements. Options either Nursing Facility Clinically Eligible or Nursing Facility Ineligible.

11 LTCO Service Coordinator is assigned. The Service Coordinator is part of a team that includes a Service Coordinator Supervisor. A strength based care plan is developed.

12 An Individual Service Plan (ISP) is developed for each participant with the input of participant and caregiver(s). The ISP must be approved by the state BEFORE services can begin.

13 PCA Available Programs Options* Waiver* Family Caregiver Support Program* Dom Care* * Please see fact sheets in your folder

14 Available Services* *Based on eligibility, need and consumer choice Personal Care Adult Day Service Home Delivered Meals Transportation Skilled Home Health Emergency Response Counseling Heavy Housecleaning/Extermination (Options Program only)

15 Referral Process In most cases, provider will receive a call from the PCA Service Coordinator indicating Demographic information Service request Duties requested of personal care aide Requested start of care date The service order (payment authorization) and Service Authorization Form (Waiver only) will follow electronically. No service can be provided without the

16 Referral Factoids 1. PCA does not mandate design of the agency intake form. Form design should facilitate a successful permanent aide assignment. 2.Service must be provided during the days and hours requested. Any variations must be approved through the PCA Care Manager. Participants and aides/assistants may not make independent adjustments to services. 3.If a provider is unable to fill a service request within the time requested, the PCA Service Coordinator must be notified ASAP.

17 Supervision Requirements Case opening Field Supervisor must be present to initiate services along with the Personal Care Aide/Personal Assistant. Ongoing At least every 90 days with the Personal Care Aide/Personal Assistant present. (Note Medicare Certified providers must meet all CMS requirements for supervision and documentation.) P.R.N. Evaluation and documentation of reported incidents; permanent aide changes; as needed to educate, support and

18 What should the RN Field Supervisor Evaluate? Appearance of Personal Care Aide/Personal Assistant Timely arrival of Personal Care Aide/Personal Assistant Ability of aide/assistant to do tasks assigned Relationship with participant and caregiver, if applicable Changes in participant status Changes in caregiver status Changes in environment Effectiveness of care plan

19 We want to know what elements of the care plan you reviewed with the aide/assistant and participant/caregiver. Did you - Demonstrate any procedure? Review transfer techniques? Instruct the aide/assistant on what to do if he/she cannot complete the care plan as ordered? The Common Sense Factor Some things cannot be evaluated on the first visit

20 Unlocking the door to quality service Supervisory Role Know staff capabilities reinforce strengths, teach new skills Set goals clearly identify expectations within the scope of practice for personal care aides. Encourage team concept make sure personal care aides/personal assistants are respected team members. Encourage communications. Be consistent. Invest extra time with new staff and new participants. Clearly defined goals, tasks, roles and expectations, along with consistent follow-through help develop best practice model of care.

21 Signature Verification RN Field Supervisors should obtain a participant signature at case opening and on each subsequent supervisory visit. Personal Care Aides/Personal Assistants and Companions should obtain consumer signature each service day at the end of service provision.

22 Reporting and Documentation The R. N. Field Supervisor should complete a report during each visit. The report should indicate the effectiveness of activities carried out by the Personal Care Aide/Personal Assistant. The report should also indicate any changes in participant status noted by the Personal Care Aide/Personal Assistant and observed by the R.N. Field Supervisor. The report must be kept on file for PCA review.

23 When to call the PCA Service Coordinator Report any changes in participant status or environment which might effect the participant care plan or require any type of intervention or follow up by PCA. Report any problems in service delivery. Report any incidents involving PCA participants or Personal Care Aides/Personal Assistants during provision of care to PCA participants.

24 Incidents Refer to the OLTL Bulletin dated October 14, 2011, effective date, October 11, 2011, Critical Incident Management Policy for Office of Long Term Living Home and Community Based Services Programs.

25 Incident Reporting Every provider is required to adhere to applicable licensing requirements.

26 Incidents (cont.) The report should State the facts Indicate the agency plan for investigation and follow up Include a participant signature indicating that he/she has seen a copy of the report and agrees to the content of the report Include participant statement if he/she does not agree with the content of the report.

27 Required Incident Reporting *Examples only; not a complete list Observed, Reported, or Suspected Abuse Observed Falls Whether the Personal Care Aide/Personal Assistant was physically involved with the consumer at the time or not. Reported Thefts Unauthorized phone use Inappropriate treatment of Personal Care Aide/Personal Assistant

28 Emergency Response PCA participants and Personal Care Aides/Personal Assistants involved in life threatening situations, medical or otherwise, should be instructed to call 911. PCA is NOT an emergency response organization. The PCA Service Coordinator should be informed of the situation and actions taken as soon as possible after the event.

29 Provider Responsibilities in Emergencies Training Support Communication

30 Provider Responsibilities Cont. Providers are expected to provide emergency assistance according to established industry standards. Personal Care Aides/Personal Assistants should know how to provide emergency first aid until 911 personnel arrive.

31 Communications Observation/concerns should be reported to the PCA Service Coordinator. If the Service Coordinator is not available in the event of an emergency, follow this communication path. Service Coordinator Supervisor IF NOT AVAILABLE I Supervisor On Call

32 Training PCA requires a minimum training level as indicated below. Cross training or higher skill level will not affect reimbursement rates. Personal Care/Personal Assistant 40 hrs. Note PCA is requesting Personal Care Aide/Personal Assistant level of care. Duties assigned must not exceed the scope of practice for these individuals.

33 Duties of Personal Care Aide Bathing Dressing Skin Care including monitoring and reporting Grooming Toileting Ambulation and transfer assistance Meal preparation and feeding Caregiver assistance Observation and reporting Medication assistance (reminders) Supervision of a cognitively impaired individual

34 Companion Service Service description includes but is not limited to Meal reminders Supervision of a cognitively impaired individual Accompany consumer on errands or appointments as an escort

35 What should I do if? Requested duties fall outside the scope of a personal care aide? Another agency is involved? Consumer may be eligible for skilled services? Other any ideas?

36 Monitoring OPTIONS - Providers will be monitored by Contract Manager from Business Administration Department. Waiver Providers will be monitored by OLTL QMET Team. Implementation of Individual Service Plans for Options AND Waiver Consumers Verification of ISP service delivery will be evaluated by PCA Business Administration staff and by LTCO Care Managers.

37 State Monitoring In an effort to make processes uniform across the state, PA. Office of Long Term Living has taken over the following functions previously completed by AAAs for Waiver Services. Certification of new providers Monitoring of AAAs and providers QMET Teams will conduct monitoring activities effective immediately

38 Thank you for coming Resources for Questions OLTL Provider Call Center (General Issues, Claims Processing, Enrollment, Billing) OLTL Website PA. Department of Health (Licensing Questions) OR Your PCA Contact Manager