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Lake Cumberland Area Agency on Aging & Independent Living Policies and Procedure Manual

Section X Homecare Program Page 1



10.1 Eligibility

10.1.1 Medicaid Eligibility and Transition Policy

10.2 Assessment, Reassessment

10.2.1 Nutrition Screening/Assessment/Referral

10.3 Plan of Care

10.4 Natural Supports

10.5 Coordinating Services

10.6 Social Services Assistant

10.7 Quality Service

10.8 Fees and Contributions

10.9 Training Responsibilities

10.10 Required Staffing Pattern

10.11 Participant Contact

10.12 Budgeted Services

10.13 Unit of Service

10.14 Home Repair

10.15 Supplies

10.16 Respite Care

10.17 Incident I Accident Reporting

Lake Cumberland Area Agency on Aging & Independent Living Policies and Procedure Manual

Section X Homecare Program Page 2

10.17.1 Incident I Accident Reporting Classification

10.18 Waiting List

10.19 Participant Rights and Responsibilities

10.20 Termination or Reduction of Services

10.21 Past Due Accounts

10.22 Ensuring a Safe Work Environment for Staff and Clients

10.23 Monitoring Homecare Participants for Health and Safety

10.24 Case Records

10.25 Contractor Responsibilities

10.26 Time In - Time Out Documentation

10.27 Home Delivered Meals Accepted by a Designee

10.28 Monitoring Homecare Client Files

Lake Cumberland Area Agency on Aging & Independent Living Policies and Procedure Manual

Section X Homecare Program Page 3

Homecare: Eligibility


Revised: February 2017

Policy Statement

Lake Cumberland Area Agency on Aging shall ensure services for the aging and disabled population are available as funding allows and incompliancewith 910KAR1:180.




(1) The homecare programrequiresageverification thatthe applicant for services isat leastsixty (60)years ofage. Theindividualsageshallbeverified utilizingoneofthefollowingdocuments: (a) Birth Certificate;

(b) Driver's license;

(c) Passport;

(d) Military ID;

(e) Letterof"NoRecord" issued bytheStatewith individuals name,dateofbirth,which yearswere searched for a birth record and that there is no birth certificate on file and asmany of the following as possible: 1. Baptismal certificate;

2. Hospital birth certificate;



5.Family biblerecord;

6.Doctor'srecordof post-natal care

(2) The homecare providerverifies the applicant isnoteligible forthesameorsimilar services throughMedicaidas requiredby910KAR1:180Section4.(b)1-2

(3) Ensurethe applicantmeetsone(1)ofthefollowingcriteria:

(a) Be functionally impaired in the performance of: 1. Two (2) activities of daily living;

2. Three (3) instrumental activitiesofdaily living;or

3. Acombination ofone (1) activity ofdaily living andtwo(2) instrumental activities ofdaily living.

(b) Haveastablemedicalconditionrequiringskilledhealthservicesalongwithservicesrelatedtoactivities of daily living requiring an institutional level of care; or

Lake Cumberland Area Agency on Aging & Independent Living Policies and Procedure Manual

Section X Homecare Program Page 4

(c) Be currently residing in: (a) Askillednursingfacility;

(b) An intermediate care facility; or

(c) A personal care facility; and

2. Abletobemaintainedathomeifappropriate livingarrangements andsupportsystems are established.

(4) Eligibility shall be determined by the Independent Care Coordinator (ICC) for the following services:

(a) In-home services; and

(b) Respite for the unpaid primary caregiver.

The homecare programshallnotsupplantorreplaceservicesprovidedbytheclient'snaturalsupportsystem.

(5) An applicant iseligible for homecare services butfunding is not available shall beadded to awaiting list for services.The applicant shallbescreened and prioritized bythe Lake CumberlandADRCpriorto being placedon the waiting list.

Lake Cumberland Area Agency on Aging & Independent Living Policies and Procedure Manual

Section X Homecare Program Page 5

Homecare:Medicaid Eligibility and Transition Policy


Revised: February 2017

Policy Statement

TheHomecare programfortheelderlywas established toassisteligible individualto receivein-homeservices. The program is designed to assist individuals to remain in their own home for as long as possible and to prevent premature placement inalongtermcarefacility.Homecare funding isnotavailable forindividualsthatqualify

forthe sameorsimilarservices through otherprograms.




(1) The LCAAAIL, ADRC orIndependentCareCoordinator (ICC)shallscreenfortheMedicaideligibilityofeach individualapplying fororreceivingservices throughtheHomecare programforthe elderly under910KAR1:180.

(2) WhentheHomecareapplicantorparticipantiseligibleforMedicaidservices LCAAAILstaffshallprovidecontact information and assistance with applying for Medicaid services available to meet the client's needs.

(3) Any Homecare applicant or current participant that qualifies for services through Medicaid shall obtain services throughMedicaid unlessthe neededservices are notavailable inthe regionwhere they reside orthere isnoservice providerabletoprovidetheservices.

(4) Whenthere are noMedicaidservicesorproviders available inthe regionwhere the individuallives,the Lake Cumberland ADRC Coordinator or Specialist shall obtain documentation of unavailability from Medicaid prior to referring the individual into the homecare program.

(5) Whentheservices throughMedicaidare unavailabledueto lackofprovider agencies,wait listorineligible for Medicaidandfundingisavailablethrough homecareandeligibleindividualmayreceiveservicesthroughthe homecare program until the individual becomes eligible for Medicaid or the services become available through Medicaid.

(6) WhenMedicaid servicesare available and a provider agency isable to meetthe service provisions, services through the homecare program are denied.

(7) ServicesthatareneededandunavailablethroughMedicaidmaybeprovidedthroughthehomecareprogramas longastheservicesarenotduplicative ofwhatMedicaid provides.

Lake Cumberland Area Agency on Aging & Independent Living Policies and Procedure Manual

Section X Homecare Program Page 6

Homecare: Assessment, Reassessment


Revised : February 2017


An assessment and reassessment shall be conducted by the Independent Care Coordinator (ICC) to establish the functional ability and needs of an applicant or current participant of the Homecare program.

Legal Authority

910 KAR 1:180 Section 5(3)



(1) Uponreceiptofa referralfor assessment, the ICCshall reviewthe referraland contacttheindividualto schedule an appointment.

(2) The collection of information shall be based on interviewing the individual and through observation of what taskthe individual andtheir naturalsupports arecapable ofcompleting. Itisacceptable to havean individual demonstrate their abilities.

(3) The ICCshalldetermine the individual's eligibility forservices asrequired in910KAR1:180Section 4and standard operating procedure DAIL -HC-13.1 Eligibility.

(4) After the initial assessment iscompleted the ICC shall complete the planofcare and allother required documents, and may refer the individual to a case manager for follow up.


