Consumer Directed Programs in Washington State

1
Consumer Directed Programs in Washington State

• Aging and Disability Services Administration
  (ADSA)
• Patty McDonald, Program Manager
• State Unit on Aging 1-800-422-3263
• Email mcdonpm_at_dshs.wa.gov

2
Choices in Long-Term Care Services The Way It
Is Now

• Long-Term Care Services are offered in a variety
  of settings.
• In-home Care
• Adult Family Homes
• Assisted Living/Boarding Homes
• Enhanced Adult Residential Care Facilities
• Nursing Facilities

3
How Do People Access Services?

• ADSA/Home and Community Services Division serves
  adults with functional disabilities over the age
  of 18 and elders.
• The Senior Information and Assistance office
  refers individuals over the age of 60 to state
  and local community resources.
• Individuals or their representatives apply for
  long-term care services (Medicaid or Medicare)
  through the States Home and Community Services
  office in their local area. A social worker does
  an assessment where the individual is residing at
  the time. Services include medical assistance,
  food stamps, and all long-term care services they
  qualify for.

4
In-Home CareFunding and Options

• Funding Options
• Medicaid Personal Care (MPC) State Plan service
  for in-home personal care.
• 4 waivers provide funding sources that pay for
  alternatives to nursing facility care. Includes
  skilled nursing services.
• Older Americans Act
• Senior Citizens Services Act
• Respite state and federal

• Provider Options
• Agency providers agency hires its own
  workforce and provides placement.
• Individual Providers the consumer recruits,
  hires, supervises and terminates their own
  worker. Family members may be paid to provide
  care.
• Skilled nursing services provided either through
  home health agencies or individual contracted RNs
  or LPNs.

5
Waiver Programs

• Waiver programs provide services in a variety of
  setting for adults who require nursing facility
  level of care. Washington has three waivers
  currently. COPES, Medically Needy In-home and
  Medically Needy Residential.
• These settings include assisted living, adult
  family homes, adult residential care/ enhanced
  adult residential care, and in-home care.
• Washington has had a waiver since 1983.
• The main service used in waiver programs is
  personal care assistance to help with bathing,
  health related tasks, toileting and other
  activities of daily living.

6
Other Waiver Services these are services
offered by current waivers

• Minor Home Modification
• Specialized Medical Equipment Supplies
• Home Delivered Meals
• Personal Emergency Response System
• Transportation
• Nursing Services
• Adult Day Health Programs
• Client Training
• Case Management

7
What Washington State Did to Move Towards
Community-Based Care and Consumer Direction

• Chore Program
• Private Duty Nursing
• Assistive Technology Project
• Nurse Delegation
• Self-Directed Care

8
Chore program (state funded) How it used to
be..

• Historically, this program was more flexible and
  consumer directed because consumers got the money
  directly, and there was a Chore Employed Disabled
  program. Program was state funded only. No
  federal match.
• Qualified providers for in-home care are limited
  to the following
• Individual providers
• Spouse provider Chore is the only program that
  will allow for a spouse provider, however the
  rate CANNOT exceed the GAU one-person standard
  amount. Payment to a spouse over the GAU
  standard requires an ETR with HQ Chore Program
  Manager approval prior to authorization WAC
  388-72A-0065
• Agency providers
• Both programs are closed due to funding
  constraints.

9
Private Duty Nursing (PDN)

• This program provides skilled nursing care to
  adults, 18 and over who would otherwise be served
  in a hospital or institution.
• Consumers must be ventilator-dependent,
  tracheostomy that requires sterile suctioning,
  intravenous/parenteral administration of
  nutritional substances or multiple medications
  and require at least 4 continuous hours of
  skilled nursing care per day.
• Consumers may receive this service in their own
  home through a licensed and contracted home
  health agency or a privately contracted RN or
  LPN.
• Can be offered in RN owned operated adult
  family homes.

