Georgia Department of Human Resources Division of Aging Services

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Georgia Department of Human Resources Division of Aging Services ...

    Georgia Department of Human Resources Division of Aging Services

    Requirements for Non-Medicaid Home and Community Based Services

Section 300 Individual Service Requirements

?308 Personal Care Service Requirements June 2002

     Revised 5/2004

?308.1 Purpose This chapter establishes the requirements to be followed

    when Area Agencies on Aging provide or contract for the

    provision of personal care services to frail elderly people

    in their places of residence.

?308.2 Scope These requirements apply to services provided in whole 1or in part with non-Medicaid federal and state funds

    managed by Area Agencies, and any associated

    matching funds. These requirements apply to personal

    care services provided to eligible persons in their places

    of residence. Agencies providing personal care services

    also may provide homemaker services through aging

    program contracts, providing there are adequate

    numbers of appropriate staff to do so, and the contract

    with the Area Agency specifies the provision of both

    services. The providers shall report the two services

    separately according to the DAS Taxonomy of Service

    Definitions and reporting requirements, and the

    contractual agreements negotiated with the Area

    Agencies on Aging.

?308.3 Service provider

    eligibility Area Agencies may contract for the provision of personal

    care services only with those agencies licensed as

    private home care providers, in accordance with the

    Rules of the Department of Public Health, Chapter 290-

    5-54 and O.C.G.A. ?31-7-300 et seq.. If an Area

    Agency provides the service directly, the agency is

    subject to licensure requirements. All provisions of that

    code section apply and take precedence over any of

    these requirements which may conflict.

?308.4 Target group.

    The target group for this service is persons 60 years of

    age or older, who are functionally impaired in their

    ability to perform regular activities of daily living.

?308.5 Client eligibility. (a) Eligible individuals meet the following criteria:

    (1) are age 60 and over; and

    (2) have some degree of physical or mental

    disability or disorder which restricts

    his/her ability to perform basic activities

    of daily living, or which threatens his/her

    capacity to live independently; and

1 Eligible funds sources are the Older Americans Act, Title III-B, and Title III-E (supplemental services); the

    Social Service Block Grant; and the State Community Based Services Program.

Georgia DHR Division of Aging Services June 2002 (rev. 5/2004)

    ?308 Personal Care Service Requirements Page 2 of 21

    (3) do not have sufficient access to persons

    who are able and/or willing to assist with

    or perform needed basic activities of daily

    living or provide adequate support to

    enable the individual to continue to live


    (b) Providers shall not accept persons whose

    maintenance and care needs cannot be

    adequately met by the agency in the clients’

    place of residence.

?308.6 Access to Services Area Agencies may receive requests for services from a

    variety of sources, which may include, but are not

    limited to the following types. Older persons may

    request services or be referred by a physician, hospital,

    case manager, family member, friend, or other service

    provider. The Area Agency on Aging shall screen all

    applicants for service. Subject to the availability of

    services, area agencies will initiate services, if providing

    directly; or refer appropriate applicants to provider

    organizations or other resources; or place applicants on 2a waiting list for services. When available, services will

    be provided in the client’s place of residence. Service

    shall not be provided in a nursing home, personal care

    home or other setting where the provision of this service

    is included in the cost of care.

?308.7 Service Activities. Personal care services are planned and provided with

    input from the client, based on the assessment of the

    client’s needs, degree of functional impairment, and

    remaining capacity for self-care and self-sufficiency.

    Service activities may include planned and routine

    provision of:

     (a) assistance with activities related to the care of

    the client’s physical health, such as:

    (1) dressing and undressing;

    (2) bathing;

    (3) shaving;

    (4) dental care and oral hygiene;

    (5) grooming, including taking care of routine

    hair and skin needs;

    (6) toileting, including assistance with

    continence care;

    (7) self-administration of medication and/or

    use of health maintenance equipment;

    (8) transferring, including moving in and out

    of bed;

     2 The Area Agency is responsible for providing notice to applicants of the disposition of their requests for service.

    Subcontractors are responsible for providing notice of service status to persons once they have been referred for

    service and a case manager or provider staff has conducted the face-to-face assessment. Suggested forms have been

    provided to Area Agencies under separate cover.

    Georgia DHR Division of Aging Services June 2002 (rev. 5/2004)

    ?308 Personal Care Service Requirements Page 3 of 21

    (9) mobility in and around the home and

    range of motion exercises; and

    (10) eating.