(1) Areassessment isconducted annually ormoreoften ifadocumented needshowsthere isreasonto conductanassessment priortotheoneyeardate.

(2) Theprocessforareassessment isthesameforaninitialassessment, except for the review of Application for services, DAIL-HC-02 Quality Service Agreement, Privacy Policy, Responsibility Policy, and the Age Verification.

Lake Cumberland Area Agency on Aging & Independent Living Policies and Procedure Manual

Section X Homecare Program Page 7

Homecare: Nutrition Screening/Assessment/Referral


Revised : February 2017


The nutrition program for the elderly shall provide participants with a screening to assess their risk of nutritional deficiencies and provide a nutritional assessment, counseling or other interventions when necessary to assist the individual with their nutritional health.


(1) LCAAAIL ADRC staff shall conduct the Level I Screening and Priority Rating which contains the Nutrition Screening. Oncethe participant isassessed byanICCfortheHomecare Program,the ICCwillagain complete a Nutrition Risk Screening Tool.

(2) The checklist shall be completed on each participant at least annually.

(3) The resultsfromthecompletion ofthechecklist areusedtoreporttotheDepartmentforAging and Independent Living the following:

(a) Identification of participants at nutritional risk and how the risk is addressed;

(b) Identification ofwhen nutrition assessment and counseling are appropriate;

(c) Identification of process for obtaining nutrition assessment and counseling when warranted;

(d) Identification of participant characteristics as a group;

(e) Comprehensive and coordinated nutrition service program planning; (D Nutrition service interventions

(g) Evaluation of nutrition services

(4) Aggregate nutritionriskdataavailablethroughthedatacollectionsystemshallbeutilizedinthe development of nutrition education plans, menu modification, and development of interventions for the most commonly identified needs.

(5) LCAAAIL shall monitor Homecare charts for compliance.

Lake Cumberland Area Agency on Aging & Independent Living Policies and Procedure Manual

Section X Homecare Program Page 8

Homecare: Plan of Care


Revised : February 2017

Policy Statement

Participants inthe Homecare programshall have a plan of care that reflects their needs, provision of services, and providerofservices andfrequency ofservices toassisttheindividual insafelyremaining intheirownhome.

Legal Authority



(1) TheHomecareapplicantIparticipantshallparticipateintheassessmentanddevelopmentofanindividualized planofcarewiththeICC or casemanager,naturalsupports andothercareorserviceproviders(personcentered planning team).

(2) The person centered planning team shall determine the service needs of the participant.

(3) The personcentered planning teamshalldevelop the planof carethatshall identifythe assessed needsofthe individualandtheservices neededtoassistwiththeidentified needs.

(4) The planofcareshall:

(a) Relate to the assessed problem(s);

(b) Identify the goal(s) to be achieved;

(c) Identify the scope, duration and units of service required including services provided by informal supports;

(d) Identify the source(s) of service, including natural or informal supports;

(e) Include a plan for reassessment;

(f) Besigned bytheclientortheclient's representative and ICC or casemanager; and

(g) Be documented on the standardized form.

(h) Clients' individual goals shall be documented and updated according to clients' self-report.

Lake Cumberland Area Agency on Aging & Independent Living Policies and Procedure Manual

Section X Homecare Program Page 9



Revised : February 2017


Thecare and support ofthe natural support systemis vital inmeeting the needs of the frail and elderly population. The Homecare Program is designed to assist the natural supports by providing services that the support system is unable to manage, for individuals that meet the eligibility requirements.


910 KAR 1:180


(1) AnapplicationfortheHomecareProgramshallbeacceptedforallindividualsthatmeettheeligibilitycriteria.

(2) The applicant, care givers, and natural supports shall participate in the assessment and care planning to determinewhatservices arecurrently being provided and bywhomaswell asadditional service needsto assist in theindividualremaining inthe home.

(3) The natural supports shall continue providing care that is already being delivered. The Homecare Program may provide additional supports and services when funding and providers are available.

(4) TheHomecareProgramshallnotsupplantorreplaceservicesprovidedbytheclient'snaturalsupportsystem. If allneedsarebeingadequatelymetbythenaturalsupports,thentheapplicant/client isdeemedineligible.

(5) An applicantwho needsrespiteservices shall notbedeemed ineligible asa resultofthis policy;respite isto provide relief to the primary caregiver.

(6) Whena natural support has achange instatus, i.e.they become ill,moveaway, etc.areassessment may be conducted and achange inservice provision made to the planofcare to address the gap inservices.

Lake Cumberland Area Agency on Aging & Independent Living Policies and Procedure Manual

Section X Homecare Program Page 10



Revised : February 2017


Participants ofthe homecare programmay havemultiple services andservice providerstoassist intheircare. In orderto begoodstewards ofthelimitedstatefunds available fortheHomecareProgramscasemanagement and coordination ofservices isaprioritytoensure the individual getthe services neededandservices are notduplicative or unnecessary.


910 KAR 1:180


(1) The participant shall be assigned one case manager to coordinate services across programs, provider agencies and service provision.

(2) The casemanager shall knowthe individuals planofcareand assist inarranging service providers.

(3) The casemanagerworkswith the service providers to understand the plan ofcare andthe rolethey have in meeting the needs of the participant.

(4) The casemanagerworkswith the service providers to establish aschedule thatworks for the participant and the providers.The casemanager shallmonitorto ensure the services are being provided according to the schedule and the planof care.

(5) When a service provider is unable to meet the schedule or plan of care the casemanager shallworkwith the participant to identify a new service provider.

(6) The casemanager / ICCshall schedule a reassessment to establish anewplanofcarewhen itisdocumented that the current planof care is not being followed or is not able to befollowed.

Lake Cumberland Area Agency on Aging & Independent Living Policies and Procedure Manual

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Homecare: Social Service Assistant


Revised : February 2017


The LCAAAIL may employ a social service assistant to assist a case manager with clerical duties, follow up with participants and monitoring of service provision.


910 KAR 1:180 Section 1(19)


(1) LCAAAIL when employing social service assistants shall ensure they meet the qualifications pursuant to 910 KAR 1:180 Section 1(19) having the equivalent of a high school diploma.

(2) Social service assistants shall work under the direction of a qualified case manager supervisor.

(3) The social service assistant may assist with the following:

a) Record keeping;

b) Filing;

c) Data Entry;

d) Phone calls;

e) Getting services to carry out the plan of care;

f) Coordinating services provided to the participant;

g) Helping the participant in applying for other services or benefits for which they may qualify;

h) Monitoring to ensure services are provided appropriately;

i) Providing telephone contact and home visits to participants assessed a level.

Lake Cumberland Area Agency on Aging & Independent Living Policies and Procedure Manual

Section X Homecare Program Page 12

Homecare:Quality Service


Revised : February 2017


Lake Cumberland AreaAgency onAging and Independent Livingstrives to providequality services forthe aging and disabled population and provides every participant the right and responsibility to participate in their service provision andthe ability tofile a complaint.