10
Assistive Technology (AT) Project (State Funded)

• AT maximizes functional opportunities for
  individuals with disabilities in all environments
  through devices and services.
• Consumers may request directly for assistance or
  through their case managers.
• Consumers also have a choice in providers of the
  equipment or service.
• Program funds evaluations and training.
• AT devices are any item, piece of equipment or
  product system, whether acquired commercially
  off-the-shelf or modified/customized, that is
  used to increase, maintain or improve the
  functional capabilities of the individual with
  the disability.
• AT services assist people with disabilities, who
  have no other funding source, to select, acquire
  or use AT devices.
• Services can be provided in any setting, with the
  goal of helping the individual transition into a
  community setting.

11
Nurse Delegation -For more information contact
Kay Kramer Sievers, MPH, RN 1-800-422-3263 or
360-651-6828Email kramek_at_dshs.wa.gov

• Critical Elements
• NA could not perform task outside of ND process
• NA can be an individual provider or from an
  agency
• Client must be stable
• RN must be notified of every change in client
  condition or treatment
• All parties must be willing
• Tasks prohibited from delegation
• Sterile procedures
• Injectable medications
• Central line maintenance
• Tasks requiring nursing judgment
• For the last 10 years, Nurse Delegation has been
  offered in adult family homes, assisted living,
  boarding homes.
• Recently, Nurse Delegation was allowed in the
  home setting by the legislature.

12
Self-Directed Care (SDC) Philosophy and the Law

• Philosophy behind the law is based on independent
  living, consumer control of services and
  self-determination.
• An adult with a functional disability living in
  his/her own home can choose to direct supervise
  a paid IP to help them with health related tasks
  that he/she cannot do for themselves.
• These health related tasks would normally be done
  by a licensed health care professional, if the
  individual could not do the task for his or her
  self.
• A paid personal aide working privately or state
  paid as an individual provider (IP) can take
  direction from the adult with the functional
  disability to provide SDC tasks.
• The person with the disability is responsible for
  having the knowledge, ability to train and
  supervise the IP.

13
Self-Directed Care

• Examples of self-directed care tasks may include
  medication assistance, injections, bowel/bladder
  programs and wound care. There is no task list in
  the self-directed care law.

14
Balance between Consumer Choice and State
Accountability

• State responsibility for ongoing monitoring and
  auditing.
• The person with the disability is responsible for
  administering the funding they have been given.
  Recognizing the money is necessary for their
  survival.

15
Case Management Services

• Case managers assess need, plan for, coordinate,
  and monitor services provided to clients. The
  objectives of case management are to
• Support client independence.
• Match services to clients needs as they change
  over time and within the limitations of the
  program to meet those needs.
• Provide a continuity of care through coordination
  with others.
• Assist clients to access needed services. Develop
  a plan to overcome barriers to accessing
  necessary services.
• Authorize appropriate services in a timely
  manner.
• Advocate for client and support client
  self-advocacy.

16
In-Home Case Management

• Case managers use the automated CARE tool to
  assess need and develop a detailed plan of
  services authorize payment for services.
• Assessments are done face to face on a yearly
  basis at a minimum.
• In-home case management is provided through the
  13 Area Agencies on Aging (AAA) statewide for
  adults over the age of 18.

17
Comparison of Traditional Case Management and
Independent Living Model (consumer directed model)
18
New Freedom Waiver in the application process

• New Freedom, which will be offered in two regions
  of the state, will be available to between 500
  and 750 elderly and disabled adults eligible for
  Medicaid long-term care. It is designed to be
  flexible, responsive, and cost effective in
  meeting each individuals needs. The target
  population is those who are eligible for nursing
  facility level of care.
• The standardized assessment tool known as CARE,
  will determine the cash value of a plan.
• Persons interested in New Freedom will meet with
  a consultant to prepare an individualized plan
  and budget. A fiscal agent will help consumers
  manage their cash allowance and associated
  responsibilities, such as payroll withholding,
  and ensuring that expenditures are in keeping
  with the plan.

