A career opportunity to support individuals with disabilities and seniors.

1. An Introduction to Home Care Services: A career opportunity to support individuals with disabilities and seniors. Presented by Brigette Menger-Anderson & Break-Thru Home Care, Inc.

2. About Your Guide: Brigette Menger-Anderson 18 years in social services & disabilities field as a front-line supervisor for group homes, a flexible case manager for CDCS recipients, a CIL Program Manager, a Compliance/QA Director for a Home Care Agency & a QP/Supervisory Nurse for PCA recipients & DSPs. Experienced Direct Support Professional (DSP) Disability Advocate with the Consortium for Citizens with Disabilities (CCD) Board Member, DSPAM Curriculum Development & Instructor for PCA Trainings Witness to how complex and frustrating navigating through these systems can be! What’s your familiarity with PCA services?

3. Today’s Agenda: Background on Home Care:PCA Choice, PCPO, Class A & Medicare-Certified Agencies. The Home Care Team: Identifying Everyone Involved in the Process for Receiving Services. State Requirements: Enrolling as a DSP, Certification & Current Legislation. DSP Roles and Responsibilities: ADLs, IADLs, Health-Related Procedures & Behaviors. DSP Training: Beyond State Testing Wait, there’s more!

4. Knowledge is Power! Wages, Benefits & Policies:What You Should Ask Prospective Agencies. Locating a PCA Provider: State Directory DSPAM: Advocacy and Education for DSP Workers CCD, ACT, ARC: Systems Advocacy DLL: Free Information & Referral. What would you like to go over together?

5. Background on Home Care: Home care allows the consumer to live independently in his or her own home or familiar surroundings, long term. This has many benefits including: Longer maintenance of the consumers level of physical, psychological and cognitive well being. Reduced health care costs. Independence costs less. Changes in the Health Care System within the last generation: Hospitals have become surgical centers with short stays and more outpatient surgeries; Nursing Homes have become rehabilitation centers for post- surgical patients; Assisted Living Facilities & Retirement Communities are preferred over nursing homes; People want to live independently!

6. PCA Services in Minnesota: Minnesota offers PCA services as a benefit through several publicly funded health care programs, but the majority of PCA services are provided through Medical Assistance (the State’s Medicaid program) and Medicaid waiver programs. CADI, CAC, EW, TBI…….

7. DANGER! Acronym overload AHEAD! MHCP ? PCPO HHA ? DHS ? PCA ? MCO MA QM ? HCSP PMAP CADI ? ADL ? QP PHN ? Help is here! http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_137159

8. HomeCareServices: Home Management Companies-Non-medical agencies that provide light housekeeping, meal preparation, socialization, companionship and transportation. They do not provide any medical assistance or help with personal cares (ADLs). This is where a homemaker would seek employment. PCA Agencies- Provide personal care services (ADLs/IADLs) under the supervision of a Registered nurse (RN) or Qualified Professional/QP.

9. Who pays for these services? To be eligible to receive medical assistance funds, the person with the disability must meet low-income guidelines and/or be certified disabled. An agency contracts with the State and /or County to receive reimbursement through the State and Federal Medical Assistance and Medicare programs. The agency then pays the DSP to provide the services. https://edocs.dhs.state.mn.us/lfserver/Public/DHS-0005-ENG

10. Agency Differences: Class A Agencies- Provide all of the services of the other two classes of home care agencies, are contracted with individual counties, and are licensed by the Department of Health. They provide at least one of the following: Nursing, therapies, nutritional services, medical social services, HHA tasks or the provision of medical supplies and equipments when accompanied by a home care service. Examples of medical services include changing IVs, sterile dressings and feeding tubes. Medicare-Certified Agencies: Provides all of the services of the other agencies, but has additional licensure requirements. Medicare certification is optional except for agencies that offer home health services paid by Medical Assistance. If an agency is Medicare-certified it must also have a Class A Home Care license but a Class A agency is not required to be Medicare-Certified.