910 KAR 1:180Section 6-Quality Service


(1) Uponenrollment intotheHomecareProgram, each participant shallbegivenacopyoftheDAIL-HC-02Quality ServiceAgreement. Useofthestandardized formis required and nochanges oralterations can bemade tothe form.

(2) TheDAIL-HC-02shallbereadandexplained totheparticipantuponenrollment.

(3) The participantshallacknowledge receiptoftheDAIL-HC-02 bysigning acopyoftheform.

(4) Acopy oftheDAIL-HC-02 shall beprovided to the participant, and theoriginal placedinthe participants file.

(5) Participants shallbeinformed oftheir righttofile acomplaint utilizingtheDAIL-HC-03 reportofComplaint or Concern.

(6) The identity of the complainant shall be kept confidential when requested.

(7) Acopy oftheDAIL-HC-03 shall bemaintained inboththe participants file and inacentralized log.

(8) Documentation ofanyinvestigationandeffortstoresolveacomplaintorservice improvementeffortsshallbe documentedintheparticipant'sfileandcentralized log.

(9) Thecentralized logandparticipant'sfilesshallbeavailableformonitoringbytheDepartmentandthecontracted agency

Lake Cumberland Area Agency on Aging & Independent Living Policies and Procedure Manual

Section X Homecare Program Page 13



Revised : February 2017


Thehomecare programstrivestoprovidequality, affordable services toanindividualthatassiststheminremaining intheirown home.Homecare services areoffered basedoneligibility and afee scale


910 KAR 1:180 Section 8 Fees and Contributions

KRS205.460 Essentialservices -Funding-Collection offees andcontributions KRS205.010(6) -Needy aged


(1) Homecare services are determined based on the financial eligibility pursuant to 910 KAR 1:180.

(2) Verificationofincomeshallbedocumented intheparticipantsfile.

(3) ThehomecarefeescheduleshallbeusedtodeterminethefeepayingstatusforeachHomecareparticipant.

(4) SSIincomeandfoodstamp allotment shall notbecounted as income.

(5) The Independent Care Coordinator {ICC) shall be responsible for determining fee-paying status.

(6) Provideragencies shallcollect thefees.Nofeeshall beassessed forthe provision ofassessment orcase management services.

(7) The ICCshallconsideronlyextraordinary out-of-pocket expenses aslistedin910KAR1:180Section 1(10) when determining a participant'sabilitytopayafee.

(8) Waiver orreduction of fee due to extraordinary out- of -pocketexpenses shall bedocumented on the fee determination worksheet and the notification of services.

(9) Personsconsideredto be"needyaged" asdefined byKRS205.010(6) shall notberequired to payafee.

(1O) Voluntary contributions from a participant or participant's family with zero percent co-pay shall be encouraged, butisnotrequired fortheeligibleparticipantto receiveservices. The voluntary contribution isadonation, the clientis notissued a bill,andservices shall notbereduced or terminated based ontheclient notmaking avoluntary contribution.

(11) Avoluntarycontribution ismadeattheclient/familydiscretion,andshallbeutilizedtohelpsupportthe program and expand services.

(12) Thecontributions arerecordedasprogramincomeandcanbecounted asmatch.

Lake Cumberland Area Agency on Aging & Independent Living Policies and Procedure Manual

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Homecare: Training Responsibilities


Revised : February 2017

Policy Statement:

Havingwell trainedstaffandvolunteers isessentialtotheprovisionofsafe,effectiveandessentialservicestothe aging and disabled population.

Legal Authority:

910 KAR 1:180 Section 2(5)


(1) The provider agency shall develop training agendas and submit them to Lake Cumberland AAAIL atleasttwoweekspriortothescheduled training.

(2) LCAAAIL will require orientation and ongoing training for staff and volunteers of the Homecare provider agencies and include:

(a) How to safely provide personal care and home making services to participants;

(b) How employees can remain safe in difficult situations;

(c) DAIL, LCAAAIL and provider agency policy and procedures;

(d) The aging process;

(e) Other relevant aging and disability topics; and

(Q Arranging for local formal and informal resources.

(3) LCAAAIL shall indicate inthe area plan, training opportunities for:

(a) Homemaker-personal care providers;

(b) Homemaker-home management providers,

(c) Respite providers; and

(d) Other service providers as applicable.

(4) LCAAAIL shall provide training for case managers and social service assistants (as applicable) to include:

(a) Fourteen(14)hoursofinitialtrainingwithinsix(6)monthsofhire,and

(b) Sixteen (16) hours of in-service training annually.

(5) LCAAAIL shall determine that provider agencies have made provisions for training of staff through:

(a) Includingtraining costsintheirunitcost;or

(b) Included training as a line item under applicable service.

(6) LCAAAIL may request, as necessary, technical assistance from the Department of Aging and Independent Living.

Lake Cumberland Area Agency on Aging & Independent Living Policies and Procedure Manual

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Homecare: Required Staffing Pattern


Revised : February 2017

Policy Statement

Operation of a safe and effective homecare program is essential for the participants and the staff providing services. Providing adequate trained staff is essential to the program operations.

Legal Authority

910 KAR 1:180


(1) Lake Cumberland AAAIL shall have a policy and procedure in place describing the staffing patterns and duties.

(2) Lake Cumberland AAAIL shall have sufficient case managers and social service assistants (as applicable) to meet the needs and demands of the homecare participants.

(3) LCAAAIL shall have a case management supervisor that shall:

(a) Meets the requirements established pursuant to 910 KAR 1:180;

(b) Be capable of providing supervision and guidance to case managers and social service assistants;

(c) Conduct at least quarterly monitoring of case records for: 1. Quality;and

2. Completeness, and

(d) Handle complaints regarding staff or program issues

Lake Cumberland Area Agency on Aging & Independent Living Policies and Procedure Manual

Section X Homecare Program Page 16

Homecare: Participant Contact


Revised : February 2017

Policy Statement:

Participants of the homecare program shall receive individualized case management and services based upon their assessed needs.

Legal Authority:

910 KAR 1:180


(1) The Independent Care Coordinator (ICC) shall complete the assessment and determine the level of care based on the assessment and DAIL-HC-01 Scoring Service Level form.

(2) The ICC will develop the plan of care utilizing person centered planning.

(3) Acasemanagershallbeassignedtoallindividualsmeetingtherequirementsof910KAR1:180(5)andscoreata LevelIorLevelIIcriteriaaccordingtotheDAIL-HC-01.

(4) Acasemanagerorsocialserviceassistant shallbeassigned toallindividualsmeetingtheLevelIllcriteria according to the DAIL-HC-01.

(5) Home visits, telephone contacts and collateral contacts are made, at least as required by the level and more often as needed, as follows:

(a) LevelI-Ahomevisitshallbeconducted everyothermonthandatelephonecontactbetween home visits.

