RELATES TO:
KRS
205.201,
205.203, 205.455-205.465,
42 U.S.C.
3001 et seq.
NECESSITY, FUNCTION, AND CONFORMITY:
42 U.S.C.
3001 et seq., the Older Americans Act of
1965, as amended, authorizes grants to states to provide assistance in the
development of new or improved programs for older persons.
KRS
194A.050 requires the secretary for the
Cabinet for Health and Family Services to promulgate administrative regulations
necessary to implement programs mandated by federal law, or to qualify for the
receipt of federal funds.
KRS
205.204 designates the Cabinet for Health and
Family Services as the state agency to administer the Older Americans Act in
Kentucky. This administrative regulation establishes the standards of operation
for the Supportive Services Program in Kentucky.
Section 1. Definitions.
(1) "Access" means information and referral
services, outreach service and transportation service.
(2) "Agency" means the area agency on aging,
an entity designated by the state to administer, at the local level, the
programs funded by the Older Americans Act of 1965, as amended.
(3) "Assessment" means the collection and
evaluation of information about a person's situation and functioning to
determine the applicant or recipient service level and development of a plan of
care utilizing a holistic, person centered approach by a qualified independent
care coordinator (ICC).
(4)
"Assisted transportation" means a one-way trip to accompany an eligible person
who requires assistance for safety or protection to or from his physician,
dentist, or other necessary service.
(5) "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:
(a) Planning;
(b) Referring;
(c) Monitoring;
(d) Advocating; and
(e) Following the timeline of the assessment
agency to obtain:
1. Service level;
and
2. Development of the plan of
care.
(6)
"Case management supervisor" means an individual meeting the requirements of
Section 5(1) and (2) of this administrative regulation and who shall have four
(4) years or more experience as a case manager.
(7) "Case manager" means the individual
employee responsible for case management including:
(a) Coordinating services and supports from
all agencies involved in providing services required by the plan of
care;
(b) Ensuring that all service
providers have a working knowledge of the plan of care; and
(c) Ensuring that services are delivered as
required.
(8)
"Community" means a county designated as either urban or rural in accordance
with the most current percentage of population listing from the U.S. Census
Bureau.
(9) "District" is defined
by KRS
205.455(4).
(10) "Educational or experiential equivalent"
means:
(a) Two (2) semesters totaling at
least twenty-four (24) hours of course work; and
(b) At least 400 documented hours of
experience assisting aging or disabled individuals through:
1. Practicum placement;
2. Clinicals; or
3. Volunteerism.
(11) "Home modification" means the
provision of minor home adaptations, additions, or modifications to enable the
elderly to live independently or safely or to facilitate mobility, including
emergency summons systems.
(12)
"Independent care coordinator" or "ICC" means the individual that completes the
initial assessment, plan of care, and reassessment.
(13) "Information and assistance" means a
service for individuals that provides current information about services
available within the community.
(14) "In-home services" means the performance
of heavy housecleaning, yard tasks, and other activities needed to assist a
functionally impaired elderly person remain in his own home.
(15) "Legal assistance" means:
(a) Legal advice and representation by an
attorney; or
(b) Counseling or
other appropriate assistance by a paralegal or law student under the
supervision of an attorney.
(16) "Multipurpose senior center" is defined
by 42 U.S.C.
3002(36).
(17) "Natural supports" means a non-paid
person or community resource who can provide, or has historically provided,
assistance to the consumer or, due to the familial relationship, would be
expected to provide assistance when capable.
(18) "OAA" means the Older Americans Act of
1965,
42 U.S.C.
3001 et seq., as amended.
(19) "Outreach" means interventions with
individuals initiated by an agency or organization for the purpose of
identifying potential clients or their caregivers and encouraging their use of
existing services and benefits.
(20) "Planning and service area" is defined
by 42 U.S.C.
3002(42).
(21) "Rural" means a community with less than
50,000 population as designated by the most current listing from the U.S.
Census Bureau.
(22) "Satellite
senior center" means a facility that is used to provide services specified in
Section 10(3) of this administrative regulation if a multipurpose senior center
is not available to provide the services.
(23) "Senior center services" means the
provision of activities that foster the health or social well-being of
individuals through social interaction and leisure.
(24) "Service level" means the minimum
contact required through face-to-face visits and telephone calls by the case
manager or social service assistant.
(25) "Social service assistant" means an
individual who:
(a) Has at least a high school
diploma or equivalent;
(b) Works
directly under the direction of the case management supervisor;
(c) Assists the case manager with record
keeping, filing, data entry, and phone calls;
(d) Helps determine what type of assistance a
client needs;
(e) Assists the
client in getting services to carry out the plan of care;
(f) Coordinates services provided to the
client;
(g) Assists a client in
applying for other services or benefits for which he may qualify; and
(h) Monitors a client to ensure services are
provided appropriately.
(26) "Supportive service provider" means an
entity that provides supportive services funded by the OAA under an approved
area plan.
(27) "Telephone
reassurance" means providing a wellness check by phone with the agreement of
the individual.
(28)
"Transportation" means transporting an individual from one (1) location to
another.