11. Traditional PCA (PCPO) PCA Choice The agency will hire, fire, train, supervise and evaluate staff. Back-up staffing and recruitment is the responsibility of the agency. The agency will decide who will work and when. Expect wages to be lower due to more administrative & staffing responsibilities that the agency assumes responsibility for. The agency is primarily responsible for the payroll for the PCA and handles the billing to DHS for the consumer. The consumer is the supervisor and is responsible for hiring, firing, training, supervising and evaluating the PCA. Wages will be higher. More options and flexibility also means more responsibility! Service Delivery Models

12. The Home Care Team: Public Health Nurse- Responsible for assessments and determining need for home care services. DHS- Oversees the provision of home care services and provides reimbursement for fee for service. Consumer- Individual with disability(s) whom chooses to have home care services. Responsible Party- If the consumer cannot direct their own cares and/or would like to delegate supervisory responsibilities, the RP can be selected by the consumer. Family, friends, neighbors! Agency- Business (for or non-profit) that contracts with the State (DHS) to provide PCA services. Supervisory Nurse- Mandatory supervision, required by DHS, can be a registered nurse or a qualified professional, depending on the complex medical needs of the consumer. Case Worker- Not all consumers have a case worker, some only have a financial worker. The DSPs! Other: ILS, behavior aide, mental health worker, advocate, peer mentor, etc.

13. What is a Home Maker? A Home Maker is an individual that is employed by an agency to provide light house keeping to individuals with disabilities and seniors. A homemaker can be anyone 16 years or older, who can pass a criminal background check. What does a home maker do? Home makers go into private homes, may be employed by an assisted living facility, nursing home, etc. and provide house cleaning supports to individuals with disabilities and seniors. It is important to keep in mind that while we all have our “own way” of doing things, you are their to provide services for someone and have an obligation to take direction from them.

14. Is it more than just cleaning? YES! A person chooses to receive home making services so that they can remain safe healthy and continue to live as independently as possible. You are providing more than a clean environment you are ensuring that the conditions of the home are also SAFE.

15. Being a DSP in Home Care: What is a DSP? A Direct Support Professional is any employee that provides home care services to individuals with disabilities and/or seniors. A DSP encompasses many home care titles: PCA-Personal Care Attendant Home Maker HHA-Home Heath Aid CNA- Certified Nursing Assistant Support staff What other titles are you familiar with?

16. Tips to guide you... We are all still learning, even the so-called “experts” You can’t know it all, so be willing to learn. Trust yourself (without being obnoxious or arrogant about it). The individual/person comes first! They are your best teacher. A few are naturals, most can learn and the rest are in the wrong line of work! Do with not for whenever possible!

17. The most important rule: “Nothing about ME, without ME.”

18. State Requirements: Employment requirements An individual who is employed as a personal care assistant must: Be 18 years of age or older. Be employed by a PCA provider agency. Initiate and clear a Criminal Background Study. Enroll with the DHS as a PCA once all employment criteria are met. An individual who is employed as a personal care assistant must: Effectively communicate with the person and the PCA provider agency. Be able to provide covered PCA services according to the person’s PCA care plan. Respond appropriately to the person’s needs. Report changes in the person’s condition to the qualified professional. Maintain daily written records including, but not limited to, time sheets. Complete training and orientation on the needs of the recipient within the first seven days after services begin. Be supervised by the consumer or the qualified professional. A person age 16-17 years old may be a PCA with the following additional requirements: Employed by only one PCA provider agency responsible for compliance with current labor laws. Supervised by a qualified professional every 60 days.

19. DSP Roles and Responsibilities: Four categories of PCA services are eligible for payment from Medical Assistance: Activities of daily living (ADLs) Health-related procedures and tasks Observation and redirection of behaviors Instrumental activities of daily living (IADLs) A personal care assistant (PCA) may assist in the four categories of PCA services if the following are met: PCA Care Plan describes needed assistance. Training of the PCA specific to the person’s needs occurs in the first seven days of PCA service for the person. Documentation of the individualized training is in the agency file. PCA documents their services on the time sheet and/or other agency form. Complete authorization for PCA services before services begin. Let’s go into more detail about supports:

20. Activities of Daily Living: Dressing - Application of clothing and special appliances or wraps. Grooming - Basic hair care, oral cares, shaving, basic nail care, applying cosmetics and deodorant, care of eyeglasses and hearing aids. Bathing - Basic personal hygiene and skin care. Eating - Completing the process of eating including application of orthotics required for eating, hand washing and transfers. Transfers - Assistance to transfer the person from one seating or reclining area to another. Mobility - Assistance with ambulation. Positioning - Assistance with positioning or turning a person for necessary care and comfort. Toileting - Helping person with bowel or bladder elimination and care. This includes transfers, mobility, positioning, feminine hygiene, use of toileting equipment or supplies, cleansing the perineal area, inspection of the skin and adjusting clothing.

21. Instrumental Activities of Daily Living: Accompany to medical appointments. Accompany to participate in the community. Assist with paying bills/budgeting. Communicate by telephone and other media. Plan and prepare meals. Shop for food, clothing and other essential items. Light housekeeping that is related to or a direct result of an ADL.