(b) Level II-Ahomevisitshallbeconductedevery fourmonthsandatelephone contactbetween home visits.

(c) Level Ill-Ahomevisitshallbeconducted everysixmonths andatelephone contact between home visits.

(6) When the case manager or social services assistant suspects that the individual's condition has changed (improvedordeclined) tothepointofneedingachangeinLevel, a referral is made to the ICC.

(7) The ICC conducts areassessment and developsan appropriate plan of care and Level Determination.

Lake Cumberland Area Agency on Aging & Independent Living Policies and Procedure Manual

Section X Homecare Program Page 17

Homecare: Budgeted Services


Revised : February 2017


Homecare services thatarenecessaryto keepaparticipant intheirown homeand prevent prematureplacement ina longtermcarefacility shallbeprovided responsibly throughout thefiscal year andallfunding sources utilizedto continue needed services.




(1) LCAAILshall havea policy inplacethat requires allservices to bebudgeted for operation throughout the fiscal year.

(2) LCAAAIL shallhavefunding fromsources otherthantheDAILto operate thehomecare program. Statefunding isseedmoney andnotthesolesupport forservice provisions.

(3) LCAAAILshallsubmittheagency'sbudgetandallbackupdocuments asinstructed annuallyfor department approval.

(4) The back-up documentation shall be true and accurate reporting of time spent providing homecare services.

(5) LCAAAIL shall ensurehomecareservices are provided totheparticipants basedonthe individualized plan of care.

(6) IfLCAAAILis notable to provide home care services as established inthe area plan and budget, the department shall be notified immediately of the agency's inability to meet the contractual requirements

Lake Cumberland Area Agency on Aging & Independent Living Policies and Procedure Manual

Section X Homecare Program Page 18

Homecare: Unit of Service


Revised : February 2017


Toassure consistency inthe homecare program, services areprovided inunits.Oneunitofserviceshallequalthirty

(30) minutes. LegalAuthority 910KAR1:180


(1) Theservice providershallrecordthe timeof arrival anddeparture toaccurately reflectthe amountoftime serviceswereprovidedtoaparticipant.

(2) When more than one service is being provided to an individual on the same day and during the samevisit theagencystaffshall document the timeeachservice took tocomplete.

(3) Only directservice provision shall be recorded as a unit.

(4) Thefollowing activitiesshall notbereported asunitsofservice:

(a) Review,updateormaintenanceofresourceoragencyfiles;

(b) Travel time incurred inthe deliveryoftheservice;

(c) Training, staff meeting; or

(d) Projectmanagement.

(5) The units of services provided shallmatch the plan of care;

(6) Assessment services follows the service definition. Assessment means the collection and evaluation of information of information about a person’s situation and functioning to determine the applicant’s or recipient’s service level and development of a plan of care utilizing a holistic, person centered approach by a qualified independent care coordinator (ICC).

(7) Case Management services follow the service definition. Case Management means a process, coordinated by a case manager, for linking a client to appropriate, comprehensive, and timely home or community based services as identified in the Plan of Care by:

• Planning;

• Referring;

• Monitoring;

• Advocating; and

Lake Cumberland Area Agency on Aging & Independent Living Policies and Procedure Manual

Section X Homecare Program Page 19

• Following the timeline of the LCAAAIL to obtain:

1. Service level; and

2. Development of the Plan of Care.

Lake Cumberland Area Agency on Aging & Independent Living Policies and Procedure Manual

Section X Homecare Program Page 20

Homecare: Home Repair


Revised : February 2017

Policy Statement:

Allow for the provision of home adaptations, additions or modifications to enable the participant to live independently, safely, or to facilitate mobility, including where appropriate, emergency response system. The Homecare program shallbethepayeroflastresorttoallowaparticipantto remainsafely and/orindependently intheirhome.

Legal Authority:

910 KAR 1:180 Homecare program for the elderly KRS 205.455


(1) A specified home repair, addition, adaptation or modification is considered one activity.

(2) Each home repair or adaptation (activity) shall be documented in the participant's file.

(3) Any approved activity that isnotable to beprovided duetothe unavailability ofresources shall be documented in the participants file.

(4) Allprovidersandsubcontractedagenciesthatprovideforhomerepairsoradaptationsshallhaveapolicy andprocedureonhowfundingisappropriated; servicesaredeliveredandverifiedpriortopaymentforsuch services.

(5) Fundingshall notexceed $250dollars perhomeinanytwelve (12)month period. Thisshall include,butnot be limited to, materials for devices, security devices, and supplies for elimination of insects or rodents infestation.

(6) Awaiverofthe$250limitmayberequested bythecontractagencytothedepartment'sHomecareprogram coordinator, for a maximum expenditure of $500

(7) A waiverwill be reviewed and determinedon acase bycase basis. Thewaiver may begrantedwhen the longtermbenefit isexpected toexceed the initialcostofthe repair.

Lake Cumberland Area Agency on Aging & Independent Living Policies and Procedure Manual

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Homecare: Supplies


Revised : February 2017


ThepurchaseofsuppliesforeligibleparticipantsoftheHomecare programshallbetoassistindividualstoremain safely intheir own home.




(1) Nomorethanten(10)percentofthetotalHomeCare allocation can bedesignated forsupplies;

(2) Themaximumexpenditure perparticipantperfiscalyearis$500;

(3) Eachpurchaseofsuppliesshall beconsidered one(1)activity recordedasone(1)contact;

(4) Documentation shall be recorded in each participants file that receives supplies with assurance that all other resources have been considered and/or exhausted prior to providing Homecare funding for supplies;

(5) Supplies shall berecorded inthestatedatasystemasaservice ofHomecarewhen homecarefunding is utilized; and

(6) Suppliesareprovidedonlyfortheuseandwell-being oftheindividualHomecareparticipant; noother person(s) shall knowingly be provided supplies funded by the Homecare program

Lake Cumberland Area Agency on Aging & Independent Living Policies and Procedure Manual

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Homecare: RespiteCare


Revised : February 2017


Respite services are available to provide short term relief from caregiving. Respite shall be available through in-home services.

Legal Authority:

910 KAR 1:180


(1) The Independent Care Coordinator (ICC) shall determine a participant's eligibility for respite care services pursuantto910KAR1:180.

(2) Respitefortheunpaidprimarycaregivershallbedetermined basedontheassessmentorreassessmentofthe participant.

(3) Ifthe CaseManager or social service assistant (SSA) determines achange instatus ofthe participant that mayrequire anincrease or decrease inthe amount of respite needed, t heywI ll reportto the Independent Care CoordI nator (ICC) .

(4) When the ICC determines a change in the the amount of respite that is needed, the planof careshall be updatedto reflect the need and change in service delivery, and provided to the case manager and/or SSA.