(b) Service activities reported as personal care do

    not include:

    (1) pet grooming/care;

    (2) home repair;

    (3) moving heavy objects or furnishings;

    (4) physical, speech or occupational therapies;

     (5) medical nutrition therapies;

     (6 medical social services;

    (7) home health aide services provided by a

    home health agency;

    (8) skilled nursing services;

    (9) meal preparation;

    (10) housekeeping tasks;

    (11) household maintenance activities, such as

    snow removal, hauling firewood, changing

    storm windows and screens, and yard


    (12) personal finances and mail, including

    paying bills and writing checks;

    (13) shopping;

    (14) performing personal care or other tasks

    for members of the household other than

    the client;

    (15) providing friendly visiting only;

    (16) performing tasks not assigned by the

    supervisor or case manager and reflected

    in the care plan

    ?308.8 Service outcomes. Service providers shall ensure that their services achieve

    the following outcomes.

    (a) Quality personal care services are provided at

    reasonable cost.

    (b) Staff are sensitive to clients' special needs,

    including the need for adequate nutrition, in

    order to provide quality services.

    (c) Services are designed to capitalize on the

    individuals’ remaining strengths, lessen the

    burden of impairment for older adults, or to

    lessen the burden of providing care.

     (d) Services provided are based on a plan

    individualized for each client's and/or caregiver's

    abilities and needs, in the manner and times


(e) The provider is able to expand service capacity

    and improve quality with additional revenue

    generated through voluntary contributions and

    client cost share, when applicable.

Georgia DHR Division of Aging Services June 2002 (rev. 5/2004)

    ?308 Personal Care Service Requirements Page 4 of 21

     3. ?308.9 State Licensure

    Providers of personal care services must demonstrate

    compliance with all applicable licensure requirements for

    private home care providers under the Rules and

    Regulations of the State of Georgia as found at ?290-5-

    54. Also refer to DAS Manual Chapter 206 “In-Home


?308.10 Delivery characteristics.

    Service providers will deliver services in the following


    (a) Assessment. The delivery of service shall be

    planned and carried out in accordance with

    specific client needs as determined by the

    designated administrative or program staff during

    the in-home assessment, based on the use of the

    DON-R instrument and other instruments or 4inventories. The assessment is conducted by

    the Area Agency, a provider of case management

    services or the personal care service provider

    agency, depending on the arrangements for

    client assessment negotiated by the Area Agency.

    If conducted by case management or provider

    agency staff, assessments shall be completed

    within ten business days of receipt of the service

    referral from the AAA.

    5 (b) Service plan.

    (1) Designated staff shall begin developing

    the service plan, using a format provided

    or approved by DAS, with the client

    and/or family during the in-home

    assessment visit. The plan, at a minimum,

    shall include:

    (A) information which clearly links the

    services to be provided with the

    functional impairments and unmet

    need for care identified by the

    DON-R and other instruments used

    to assess clients and caregivers;

     3 The complete rules and regulations of the state of Georgia which pertain to licensure of private in-home care

    providers are found at http:\\ and are at ?290-5-54.

     4 The core assessment instrument for non-Medicaid Home and Community Based Services is the

    Determination of Need-Revised (DON-R) instrument. Use of additional tools, including, but not limited to the Nutrition Screening Initiative-DETERMINE Checklist (NSI-D), the Folstein Mini-Mental Status Examination

    (MMSE), and the Center for Epidemiological Studies Depression Scale (CESD), also may be indicated in order to complete a comprehensive client assessment.

     5 Reference: Rules and Regulations of the State of Georgia ?290-5-54-.11

    Georgia DHR Division of Aging Services June 2002 (rev. 5/2004)

    ?308 Personal Care Service Requirements Page 5 of 21

    (B) types of service required/tasks

    requested or indicated and tasks to

    be performed;

    (C) the expected days, times,

    frequency, and duration of visits in

    the client's residence;

     (D) expected duration of the need for


    (E) the stated goals and objectives of

    the service; and

     (F) discharge plans.

    (2) When applicable to the condition of the

    client and the services to be provided, the

    service plan shall also include information

    on pertinent diagnoses; medications and

    treatments; equipment needs; and

    dietary and nutritional needs.

     6(3) The service supervisor/case manager

    shall complete the plan within seven

    working days after services initially are

    provided in the residence. Service plans

    are to be revised as necessary, and

    reviewed and updated by staff members

    involved in serving the client at the time

    of each supervisory visit, at least every 92 7days.

     (c) Service initiation.

    (1) The provider agency has the discretion to

    begin providing minimal levels of services

    in the home prior to the completion of the

    initial service plan.

