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STATE OF NEVADA
DIVISION FOR AGING SERVICES
SERVICE
SPECIFICATIONS
HOME
CARE SERVICE
including Personal Care
(Revised
1/03)
Any
exception to these Service Specifications must be requested in advance in
writing and approved by the Administrator.
SERVICE DEFINITION:
This service may include light housekeeping, grocery
shopping, transportation, bill paying assistance, correspondence assistance,
medication reminders, medical care advocacy, and non-medical in-home care
assistance for seniors who are unable to perform self-care.
SERVICE CATEGORIES AND UNIT MEASURES:
The following service categories and unit measures
established by the Administration on Aging (AoA) must be used to document the
amount of service provided:
Home Attendant /
Personal Care: Provides
assistance to persons having difficulty with one or more of the following
activities: preparing meals; shopping for food, prescriptions or household
goods; bathing and personal care; housework; bill paying; writing letters;
medication compliance, and/or navigating the medical care system.
One unit equals one hour of Home Attendant / Personal Care.
SPECIFICATIONS:
1.
Required Services for Home Attendants and Personal Care Attendants:
1.1
Standby assistance with dressing, bathing, personal hygiene, grooming,
toileting, transferring, and ambulating. Licensed Certified Nursing Assistants
or certified Personal Care Aides may provide direct assistance.
1.2
Prepare meals if home-delivered meals are unavailable or insufficient to
meet client needs. This might include planning menus, cooking, and assistance
with eating, if necessary.
1.3
Reinforce the importance of taking the proper dosage of medication and
remind client to take self-administered medications.
2.
Additional Required Services for Home Care Attendants:
2.1
General Cleaning: vacuum,
mop, sweep, clean bathroom, clean kitchen, empty trash, dust, change linens,
water plants and do laundry.
2.2
Shop for groceries, prescriptions and/or household goods; pick up
mail.
2.3
Assistance with correspondence.
2.4
Assistance in filling out checks or obtaining money orders to pay
bills and transporting client to pay bills.
2.4.a
Prior to accepting a client for this service, an attempt will be made to locate
family or friends who can perform this service.
2.4.b
The program will perform this service only if:
(1)
Family or appropriate friends are unwilling or unable to assist
client.
(2)
Family/friends have exploited or abused client.
(3)
The client needs help but not to the degree that
intervention is necessary by the tribal
representative payee service (if the client is
Native American).
2.4.c
Assistance will be limited to filling out documents for the client’s
signature and/or transport the client to pay bills.
3.
Optional Services for Home Care Attendants:
3.1
Heavy cleaning: Provide
heavy cleaning (prior to the start of regular Home Attendant service) if the
home is unsanitary or severely neglected. Funding for this one-time service is
limited to $200. Programs may establish a cost-sharing agreement with the client
to pay for this service.
3.2
Transportation: The program must maintain current proof of drivers'
licenses and vehicle insurance for all attendants involved in transporting
clients.
4.
Optional Services for Personal Care Attendants:
4.1
Serve as client’s advocate within the health care system to ensure that
proper and adequate medical care is obtained.
4.2
Transportation: The program must maintain current proof of drivers'
licenses and vehicle insurance for all attendants involved in transporting
clients.
5.
Service Prohibitions:
5.1
Staff shall not accept tips, gifts, loans, or fees from clients.
5.2
Staff shall not smoke in client homes or while transporting
clients.
5.3
Staff shall not purchase alcohol or illegal substances for clients.
5.4
Staff shall not borrow the client’s car or other personal
belongings.
5.5
Staff shall not bring family members, other people or pets to the client’s
home without client’s permission and supervisory approval.
5.6
Staff shall not eat the client’s food.
5.7
Staff shall not recommend or influence medical care decisions or make
personal decisions on behalf of the client.
6.
Safety:
6.1
The grantee cannot assign Home Attendants / Personal Care Attendants to
work in conditions that jeopardize their safety.
6.2
Prior to providing services, Home Attendants / Personal Care Attendants
are required to have a fingerprint search conducted by the Nevada Highway Patrol
Criminal Information Services. The search will include a review of the records
contained in the Nevada Criminal History Repository. If the Home Attendant /
Personal Care Attendant resides on a reservation, the search will include a
fingerprint search conducted by the tribal police. The tribe is responsible for
satisfying this requirement.
7.
Assessment/Certification:
7.1
Client Assessment: A client assessment must be completed prior to the
start of service. The assessment must document the condition of the client based
on the Assessment Criteria contained in Appendix A.
An
intake form and assessment must be completed on each separate person over the
age of sixty (60) residing in the household.
7.2
Care Plan: A Care Plan must
be established for each household based on the needs identified in the
assessment. See Care Plan Criteria contained in Appendix A. A signed copy of the
Care Plan must be provided to the client. A new Care Plan must be established
whenever changes are made to the plan and a copy of the new plan must be
provided to the client.
7.3
Reassessment: A reassessment
is required whenever there is a substantial change in a client’s physical
condition, support system, or home environment. At a minimum, clients must be
reassessed annually through an in-home visit. The reassessment must be based on
the assessment criteria contained in Appendix B. Reassessment documentation must
be recorded separately from the original assessment documentation.
8.
Documentation Requirements:
8.1
Home Attendant / Personal Care Attendant Progress Notes:
Service must be provided in accordance with the established care plan.
