Self-Directed Attendant Care - PPL
Self-Directed Attendant Care:An Overview forIndividuals providing services
Table of Contents BackgroundRole of the RepresentativeRole of the Case ManagerWho is eligible to be aPersonal Attendant? What are Allowable Activities? Employee’s ResponsibilitiesReturn to Table of ContentsPage 2
Table of Contents Steps towardBecoming an Employee Employee Compensation Staying on Track Rights and Responsibilities Abuse and Neglect Sticky SituationsReturn to Table of ContentsPage 3
BackgroundBeginning more than 30 years ago, many states began experimenting with a newform of home and community-based care for individuals who were directing inhome services.The alternative form of service delivery empowers directing care to direct theirown care with the option of choosing some or all of their own care attendantsand essentially serving as the direct employers of their caregivers.The movement gradually gained in popularitybecause individuals were ready and willing to takecharge of their own care and experienced greatersatisfaction with their lives once they had done so.In other states where the program has alreadybeen implemented, the level of satisfaction isreportedly very high.Return to Table of ContentsPage 4
Self-Directed Attendant CareSelf Directed Attendant Care is available as an option to those served underthe Aged & Disabled Medicaid Waiver who qualify for attendant care.The program allows for the hiring of a friend, neighbor, or formally trainedperson to serve as personal attendant, orAn individual may choose to advertise, interview and hire the best-qualifiedapplicantIndividuals may choose among the followingoptions: choose Self-Directed Attendant Care,solely. combine Self-Directed Attendant Carewith traditional agency-based services. utilize the traditional agency-basedservices they are familiar with.Return to Table of ContentsPage 5
Frequently Used TermsFiscal Intermediary: Public Partnerships, LLC (PPL) is the fiscal intermediary.This means that PPL will process payroll and taxes.Individual or Waiver Program Participant: If you are the individual on theMedicaid Aged and Disabled Waiver, this is you. The Individual orwaiver program participant is the person who receives attendant carethrough the Medicaid Aged and Disabled Waiver.Representative: A voluntary, unpaid person who may be appointed to assist awaiver program participant in performing the responsibilities of theemployer when the individual chooses not to do so independently.Employer, or Employer of Record: This term refers to the person in thehousehold directing the work of the employee. This may be the waiverprogram participant or a representative.Employee: The person who provides services to the waiver program participant isthe employee or personal attendant.Return to Table of ContentsPage 6
Role of the RepresentativeEligible individuals may appoint a Representative to assist in performing theresponsibilities of the employer.The Representative may work to: Complete paperwork Determine a schedule for work and the number of employees neededfor that scheduleThe Representative may also be involved for support. Or, they may beinvolved in the beginning to get the bulk of the hiring and training and, then,be available on an as needed basis.This position can be whatever you need to fulfill the responsibilities asthe employer.This position is voluntary and not a paid position.Return to Table of ContentsPage 7
Role of the Case Manager Information brokerage:Information, explanation theprogram and requirements tothe individual Initial Services:Counseling and assistancewith enrollment and workingwith the individual to developand monitor allocation ofhours. Continuing services:Monitoring, evaluating, andassisting you with changes ifthe plan of care changes.Return to Table of ContentsPage 8
Who is eligible to be aPersonal Attendant? Must be at least 18 years of ageCan be a family member (*see next slide)Must not have been convicted of a felonyMust review training materialsMust be registered withFiscal Intermediary beforeproviding care and beingpaid by the Medicaidprogram Must provide copy of driver’slicense and proof of insurance,if providing transportationReturn to Table of ContentsPage 9
Who is not eligible to be anEmployee / Personal Attendant?The following individuals are not permitted to be anemployees / Personal Attendants: Spouses Parents, if the individual is a minor child receivingservices through this program Persons who are legally responsible for the individualreceiving services Persons who are serving as aRepresentative for the individual receiving servicesReturn to Table of ContentsPage 10
Can I be a provider as thePower of Attorney? Yes and no. This depends on the type of POA. Nondurable POAs have rights to conduct onlyspecific transactions (like PPL). Nondurable POAsmay be providers. Durable POAs enables the Agent to make decisionsfor you. Durable POAs may NOT be providers. Please call us if you have questions concerning yourspecific case. (866) 264-2296Return to Table of ContentsPage 11
