D.Service Standards – Residential Services

Issue Date: 8/28/09 / Rev Date: 10/4/11
Service Name / Residential Services, Waiver (Licensed Adult Foster Care/Home for the Aged)
Service Definition / Residential services include enhanced assistance with activities of daily living and supportive services. MI Choice participants who receive this service must reside in licensed homelike, non-institutional settings. These settings include continuous on-site response capability to meet scheduled or unpredictable resident needs and provide supervision, safety, and security. Third parties may only furnish this service with the approval of the participant, licensee, and waiver agent. Payment excludes room and board, items of comfort or convenience, and costs of facility maintenance, upkeep, and improvement.
Service Code / T2032 Residential care, not otherwise specified (NOS), waiver; per month
T2033 Residential care, not otherwise specified (NOS), waiver; per diem
Units / T2032 – one unit per month
T2033 – one unit per day
Service Delivery Options /  Traditional/Agency-based
 Self-Determination
  1. MINIMUM STANDARDS for TRADITIONAL SERVICE DELIVERY
  1. Each direct service provider must have written policies and procedures compatible with the General Operating Standards for vendors in Section C.
  1. Residential Services (RS) include assistance with:

a)Activities of daily living such as bathing, eating, dressing, and personal hygiene

1)The services and supports provided under RS are in addition to and shall not replace usual and customary care furnished to residents in the licensed setting.

2)Documentation in the participant’s record must clearly identify the participant’s need for additional supports and services not covered by licensure.

3)The plan of care must clearly identify the portion of the participant’s supports and services covered by RS.

b)Homemaking tasks incidental to the provision of assistance with activities of daily living may also be included in RS, but shall not replace usual and customary homemaking tasks required by licensure.

c)Non-medical care (not requiring nursing or physician intervention)

d)Preserving the health and safety of the individual so that he/she may reside, receive services, and be supported in the most integrated and independent community setting.

  1. RS excludes nursing and skilled therapy services.
  1. RS does not include the costs associated with room and board.
  1. Waiver agents authorize this service when necessary to prevent the institutionalization of the participant served and allow the participant to reside in the most independent setting of their choice.
  1. Waiver agents cannot approve RS in circumstances where the service duplicates services available under the state plan, by licensure, or elsewhere. When more than one waiver service is included in the participant’s plan of care, the waiver agent must clearly distinguish services by unique hours and units approved.
  1. Individuals providing RS must be at least 18 years of age, have the ability to communicate effectively both orally and in writing and follow instructions.
  1. Members of a participant’s family may provide RS to the participant. However, waiver agents shall not directly authorize MI Choice funds to pay for services furnished to a participant by that person’s spouse.
  1. Family members who provide RS must meet the same standards as providers who are unrelated to the individual.
  1. The waiver agent, provider agency, and/or licensee must train each worker to perform properly each task required for each participant the worker serves before delivering the service to that participant. The worker’ssupervisor must assure that each worker can perform every task assigned competently and confidently for each participant served.
  1. Staff Orientation and TrainingMinimum Standards.

Orientation Training

1.Orientation Training

New staff must receive an orientation training that includes, at a minimum:

a.Introduction to the AAA 1-B programs (both MI Choice waiver and state-funded programs)

b.Service delivery techniques

c.Observation of new staff performing service activities

d.The aging network

e.Maintenance of records and files (as appropriate)

f.The aging process, which may include, but not be limited to:

(1)Cultural diversity

(2)Dementia

(1)Cognitive impairment

(2)Mental Illness

(3)Abuse and exploitation

g.Working with disabled individuals

h.Ethics and Code of Conduct

i.Emergency procedures and protocols

j.Universal Precautions

k.Advanced Directives and DNR’s

Vendors shall maintain records detailing dates of training and topics covered in employee personnel files.

In-Service Training:

1.Staff of vendors performing home-based services must receive in-service training at least twice per fiscal year. Each vendor must design the training so that it increases staff knowledge and understanding of the program and its participants and improves staff skills at tasks performed in the provision of service.

