208 In-Home Services | HCBS-5300-MANUAL

Georgia Division of Aging Services
Home and Community-Based Services Manual

Chapter:

200

Effective Date:

03/01/2023

Section Title:

In-Home Services

Reviewed or Updated in:

2023-01

Section Number:

208

Previous Update:

2015

208.1 Purpose

The standards contained in this section are to be used by senior center facilities to meet the operational, programmatic, and service requirements for any activities provided under the authority of the senior center.

208.2 Scope

AAAs should provide in-home services to secure and maintain maximum independence and dignity in a home environment for older individuals and persons with disabilities who are capable of self-care with appropriate supportive services.

These requirements apply, except where noted, to:

Homemaker
Personal care
Home modification/repair service
Chore service
Friendly Visiting
Telephone Reassurance
Assistive Technology

Specific program requirements can be found in each service’s corresponding chapter.

208.3 Definitions

Supportive services: services designed to assist older individuals in avoiding institutionalization. Services include in-home services and other community services, including home health, homemakers, shopping, escort, reader, and letter writing services, to assist older individuals to live independently in a home environment. (see OAA – Section 321(a)(5)).

208.4 Target Group / Eligibility

Eligible individuals must meet the following criteria:

Are age 60 and older, or
Adults of any age who receive services through the State-funded Alzheimer’s fund source, who have Alzheimer’s disease or a related disorder, or
Adults who have a physical or mental disability that restricts his/her ability to perform basic activities of daily living (ADLs) and/or instrumental activities of daily living (IADLs), or that threatens his/her capacity to live independently

In addition, the individual must lack sufficient access to persons who are willing and/or able to assist with or perform needed basic ADLs and/or IADLs or provide adequate support to enable the individual to continue to live independently.

The AAA should place special emphasis on individuals that the Older Americans Act identifies as priority populations (See MAN 5300, 118 Prioritizing Clients).

When determining eligibility criteria for enrollment of clients into services, the AAA must follow the criteria established for each fund source.

Because not every consumer will desire, accept, or benefit from in-home services, it is imperative that the AAA target in-home services to consumers who can most benefit from community-based in-home services and who are at highest risk of institutionalization.

AAAs may not provide In-Home Services in a nursing home, personal care home, or other setting where the provision of this service is included in the cost of care.

208.5 Conflict-Free Service Delivery

An efficient service delivery system is characterized by person-centered approaches and cost-effective outcomes for both consumers and the community. Therefore, DAS supports the implementation of a conflict-free service delivery system.

MAN 5300, 202 Program Guidelines and Requirements includes the key elements included in the design of such a system.

208.6A Service Activities

Service activities include:

Homemaker services (Appendix A)
Personal care services (Appendix A)
Chore services (Appendix A)
Home modification/repair services (CH 314)

Service activities do not include:

Physical, speech, or occupational therapies
Medical nutrition therapy
Medical social services
Home health aide services provided by a home health agency
Skilled nursing services

Refer to Appendix A for details about allowable activities and prohibited activities.

208.6B Prohibited Activities

Refer to MAN 5300, 202 Program Guidelines and Requirements

See Appendix A for prohibited activities.

208.7 Access to Services

For information regarding screening through Aging & Disability Resource Connection, see MAN 5200, Section 5025. The AAAs will maintain and manage waiting lists for the services, as necessary. See Manual 5200, Section 5038 “Waiting List Management”.

Not every applicant will request, require, or benefit from in-home services. Each AAA will clearly identify in its Area Plan how services will be coordinated and how resources will be allocated and managed to optimize the effectiveness and efficiency of in-home services.

208.8 Assessments

DAS requires that staff use the DON-R to determine an individual’s need and potential benefit for in-home services. The preferred method of assessment for in-home services is via home visit.

MAN 5300, 114 Guidelines for Client Assessment contains training information and guides for the DON-R and other instruments for assessment.

208.9 Service Initiation and Standards of Promptness

The provider agency has the discretion to begin providing minimal levels of service prior to the completion of the initial service plan (refer to MAN 5300, 114 Guidelines for Client Assessment).

The agency must initiate services within ten (10) working days from the date of receiving the referral, and thereafter deliver them on a regular basis in accordance with the established service plan. The AAA or its designee must contact the client within the first sixty (60) days of service initiation and annually thereafter to ensure client satisfaction and that services are meeting the needs of the individual/family.

208.10 Service Plan

Designated staff will begin developing the in-home service plan, using a format provided or approved by the Division of Aging Services (DAS), with the client and/or family during the in-home assessment visit.