What are Allowable Activities?According to the Medicaid Waiver, self-directed attendantcare services may include attendant duties, as specified inthe plan of care, including the following: Personal CareBathing (tub, shower); partial bath; oral hygiene; hair care;shaving; intact skin care; dressing; clipping hair; application ofcosmetics; hand and foot care. MobilityProper body mechanics; transfer between bed and chair;wheelchairs and motor vehicles; ambulation (not including useof assistive devices).Return to Table of ContentsPage 12
What are Allowable Activities?(continued.) According to the Medicaid Waiver, self-directedattendant care services may include attendant duties, as specifiedin the plan of care, including the following: NutritionFeeding including preparation and clean up. EliminationAssisting with bedpan, bedside commode, toilet; incontinence orinvoluntary care; and emptying urine collection and colostomy bags.Return to Table of ContentsPage 13
What are Allowable Activities?(continued.) According to the Medicaid Waiver, self-directedattendant care services may include attendant duties, as specifiedin the plan of care, including the following: Correspondence and Bill Paying EscortingCommunity activities that are therapeutic in nature or that assist withdeveloping/maintaining natural supports.Providers who are hired to provide transportation services will be askedto provide a copy of their valid driver’s license and proof of insurance.Return to Table of ContentsPage 14
What are Allowable Activities?(continued.) According to the Medicaid Waiver, self-directedattendant care services may include attendant duties, as specifiedin the plan of care, including the following: SafetyUse of the principles of health and safety in relation to self and client;identify and eliminate safety hazards; and practice health protectioncleanliness by appropriate techniques of hand washing. Waste Disposal and Household TasksReturn to Table of ContentsPage 15
What Activities are not allowed? Attendant Care services must follow a written plan of careaddressing specific needs determined through an assessment. The Medicaid Waiver does not allow for medical procedures. Attendant Care services will not be provided to medically unstableindividuals as a substitute for care provided by a registered nurse,licensed practical nurse, licensed physician, or other healthprofessional. Coverage questions should be referred to the Medicaid Specialistwho works with the case manager.Return to Table of ContentsPage 16
What Activities are not allowed?Services that are exclusively for the benefit of other householdmembers are not allowed. Examples include: Running errands for other household members. Cooking for other household members. Completing laundry for other household members. Providing childcare for other household members.Under the CHOICE program, certain medical procedures could beperformed by attendants if a physician authorized them. Under theMedicaid Waiver, there is no provision for this.Return to Table of ContentsPage 17
What Activities are not allowed?Medical Services are not allowed; examples are in the following list: Bearing of full weight of individual during transfer.Assistance with ambulation using assistive devices.Specialized feedings.Other activities which must be performed by a licensed healthcare professional.Total lift transfer of as a quadriplegic.Passive range of motion exercises.Skin care on broken skin.Occupied bed changes.Bed baths.Return to Table of ContentsPage 18
Employee’s ResponsibilitiesAs an employee, you assume certain risks such as bodily injury orproperty damage.You should work with your employer to define your duties so as tominimize this risk. Can you physically do the job? Are you dependable? Your employer is depending on youfor tasks that they need to live independently. To minimize the risk of breaking valuables, stay in the areaof your employer’s home where you are doing your tasks. Discuss your enrollment in the program with your insuranceagent, to review your coverage.Return to Table of ContentsPage 19
Employee’s Responsibilities(continued ) As an employee, you assume certain responsibilities,including the following: Complete online training (alternate formats are available) andreview a checklist that verifies your understanding of theprogram and its requirements. Respect your employer and their needs and privacy. Reporting abuse or fraud promptly to the specified authorities. Reliably show up on time to perform services. Only performing the tasks outlined in your job description. Othertasks may not be covered by the employer’s plan of care andwould not be covered under this program. Specifically, medicalservices are not covered under this program.Return to Table of ContentsPage 20