Lake Cumberland Area Agency on Aging & Independent Living Policies and Procedure Manual

Section X Homecare Program Page 23

Homecare: Incident/ Accident Reporting


Revised : February 2017


All contract agencies and provider's shall take immediate steps to report, investigate and prevent incidents and accidents from occurring.


910 KAR 1:180.


(1) All Homecare subproviders/subcontractors for homecare services shall have a policy and procedure (P&P) for reporting, investigating and preventing incidents/accidents;

(2) The P&P shall include how to report incidents/accidents, including: (a) Towhomthe reportshall bemade;

(b) The timeframe for making the report;

(c) Documentation required; and

(d) Measuresputintoplacetoeliminateanyimmediateconcerns suchas: 1. Threatening behavior toward staff or participants;

2. Potential safety hazards;

3. Abuseorneglectofaparticipant;

(3) Provide how incidents will be investigated, resolved, and followed up on for further actions needed such as reporting to other entities; i.e., law enforcement, adult protective services, Office of Inspector General, etc.

(4) All incidents/accidents are to be documented, submitted to the Homecare supervisor/manager and filed in theparticipantsrecordandrecordedinanincident/accidentlog;

(5) All significant incidents/accidents associated with Homecare services, personnel, clients, or the public will be documented and reported to the Homecare supervisor/manager and a copy forwarded to LCAAAIL and DAIL.

Asignificant incident isdefined asanyincident thatis unexpected orhasan unexpected outcome.

(6.) The incident documentation shall include:

(a) Whowas presentattimeofthe incident;

(b) Whatcausedthe incidenttooccur, ifknown;

(c) Description of environment at time of incident;

(d) Condition of participant at time of incident;

(e) Action taken to stabilize participant after incident.

Lake Cumberland Area Agency on Aging & Independent Living Policies and Procedure Manual

Section X Homecare Program Page 24

(7.) Provideragencies shall bemonitored toensuretheyarefollowing thecontractagency's policyand procedure for handling and reporting incidents, including but not limited to:

(a) Injuries to employee, client, or family members resulting from accidents or errors;

(b) Participant falls, if:

1. Fallisobserved (whether injury notedor not)withdate,time, locationandfollowup;and

• Fallisreportedbyparticipant orfamily (Onlyifparticipantoraidsbelieveinjuryhas occurred).

(c) Health, safety or welfare of a participant or staff if placed in jeopardy; or

(d) Neglect, abuse, exploitation, abandonment, theft, or other events that inhibit the health, or care of a participant or staff.

Lake Cumberland Area Agency on Aging & Independent Living Policies and Procedure Manual

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Homecare:Incident IAccident Reporting Classification

LCAAAIL HC 10.17.1

Revised : February 2017



All significant incidents associated with the Lake Cumberland Area Agency on Aging & Independent Living and service providers, personnel, client, or the public will be documented and reported to the worksite supervisor/manager and a copy forwarded to the Program Director. A significant incident is defined as any incident that is unexpected or has as unexpected outcome. All employees, contract personnel,volunteers, and/or agents of LCAAAIL will follow the Incident Reporting Policy.


A mechanism for handling reportable incidents must be established in an effort to ensure proper management of incidents, determine any potential legal liability, and to enhance the quality of care to our clientsbyidentifying problemareasinanefforttopreventtheoccurrence offuture incidents. Itisalsodone to document threatening incidents to staff so that potential safety hazards can be addressed by agency.


Incidents are categorized into classes: Class I,Class IIandClass Ill:

(1) A Class Iincident is minor in nature and does not create a serious consequence (nobody was injured, nophysical harmorchemicalrestraintswere needed, nopolice,court,orAdult/Child Protective agency involvement was necessary and incident did not require an investigation).

(2) A Class II incident is serious in nature, involves the use of physical or chemical restraint, includes a medication error, results in injury to any involved party, requires an investigation by the provider, and may or may not necessitate police or court involvement.

(3) A Class Ill incident is grave in nature, includes serious injury to any involved party, involve suspected abuse, neglect, or exploitation necessitating Adult or Child Protective agency involvement, may or may notrequire policeorcourt involvement, includesmedication errors that requires amedical intervention, involve a death, and immediate investigation is indicated.

Class I Incidents must:

-Be reported to the Program Director within 24 hours; and

-Be reported to guardian (if applicable).

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-Completed Incident Reports must be turned into Program Directorwithin 24 hours following notification of the occurring incident

Class II Incidents shall:

-Be reported to the AAAILwithin 48 hours of discovery;


-Staffwill berequiredto notifyguardian (ifapplicable)within24hoursofdiscovery;

-Completed Incident Reports must be turned into Program Director and AAAIL within 24 hours following notification of the occurring incident.

Class Ill Incidents must:

-Haveaninvestigationbeinitiated immediately upondiscovery and involve theAAAIL;

-Completed IncidentReportsmustbeturned into the programandAAAILDirectorwithin 24 hours following the notification of the occurring incident

-Staff shall notify the Department for Community Based Services - Adult Protective Services (APS)/Child Protective Services (CPS) immediately upon discovery, if involving suspected abuse, neglect, or exploitation in accordance with KRS Chapter 209;

-Staffshallnotifytheguardian (ifapplicable)within 8hoursofdiscovery;

-AAAIL shall notify DAIL in writing within 8 hours of discovery. If incident occurs after 5pm EST on a weekday or occurs on a weekend or holiday, written notification to DAIL shall occur on the following business day; and

-AAAIL will send DAIL a complete written report of the incident investigation and follow-up within 7 calendar days of discovery.

All incidentreportsshallbekeptinacentralizedfile,separatefromthe participants file.

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Homecare: Waiting List


Revised : February 2017


Lake Cumberland AAAIL is committed to serving eligible individuals in need of services to assist them in remaining in their own home when funding and providers are available. When services are needed but there is no funding or providers the eligible individuals shall be placed on a waiting list and prioritized based on need.




(1) Individuals requesting services shall be screened by the Aging and Disability Resource Center (ADRC) utilizing the DAIL Priority Screening tool, for needed services and eligibility.

(2) Thewaiting listshall bemanaged by providing services to the individual determined to bein the greatest need at the time funding becomes available.

(3) Priortobeingplacedonthewaiting listfor homecare funded services the individualmustmeetthe eligibility requirement for homecare including providing documentation of being ineligible or denied for Medicaid services utilizing the Homecare Determination Worksheet.

(4) Individualsdenied byMedicaidand placedonthehomecarewaiting listshallbeconfirmed as ineligiblefor Medicaidagainpriortobeingplacedonhomecarefunded servicesbycompletinga newHomecare Determination Worksheet.

(5) Theindividual shall bescreened forMedicaid eligibility atleastannually andatanytimethey become Medicaid eligible services shall be obtained through Medicaid and homecare funding reduced or eliminated based on the availability of services through Medicaid.

