Home and Community Services Social Services Programs

Agenda: Mission and vision Eligibility determination CARE assessment Long-term care programs Long-term care settings SNF, hospital, behavioral support units MAC & TSOA Other supports

Aging and Long Term Support Administration Vision Seniors and people with disabilities living with good health, independence, dignity, and control over decisions that affect their lives. We want to share the Vision of ALTSA with you so you can see how HCS services fit into the bigger picture.

ALTSA Mission To transform lives by promoting choice, independence and safety through innovative services. HCS is one Division within ALTSA, and we all share the same Mission.

Home and Community Services HCS determines initial & ongoing eligibility for long-term care services (LTC) and authorizes services to contracted providers. Once we receive an application for Medicaid LTC, we determine: Financial Eligibility ~ completed by a financial worker Functional Eligibility ~ completed by a SW or RN Both processes may occur at the same time. Being the front door for the state’s community-based long-term care services a large part of what we do is handle requests for assistance from people in the community. What this typically means is HCS…

How is Functional Eligibility Determined? CARE assessment = Comprehensive Assessment & Reporting Evaluation The CARE assessment is used to take a comprehensive evaluation of an individual’s functional abilities by reviewing their medical and psych/social conditions. The need for assistance with personal care tasks or “activities of daily living” (ADL’s) are the primary consideration of functional eligibility. Social Services manages the Functional eligibility piece. Cases are assigned to SWs or RNs once a Medicaid application is submitted to HCS.

CARE Assessment Activities of Daily Living (ADL’s): Medication management Bathing Dressing Bed mobility/positioning Transferring Ambulation Eating Toileting Personal hygiene/skin care The initial CARE assessment can take up to 3 hours, as it is very comprehensive. Activities of Daily Living – personal care tasks.

CARE Assessment Some sections of the assessment are evaluated based on client performance during “look back” periods of time, as opposed to looking toward the future. The need for or receipt of assistance with housework, shopping, meal preparation, and transportation do not impact eligibility in and of themselves. Explain “Look Back” periods.

CARE Assessment The assessment is completed on an initial and annual basis as well as when client’s care needs change significantly. Circumstances for possible deduction of in-home care hours: Willing, informal supports that are available to client Caregiver who lives with client Multi-client household Once the CARE assessment is completed, the number of hours per month for in home OR daily rate for residential settings is determined. The CARE assessment is used to: provide documentation of the individual’s care needs, assist in locating placements, provide a care plan for the client and caregiver

Long Term Care Programs Once a person is financially and functionally eligible, we discuss the program options: CFC - Community First Choice COPES – Community Options Program Entry System MPC – Medicaid Personal Care New Freedom PACE – Program of All-Inclusive Care for the Elderly RCL - Roads to Community Living Community First Choice – CFC, is the new State Plan benefit due to changes and requirements of the Affordable Care Act. Personal Care was refinanced under the new State Plan benefit – CFC – vs being part of the COPES waiver. The changes allow for a richer benefit package to better support individuals in the community The federal match increased from 50% under COPES to 56% in CFC. Most LTC Medicaid clients in WA state will be using the State Plan benefit of CFC vs MPC.

Here is a brief look at the various programs offered through HCS.

Long Term Care Settings In-home personal care (homecare agency or individual provider) Residential placement and case management in licensed facilities with a Medicaid contract: Adult Family Home (AFH) Assisted Living Facility (ALF) Adult Residential Care (ARC) Enhanced Adult Residential Care (EARC) Skilled Nursing Facility case management and relocation care planning Client’s choices and wishes are highly valued and respected. The CARE assessment encourages Person Centered Planning. Safety of client is a primary consideration HCS provides case management for clients who live in residential settings (AFH/ALF/SNF/ARC/EARC) The SW/RN will review all the setting options for LTC services.

Individual Provider (IP) In-Home Personal Care Homecare Agency Many contracted agencies to choose from Agencies provide supervision and support to caregiver(s) Back-up caregivers available Individual Provider (IP) Family (other than spouse) or person of choice IP’s are contracted directly through DSHS They become a member of a union (SEIU) Must pass background check, fingerprinting and complete initial and ongoing training requirements *DSHS only does initial assessment. Case management & follow-up assessments are done by one of our area agencies on aging (AAA’s) 24 hour care cannot be provided in home. Case management for clients who choose in–home care is provided by the Area Agency on Aging (AAA) IP Training includes: View & report back on 5 hour initial training DVD’s Complete 70 hours of training within 120 days of hire (with some exceptions) Pass test to become a certified homecare aide through Department of Health within 200 days of hire ($115)