The in-home service plan must include, at a minimum:

Types of services requested
Discrete tasks requested
Frequency of services requested
The preferred days, times, frequency, and duration of visits in the client’s residence
Estimated duration of the need for services

208.11 Service Outcomes

The primary goal of in-home services is to aid older adults, persons with disabilities, and their caregivers to achieve maximum self-sufficiency and enhance their quality of life.

Outcome #1: Ensure maximum safety and health in the individual’s residence of choice Indicators:

Reduction in number of barriers to living safely in the home provided by provision of home repair/home modification as measured by a home safety assessment
Reduction in safety hazard by provision of chore services as measured by Unmet Need for Care in the outside home domain of DON-R
Maintaining or reducing safety and health hazards by provision of homemaker services as measured by Unmet Need for Care in following domains of DON-R: housekeeping, laundry, preparing meals
Reduce personal health barriers by provision of personal care services as measured by Unmet Need for Care in the following domains of DON-R: eating, bathing, grooming, dressing, transferring, continence

Outcome #2: Enhance maximum independence for the individual to live in their residence of choice

Indicators:

Reduction in number of barriers to accessibility within the home provided by home modification services as measured by a home and safety assessment such as Safe at Home Checklist (Appendix B) or other appropriate home safety evaluation.

For specific outcomes for assistive technology services, see MAN 5300, CH 208.

208.12 Reassessments

Designated staff must conduct reassessments according to DAS requirements. The reassessment will address changes in the cognitive, emotional, physical, functional, economic, or physical/social environment in which the client lives and must provide the basis for any changes indicated for the service plan. MAN 5300, 114 Guidelines for Client Assessment contains information and guidelines about reassessments.

208.13 Emergency Contact

The AAA should ensure that each client record contains emergency contact information (name and telephone number(s) at a minimum) and verify/update emergency contact during each reassessment.

208.14 Service Termination and Discharge

Refer to MAN 5300, 202 Program Guidelines and Requirements

208.15 Client’s Rights and Responsibilities

AAAs and provider agencies will assure that all consumers, or their caregivers, receive a written copy of their rights and responsibilities as program/service participants upon their admission to services. See MAN 5300 Appendix E for the suggested “Client’s Rights and Responsibilities”.

208.16 Client Complaint Procedures

AAAs will establish written client complaint procedures for use by each provider. Procedures should include the minimum requirements outlined in MAN 5300, 202 Program Guidelines and Requirements. In addition, the complaint procedures must include:

A telephone number for the provider which the client can call for information, questions, or complaints about the services supplied by the provider and information regarding supervision by the agency of the services to be provided
The telephone number of the state licensing authority for information and filing of complaints which have not been resolved satisfactorily at the local level, for those agencies providing services subject to state licensure, or the number of the AAA and DAS, if not subject to licensure

208.17 Appeals and Grievances

AAAs will establish written appeals procedures for use by each provider and are consistent with MAN 5300, 110 Grievance Procedures for Individuals in Non-Medicaid HCBS Programs.

208.18 Service Agreements

Providers must adhere to guidelines issued by the Georgia Department of Community Health related to service agreements with recipients of in-home services from licensed private home care providers agencies, found in Department of Community Health Rules and Regulations of the State of Georgia as found at 111-8-65.09. DAS may ask for proof of compliance or of licensing or certification as issued by the Department of Community Health.

AAA must notify DCH immediately if they believe the service provider(s) is not in compliance with DCH Rules and Regulations.

208.19 State Licensure

Providers of in-home services must provide a current, valid license to operate a private home care agency issued by the Georgia Department of Community Health to prove that they are in compliance and good standing with all applicable licensure requirements for private home care providers under the Rules and Regulations of the State of Georgia as found at section 111-8-65.

AAA must notify DCH immediately if they believe the service provider(s) is not in compliance with DCH Rules and Regulations.

208.20 Insurance Coverage

AAAs are responsible for ensuring that each provider agency maintains appropriate types and levels of insurance coverage that protects the health and safety of clients and employees, and that comply with all applicable contractual obligations and state and federal statutes to include:

Worker’s compensation
Professional liability
Errors and omissions
General liability
Any agency-owned vehicles

208.21 Staffing

Providers of in-home services must have enough qualified staff to provide services specified in the service agreements with clients.