The Home Attendant / Personal Care Attendant Progress Notes must be completed
after each service visit and must contain the following documentation:
8.1.a
Housekeeping, personal care tasks, transportation information, bill paying
services, and medical care advocacy provided to the client, including any
services provided in addition to those specified in the Care Plan.
8.1.b
Attendant’s time of arrival and departure.
8.1.c
Signatures of client and attendant.
8.1.d
A list of authorized care plan services not provided to the client and a brief
explanation of why they were not provided.
8.1.e
Client signatures are to be obtained only after services have been
provided.
8.2
Verification System for Shopping: A
procedure must be established that allows Home Care Attendants and clients to
verify the amount of money given to the attendant, cost of items purchased, and
change returned to the client. Documentation of the transaction must be included
on the Home Attendant / Personal Care Attendant Progress Note.
8.3
Verification System for bill paying:
A procedure must be established that allows the attendant’s supervisor
to review bill paying procedures and verify that bills are being paid in an
accurate and timely manner. Documentation of all transactions must be included
on the Home Health Attendant / Personal Care Attendant Progress Note.
8.4
Prepare a Quarterly Service Summary form that identifies the dates of
service and the number of hours of service delivered to each client. The
Quarterly Service Summary must be submitted to DAS by the 15th of the month
following the end of the quarter. The Division will provide the reporting
format.
9.
Operating Procedures:
9.1
A waiting list is to be established only after all other measures for
improving the efficiency of the service delivery system have been examined and,
when feasible, implemented. Grantees are required to establish a waiting list
policy that will be activated in the event that demand for service exceeds the
program’s capacity. Waiting list documentation must include, at a
minimum:
9.1.a
the client’s name, address, and telephone number;
9.1.b
the date the client was placed on the waiting list; and
9.1.c
the description of each client’s need for service.
Clients with the greatest needs are to receive
priority consideration. The program will define “greatest need.”
The program must establish a procedure for updating the continued service
needs of clients placed on the waiting list.
10.
Training:
10.1 Home Attendants / Personal Care
Attendants assigned to provide bathing assistance must receive training, which
includes hands-on standby experience, prior to provision of service. Training
must be provided under the supervision of a qualified health professional. (Home
Attendants / Personal Care Attendants licensed as Certified Nurse Assistants or
certified as Personal Care Aides are exempt from the training
requirement).
Documentation of training must include:
dates of training; name of Home Attendant / Personal Care Attendant
receiving training; name, title, and agency of trainer; list of topics covered
during the training; and copies of training material.
11.
Quality Improvement:
11.1 A quality assurance visit or
phone call must be provided to each client at three-month intervals following
each assessment or reassessment. The quality assurance check conducted six
months after each assessment or reassessment must be in person.
The purpose of the quality assurance check is to:
verify that the Care Plan is being followed, assess client satisfaction
with the service, and amend the Care Plan as necessary to ensure that the client
receives the services needed.
12.
Client Contact Time Frames:
12.1
The following is a summary of the client contact time frames for
assessments, reassessments, and quality assurance:
Þ
Begin Date - Initial Assessment
Þ
3 Months - Quality Assurance Visit or Phone Call
Þ
6 Months - Quality Assurance Visit
Þ
9 Months - Quality Assurance Visit or Phone Call
Þ
12 Months - Reassessment
APPENDIX
A
CARE
PLAN CRITERIA
Care Plans must be established based
on the following maximum and minimum frequencies for each service task. Home
Attendant / Personal Care Attendant services cannot
exceed three hours per visit.
*Permitted more frequently if
performed in conjunction with bathing assistance.
Other Required Documentation:
Þ
The number of service hours to be provided each visit and the
number of visits per week or month.
Þ
The length of time services are authorized (maximum period is 12
months)
Þ
The signature of the agency representative and date
Þ
The client or client’s representative signature and date
APPENDIX B
HOME
ATTENDANT / PERSONAL CARE ASSESSMENT CRITERIA
The client assessment must document
the condition of the client in the following areas:
1.
Description of Client’s Medical/Physical Condition:
¨
Diagnosis (if known)
¨
Recent Hospitalizations/reason
¨
Physical condition of client: areas of the body impaired, severity of impairments
¨
Assistive devices used by client in performing Activities of Daily
Living, e.g. wheelchair, oxygen
¨
Required medications
3.
Analysis of Client’s Physical Status in the following areas:
¨
Ambulation
¨
Ability to Stand
¨
Vision
¨
Ability to grasp, bend, reach, lift
¨
Ability to transfer
¨
Ability to tolerate exertion needed to perform household tasks
¨
Ability to go outside the home without assistance
4.
Analysis of Client’s Support System:
¨
Number of persons in household and their relationship to the
client
¨
Homemaking tasks performed by family and friends
¨
Bill paying and correspondence performed by family or friends
¨
Medication management and/or medical advocacy performed by family
or friends
¨
Transportation, e.g. client owns car, client drives, others who
provide transportation
5.
Analysis of Home Environment:
¨
Number/types of rooms to be cleaned
¨
Number/type of pets
¨
Type of housing: mobile,
apartment, townhouse, house
¨
Indicate whether refrigerator, oven, heating and plumbing are in
working condition
¨
Indicate availability of laundry facilities:
in the home, on-site, off-site
¨
Indicate whether the client needs assistive devices for bathing,
e.g., shower chair, grab bars
¨
Indicate unsafe conditions and follow up as needed
