Decision 2: Service/Care Planning
Guidelines for Decision Making
- Care plans should include the scope, amount, frequency, and duration of each service; type of provider to furnish such service (including the option, if applicable, to employ families and friends); location of the service provision; and identification of risks that may pose harm to the individual along with a written individualized backup plan for mitigating those risks.
- Care planning must be done utilizing a person-centered and directed planning process to ensure the following:
- Identification of the person’s preferences, choices, and abilities to self-direct;
- An assessment of, and a plan developed for, management of any risk that might arise during the person’s participation in the program.
Protocols for care planning
Will individuals or their designee be offered the opportunity to manage a flexible individual budget and purchase items, goods or services to promote the provision of their service independence? If yes, what rules will govern the process? What range of services will be allowed including what additional services (and ways of delivering those services) will be covered?
- Spillman, B.C., Black, K.J. & Ormond, B.A. (2007). Beyond Cash & Counseling: The Second Generation of Individual Budget-based Community Long Term Care Programs For the Elderly. Washington CD: The Kaiser Commission on Medicaid and the Uninsured; The Urban Institute (p.33). Retrieved December 23, 2008.
Will individuals or their designee be offered the opportunity to recruit, interview, hire and dismiss their own workers for NHD provided services?
If yes, what role will the AAA play in helping the consumer to perform “employer” tasks? What protocols will be implemented to monitor consumer safety? What restrictions will be placed on the employment of family members?
- Consumer Directed Care Plus (2004). Consumer Notebook (p. 34). Retrieved January 5, 2009.
- University of Arkansas for Medical Sciences. (2005). Consumer Directed Model Training Manual (p. 47). Retrieved January 7, 2009.
Describe the various funding sources that comprise the participant’s financial support in NHD. Are these funding sources tied to a particular service provider? Describe how the NHD funds are flexible and responsive to changing consumer needs and are based on their preferences.
- Spillman, B. C., Black, K. J. & Ormond, B. A. (2006). Beyond cash and counseling: An inventory of individual budget-based community long term care programs for the elderly (p. 8).Washington: The Kaiser Family Foundation. Retrieved December 23, 2008.
- Robert Wood Johnson Foundation. (2007). Choosing Independence: A Summary of the Cash & Counseling Model of Self-Directed Personal Assistance Services (Section 1:6). Retrieved January 7, 2009.
- Spillman, B.C., Black, K.J. & Ormond, B.A. (2007). Beyond Cash & Counseling: The Second Generation of Individual Budget-based Community Long Term Care Programs For the Elderly. Washington CD: The Kaiser Commission on Medicaid and the Uninsured; The Urban Institute (p. 34). Retrieved December 23, 2008.
If the program offers consumer-direction and the individual is either not interested or not able to participate, describe the alternative service delivery option available (e.g., traditional agency services). Who will decide this and how will it be documented?
- State Grantee: Pennsylvania. (2004). Survey for Eligible Consumers who Chose Not to Enroll. Aging and Disability Resource Center Technical Assistance Exchange.
- Loughlin, D.M., Simon-Rusinowitz,L. & Mahoney, K. (2006). Is Consumer Direction Appropriate for Everyone Who Wants It? Experience from the Cash & Counseling Demonstration and Evaluation. Retrieved January 8, 2009.