(29) "Unit of service"
means one (1):
(a) Hour of direct contact with
or on behalf of the participant;
(b) Contact for the information and referral
service;
(c) Call for the telephone
reassurance service;
(d) Contact
for the outreach service;
(e)
One-way trip for the transportation service; and
(f) Contact for senior center
service.
(30) "Urban"
means a community with 50,000 or more population as designated by the most
current listing from the U.S. Census Bureau.
Section 2. Eligibility.
(1) Participants receiving supportive
services funded by the OAA shall be sixty (60) years of age or older.
(2) Agencies shall utilize the DAIL-GA-01
Priority Screening Tool for prioritizing applicants to ensure services are
targeted to those in greatest need.
(3) Means tests shall not be allowed to
determine eligibility.
Section
3. Service Provider Responsibilities.
(1) A service provider contracting with a
district to provide supportive services supported in whole or in part from
funds received from the cabinet shall:
(a)
Provide services in accordance with the approved agency area plan which shall
ensure the provision of supportive services throughout the geographic area
covered under its plan;
(b) Review
the provision of supportive services to assure safety and
consistency;
(c) Treat the client
in a respectful and dignified manner and involve the client and caregiver in
the delivery of services;
(d)
Permit staff of the cabinet and the district to monitor and evaluate services
provided;
(e) Assure that each paid
or voluntary staff member meets qualification and training standards
established for each specific service by the department;
(f) Maintain a written job description for
each paid staff and volunteer position involved in direct service
delivery;
(g) Develop and maintain
written personnel policies and a wage scale for each job
classification;
(h) Designate a
supervisor to assure that staff providing in-home services are provided
supervision;
(i) Monitor, evaluate,
and conduct satisfaction surveys; and
(j) Maintain a record for each client
including:
1. Participant name;
2. Address;
3. Phone number;
4. Emergency contact information;
5. Request for services;
6. Verification of eligibility;
7. Services provided; and
8. Monitoring of services provided.
(2) Staff of the
provider agency shall not:
(a) Accept personal
gratuities from participants or vendors; or
(b) Be involved in any client financial
transaction without prior approval from the contracting agency.
(3) A procedure shall be utilized
annually for the evaluation of unmet need, the results to be made available to
the agency.
(4) The legal
assistance provider shall:
(a) Specify how it
intends to target services for the needs of low-income minority
individuals;
(b) Attempt to provide
services to the population of low-income minority individuals in at least the
same proportion as the population bears to the older population as a
whole;
(c) Provide individual legal
casework, legal referral, and legal education to the elderly and training for
attorneys in areas of law relevant to the elderly;
(d) Contact institutionalized elderly and
inform and educate these individuals about the legal assistance services
available;
(e) Specify how it
intends to coordinate its efforts with the efforts of the Long-term Care
Ombudsman Office;
(f) Meet at least
annually with the local ombudsman program;
(g) Submit a written quarterly activities
report to the agency, documenting the legal activities and services provided to
participants; and
(h) Not divulge
information protected by the attorney-client privilege.
Section 4. Support Services.
Services funded by the OAA and administered by the area agencies on aging and
independent living shall be provided as established in this section.
(1) Except for senior center and access
services, the ICC and the individual shall determine the service needs of the
individual.
(2) Information and
assistance services shall:
(a) Provide
information in response to an inquiry regarding opportunities and services
available;
(b) Assist in accessing
opportunities and services;
(c)
Follow-up to determine whether services were received and identified needs were
met; and
(d) Utilize current
records of appropriate community resources, including local procedures for
assessing participant needs and for making referrals to appropriate
agencies.
(3) Legal
assistance services shall:
(a) Be available
for institutionalized older persons and other elderly persons otherwise
entitled to legal assistance;
(b)
Not be denied because of a person's failure to disclose information about
income or resources; and
(c) Assure
providers maintain records to include individual client services and group
activities, covering topics, presenters, locations and numbers of
participants.
(4)
Outreach services shall:
(a) Locate or
reestablish contact initiated by providers, to identify participants in need of
services;
(b) Provide
information;
(c) Encourage the use
of existing services;
(d) Be
provided in the total geographic area served by the agency, in accordance with
a plan to identify the elderly and caregivers in the area, with priority given
to a rural, low income minority, limited English speaking, or disabled
individual; and
(e) Be provided by
a worker with current knowledge of services available to the elderly,
caregivers, and individuals with disabilities in accordance with an established
procedure for worker assistance to the participant in accessing appropriate
services, including follow-up to assure needs have been met.
(5) Senior center services shall
provide activities which foster the health or social well-being of an
individual through social interaction and the use of leisure time.
(6) OAA Title IIIB allocation shall be
provided:
(a) By staff who are knowledgeable
and skilled in the services provided, including a volunteer under the
supervision of the center director; and
(b) With consideration for the physical and
mental conditions and activity preferences of a participant.
(7) Telephone reassurance services
shall:
(a) Provide regular telephone contact
to or from isolated individuals;
(b) Be provided by a staff who is
knowledgeable and skilled in the services provided, including a volunteer under
the supervision of the center director;
(c) Include a prearranged schedule for
contacting the participant;
(d)
Maintain a log of calls documenting:
1. Date
of the contact;
2. Length of the
call;
3. Summary of the
contact;
4. Demographics of the
participant;
5. Determination of
safety and well-being; and
6.
