Health, Department of

Aging Division

Chapter 7: Community Based, In-Home Services

Effective Date: 07/25/1994 to 12/18/1998

Rule Type: Superceded Rules & Regulations

Reference Number: 048.0003.7.07251994

Date Filed 07/25/94

Expr Date

Supr Date

Repeal Date

Document Type RULES

CHAPTER VII

COMMUNITY BASED, IN-HOME SERVICES

Section 1. Authority. The Wyoming Division on Aging pursuant to W.S. 9-2-1204 (1977) and Session Laws of Wyoming, 1986, Chapter 102, p. 214, n.12, is authorized to adopt rules and regulations governing programs and services for the Community Based, In-Home Services for the Elderly in the State of Wyoming.

Section 2. Purpose. The purpose of these rules is to establish standards for the delivery of community based, in-home services for the elderly and includes provisions related to program operations that are directly related to the quality of such services.

Section 3. Case Management. All grantees/contractors shall have at least a part-time case manager who shall manage community based, in-home services as follows:

(a) case finding - identify and establish contact with persons who need the services provided by the program, especially for those individuals who are "at risk" of entering institutional care. This requires the use of outreach, information and referral, and public information campaigns to heighten awareness among potential clients and potential referral sources about the program characteristics and services;

(b) pre-screening - making a preliminary determination, prior to a full intake assessment, regarding the suitability of the program for a person who is being referred to or seeking services from the case management program;

(c) intake - committing the program to serve the client and engaging the client in the care planning process, which may include a preliminary determination of the offer, how it works, and responsibilities of the client, obtaining the person's agreement to become a client and setting up a case record;

(d) client assessment - interviewing and observing the client, usually in the client's home, in order to obtain information on the client's functional capacity, available personal and social support resources, perceived problems and services currently received either from formal or informal sources. The client assessment tool to be used for the community based, in-home services program will be prescribed by the Division.

(e) goal setting - stating the broad or specific purpose for which services are to be provided as the basis for a care plan with complete specific action steps;

(f) care planning - develop the care plan in response to the needs and goals previously identified. The plan shall reflect the desired outcome, what is to be done about whom (client, family or informal supports, case manager, other agencies, when, for how long, how often, for what price, how paid, point for reassessment, alternatives that may be preferable though not available, etc.);

(g) plan implementation/service coordination - performing tasks with the client, the client's informal support systems and other agencies that will be providing services. This shall include informing the client of services, demonstrating how to secure services, advising about problems, purchasing actual services, mediating conflicts, identifying gaps in service, updating information on services available and/or agency capabilities, identifying barriers to services, advocating within the community for needed services to fill the service gaps;

(h) reassessment - updating the status of the client in relation to specific conditions targeted for service or related conditions that can be addressed by the program. This will be completed at least quarterly or according to the care plan schedule;

(i) termination - removing a client from the program, either due to self-removal, provider decision, achievement of case goals, entry into an institution, death or decision that client no longer merits services;

(j) maintaining relationships - providing an ongoing communication link with terminated clients to reinforce client achievements and tracking program results to detect early warning of adverse changes in the status of the older individual;

(k) regular meetings with other agencies involved in providing services for the client to provide a comprehensive program for that client and to avoid duplication of services.

Section 4. Care Plan Implementation. Service providers will implement in-home services as specified in a care plan within fourteen (14) days of the effective date of the care plan.

Section 5. Client Fees. Clients will pay a fee for services based on the fee schedule, developed by the Division. Such fees will be considered program income.

(a) Client will be provided with a monthly statement regarding the number of service units they have received, the actual cost of the service unit and the required fee for the services.

Section 6. Eligibility. Clients are eligible for community based, in-home services based on the following requirements:

(a) at least sixty (60) years of age;

(b) is 'at risk';

(c) his/her needs can be adequately met through the services offered in this program; and,

(d) client desires community based, in-home services.

Section 7. Emergency Provisions. In an emergency. Clients will be provided with in-home services emergency as soon as appropriate services can be initiated by the case manager. In the event of an emergency, the process of prescreening, intake, client assessment, goal setting, and care planning can be delayed for up to a maximum of five (5) working days.

(a) Should the client receiving emergency services be found to be ineligible, those services will be terminated.

Section 8. Training. All project directors and case managers will attend training sessions and workshops as required by the Division.

Section 9. Grant Application. All grants must include:

(a) specifications of services currently available in the community;

(b) specifications/projections of numbers of individuals needing services;

(c) Specifications/coordination procedures needed to fully utilize existing community based services.

(d) current letters of support for the project and anticipated coordination from other providers in the community, including any financial commitments;

(e) specifications of services alternatives which need to be developed to meet service gaps in the community;

(f) specifications of from where additional resources will be obtained to provide the services;

(g) identification of the current and projected 'at risk' population in the community;

(h) identification of a case manager for the project;

(i) specifications of the geographical area to be served in the project;

(j) a budget narrative that includes break-outs of the cost of:

(A) each staff person's salary and fringe benefits;

(B) travel by per diem, miles and type of staff vehicle;

(C) equipment by each piece to be purchased under the proposed grant/request;

(D) consumable supplies by each type;

(E) other costs for items such as, but not limited to, rent, utilities, sub-contracts and other allowable costs.

Section 10. Reporting Requirements.

(a) Grantees/contractors will comply with reporting requirements as prescribed by the Division.

(i) Failure to comply will result in termination/suspension of grant/contract in accordance with Chapter VI, Section 2.