Note: The AAA 1-B recommends that in-service trainings cover, at a minimum:
  1. Safety
  2. Sanitation
  3. Body mechanics
  4. Household management
  5. Emergency procedures
  6. Universal precautions
  7. Additional trainings as needed
Note: See Section D. Service Standards for additional Homemaking service topics.
Each vendor must provide evidence (i.e., submit a written policy requiring direct care staff to receive two in-service trainings per year) as part of enrollment into the DSP vendor pool.
Note: See Section D. Service Standards for Personal Care service RN requirements.
  1. Vendor Records for Participants:

1. Each vendor MUST maintain comprehensive and complete

participant records THAT CONTAIN, at a minimum:

a.Participant/Worker Log Sheet(s). (The five items listed below must be documented as services are provided.)

(1)Date of service

(2)Total Hours Per Service Authorized per Diem

(3) Service log of tasks performed

(4)Worker’s signature

(5)Worker observations

  1. The AAA 1-B requires that the five items listed above be contained in one document referred to as the Participant Worker Log Sheet.
  2. The AAA 1-B requires all vendors to submit a copy of both the Participant Worker Log Sheet(s) and written policies and procedures for completing the Participant Worker Log Sheet(s).
  3. The Participant Worker Log Sheet(s) is the official documentation required to substantiate service delivery.

Worker observations of the participant are:
a.Changes in the participant’s condition (condition of skin, change in appetite or appearance, etc.)
b.The amount of assistance needed
c.How well service is tolerated
d.Any concerns or changes observed

b.Documentation

(6) CSS Authorization Form

(7)CSS Assessment and/or Reassessment

(8)Residential Care Agreement

(9)Notes in response to participant, family, and agency contacts (not required for home delivered meal programs)

(10)Progress Notes

(11)A record of release of any personal information about the participant and/or a copy of a signed release of information form

2.Vendor records must contain a listing of all dates of service for each participant and the number of units provided each day. Absence of a worker service record at a review for any date of service for which the vendor makes a claim is equivalent as having no record that the service was rendered.

3.The Participant/Worker Log Sheet is a daily account of services furnished and must be written by the worker who provides the service. Workers must maintain a record of servicesfurnished by date of service and description of service provided on each date.

4.Worker time sheets without tasks performed do not meet these criteria and should not be used as worker service records.

  1. Activities of Daily Living
  1. When the RS provided to the participant include assistance with activities of daily living, the direct service providers furnishing RS must also:

a)Be supervised by a registered nurse licensed to practice nursing in the State. At the State’s discretion, other qualified individuals may supervise RS providers. The direct care worker’s supervisor shall be available to the worker at all times the worker is furnishing RS services.

b)Develop in-service training plans and assure all workers providing RS are confident and competent in safety and body mechanics before delivering RS to MI Choice participants, as applicable to the needs of that participant.

c)Provide an RN to individually train and supervise RS workers who perform higher-level, non-invasive tasks such as maintenance of catheters and feeding tubes, minor dressing changes, and wound care for each participant who requires such care. The supervising RN must assure each worker’s confidence and competence in the performance of each task required.

d)Vendors must conduct on-site supervision of their staff at least twice per each fiscal year. A qualified professional must conduct the supervisory visit. Documentation of the supervisory visits must include:

1)Date of supervision

2)Place of supervision

3)Participant name

4)Name of worker

5)Skills/tasks observed and level of competence

6)Signature of supervisor

e)The AAA 1-B requires that a copy of the supervisor’s qualifications be submitted with the bid application.

f)Vendors shall maintain documentation of each on-site supervisory visit for 6 years in the client file.

g)Be trained in first aid and cardio-pulmonary resuscitation

(CPR).

h)MDCH strongly recommends each worker delivering RS

complete a certified nursing assistance training course.

  1. MINIMUM STANDARDS FOR SELF-DETERMINED SERVICE DELIVERY
  1. When authorizing RS for participants choosing the self-determination option, wavier agents must comply with items B through G of the Minimum Standards for Traditional Service Delivery specified above.
  1. Each chosen provider must minimally comply with Section C of the “General Operating Standards for MI Choice Waiver Service Providers”.
  1. The individual furnishing RS must also be trained in CPR. This training may be waived when the provider is furnishing services to a participant who has a “Do Not Resuscitate” order.

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