H08- 064 – Policy and Procedure

September 3, 2008

TO: / Area Agency on Aging (AAA) Directors
FROM: / Bill Moss, Director, Home and Community Services Division
SUBJECT: /
Family Caregiver Support Program Changes and Planning Considerations Related to TCARE Roll-Out in July 2009
Purpose: / To notify AAA staff about the changes to the Family Caregiver Support Program (FCSP)in preparation for implementation of the Tailored Caregiver Assessment and Referral (TCARE) tool.
Background: / The last two legislative sessions have included the largest increases in funding throughout the 20 year history of the Respite and Family Caregiver Support Programs. This legislation providesfunding and the requirement to automate the new caregiver assessment process referred to as TCARE. The intent of the assessment is to move toward a more evidence-based approach for supporting family caregivers in choosing the type and scope of services that will best help them. The TCARE assessment tool is expected to begin implementation statewide by July 2009. The Family Caregiver Support Policy Team comprised of seven AAAsand ADSA staff has been providing input on the development of TCARE. Program policies related to the Family Caregiver Support Program and TCARE will be developed over the next year and all of the AAAs will have a chance to review and have input.
The increase in family caregiver support program funding appropriated in the last legislative session was allocated to AAA’s in the FY09 State/Federal contracts.
What’s new, changed, or
Clarified / AAAs should start planning for staffing, training and equipment needs nowbased on their determination of the screening methodology and the number of screenings and assessments they project in a year. This MB is to provide as much information as is known at this time to help AAAs start to make plans as early as possible. More detail will be available before the TCARE roll out.
The following are several factors you should considerin planning for TCARE implementation and operation:
Implementation Schedule:
TCARE roll out is scheduled to begin in July 2009. ADSA is planning three waves of training and TCARE implementation. Staff involved in the first wave of roll-out will participate in TCARE Certification training beginning in March 2009. The second and third waves of TCARE training and implementation will occur between August and December 2009. Training on the TCARE computer application and changes to the FCSP policies will begin in June 2009. More details regarding training timeframes for both certification and for screeners will be provided as we get closer to the roll-out date.
Training Costs:
Training costs that will be covered by ADSA are travel expenses for Dr. Rhonda Montgomery and her training staff as well as facility costs for the three classroom training sessions and the TCARE IT application and program training tools. TCARE materials for the training will be provided by Dr. Montgomery and ADSA. Each AAA will be responsible for their staffs’ travel, lodging and per diem costs for each of the sessions. The amount and nature of training, locations, and delivery methodswill be discussed with AAAs at the September 10th planning and development meeting that has been set to discuss TCARE implementation.
Administering TCARE:
The TCARE screening tool can be:
  • Administered in the office via a face-to-face interview with the
Caregiver;
  • Mailed to the caregiver;
  • Downloaded by the caregiver via a PDF TCARE form on-line from the AAA website and mailedto a AAA office; or
  • Completed over the phone with a trained TCARE screener.
After the screening information is entered into the TCARE system, algorithms willrun automatically and will provide the scores for the various screening measurements (stress and burden, depression, uplifts, etc.) Some family caregiver services will be available without further assessment activity. Caregivers who meet a certain acuity level on the screening measurementswill be provided the option of completing a full TCARE assessment. The acuity level that will trigger the full assessment is one of the policy decisions that has not been determined. This decision will be made jointly with AAAs in light of resources.
The full TCARE assessment will be completed in a face-to-face interview with the caregiver, whether in the caregiver’s home, in the office, or other convenient setting.
The TCARE screening and assessment process will change how a caregiver accesses services. In order to receive certain family caregiver support services, such as Respite Care, a caregiver will need to complete the TCARE screening and a full assessment. TCARE will replace the CARE assessment for Respite clients. The outcomes of the TCARE screening and assessment will inform the discussion with the caregiver about what options might best address their stress and burden. At this time, rescreening and reassessment timeframes,or which FCSP services will require a TCARE assessment beyond Respite, have not been determined.
Staffing:
AAAs can begin to approximatestaffing levels needed to complete TCARE screeningsand/or assessments. You can estimate 20 minutes is needed to complete the TCARE screening process per caregiver. (If the caregiver completes the screening form on their own, staff time will be limited to input of the data into the TCARE system.) This does not include any additional I & A/FCSPintake process that may be internal to your AAA. For those caregivers going on to complete a full TCARE assessment and service plan, you can anticipate the process to take 3 hours per caregiver. While the exact number of full TCARE assessments that would be accomplished is not yet known, the number of Respite assessments your agency currently does would be a reasonable estimate for planning purposes.
Staff Education and Experience Qualifications:
The AAAs will need to have appropriately qualified staff in place to conduct the TCARE protocol.
Staff who will administer the TCARE screening toolwill be required to meet the qualifications of an Information and Assistance Telephone Screener as defined in the IandA Program Standards.
Staff administering the full TCARE assessment/consultation and service planningmust meet the minimum qualifications of a Case Manager.
Staff who can follow-up with the caregiver to coordinate services can include the case manager, I and A telephone screener or if needed, a case aide.
Connectivity:
The TCARE application will only be fully functional when connected to the DSHS network. Each AAA will need to decide on the most efficient method for gathering and entering data for the caregivers you serve.Your options for network connectivity of the TCARE assessment include:
  • Off-line which means there is no intranet connectivity to the DSHS network. The case manager/FCSP Specialist can complete a TCARE assessment in the caregiver’s home or other convenient location, but the algorithms that determine a caregiver’s stress and burden scores will not run until the information is downloaded at a network connection.
  • On-line which means there is intranet connectivity either in an office that has a connection to the DSHS network or where there is good cellular reception, via a Broadband card connection that the AAA would purchase for staff (see attachment (A) Broadband Connection in a Caregiver’s Home).
  • TCARE screening and assessment forms can be offered in a paper version and then manually posted by someone with a network connection.
Equipment and Material Costs:
Equipment and material costs related to TCARE are the responsibility of each respective AAA. Attachment (B) provides a list of items required to adequately meet the needs of your organization or your subcontractors before TCARE implementation. The majority of costs may come from the purchase of inventory; such things as laptops and/or Broadband connectivity as well as printing costs of the TCARE screening and assessment forms.
ACTION: / AAAs should begin planning for decisions on operational methods, staffing, training needs, and equipment investments in preparation for TCARE roll out. Draft policy questions and answers are attached below.
Related
REFERENCES: / None
ATTACHMENT(S): / Attachment (A) Attachment (B)

Family Policy Team – Draft Policies/Recommendations:

CONTACT(S): / Leigh Wellcome, Family Caregiver Program Manager
(360) 725-2547

Hilari Hauptman, Kinship & Family Caregiver Program Manager
(360) 725-2556

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