Employee’s Responsibilities(continued ) As an employee, you assume certain responsibilities,including the following: Complete the required enrollment packet for the Self-DirectedAttendant Care program. Capably perform the tasks that you have been hired to perform. Work with your employer to develop a schedule for the servicesto be performed. Report your time accurately and appropriately using the methodsoutlined in the manual.Return to Table of ContentsPage 21
Performance ExpectationsCleanliness You should practice good personal hygiene before reporting towork. It is important that personal attendant be clean and neat. Wearhair in a manner that it will not be your face or getting into food, or youremployer’s face. Do not wear perfumes or colognes.Problem Solving You must be able to assess needs within agreed uponduties and present reasonable solutions/course of action for meetingthose needs. You should be able to remain calm and look at anysituation rationally.Emergency Care You must have the ability to remain calm and provideimmediate care to employer in order to insure his or her health andsafety and prevent further danger or injury. You should be able tocontact emergency services order to resolve the situation (i.e. police,ambulance, fire department). You must follow emergency proceduresas outlined by employer training.Return to Table of ContentsPage 22
Steps towardBecoming an EmployeeIt is a wonderful thing that you plan to do. You are helpingsomeone keep their independence.Please, keep in mind that the majority of the obstacles in front of you andyour employer can be traced to– Respect Respect your employer and their time and privacy Understand what tasks are in your job description. Show up at the scheduled time, every time.– Communication Begin with open and honest communication– Professionalism Treat this as you would any other employee/employee relationshipReturn to Table of ContentsPage 23
Review and understand the JobDescription and Provider AgreementWhy have a Job Description / Personal Attendant ProviderAgreement– To help you identify your qualifications for the job– To identify what services will be provided– To start a discussion with your employer andoutline the details of the job for everyoneReturn to Table of ContentsPage 24
Review and understand the JobDescription and Provider AgreementUnderstand your employer’s expectations through a Job Description.– You will have guidelines and know what is expected from thestart.– You know that you will be evaluated regularly and givenfeedback about your performance.– The job description will be very valuable for guidance. Itcreates an outline for you to use while discussing your workwith your employer.Return to Table of ContentsPage 25
Employee Compensation Units of care are measured in 15 minute increments, similar tocurrent system, following the plan of care/cost comparison budget. Employees will be paid at a rate of 9.80 (effective 10/2006) perhour. Raises will be determined by the State of Indiana. Taxes will be withheld from paychecks. Paychecks are issued everytwo weeks. The State of Indiana will cover: taxes on behalf or the employer, in addition to unemployment insurance Contributions are made to provider’s Social Security andUnemployment Compensation accounts. There is no Worker’s Compensation for this program. Service hours will be limited to no more than 40 hours per weekper provider for this employer. No overtime will be paid.Return to Table of ContentsPage 26
Staying on Track Being assertive in communicating your needs toyour employer Discuss your employer’s emergencyinformation and other important documentationfor this program Report your time accurately and appropriately Ask your employer for feedback and make suretheir needs are being metReturn to Table of ContentsPage 27
Communication:Giving Feedback Describe the situation as soon as possible after thesituation occurs. Discuss only one incident at a time. Do not bring up things from the past.Stick to the present. Discuss the person’s actions, not the person. Keep it brief and to the point.Return to Table of ContentsPage 28
Communication:Giving FeedbackThe following 3 slides show different ways to respond to asituation.The last example is the most effective way to resolve thesituation. You can effectively have your needs met withoutcreating conflict that would lead to an end to your workingrelationship with your employer. Let’s see how Return to Table of ContentsPage 29
Communication:Passive ResponseSituation: You have been working for Joe for several months. Youcome in at 8:00 p.m. each evening and help him get ready for bed.Tonight he asks you if you could come in at 10:30 p.m. tomorrowevening. You usually plan to be home by 10:30 p.m., as you have toget up early the next morning.Passive Response: You do not say anything and you come in at10:30.Result: You are upset because you know how tired you will be the nextday. All the time you are helping Joe, you feel irritated. He asks ifthere is something wrong and you say, “No”.Return to Table of ContentsPage 30