1) The ICC/Case Managers/Coordinator or Service Assistant Advisor or other designated staff will review the waiting list at least quarterly to update the priority rating, explore other service options, or ensure continued eligibility and need for services. Consumers who are unable to be contacted shall remain on the waiting list and the following procedure should be utilized:

a) Phone the consumer, contact person, family member, or emergency contact. Attempts are made to reach the previous-mentioned persons for 20 working days.

If no contact is made within 20 working days, the case manager shall send a letter which states the following: Contact cannot be made, Request the person/consumer to contact the LCAAAIL within thirty days regarding their need for services, and inform the person in writing if no response is received within thirty working days; the consumer’s name will be removed from the waiting list.

b) After 30 working days, if no response is received, the consumer’s name is removed from the waiting list.

Should consumers decide they are not in need of services when the service becomes available, the consumer is notified that their name will be removed from the waiting list and they are responsible for calling LCAAAIL to request services when they decide they need assistance.

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Revised : February 2017


Participants of the Homecare Program have rights and responsibilities for participation in the program and shall be informed of their requirements as well as the requirements of the providers.




(1) Theparticipantshallbeinformedinwritingofhis/herrightswhichshallincludetherightto:

(a) Betreated in a considerate and respectful manner;

(b) Be treated with respect;

(c) Have property and personal belonging treated with respect;

{d)Knowthename,worktelephone numberanddutiesofanystaffpersonprovidingtheparticipantwith services;

(e)Participateinthedecisionsmadetodevelopandimplementthe planofcareandservices;

(f) Know the cost of services prior to accepting services;

(g)Designateapowerofattorney,familymemberorotherindividualtoacton their behalfindeveloping and participating inthe planofcare;

{h) Be provided with services without discrimination as to age, race, religion, sex, national origin, sexual orientation, or source of payment;

(i)Voice grievances andsuggestchanges inservice orstaffwithout fearof restraint or discrimination;

0) Privacy; and

(k) Confidentiality of records, unless the participant signs for the release of information to a specific individual, agencyorentity,orthestaffhavereasontobelievetheparticipantisbeingabused,neglectedorexploitedand then the staff shall report the situation to the Department for Community Based Services or law enforcement.

(2) The participant shall be informed in writing of the responsibilities required to remain in the Homecare program which shall include:

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(a) Treating all workers, provider agency and case management, Aging and Disability Resource Center (ADRC) or other staff members with respect. Physical or verbal abuse toward others, by the participant, participants familymembersorguestsoroftheparticipant isprohibited.Violationsofthismayresultinthe termination of services;

(b) Provide all information necessary to determine eligibility for the Homecare program;

(c) Allowing the Case Manager, Social Service Assistant or Independent Care Coordinator to complete the required home visits.

(d) Participating in the assessment of ongoing needs and eligibility for services, provide information to update annual paperwork, including, but not limited to the Financial Assessment Form;

(e) Participate in the decisions involved in developing and implementing the plan of care and services;


(g) Provide any needed documents;

(h) Submitpaymentoftheparticipant'sshareofthecostoftheservices;

(i) Informing the Case Manager or Social Service Assistant and provider agency when they will be away from home on dates of scheduled services;

(j) Informing the Case Manager or Social Service Assistant and provider agencies of any plans to relocate or move from the current residence;

(k) Refraining from offering gifts, tips, donations or bribes to the workers who provide homecare services;

(I) Reporting inappropriate behavior of provider agency staff, including: 1. Consuming alcoholic beverages in the home or appear to be intoxicated;

2. Smoking in the home;

3. Useoftheparticipant'sphonetomakepersonalcallsorrequestthe useoftheparticipant's automobile;

4. Solicitmoneyorgoodsfromtheparticipant foranypurposeorcause;

5. Treat the participant disrespectfully or in any other manner the participant feels is inappropriate or offensive.

(m)Pursuing all other funding sources for similar services for which the participant may be eligible.

(n) Refusaltopursueorparticipateinservicesprovidedbyotherfundingsourcesmayresultinterminationof Homecare services;

(3) Acopy ofthe participant's rights andresponsibilities shall besigned offonbytheparticipant and acopy placed in the participant's file

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Homecare:Termination orReduction of Services


Revised : February 2017


Statefunded services such as the Homecare Programareavailable onlyto the extentthat funding isavailable and the participant qualifies for services.




(1) The Independent Care Coordinator (ICC) shall inform the individual during the initial assessment that servicesaresubjecttotermination orreduction basedon:

(a) Funding reductions;

(b) Change in participant's condition;

(c) Increase in support system;

(d) Eligibility for Medicaid funded services;

(e) Inabilitytoobtainaprovider;

(f) Inability or unwillingness to follow the planof care; or

(g) Unresolved safety issues.

(2) The clientmay terminate all or part of the services being provided according to the planofcare at any time.

(3) LCAAAIL shall haveapolicy and procedure for:

(a) Non-paying clients;

(b) Participants needs exceeding available services;

(c) Health,safetyandwelfare ofparticipantor

(d) Participant behavior and corrective action on behavior.

(4) IfHomecareservices arereducedorterminated for reasons otherthanareduction instatefunding LCAAAIL shall:

(a) Informthe participant ofthe rightto file acomplaint;

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(b) Notifythe participant orcaregiver of theactiontaken;

(c) Assist the participant and family in making referrals to another agency if applicable;

(d) Providetheparticipantwithanupdatedplanofcarecreated bytheICC;and

(e) Adjusttheservicesintheagingdatasystem(SAMS).

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Section X Homecare Program Page 32

Homecare:Past DueAccounts


Revised : February 2017



Fee Paying Home Care clients shall submit a payment upon receipt of their bill. Clients who fail to submit payment fortwomonthsmaybeterminated fromtheprogram.


1. TheProviderAgency shallsubmitpastdueaccountlistsimmediatelytotheAgingDirector.

2. TheAging Directorwill notifythecasemanager of record.

3. The case manager will contact the client to discuss the overdue account and discuss any circumstances that prevents the client from paying. If there are no special circumstances, then the casemanager will discuss with the client how and when the client intends to pay the overdue service fee. The case manager shall informthe client of possible termination if payment does notoccur. However, ifa special circumstance arises, thenthecasemanagerwill reassess the client, re-determine the feepaying status andwaive thefee.

4. The case manager will document in the case note the date the client was notified of the past due account andwhatoccurredregarding theissue.

5. If no special circumstances exist and the client refuses to pay, the case manager shall notify the client in writing of possible termination and include aform toappeal thedecision. The noticewill also informthe client that theywill be removed fromthe programifpayment is not receivedwithin 1Odays, or arrangements for payment aremadewith theCaseManager of payment plan.