Providers must meet all staffing rules and regulations cited by licensing agencies. Information and guidelines are located: State of Georgia Rules and Regulations for Private Home Care Providers: 111-8-65-.09(5) rules.sos.state.ga.us/gac/111-8-65

208.22 Employee Identification

The provider agency will furnish adequate identification (ID) to employees who provide in-home services or who have direct contact with clients/caregivers.

Each employee must carry the ID and either wear it on his/her person or present it to the client/caregiver upon request
An adequate ID is one that is made of permanent materials and which shows the provider agency name, the employee’s name, title, and photograph.
The provider must issue the ID at time of employment and must require the return of the ID upon termination of employment.

208.23 Orientation and Training Requirements

In addition to state regulatory guidelines for staff training, the provider agency will employ personnel who possess the qualifications and competencies to perform the requested and agreed upon services of the client or family.

The provider agency must ensure each employee receives the following information during orientation and training:

Agency policies and procedures
Philosophy and values of community integration
Consumer-directed care
Person-centered planning
Recognizing and reporting suspected abuse, neglect, exploitation
Recognizing changes in the client’s health condition indicating the need for emergency procedures or health services
Agency code of ethics and employee conduct
Client rights and responsibilities
Agency complaint process
Recognizing and reporting client progress, services provided, and problems to supervisory staff
Employee’s obligations to inform the employer of known exposure to tuberculosis, hepatitis, or any other communicable disease

The provider agency must ensure that the staff responsible for directing/providing training meets minimum qualifications.

Annual Training

Each employee must participate in a minimum of eight (8) clock hours annually of in-service or additional training related to performance of job duties. The provider agency may provide the training or assist employees in locating and attending the appropriate training. The objective of ongoing training is to improve each employee’s ability to meet the needs of the client/caregiver and support the accomplishment of service outcomes.

208.24 Criminal Records Investigations

AAAs must assure that providers employing persons having direct care or treatment responsibilities, as primary, secondary or alternative job duties conduct a criminal records investigation, according to state law and current policy of the Department of Human Services in MAN 5600, 3036 Criminal History Investigations.

208.25 Supervisory Visits

Appropriate supervisory staff will make visits to each client’s residence, in accordance with time frames by state licensure requirements (see State of Georgia Rules and Regulations for Private Home Care Providers: 111-8-65-.10, rules.sos.state.ga.us/gac/111-8-65).

208.26 Administrative Requirements

The providers must establish and implement written policies and procedures that define the scope of in-home services it offers and the type of clients it serves.

Provider agencies must maintain accurate administrative, fiscal, personnel, and client case records that will be accessible and available to authorized representatives of the AAA, DAS, the Department of Human Services, and others, as required by law and in compliance with MAN 5300 and MAN 5600.

208.27 Data Collection and Reporting

Providers must maintain separate files containing all written or electronic records pertaining to the services provided for each client served, including, at a minimum, the following:

Identifying information including the name, address, telephone number, and responsible party, if applicable
Assessment and reassessment documentation, gathered through the use of instruments or inventories specified or approved by DAS
Current service agreement
Current service plan
Documentation of tasks performed
Documentation of findings of home supervisory visits
Any material reports from or about the client that relate to the care being provided, including items such as progress notes and problems reported by employees of the provider agency; communications with personal physicians or other health care providers; communications with family members or responsible parties
The names, addresses and telephone numbers of the client’s personal physicians, if any, if applicable to the service being provided
The date of the referral
Any additional information requested or required by DAS

208.28 Retention and Confidentiality of Records

Providers must establish and implement written policies and procedures for the maintenance and security of client records, specifying who will supervise the maintenance of records, which will have custody of records, to whom records may be released, and for what purposes in compliance with MAN 5600, 3012 Area Agency on Aging Records.

208.29 Personnel Records

Refer to MAN 5300, 202 Program Guidelines and Requirements

If the agency requires employees to be bonded, the personnel records must include documentation of bonding, if employee performs homemaker functions which permits limited or unlimited access to the client’s personal funds. If coverage is provided through a general liability policy, the provider need not maintain documentation separately in each personnel file.

208.30 Fee for Service Guidelines

Each AAA/provider is encouraged to offer in-home services as a fee-for-service enterprise to enhance the sustainability of the Aging network. In doing, the AAA must follow all requirements of the Older Americans Act and MAN 5600, Sections 2025-2028, “Fee for Service System”, “Cost Share”, “Voluntary Contribution”, and “Private Pay Services”.

In-home services provided to consumers as a fee-for-service should not differ in quality from service provided to consumers funded through public funds.