    (2) The agency shall initiate services within

    ten working days from the date of

    receiving the referral, and thereafter

    deliver them on a regular basis in

    accordance with the established service


    (3) The provider agency shall make telephone

    or other contact within the first four weeks

    of service initiation to ensure client

    satisfaction, and annually thereafter for

    the duration of the service relationship.

     6 Rules and Regulations of the State of Georgia ?290-5-54-.10. “A licensed registered professional nurse or practical

    nurse shall supervise the provision of personal care tasks for clients determined to be medically frail or compromised. If supervision is provided by a licensed practical nurse, the LPN shall report to a licensed professional RN who will

    continue to be responsible for the development and management of the service plan. “

     7 See preceding note.

    Georgia DHR Division of Aging Services June 2002 (rev. 5/2004)

    ?308 Personal Care Service Requirements Page 6 of 21

    (d) Supervisory/monitoring visits. The appropriate

    provider agency supervisory staff will make

    periodic visits to each client’s residence, in

    accordance with time frames established by state 8licensure requirements, starting from the date of

    initial service in a residence or as the level of

    care requires, to ensure that the client’s (and/or

    caregiver’s if present) needs are met. The visit

    shall include an evaluation of the client’s general

    condition, vital signs, a review of progress toward

    goal attainment, any problems noted, and the

    client’s/caregiver’s satisfaction with services.

    Supervisors also shall observe and note the

    appropriateness of the level of services being

    provided. If significant changes in the client’s

    rev. 5/2004 condition or circumstances are observed at any

    time, staff of the provider agency, or case

    management agency, if involved, shall initiate a

    complete re-assessment, using the formal

    instruments indicated.

    (e) Reassessment. Depending upon the options

    exercised by the Area Agency to conduct client

    assessments, designated Area Agency, case

    management agency, or provider agency staff

    shall reassess annually at a minimum, or more

    rev. 7/2002 frequently, as otherwise indicated.

    [ See also? 308.10(d), Supervisory Visits.]

(1) Designated staff responsible for

    assessment activities shall conduct

    reassessments, either when contact with

    the client indicates the client's needs have

    changed, based on changes in functional

    status or other conditions, or when staff

    providing services or a caregiver reports

    the client's needs have changed.

(2) The reassessment shall address changes

    in the cognitive, emotional, physical,

    functional, economic or physical/social

    environment in which the client lives, and

    be documented using formats specified or

    approved by the Division.

    Staff responsible for reassessment shall

    involve the personal care aide in the

    process, by obtaining feedback from the

    aide regarding the appropriateness of the

    service plan (tasks to be performed,

    scheduling, etc.); relationship with the

    client; adequacy of supplies and rev. 5/2004

    equipment; and adjust the service plan


    8 Supervisory visits for personal care services are conducted every 92 days.

    Georgia DHR Division of Aging Services June 2002 (rev. 5/2004)

    ?308 Personal Care Service Requirements Page 7 of 21

    (f) Emergency contacts. Clients will furnish to the

    provider information on an emergency contact

    which the agency will maintain in the provider

    agency's client record. If no emergency contact

    person is identified, the provider shall list the

    local emergency response number (example: 911

    service), if available in the area of service, or

    local law enforcement agency as the contact. The

    emergency contact person and phone number(s)

    shall be verified and updated at the time of


    (g) Service termination and discharge.

    (1) The provider agency shall discontinue


    (A) upon the death of the client, entry

    of the client into a personal care or

    nursing home, or when there is no

    longer a need for the service.

    (B) when the client or caregiver is non-

    compliant with the plan of care

    through persistent actions of the

    client or family which negate the

    9services provided by the agency ,

    but only after all attempts to

    counsel with the client/family have

    failed to produce a change in

    behavior leading to compliance.

    (C) when the client or client’s family

    threatens or abuses the in-home

    service worker or other agency

    staff to the extent that supervisory

    staff have determined that the

    staff’s welfare and safety are at

    risk and good-faith attempts at

    corrective action, including

    counseling, have failed. Agency

    administrators shall use discretion

    and professional judgment in

    determining in which situations

    immediate removal of staff and

    termination of service are


    (D) when the provider agency

    resources are not adequate to

    meet the maintenance needs of the


     9 In cases of non-compliance, supervisory staff shall evaluate the need for referral for protective or mental health

    services, and make such referrals as appropriate prior to discharge and termination whenever possible.

    Georgia DHR Division of Aging Services June 2002 (rev. 5/2004)

    ?308 Personal Care Service Requirements Page 8 of 21

    (E) upon the request of the client (or

    caregiver, if acting as authorized

    representative of the client).