6. If payment arrangements are arranged, the case manager will notify the Fiscal Department of the payment arrangements.

7. Iftermination occurs, the clientmayfile an appeal regarding the termination decision; however, serviceswill continue until ahearing can be held.

Quality Assurance:

1) Inall cases, the casemanagerwill read, or have read and explained to the client the purpose of the "DAS- 889, Quality Service Agreement"; the case manager will provide a copy of the completed agreement to the client.

2) In all cases the client shall be informed of the right to file a "Lake Cumberland Development District Area Agency on Aging Complaint or Concern form," which will be provided to the Director of Aging Services for review and investigation. (If requested by the client, the case manager will assist the client in completing the Compliant or Concern Form). Also the clientwill be informed of their right to appeal directly to the Department

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of Aging and Independent Living and will be provided with a copy of the "DAS-890, Report of Complaint or Concern form." (If requested by the client, the case manager will assist clients in the completion of the "DAS-890").

3) The clientwillbeinformedthat theymay requestahearing as provided byKRS138.010-170.

4) The investigation and efforts will be documented until resolution or termination, and will be available for monitoring.

Lake Cumberland Area Agency on Aging & Independent Living Policies and Procedure Manual

Section X Homecare Program Page 32

Homecare:Ensuring a SafeWork Environment for Staff and Clients


Revised : February 2017


The Lake Cumberland Homecare programshall ensure asafeand healthyworking environment for allworkers (staff and volunteers) and clients.


Staff should plan all visits using the following guidelines:

1) Schedule an appointment and call ahead to confirm initial visit.

2) Know the location of the visit. Be aware of the community and possible areas of concern. Map out the safest and most direct route.

3) Wear shoes and clothes you can run in, wear minimal jewelry, and do not carry a purse unless absolutely necessary. Keep valuables out of sight. Purses and items of value should be locked in a concealed location prior to leaving for visit.

4) Carry change for pay phones, identification, and car keys.

5) Always leave an itinerary at primary location and notify the Program Coordinator or his/her designee of any changes.

6) Keep vehicle well maintained and gas tank at least half full.

7) Be aware of and carefully observe the surroundings. Avoid people and groups that seem to be hostile or unruly. Be aware of animals and avoid them if possible.

8) Choose open parking places so that the car can’t be blocked in if at all possible.

9) Be aware of one-way and dead-end streets. Try to park in the direction of departure.

10) Lock all car doors and keep windows rolled up.

11) Trust your instincts at all times. Be aware of potentially dangerous situations. Do not enter or remain in any environment, such as but not limited to buildings, apartments, or houses, if you suspect an unsafe situation.

12) If an emergency / criminal situation arises, be aware of the following: a. Type of incident.

b. Time of incident.

c. Location of incident; be as specific as possible.

d. Description of the individuals involved and names if known.

e. Any weapons involved.

f. Vehicles involved.

g. Direction of flight.

13) Develop and use a distress word or phrase if you feel your safety is in jeopardy while on a visit. The Director of Aging Services or his/her designee is to be advised of this word / phrase.

14.) Document carefully the course of such interactions, from greeting to termination, with specific attention to the nature of the interaction, the staff member’s statements and / or directives, the inquirer’s responses, and the outcome of the interaction. Additionally, the staff person will notify the Director of Aging Services or his/her designee of the event.

Under the following conditions, but not limited to those conditions, workers and clients shall have the right to take

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Section X Homecare Program Page 33

appropriate actions to protect themselves from harm:

• Worker or client exhibits behavior regarded as a threat to the other member such as yelling, aggressive or inappropriate gestures or movements, display of items that could be considered weapons (guns, knives, etc.), inappropriate verbal statements (explicit or implied) especially related to a sexual, abusive or threatening context.

• There exists a criminal history of a worker or client convicted of an offense related to the physical harmof another individual, felony theft, drug, or weapons offenses.

• Sanitary conditions of the residence present a health hazard to theworker or client such as: human or animal waste uncontained in the home, medical waste such as syringes or other bio-hazardous waste uncontained in the home, uncontrollable infestation of rodents and/or insects, etc.

• Illegaldrugsordrugparaphernalia (suspected) areopenly presentinthehome,etc.

• Unrestrained animals are present and may cause a hazard.

• Unknown personsare present inthe homeatthe timeofserviceandmay representathreat.

Ifthese, or other, threatening conditions are presentandtheworker orclient perceives athreat to his/herwell-being, theworker orclientmaytakethefollowing precautions:

• Worker may remove themselves fromthe premises immediately indicating the reason for doing so or client may request that the worker leave the premises immediately.

• Notify supervisors or agency immediately.

• Requestareviewofthesituation byagencystaff.

• Insomecases, referraloftheclienttoDCBSmay beappropriate andshould bemadebytheworker. Afterreviewandinvestigationofthesituationbyagencymember(s),thefollowingprocessshallbefollowed:

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Section X Homecare Program Page 34

• Worker and/or client shall be notified in writing by the appropriate Homecare staff person of the unacceptable behavior and shall be offered one opportunity to correct the situation.

• Ifthe situation isnotcorrected to the satisfaction oftheworker orclient,the agency maydiscontinue service provision to an offending client or reassign another worker (or two) to provide the client's service; or, in the case of an offending worker, the agency may reassign or dismiss the offending staff.

• Theworkerorclientshallhavetherighttothecustomaryappealprocess,ifdesired.

The Homecare programwillmake every effort to assist the worker or client to resolve the situation so that services can continue to be provided.

In the event an acceptable resolution is accomplished after services have been discontinued, the client may be placed back on the program when an opening exists.

No person shall be discriminated against due to race, nationality, religion, ethnicity, age, gender, or disability.

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Homecare:Monitoring Homecare Participants for Health andSafety


Revised : February 2017

Policy Statement:

Thehealth and safety ofparticipants inthehomecare programisessential totheparticipant's abilitytoremaininthe community with services.

Legal Authority

910KAR1:180Homecare programfortheelderly

910 KAR 1:220 General Administration, programs for the elderly


(1) LCAAAIL shall monitor the provision of case management to Homecare participants to include:

(a) Reviewofeachcasemanager/social serviceassistantcaseloadtoensurecompliancewiththehome visit and other contact requirements determined by the level of case management services;

(b) Review of written documentation and data system entries to ensure proper and descriptive documentation that reflects the needsofthe individual and that theservices areorare notmeetingthe needsandhowthe needswillbeaddressed.

(c) Verify that anysub-provider invoicematches the numberofunits billedandthe numberofclients that services are provided monthly.

(2) LCAAAIL shall:

(a) Annually,, or more often as needed, conduct monitoring of the case management agencies case records to ensure the required contacts have been maintained and services have been monitored; and

(b) Provide technical assistance and desk top monitoring of data entered into the state data system.

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Section X Homecare Program Page 36

Homecare:HomecareCase Records


Revised : February 2017


Homecare Case Records must be centrally located in the offices of Lake Cumberland Area Development District at all times.