Communication:Aggressive ResponseSituation: You have been working for Joe for several months. Youcome in at 8:00 p.m. each evening and help him get ready for bed.Tonight he asks you if you could come in at 10:30 p.m. tomorrowevening. You usually plan to be home by 10:30 p.m., as you have toget up early the next morning.Aggressive Response: You say to Joe, “Don’t you think that I mightbe really tired if I come that late?”Result: Joe gets angry. He says that you are being rude andinconsiderate of his needs. The next time either the privateattendant or the employer wants to change the schedule neither ofyou will want to ask.Return to Table of ContentsPage 31
Communication:Assertive ResponseSituation: You have been working for Joe for several months. Youcome in at 8:00 p.m. each evening and help him get ready for bed.Tonight he asks you if you could come in at 10:30 p.m. tomorrowevening. You usually plan to be home by 10:30 p.m., as you have toget up early the next morning.Best Response, Assertive Response:Express your genuine concerns.“Joe, I would really like to help you out but it is difficult for me to stay upthat late and then to feel rested the next morning. Is there any otherway that we could figure out how to meet your need?”You have been open and honest as to why this does not work for you,but you have shown him your concern for his needs and yourwillingness to try to figure out another way of working it out.Return to Table of ContentsPage 32
Rights and ResponsibilitiesEmployer RightsPersonal Attendant Rights Direct your own personal care. To be treated with respect Decide who your personalattendant will be and when theywill work for you. Be provided with equipment andsupplies that are needed to completeassigned duties Be treated with dignity andrespect, which includes respect ofyour privacy and confidentiality. To request time off with adequatenotice Replace personal attendants whodon’t respect your rights. To work in a pleasant, safe, nonthreatening environment To be paid on timeReturn to Table of ContentsPage 33
ResponsibilitiesEmployer Being assertive when asking for orturning down help. Writing a job description for yourpersonal attendant to sign beforestarting work. Giving praise when it is due. Being respectful when talking toyour personal attendant. Making sure your personalattendant gets paid on time. Making emergency informationavailable to your personalattendant.Return to Table of ContentsPersonal Attendant Always being on time Being honest and open about his/herfeelings Knowing his or her own skills and limitationsand able to discuss them Providing reliable, safe, high qualityservices, as directed Making a work schedule with your employer Respecting employer and his or her right toprivacy and confidentiality Notifying employer as soon as possiblewhen he or she knows he or she will be lateor unable to work Giving at least two weeks notice beforemaking changes or quitting Completing job duties as directedPage 34
Abuse and NeglectAbusive behavior is completely unacceptableand is against the law. Physical abuse means any action that causes physical painor injury including but not limited to hitting, pushing, pinching,or kicking. Sexual abuse includes but is not limited to rape; anyunwanted sexual contact, or sexual harassment. Emotional and verbal abuse includes but is not limited toname calling, intimidation, yelling, and swearing. Neglect is defined as the lack of attention and due care. Failing to show up for work is neglectful behavior. Failure to provide the appropriate care, water, food ormedication is neglectful behavior.Return to Table of ContentsPage 35
Sticky SituationsReturn to Table of ContentsPage 36
Sticky SituationsBy planning ahead, you can avoid many stickysituations. The following slides discuss commonsituations and how to avoid them.Many of these situations are avoided by: communicating effectively with your employer, be a responsible employee, respecting one another, and treating your working relationship professionally.Return to Table of ContentsPage 37
Sticky SituationsTasks not performed properly or completelyIt is important that the activities are performed for youremployer. First, because your employer and their casemanager have determined that he or she needs theseactivities for daily living.In addition, this is a Medicaid program. If someone is notperforming the services that they are hired and paid to do, thatcould constitute fraud. Medicaid could investigate and takeaction if fraud is suspected.Enforcement could result in prosecution of all parties involved.Return to Table of ContentsPage 38
Sticky SituationsCommunication ProblemsBegin by communicating effectively. Recognizewhen there is a problem as soon as possible andaddress it with your employees.Sometimes it is difficult to think of effective ways tocommunicate. Take a little time, talk it over withsomeone to roll play, if you need to.Return to Table of ContentsPage 39