19
Individual Provider Requirements

• Training
• Caregiver Orientation must be completed within 14
  days of beginning employment, including the
  process for completing the Caregiver Orientation
  workbook and video.
• Revised Fundamentals of Caregiving must be
  completed within 120 days of employment (or 180
  days for parent providers). Note An IP may
  take the Modified Fundamentals of Caregiving
  Self-Study course in lieu of the full
  Fundamentals course, if the IP documents
  successful completion of training as an RN, LPN,
  nursing assistant certified, PT, OT, or a
  Medicare certified home care aide.
• Continuing education of 10 hours must be
  completed each calendar year following the
  fundamentals training. Note This training is
  not required for parent providers.
• Required training as outlined in WAC 388-71-05805
  through WAC 388-71-05830, for an IP who will be
  performing a nurse delegated task.
• Individual Provider Safety Training is provided
  on line.

• Background Checks
• Because providers have unsupervised access to
  vulnerable adults and children, background checks
  are required by law.
• All individual providers and agency providers
  must complete a background check every two years.
• If the provider has lived in the state of
  Washington less than three years, they must be
  finger printed for a FBI check.
• Washington state statute dictates crimes that are
  disqualifying. The disqualifying crimes for the
  most part are crimes against persons, for example
  assault.
• Some of these crimes are time limited.
• Washington state statute also requires both the
  department and the consumer do a competence,
  character and suitability determination on any
  potential provider.
• If the department and consumer disagree, the
  consumer has the right to an administrative
  hearing over the denial of their choice of
  provider.

20
Home Care Quality Authority (HCQA) and SEIU

• Establishment of qualifications for in-home care
  individual providers
• Recruitment of individual providers .
• Provision of training opportunities for consumers
  and providers
• Establishment of a referral registry of
  individual providers .
• Removal from the referral registry those
  individual providers who have committed
  misfeasance or malfeasance in the performance of
  his or her duties . and
• Representation for the state as the public
  employer of individual providers for the sole
  purpose of collective bargaining.

21
Service Employees International Union (SEIU Local
775)

• Service Employees International Union (SEIU)
  Local 775 represents the in-home care providers.
• The state negotiates a collective bargaining
  agreement with the union that sets general terms
  of employment for independent providers such as
  wages or other benefits. The consumer of in-home
  care services is the direct employer of the
  individual provider.
• The Legislature must approve or reject the
  submission of the request for funds as a whole.
  If the Legislature rejects or fails to act on the
  submission, the collective bargaining agreement
  will be reopened by the state bargaining unit and
  SEIU solely for the purpose of renegotiating the
  funds necessary to implement the agreement.

22
Managed Care Programs for more information
contact Kristi Knudsen at 360-725-2537 or Email
knudskl_at_dshs.wa.gov

• PACE Program for All-inclusive Care for the
  Elderly
• WMIP Washington Medicaid Integration
  Partnership Project
• MMIP Medicare/Medicaid Integration Project

23
Older Americans Act Programs

• Through the use of volunteers, Volunteer Chore
  Services (VCS) this program provides assistance
  with housework, laundry, shopping, cooking,
  moving, minor home repair, yard care, limited
  personal care, and transportation to eligible
  elderly and disabled persons. These services are
  provided primarily through an agency but people
  on the service can recruit their own volunteers.

24
For more information about these programs
contactHilari Hauptman 1-800-422-3263 Email
haupthp_at_dshs.wa.gov

• State Respite Care Program
• Family Caregiver Support Programs
• Kinship Caregiver Support Program
• Kinship Navigator Program
• Relatives as Parents Program

25
Consumer Direction

• All adults with disabilities no matter what age,
  should have the right to
• Make their own decisions
• Direct their own lives
• Live where they choose
• Access all the opportunities in their
  communities.