2. 3. Rights and Grievance Procedures a. b. The Medicare conditions of participation for home health agencies shall apply to all agencies defined as home care under this Act, except as noted under Section IV Cl below. The following additional Conditions of Participation shall apply to all agencies, programs or services defined as home care under this Act, unless otherwise noted. 1) Beneficiary Bill of Rights a) Providers shall comply with the federal bill of rights as described in Section III of this Act. Provisions shall also be made to make the bill of rights available to all beneficiaries or their designated representatives. b) Each agency, program and service identified under this Act shall have written client grievance procedures. Assessment and Plan of Care a. b. All agencies, programs and services identified in this Act shall have in writing the services to be provided and the schedule for providing these services to the beneficiary. All agencies, programs and services identified under this Act shall have the means to identify any additional service needs of beneficiaries beyond those they provide; make referrals; and coordinate with other agencies, programs and services providing services to the 'beneficiary. M Training and Evaluation All persons providing services as identified under the provisions of this Act shall be trained. 1) The Secretary shall determine the amount and content of the training. 2) Agencies, programs and services providing home care services as identified under the provisions of this Act shall disclose to beneficiaries the amount of training and/or level of certification achieved by the individual worker.. Supervision, as determined by the Secretary, shall be provided ́for all workers providing services as identified under this Act. The annual evaluation of the home care agency, program and service shall provide for and document consumer involvement. 1. Home health services as identified under this Act, excluding agencies that are exclusively durable medical equipment agencies, programs or services, shall have client care processes (provided directly or under contract) which include the following. a. b. C. d. A mechanism for identifying beneficiaries for which a comprehensive service assessment is indicated; Client assessment appropriate to the service provided to identify and monitor needs; A plan of care which states reasonable and measurable client objectives and services to be provided to meet the objectives; A plan of care that employs outcome measures care insofar as they are appropriate and available for each client served; Is there objection? Without objection, this summary will appear at this point in the record. [A summary of the report, "The 'Black Box' of Home Care Quality," presented by the chairman of the Select Committee on Aging, and prepared by the American Bar Association; Comm. Pub. No. 99-573, August 1986, follows:] • CHAIRMAN'S FOREWORD Home care services, in the broadest sense, generally enjoy a good reputation and are key to the goal of giving dependent persons the opportunity to live on their own or with their families in the community. Yet, we hear anecdotal accounts from home care consumers and providers of unreliable and poorly trained aides, of questionable care techniques, and, in some instances, of abuse and neglect. What is most disturbing is that we simply do not know how serious or widespread these problems of home care quality are. Nor do we have the means to adequately protect one of the most vulnerable of all consumer groups persons receiving care in the home, away from public and professional eyes. In these respects, the quality of care in the home is a "black box" a virtual unknown. - The decision to release this report, prepared by the American Bar Association (ABA), is a statement of the Committee's concern for the well-being of persons receiving home care and our intent to fortify the largely positive regard home care now enjoys. This concern is only heightened by the rapid increase in the use of home care services by our aging society, by the numbers and varieties of providers entering the home care market, by the growing public and private investment in home care, and by the impact of recent cost containment measures on access to and quality of home care. The ABA is to be commended for their thorough and timely review of home care quality and the current system of standards and monitoring. The report is a critical first step in documenting the inadequacy of the present quality assurance system for home care and in recommending needed reforms. As such, it is a vital contribution to public policy and to public safety. With this report and its recommendations in hand, it is now the responsibility of federal, state and local governments and the private sector to work cooperatively to create a system of quality assurance that ensures that all care provided in the home is of the highest quality possible and delivered in the best interests of the consumer and their family. The Committee extends its appreciation to the ABA, to the report's author, Mr. Charles Sabatino and to the Staff Director of the ABA's Commission on Legal Problems of the Elderly, Ms. Nancy Coleman, for their fine work and cooperation in releasing this report. Thanks are also extended to Dr. Marvin Kaiser of Kansas State University for his assistance in the Committee's efforts to ensure the quality of care in the home. Edward R. Roybal Chairman August, 1986 5. 6. f. The Secretary shall encourage states and local jurisdictions to Hot-lines a. b. C. PROS and home help monitoring agents shall each have and The State Nursing Home Facilities and Home Care Ombudsman The CAB shall have access to the information received from the Consumer Education a. The CAB, PROs and home help monitoring agents shall be A. B. The Secretary shall have or establish policies and procedures, as a condition 1. The sanctions available shall be both administrative and judicial, and 2. The policies and procedures shall provide for public disclosure of The Secretary, as a condition of funding under Medicaid, the Social Services 1. 2. The sanctions available shall be both administrative and judicial, and Provisions shall be made for public disclosure of major quality A. The Secretary shall encourage states to develop policies and procedures for 1. The Secretary shall gather and publish state licensure and certification activities for home care agencies programs and services within two years of enactment of this Act. This report shall be updated on a biannual basis. Section VIII: Homecare Quality Assurance Council A. The Secretary shall implement all provisions of this Act in consultation with Section IX: Training and Certification Grants A. The Secretary shall provide grants for training programs for home care personnel and caregivers. 1. 2. 3. Special consideration shall be given to: a. The training of paraprofessionals, including homemakers, home health aides, personal care attendants and family caregivers; b. C. d. The training of minority and ethnic group home care personnel; Training programs for high technology services provided in the home and for programs that assist paraprofessionals adapt their services to high technology therapies provided to home care beneficiaries; The Training of home care personnel to work with minority and ethnic beneficiaries. Training materials shall be made available to states and home care agencies, programs and services. The Secretary shall encourage states to work with educational institutions, especially those with a demonstrated expertise in gerontology and geriatrics, to provide training for home care personnel. Section X: Research and Demonstrations A. 8. The Secretary shall establish guidelines and fund studies on quality assurance measures for home care. These studies shall include the following. 1. 2. 3. 4. 5. 6. 7. 8. Methodologies which develop and evaluate outcome standards in the provision of home care services. Mechanisms for ensuring and monitoring quality by episodes of care. Mechanisms for ensuring and monitoring the quality of care provided by small agencies and independent contractors, including waivers of any programs covered under Medicare, Medicaid, the Social Services Block Grant, and the Older Americans Act. Role and importance of case management for ensuring quality in provision of home care services. Evaluation of the differing approaches to and responsibility for the development of a plan of care. Effectiveness and efficiency of the use of "deemed status" to determine and monitor home care quality assurance standards. Determination of home care agencies, programs and/or services that should meet federal and/or state conditions of participation and which should be exempt from some or all of the conditions. Evaluation of quality assurance provisions in contract biding processes at the state and local levels. The Secretary shall establish guidelines and fund demonstration projects focusing on home care. These projects shall include the following. 1. The Secretary shall explore the feasibility of developing certification requirements for homemakers, home health aides and personal care attendants providing services under Medicaid, the Social Services Block Grant Program and the Older Americans Act. Expansion of PRO's composition and responsibility to include home help services; |