Sticky SituationsQuitting as a Personal AttendantSometimes things do not work out, for any number of reasons.Ending a work relationship does not have to ruin a relationship with afriend or family member.Again, communication is the key. Address problems as they arise.Avoid arguments and try to communicate your feelings assertively.Maybe your personal or work life has changed recently. Or you mayhave thought you could do the work, but you realized that youcannot. It is ok.Be honest and talk about it. Chances are, your employer knows thatthings are not working out, but they don’t know how to handle it.Return to Table of ContentsPage 40
What is a Fiscal Intermediary?A Fiscal Intermediary processes payroll and completes tax processeson your employer’s behalf. The State of Indiana has contracted withPublic Partnerships, LLC to perform the role of fiscal intermediary forthis program.Specifically, a Fiscal Intermediary: Pays employees/personal attendants on your employer’s behalf Withholds and deposits taxes, and files tax and labor reports Provides you, your employer and the case manager with regularreports that show how authorized units have beenspent, and the amount of taxes paid Responds to your questions and questions from your employer, andthe case managerAdministers the limited criminal history Return to Table of ContentsPage 41
About Public Partnerships,LLC (PPL) Public Partnerships, LLC (PPL) is an affiliated company of PublicConsulting Group, Inc. (PCG). PCG is a national consulting firmfocused on assisting state and local governments to dramaticallyimprove their financial and operational performance. PPL was founded in 1999 to focus exclusively on the financialoperations of consumer-directed services. PPL contracts in twelve other states to serve as the Fiscal Intermediaryfor a variety of human services populations, including mental health,developmental disability, adult protective services, child protectiveservices, and foster care arrangements. PPL was hired by Indiana FSSA to be the Fiscal Intermediaryfor the self-directed care program that is part of the Aged &Disabled Medicaid Waiver.Return to Table of ContentsPage 42
Fiscal Intermediary Benefits You will receive a W-2 statement at the end of eachcalendar year. Contributions are made to your Social Security andUnemployment Compensation accounts. You receive bi-weekly paychecks, based on timereported to PPL.Return to Table of ContentsPage 43
Overview of Employee Forms USCIS Form I-9 – Employment Eligibility Verification. Thisfederal form tells the USCIS that the employee is eligible foremployment in the United States. IRS W-4 Form - Employee’s Withholding Allowance Certificate.This federal form tells the IRS about the withholding allowancesfor which the employee is eligible. Form WH-4 - Employee’s Withholding Exemption and CountyStatus Certificate. This form tells the State about thewithholding allowances for which the employee is eligible.Return to Table of ContentsPage 44
Overview of Employee Forms Employment Terms and Conditions – This form serves as acontract between employers and employees. Employee Data Form – This form collects basic demographicdata about employees. Employee Training Checklist – This form is documentation ofemployee understanding of self-directed care. Federal Tax Exemption Information Form – This form is to becompleted by family members serving as employee for thepurpose of identifying special tax circumstances.Return to Table of ContentsPage 45
TimekeepingThere are two methods for submitting time worked:– Telephonic timesheet (preferred method)– Physical timesheet (back-up method) The telephonic timesheet is done over the phone.1) The employee calls a toll-free phone number upon arrival.2) The employee enters the individual’s Medicaid ID# and theirEmployee ID# in order to “clock in”.3) After services have been performed, the employee calls the sametoll-free number to “clock out”.4) The employee will enter a service code and activity codes for theservices performed. Service hours will be limited to no more than 40 hoursper week per provider for each individual enrolled.No overtime will be paid.Return to Table of ContentsPage 46
TimekeepingThere are two methods for submitting time worked:– Telephonic timesheet (preferred method)– Physical timesheet (back-up method) The physical timesheet is completed every two weeks and signedby both the Employer and Employee.The timesheet can either be: faxed using a toll-free fax number, or mailed to PPL Service hours will be limited to no more than 40 hoursper week per provider for each individual enrolled.No overtime will be paid.Return to Table of ContentsPage 47
TimekeepingHere is an example of a correctly completed time sheet.Return to Table of ContentsPage 48
Timekeeping: Activity CodesService and Activity Codes are entered as you are logging(clocking) out. These codes refer to the services that youprovided. The following is a list of some Service and ActivityCodes:Service CodesActivity Codes01 Personal Care11 Bathing12 Grooming13 Hair Care14 Walking15 Meal PreparationAdditionalService and16 HousekeepingActivity Codesmay be added17 Laundryin the future.18 Errands19 Other TasksReturn to Table of ContentsPage 49
