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STATE
OF NEVADA SERVICE
SPECIFICATIONS GERIATRIC
HEALTH AND WELLNESS SERVICES Any
exception to these Service Specifications must be requested in advance in
writing and approved by the Administrator. SERVICE
DEFINITION: This
service provides individuals 60 and over access to a comprehensive
health/medical screening or assessment. Other services that may be provided
include primary health care, dental care, mental health care, health education
and wellness services, geriatric care management, medication management, and
Internet health services. Patients with suspected dementia may also access a
comprehensive social evaluation. SERVICE
CATEGORIES AND UNIT MEASURES Health
Screening: May consist of one of the following
services: A.
Access to primary health care, including a comprehensive
physical exam, an assessment of body systems, a medical history review, baseline
lab tests, dental exam, a mental health screening and counseling to patients to
assist them in maintaining their health. B.
Access to Internet health assessment tools, health education information
and access to health-related services such as prescription programs and other
health education resources. (Internet programs are unable to assess a patient’s
individual medical information.) C. Access to other
self-assessment tools intended to educate individuals about their level of risk
and need for geriatric medical services. One
unit equals: ·
One health-screening visit or
self-assessment ·
One wellness service ·
One Internet visit Direct
Patient Care for Medical and Dental Program: Primary health care may
include diagnosis, treatment and management of medical or dental services,
referral to specialists when indicated, and counseling patients regarding
management of medical, dental, or related conditions. One unit equals: ·
One primary care visit, case
management, follow-up, or reassessment visit ·
One health screening or
testing ·
One person-to-person
consultation and/or referral · One dental procedure Mental
Health Programs:
Assistance either in the form of access or care coordination where the
older person and/or their caregiver are experiencing diminished functioning
capacities, personal conditions or other characteristics which require mental
health screening, testing, direct care, counseling, case management, and/or
referral. One
unit equals: ·
One person-to-person
consultation and/or referral ·
One mental health screening
or testing ·
One session of direct care,
case management, follow-up, or reassessment ·
One session of group
counseling for the client or caregiver Alzheimer’s
Diagnosis: The process of determining, by examination and analysis, the
nature and circumstances of a disease condition. Patients will be provided a
comprehensive medical and social evaluation and from that, a case plan will be
developed which may include treatment, prescriptions, and referrals for other
medical and social services. One
unit equals one diagnostic or follow-up visit. Geriatric
Assessment and Care Management:
Provides an evaluation of medical, mental health and social problems
focusing on improvement of physical and/or social functioning and reducing
disability, includes the development of a medical action plan and advocating
that the plan is carried out. One
unit equals one hour of assessment, planning and/or care management service. Health
Education: Provides health care professionals, students, clients and/or
caregivers with education and training in geriatric health issues, techniques
and/or trends. One
unit equals: ·
One hour of
training/educational meeting (including preparation time) in a group setting ·
One face-to-face session ·
One Internet session ·
One written communication to
a medical professional Exercise Programs: Provides Managers, Activity Directors of Senior Centers and other group settings for seniors, information about and access to establishing structured exercise programs such as a “Resistance Training” program. The program may be leader led or seniors may follow a video presentation. Exercise programs may include the use of equipment/weights. Video programs will include an introduction explaining the benefits of “Resistance Training,” the purpose, research results and demonstrations of the exercises to be performed. One
unit equals: ·
One documented, structured,
exercise session in an individual or group setting. ·
One Resistance Training
presentation to a Senior Center, assisted living facility, nursing home or
senior group activity. Medication Management:
May include one or more of the following: ·
A reminder to take medications ·
An evaluation of the combination of
any number of medications (prescription, over-the-counter, herbal remedies, and
vitamin and mineral supplements) ·
The organization of medications for
a daily, weekly, or monthly duration of time. ·
A contact with a client for
medication management consultation, education, or follow-up purposes. One unit equals: ·
One reminder to take a
medication ·
One evaluation from a doctor
or pharmacist comparing any number of medications, herbal remedy, or
vitamin/mineral supplements with appropriate education for the usage of
medications ·
One visit to organize
medication(s) for a daily, weekly, or monthly duration of time, with appropriate
education for the usage of medications ·
A contact with a client for
medication management consultation, education, or follow-up purposes. GENERAL
REQUIREMENTS: A.
Pursuant to NRS 632.010-632.500, grantees must meet all applicable
statutes pertaining to nursing. B
Pursuant to NRS 630.003-630.411, grantees must meet all applicable
statutes pertaining to physicians and assistants. C
Pursuant to NRS 631, grantees must meet all applicable statues pertaining
to dentists and dental hygienist. D
Pursuant to NRS 641.010-641C.950, grantees must meet all applicable
statutes pertaining to psychologists, therapists, social workers, counselors and
related professions. SPECIFICATIONS: 1.