Complete Client files shall bemaintained in a locking file cabinetwithin the LCAAAILoffice. The office shall be locked and not accessible to anyone not employed by Lake Cumberland Area Development District unless LCADD staff are present.

Allfiles mustbekept ina locked filecabinet andmay notbekept inpersonalhomes orvehicles.

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Section X Homecare Program Page 37

Homecare: Contractor Responsibilities


Revised : February 2017

Policy: The contract agency for Homecare services that are supported inwhole or in part from funds received from LCAAAIL and the Cabinet for Health and Family Services agrees to fulfill specific responsibilities to assure quality services.


The contract agency shall:

A. Assure theprovisionofservicesthroughoutthegeographicareaorcountiescovered underitsplanorproposal.

B. Treat the client in a respectful and dignified manner, involve the client and caregiver in the delivery of services and provideservices inasafemanner.

C. Permit staff of LCAAAIL and or the Cabinet for Health and Family Services to monitor and evaluate services provided.

D. Assure thateachpaidorvoluntarystaffmembermeetsqualification andtraining standards established foreach specific service by 910 KAR.

E. Maintainwrittenjobdescriptions forstaffandvolunteer positions involvedindirectservicedelivery.

F. Develop and maintain written personnel policies and wage scales for each job category.

G. Designate a supervisor and assure that staff providing Homecare services are provided professional supervision.

H. Notify case management when a client refuses a particular service (s) and indicate the number of times the client has refused services.

I. When aclient has cancelled and/ormissed three (3) consecutive times, case management may close services. If, after reporting to casemanagement, the problem persists and client is not closed, provider shall report problem and prior action taken to the Aging Services Director at LCADD AAAIL for consideration.

J. Assure that upon termination of agreement, copies of all appropriate records of all active clients and/or participant datashallbeprovidedtothenewcontractorfortransferofclientrecords.

K. Provide or arrange for appropriate insurance coverage to protect volunteers from personal liabilities.

L. Ensurerequiredorientationandin-servicetraining forstaffresponsiblefortheprovisionofHomecareservices is offered through the designated provider.

M. When service is missed or rescheduled, providers shall document missed or rescheduled service.

N. Whentheelectronicdatacollectionsystemisnotworking, othermethodstocommunicate betweentheprovider and case management agency shall include fax, e-mail, or telephone.

0. Providers are expected to complete data entry of client information and units to bebillednolaterthantwo (2) weeks following the date of service or contact. All units billedfor a specifiedmonth shall beentered intothe electronic data system by the close of business on the 5th day of themonth following themonth forwhich services are reported. If the 5th falls on a weekend or holiday, data entry must be completed the last business day priorto the 8th day of the month.

P. Subcontracting isprohibitedwithout priorwritten approval ofLCADDAAAIL.

Q. Providers shall notify Adult Protective Services and LCAAAIL when potentially unsafe and/or hazardous conditions existthatmayplacetheclient, casemanagers, aidesorothers inimminentdanger.

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Section X Homecare Program Page 38

Homecare:Time In -Time Out Documentation


Revised : February 2017


Lake Cumberland Case Management Staff and Direct Service Providers shall document Time In/Time Out to assist with accountability, supervision and standardization.


Case Management:

• Thetimethatacasemanagerspendswithaclientshouldberecordedasthetotalamountoftimespent.

• Total time spent and case management task documented in case note.

DirectService Providers:

• Encounters by providers shall be recorded by time in/time out with task documented in each case note.

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Section X Homecare Program Page 39

Homecare: Home Delivered Meals Accepted by a Designee


Revised : February 2017


Meals shall be delivered only to eligible persons intheir homes. Meals may be left with a designee of the older person provided the designee has been informed of the requirements of the Nutrition Programand has indicateda,willingness tocomply withthose requirements.


• Thedesigneemustbeapproved bytheeligible clienteither byverbalapproval tothe nutritionsite or county senior center, andor the personwho isdelivering themealifthe consumer isonsite and unable to cometo thedoor orbywrittenapproval.

• Ifthe consumer isnotpresent orisotherwise unabletoconsume themealwithin 10minutesof deliverythedesigneemustbeinformedoftherequirementsoftheNutritionProgramandindicatea willingness to comply with those requirements. This information should include the following:

1. Themeal isto beconsumed bytheeligible person only.

2. Assurance thatthedesignee isabletostorehotfoods in amannerthatmaintains the temperature above 140° For below45° F.

3. Coldfoodshouldbemaintainedbelow45°F.

(BestPractice: Coldfoodsshouldbemaintainedbelow41°F).

Note: Maintaining coldfood at41°For lessisthe standard identified by the FDAinthe2005 FoodCode. Since most pathogenic microorganisms do not grow at refrigerator temperatures of less than 41°F, this is therecommended goalformaintainingcoldfood. Microorganisms suchasListeriawillgrowinthe41°Fto 45°Ftemperature range. Ready-to-eatfoods suchassoftcheeses, hotdogsandcoldcutsordelimeats arethetypesoffoodthatareassociatedwith Listeria.

Compliance: Nutrition Program Compliance Information Form will be provided with each meal which is acceptedbyadesignee fortheeligibleconsumer. TheAAAandtheElderNutritionCoordinatorwill monitor for compliance during each site visit.

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Homecare:Monitoring Homecare Client Files


Revised:Fe b r u a r y 2017

Policy and Procedure:

Lake Cumberland Area Agency on Aging and Independent Living will maintain and manage a comprehensive Quality Assurance System that includes Homecare file monitoring and review.


The Lake Cumberland Area Agency on Aging and Independent Living Director and/or Home care Coordinator will monitor Homecare Case Files Quarterly. A minimum of 10% of each Case Managers Homecare Case Loadwill bemonitored each quarter utilizing the Lake Cumberland CaseRecord Review Sheet.

Case Managers will receive copies of all completed monitoring of files and be given a deadline for corrective action if deficiencies are noted. Case Managers then have a specified amount of time to make thenecessarycorrections tothefile.

Homecare Case File Monitoring will review:

1. Eligibility

2. Income Verification

3. AgeVerification

4. Completed Assessment/ Reassessment

5. Care Plan is appropriate for identified problems

6. Care Plan identifies formal providers, informal providers, community providers and funding of services

7. Care Plan addresses individualized goals.

8. Case Management Duties are performed and documented monthly.

9. Assessment, Reassessment and Care Plan is properly entered into the SAMS System

LCADD Contact Info

Lake Cumberland Area Development District
P.O. Box 1570
(mailing address)
2384 Lakeway Dr.
(street address)
Russell Springs, KY 42642
Phone: 270-866-4200
Toll Free: 800-264-7093
TDD: 800-648-6056
Fax: 270-866-2044

LCADD Calendar

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