TimekeepingAdditional information concerning theprocess of timekeeping can be found: by reviewing the online training for theFiscal Intermediary Services Or, by referring to the employee manual:A Guide for the Individual Providing CareReturn to Table of ContentsPage 50
Overview of Reporting Family Reports: Detailed monthly reports foreach service includes amount of funds spentand remaining funds Case Manager Reports: Detailed monthlyreports allow monitoring and managingresources across individuals Funder Reports: Detailed monthly reportsinclude year-to-date spending and services Customized Reports: Generated as neededReturn to Table of ContentsPage 51
Family Friendly Report Designed for a familyaudience Summarizes accountspending activity to date Reflects budget variances Easy to read and understand Mailed directly to casemanagers and families on amonthly basis Can be produced in multiplelanguagesPUBLIC PARTNERSHIPS, LLCPUBLIC148 State Street, 10th FloorPARTNERSHIPSYEAR TO DATESPENDING SUMMARY REPORTAccount InformationParticipant, JimAddressCity, State ZipISNB#:1234-FF-1Case Manager:Jane SmithReport Print Date:Fiscal Year-Period:4/30/20012001-10How to Read this ReportRead the chart below to see how much money you have spent for each item compared to how you budgeted. Checkthe "remaining balance" column to see if you still have funds available for each item. If there are no "( )" around theamount, that means you still have funds available to you for that service item. But, if there are "( )" around the"Remaining Balance" amount, that means you have exceeded the dollars budgeted to you for that service item. Azero indicates that you have no funds budgeted for that item, but you may have submitted invoices for payment.Additional pages may follow this summary that include detailed payment information.How Much of My Budget Have I Spent Through April 30, 2001Service Description1:1In HomeSupport ( 24)PersonalAttendantServicesJob DevelopmentJob CoachingIn-home educationCab ServicesMBTAPersonal StipendBoston, MA 02109(617) 426 2026GRANDGRANDTOTALSTOTALSFundsBudgetedFunds 0.001,806.00684.00202.16 15,653.203,392.72 0.00194.000.0097.84 1,007.282,217.92% ofFunds3%65%3%20%6%10%0%33%6%65%Return to Table of ContentsPage 52
Network Development Network is infinite! Individuals select providers based on theirplan of care. Employees may be traditional or nontraditional. Potential for family members to becomeemployers.Return to Table of ContentsPage 53
Website & Provider Registry Contains forms andtraining materials Allows individuals andcase managers accessto provider database Includes services,credentials, hours,location, and contactinformation forproviders who chooseto be listedwww.publicpartnerships.comReturn to Table of ContentsPage 54
Quality AssuranceYour employer will follow up with his or her case manager,regularly, every 90 days, to ensure that the program is working asplanned, or to address any problems that arise.If a negative report is made, a case manager will file an incidentreport with the Indiana Family and Social Services Administration(FSSA). An internal committee within FSSA will review qualitycomplaints.Unresolved, negative quality reports will lead to appropriate actionwhich may include dismissal and removal from the providerregistry.Employees will be notified, in writing, of any complaints and ofaction to be taken. There is a process in place for appeal.Return to Table of ContentsPage 55
90-DayChecklistReturn to Table of ContentsPage 56
Working witha person with a disability9 Let the individual give you direction on how he or she wants you toassist him. Before helping, ask the person if he wants you to help.9 Do not hang or lean on an individual’s wheelchair because it is part ofthat individual’s personal body space.9 Speak directly to the individual with a disability, not to someonenearby as if the individual with the disability were not there.9 Do not pat an individual in a wheelchair on the head or refer to peoplein “affectionate” terms such as “sweetie”, “dear”, etc. These things areusually seen as put-downs to people.9 If an individual has diminished eyesight, allow him to tell you what kindof assistance you can give.9 Do not discourage children from asking questions about disabilities.9 When an individual is using an assistive device to t
Fiscal Intermediary: Public Partnerships, LLC (PPL) is the fiscal intermediary. This means that PPL will process payroll and taxes. Individual or Waiver Program Participant: If you are the individual on the Medicaid Aged and Disabled Waiver, this is you. The Individual or waiver prog
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The role of the Attendant Care Worker (ACW) is to provide attendant care services outlined in the service plan while maintaining a safe and comfortable environment. The member and the case manager are responsible for creating the service plan. F ATTENDANT RIGHTS . An ACW in the Self Directed Attendant Care (SDAC) option has the right to:
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