22. BEFORE you drive a consumer... Although a DSP can assist with transportation to/from appointments, grocery stores, pharmacies, etc. a DSP is not supposed to drive a consumer in their own personal vehicle- DHS does not provide mileage reimbursement to the agency and the agency (most often) does not provide reimbursement to the DSP. If you chose to drive anyway, please know that you are (more than likely) not insured by the agency and the consumer can attempt to hold you liable for injuries sustained in the accident! If you drive the consumers vehicle you are BOTH responsible for ensuring proper liability coverage.

23. Health-Related Procedures: Under state law, a licensed health care professional may delegate health-related procedures and tasks to a personal care assistant when the following are present: Procedures and tasks meet the definition of health-related procedures and tasks. A qualified professional who is a nurse trains and supervises the PCA. PCA demonstrates competency to safely complete the procedures and tasks. Examples of health-related procedures and tasks include: Assistance with self-administered medications Interventions for seizure disorders, including monitoring and observation Range of motion to maintain a person’s strength and muscle functioning.

24. Behavioral Supports: A PCA service may include observation of a person who: Has episodes of behaviors. Needs redirection to remain safe in his/her environment (cues, prompting). A PCA may not restrain a minor or an adult unless that individual has a documented RULE 40 which authorizes only trained, professional staff to provide therapeutic holds and compressions- EVEN if the Parent or guardian tells the DSP to!

26. Recent Legislative Changes: DSPs are considered under a companionship exemption, therefore they have to work 48 hours before being eligible for overtime. Legislators have recently passed a law that prohibits a DSP from working more than 275 hours per month, regardless of the number of agencies or consumers they work for. Effective July 01, 2010, PCAs who are paid caregivers of immediate family members are no longer eligible for unemployment benefits for the wages earned as an employee with an agency. Legislators also require PCA agencies to pay 72.5% of the reimbursement rate directly to DSPs in wages and benefits. In January 2010 and in July 2011, additional dependency criteria to be eligible to receive PCA services will be implemented, causing most people with mental health, behaviors and minimal ADL dependencies to be ineligible for PCA services.

27. Standardized Training: The 2009 Legislature requires basic training for individual PCAs.: A free on-line course. Contain a separate, free test-out process (e-mail/on-line registration required). Required for all individual PCAs. Individual PCAs may take the training or test as often as needed, but must pass: Before MHCP enrollment. For individual PCAs already enrolled with MHCP and affiliated with a PCPO/PCA Choice provider, within one year after training becomes available. 25 questions, need to get 20 correct. DHS will issue a certificate of completion, which is transferable to other agencies.

28. DSP Training should include: Services and supports outlined in the Care Plan & services not allowable Can a PCA “pass/give” medications? Language: Does it have power? Various disabilities: Physical and/or visible and non-visible Lifting & transfers Mental Health & Wellness Medical Equipment used in home care Ventilator supports Standard Precautions Emergency Preparedness Professional Ethics & Responsibilities Home Care Bill of Rights. Review Handouts

29. Locating a PCA Provider: There are over 600 PCA providers in the State of Minnesota! DHS Provider Directory: http://www.dhs.state.mn.us/main/groups/county_access/documents/pub/dhs_id_027985.pdf What other options are there for screening PCA provider agencies?

30. Wages, Benefits & Policies: What to ask potential providers. The National average for DSPs is $10.27. Here in Minnesota it is $10.41 The current reimbursement rate for PCA services to the agency, is $15.84. Most agencies offer from minimum wage up to $12/hr. What is the process for getting raises for your PCAs? What written policies are in place? What training is offered to PCAs, do they get paid for training? Most agencies do not offer PTO, medical coverage tec., due to low reimbursement rates and not being able to employ PCAs full-time. Most agencies do not provide mileage reimbursement to their PCAs. Agencies should not allow PCAs to drive clients in their own vehicles unless they can provide to the agency and the client proper liability coverage. If a PCA is going to drive a clients vehicle, the agency should verify that the proper liability coverage is in place. Most agencies do not conduct motor vehicle history reports. Some agencies offer emergency, on-call and after-hours back-up staffing supports. If you may need this service, be sure to ask about your staffing options! What other questions would you want to ask?

31. Advocacy& Resources DSPAM www.nadsp.org/dspam

32. Contact the Presenter: Brigette Menger-Anderson bma@breakthrucare.com findb@hotmail.com 612-659-1505 www.breakthrucare.com Providing professional PCA Choice & Traditional PCA Services