Residential Care Adult Family Home (AFH) Adult Residential Care (ARC) Must have certification for mental health, dementia, &/or developmental disabilities if resident(s) have such a diagnosis Licensed and contracted for up to 6 residents Adult Residential Care (ARC) Typically low-level physical care needs Assisted Living Facility (ALF) Single rooms Provides nursing care Enhanced Adult Residential Care (EARC) Provides limited nursing services *Residential is the only community setting for 24 hour care *Case management & follow-up assessments are done by DSHS Adult Family Home (AFH) – All programs accepted except New Freedom Assisted Living Facility (ALF) - All programs except MPC & New Freedom Enhanced Adult Residential Care (EARC) – All programs except MPC & New Freedom Adult Residential Care (ARC) – all programs are now available in an ARC

Skilled Nursing Facilities (SNF) Options include long-term, rehabilitation, and temporary placements HCS determines Nursing Facility Level of Care within 10 days of admission CARE assessments are completed to assist clients in relocation to more independent settings Relocation efforts include help with identifying the next setting, determining equipment and other support service needs

Hospital Unit Conducts functional assessments for clients who are inpatient at all King County hospitals and SNF’s within hospitals. Assist hospital Social Workers/discharge planners with establishing safe discharge plans for clients. Assist with funding for non-covered DME items. Determine and implement supportive services.

Behavioral Support Unit Assists HCS LTC clients residing at Western State Hospital, Department of Corrections and local psychiatric hospitals to transition back to a community setting. Case manage clients in Region 2 who have been identified as having exceptional care needs due to behavioral issues. Provide case staffing for difficult and challenging cases. The Behavioral Support Unit provides case management to designated clients and manages Expanded Community Services to eligible clients.

Cost to Clients Clients may have to contribute to the cost of their care depending on their medical program coverage, monthly income, and/or marital status. This is called “client responsibility” or “participation”. Financial determines “participation” or “Client Responsibility” in most cases.

Medicaid Alternative Care (MAC) Supports for unpaid caregivers caring for individuals on Medicaid (CN/ABP) but not receiving LTC/caregiver services Caregiver assistance services (including respite if caregiver is providing 40 hrs/wk of unpaid care) Training, education & consultation Specialized equipment & supplies Health maintenance & therapies No participation/client responsibility No estate recovery Care receiver must be 55+ & NFLOC Eligibility provides: Max of $558/month, $3345/6 months depending on circumstances (determined by AAA) HMA = up to 6 months of housing costs = $973.00 per month while in a SNF if approved Other supports are COPES Ancillary Services that are available when a client is eligible

Tailored Services for Older Adults (TSOA) Pre-Medicaid services & supports for individuals with or without an unpaid caregiver Caregiver assistance services (including respite if caregiver is providing 40 hrs/wk of unpaid care) Training, education & consultation Specialized equipment & supplies Health maintenance & therapies Personal care services (if there is no unpaid caregiver) No participation/client responsibility No estate recovery Care receiver must be 55+ & NFLOC Income must be $2250/month or less; resources must be less than $53,100 (individual) or $108,647 (married couple) Eligibility provides: Max of $558/month depending on circumstances (determined by AAA) HMA = up to 6 months of housing costs = $973.00 per month while in a SNF if approved Other supports are COPES Ancillary Services that are available when a client is eligible

Other Supports Home Maintenance Allowance (when in SNF < 6 mos.) Client Training (COPES) Chronic Disease Self Management Nutrition Services P/T, O/T & S/T Independent Living Skills PEARLS (at-home counseling) Home Delivered Meals (COPES) PERS - Personal Emergency Response (CFC) HMA = up to 6 months of housing costs = $973.00 per month while in a SNF if approved Other supports are COPES Ancillary Services that are available when a client is eligible

Other Supports (COPES) Specialized Medical Equipment Environmental Modifications Adult Day Health Adult Day Care Skilled Nursing Wellness Education The client’s assessment results will influence the Care Plan. When a Care Plan indicates the need for additional supports, the SW/RN will discuss and authorize the necessary services.

Web Resources Medicaid Application: https://www.washingtonconnection.org/home/ DSHS Social & Health Services for Adults: http://www.dshs.wa.gov/adults.shtml Forms in the Publication Library: http://www.dshs.wa.gov/publications/library.shtml 22-619 Medicaid and Long-Term Care Services for Adults 22-707 Choosing Care in an Adult Family Home or Boarding Home 22-810 Partners in Protection: A Guide for Reporting Vulnerable Adult Abuse 22-866 Summary of Home and Community Services and Eligibility

Home and Community Services Region 2 South 1737 Airport Way South Seattle, WA 98134 206.341.7600