    (2) The provider agency shall provide written

    notice of termination and discharge at

    least 21 calendar days prior to the date of

    discharge, when applicable.

    (3) During the 21-day period, the provider

    shall work with the Area Agency and/or

    case management provider to make

    appropriate arrangements with the client

    and/or family for transfer to another

    agency, institutional placement, or other

    appropriate care.

    (4) The provider shall continue to provide

    care in accordance with the service plan

    for the 21 day notice period or until

    alternate arrangements can be made,

    whichever occurs first, unless staff

    providing in-home services are at

    immediate risk of harm.

    ?308.11 Staffing. Providers of personal care services shall have sufficient

    numbers of qualified staff, as required by the

    Department of Human Resources rules and regulations,

    and/or the Division of Aging Services service

    requirements, to provide services specified in the service

    agreements with clients. Agencies providing personal

    care services shall adhere to all requirements regarding

    staffing and supervision as stated in the rules of the

    Department of Human Resources Public Health,

    Chapter 290-5-54, regarding the licensure of Private

    Home Care Providers. The provider may employ

    personal care assistants to perform personal care tasks.

    These staff qualify for employment in this capacity upon:

(a) successful completion of nurse aide training and

    competency evaluation program; or

     (b) successful completion of a competency

    examination for nurse aides recognized by the

    Department; or

(c) successful completion of a health care or

    personal care credentialing program recognized

    and approved by the Department; or

(d) successful completion or progress toward the

    completion of a 40-hour training program

    provided by a private home care agency. See

    ?308.10.(b) for training course content.

    Georgia DHR Division of Aging Services June 2002 (rev. 5/2004)

    ?308 Personal Care Service Requirements Page 9 of 21

    ?308.12 Orientation and

    training requirements. The provider agency shall provide services with

    personnel who meet the qualifications and competencies

    to perform requested and agreed upon services of the

    client or family. The agency shall arrange or provide

    forty (40) hours of core training to personal care

    assistants who have not completed a course of licensure

    or certification as described in ?308.11(a)-(c).

    Those staff for whom this training is appropriate shall

    complete the initial twenty (20) hours of the coursework

    before beginning to work with clients and the remaining

    twenty hours (20) within six (6) months of the date the

    training first began.

(a) The provider agency is responsible for the


    (1) providing an orientation for personnel to

    their job responsibilities including, but not

    limited to:

    (A) agency policies and procedures;

    (B) orientation to the philosophy and

    values of community integration

    and consumer-driven care;

    (C) recognizing changes in the client's

    health condition indicating the

    need for emergency procedures or

    health services;

    (D) agency code of ethics and

    employee conduct;

    (E) client rights and responsibilities;

    (F) the agency’s complaint handling


    (G) the process for reporting client

    progress and problems to

    supervisory staff, including

    suspected cases of abuse, neglect

    or exploitation;

    (H) the employee's obligation to inform

    the employer of known exposure to

    tuberculosis and hepatitis, or any

    other communicable disease.

    (2) maintenance of documentation to

    demonstrate that an individual is able to

    perform the services for which s/he is

    responsible; and

    Georgia DHR Division of Aging Services June 2002 (rev. 5/2004)

    ?308 Personal Care Service Requirements Page 10 of 21

(3) assuring that the staff responsible for

    directing/ providing training meet 10minimum qualifications.

(4) requiring each employee after the first

    year of employment to participate in a

    minimum of eight clock hours annually of

    in-service or additional training or 11instruction as appropriate.

    (b) The provider agency may provide the training

    directly or assist employees in locating and

    attending the appropriate training. Additional

    training should better prepare the employee to

    meet the needs of the client and support

    accomplishment of service outcomes. Specific

    training content for personal care assistants

    includes, but is not limited to:

    (1) assisting with ambulation and transfer of

    clients, including positioning;

(2) assistance with bathing, toileting,

    grooming, shaving, dental care, dressing

    and eating;

(3) basic first aid and adult cardiopulmonary

    resuscitation (CPR);

    (4) caring for clients with special conditions

    and needs, so long as the services

    provided are within the scope of tasks

    authorized to be performed by


    (5) home safety and sanitation;

    (6) infection control in the home;

    (7) medically related activities, including

    taking vital signs;

    (8) proper nutrition for older persons, with

    emphasis on nutritional supports for

    chronic disease states.

    10 Rules and Regulations of the State of Georgia, ?290.5.54.-09(5)and (6)

    11 Rules and Regulations of the State of Georgia, ?290.5.54.-09 (6)(b)

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