Required Services: 1.1
For direct client services, provide patients with the opportunity
to receive an annual physical exam. 1.1.a
A physical exam must include at a minimum:
a general assessment of body systems, review of past medical history,
baseline lab tests, and a treatment plan. 1.2
For an Internet program, provide an Internet assessment tool that enables
the client to query health questions and to obtain resource information. 1.3
For other programs, provide a self-assessment tool that educates
individuals about their level of risk and need for geriatric medical
services. 1.4
For a visiting nurse program, providing health assessment, client
monitoring, health counseling and education, or medication management, services
may be provided in the home when deemed necessary by the medical services
team. 1.5
For the mental health program, a written screening procedure must be used
to assess the appropriateness of the client referrals. The designated counselor
must act as an advocate on behalf of the client/client’s family with agencies
and service providers. 1.6
Perform autopsy services. A pathological examination of the brain will be
performed when appropriate approvals have been secured. 1.7
For a medication management program, counseling and education must be
provided to assist clients with the evaluation of medications and to help with
organizing medications. A reminder
service may occur in person or via telephone. 2.
Optional Services: 2.1
Provide the following primary health care services:
Perform health screenings and lab tests based on the patient’s
presenting problem, develop treatment plans for problems identified as a result
of physical examinations, manage stable chronic illnesses, treat minor acute
illnesses, provide referral to specialists when indicated, and provide
counseling to patients to assist them in managing their health. 2.2
Provide health promotion through education/training and wellness
activities to seniors, caregivers, health care professionals and/or medical
students on health topics that affect the elderly such as dietary counseling,
prevention of heart disease or stroke, cancer, hormone replacement, the
prevention of falls, and medication management. 2.3
For mental health programs, transport of clients to apply for needed
services may be provided as part of the service. The grantee must verify that
the counselor maintains automobile insurance per NRS 485.185. 3.
Documentation Requirements: 3.1
Primary care programs shall establish individual patient charts
indicating the results of the physical exam or dental exam and any other
specialized services received by the patient. 3.2
Internet programs shall maintain information by establishing anonymous
client files that record basic client information and visits to the site, or
programs that provide self-assessment tools shall maintain records of the
numbers of tools completed. 3.3
Programs that provide
training and education to health care professionals, students, caregivers and/or
clients shall maintain records of attendance at group sessions and appropriate
documentation of one-on-one training sessions. 3.4
Programs that provide geriatric assessments and care management shall
maintain individual client files that include results of assessments, medical
action plans and follow-up notes. 3.5
Programs that provide mental health services must document in the client
file: 3.5.a
An appraisal of the client’s support system; 3.5.b
A description of the clients physical/mental health and ability to
perform Activities of Daily Living (ADLs) and Instrumental Activities of Daily
Living (IADLS); 3.5.c
A description of the home environment; 3.5.d
A care plan, reassessed annually; 3.5.e
Case narrative notes that document each contact with or on behalf of the
client; and 3.5.f
A reassessment of the client’s physical health, mental health, and
support system every six months, including a summary of any change to the client’s
condition since the last assessment, if any. 3.5.g
The client’s condition must be monitored monthly by phone or in person.
A home visit, or a client’s visit to the mental health worker located in the
program’s office is required at least quarterly. 3.5.h
Statement of Understanding that explains the client’s rights and
obligations under the program and indicates the clients desire to receive
services. The form must be signed and dated by the client/client representative
and counselor. 3.5.i
All applications completed on behalf of the client. 4.
Operating Procedures for Direct Client Services: 4.1
Establish a scheduling system that maximizes utilization of
available patient appointments. 4.2
Provide referral assistance to all patients who require medical
consultation and care beyond the scope of services offered by the program. 4.3
Establish a system to ensure that there is follow-up on all lab tests and
all referral assistance provided to patients. 4.4
Establish written medical protocols for the health services provided by
Advanced Practitioners of Nursing. 5.
Quality Improvement/Performance Indicators: 5.1
Conduct at least one quality assurance review annually. The review must
evaluate the quality of medical service provided by the program and the adequacy
of documentation. The results of the review must document any program
deficiencies and contain a plan of correction. For
direct client care, conduct a combined quality assurance and performance
indicator survey to evaluate the quality of medical, dental or mental health
service provided by the program, client satisfaction and client outcome wellness
indicators. A six-month follow-up survey will be completed to assess health
outcomes. For programs serving large client populations, a sample survey is
acceptable with the approval of the Division. 5.2
For Internet programs, the programs will conduct an initial survey of
performance indicator questions at the time of registration and conduct
six-month follow-up surveys using questions approved by the Division. 5.3
Programs that provide
other self-assessment tools must conduct a sample survey on an annual basis to
determine whether the tool improved the health and/or quality of life of the
users. 5.4
Programs that provide training and education to health care
professionals, students, caregivers and/or clients must develop an evaluation
tool for use by participants in group sessions, and a follow-up survey for
individuals involved in one-on-one sessions. 5.5
Programs that provide geriatric assessments and care management must
conduct a combined quality assurance and performance indicator survey to
evaluate the quality of service provided by the program, client satisfaction and
client outcome wellness indicators. A six-month follow-up survey must be
completed to assess health outcomes. 6. Special Compliance
Requirement: 6.1
Grantee must have current commercial and professional liability coverage
as appropriate. 6.2 Grantees providing medical, mental or dental services may choose to use legal representation to handle client complaints instead of establishing grievance procedures that are required under the General Requirements Service Specifications. |
Questions or Comments for the Division for Aging? Last Updated: 09/18/08 Disclaimer Search Regional Offices/Contact |