Determination of special assistance needed;
(e) Establish a procedure to be implemented
in the event of a non-answered call; and
(f) Include the participant's preference
regarding frequency of calls.
(8) Transportation services shall:
(a) Be provided by a trained
individual;
(b) Carry older persons
to or from community resources to access or receive needed services;
(c) Comply with federal, state, and local
regulations; and
(d) Use vehicles
safe and accessible to older persons and properly insured to protect the
participants in accordance with state laws.
(9) Assisted transportation services shall be
provided:
(a) In accordance with subsection
(8) of this section; and
(b) To a
person who requires accompaniment for reasons of safety or protection to or
from his physician, dentist, or other necessary services as determined by the
ICC.
(10) In-home
services shall be provided:
(a) By trained
staff; and
(b) As determined by the
ICC.
Section
5. Case Manager Requirements.
(1)
A case manager and an ICC shall:
(a)
1. Possess a bachelor's degree in a health or
human services field from an accredited college or university:
a. With one (1) year experience in health or
human services; or
b. The
educational or experiential equivalent in the field of aging or physical
disabilities;
2. Be a
currently licensed RN as defined in
KRS
314.011(5) who has at least
two (2) years of experience as a professional nurse in the field of aging or
physical disabilities; or
3. Be a
currently licensed LPN as defined in
KRS
314.011(9) who:
a. Has at least three (3) years of experience
in the field of aging or physical disabilities; and
b. Is supervised by an RN who consults and
collaborates on changes to the plan of care;
(b) Be a department certified case manager
beginning July 1, 2015; and
(c) Be
supervised by a case management supervisor.
(2) A master's degree from an accredited
college or university may be substituted for the required experience.
(3) Each client shall be assigned a:
(a) Case manager; or
(b) Social service assistant.
(4) A client shall be assessed
initially and reassessed at least annually thereafter by an ICC that possesses
a bachelor's degree, a master's degree, or is a licensed registered nurse
(RN).
(5) After each assessment or
reassessment, the ICC shall determine eligibility and service level based on
the DAIL-HC 01, Scoring Service Level of each assessed individual.
(6) If the client is ineligible, the case
shall be closed and the reason documented in the case record with notification
mailed to the client or caregiver.
(7) The case manager shall:
(a) Be responsible for coordinating,
arranging, and documenting those services provided by:
1. Any funding source; or
2. A volunteer;
(b) Make a reasonable effort to secure and
utilize informal supports for each client;
(c) Document the reasonable effort in the
client's case record;
(d) Monitor
each client by conducting a home visit according to the assessed service level
and coordinate a telephone contact between home visits. Clients shall be
contacted at a minimum as follows:
1. Level 1,
a home visit shall be conducted every other month;
2. Level 2, a home visit shall be conducted
every four (4) months; or
3. Level
3, a home visit shall be conducted every six (6) months; and
(e) Document in the case record
each contact made with a client, as specified in paragraph (d) of this
subsection.
(8) A
district shall employ an ICC to assess the eligibility and needs for each
client.
(9) A client assessed at a
Level 1 or a Level 2 shall be assigned a case manager.
(10) A client assessed at a Level 3 shall
have a case manager or a social service assistant assigned to assist with
meeting their needs.
(11) A client
shall receive in-home services in accordance with an individualized plan of
care developed through participant directed planning which shall:
(a) Relate to an assessed problem;
(b) Identify goals to be achieved;
(c) Identify a scope, duration, and unit of
service required;
(d) Identify a
source of service;
(e) Include a
plan for reassessment; and
(f) Be
signed by the client or client's representative and case manager with a copy
provided to the client.
(12) Case management services shall not be
provided to an individual on a waiting list.
Section 6. Multipurpose Senior Center
Selection.
(1) An AAAIL shall designate a
multipurpose senior center within each urban community of the AAAIL's planning
and service area.
(2) If only rural
communities are within an AAAIL's planning and service area, the AAAIL shall
designate at least one (1) multipurpose senior center in the AAAIL's planning
and service area.
(3) Selection of
a multipurpose senior center location shall be based on:
(a) Demographic information concerning the
population of older persons in its service area; and
(b) The advice of public and voluntary
agencies serving the elderly.
(4) The AAAIL shall specify designation of a
multipurpose senior center within its area plan.
(5) The following factors shall be given
consideration in choosing a site for the multipurpose senior center:
(a) Demographic information and
projections;
(b) Accessibility to
the maximum number of people with particular attention to:
1. Low-income older individuals, including
low-income minority older individuals;
2. Older individuals with limited English
proficiency;
3. Older individuals
residing in rural areas; and
4. The
number of older individuals at-risk for institutional placement;
(c) Proximity to other services
and facilities;
(d) Convenience to
public or private transportation or a location within walking distance for
participants;
(e) The absence of
structural barriers or difficult terrain; and
(f) The safety and security of participants
and staff.
Section
7. Multipurpose Senior Center Specifications.
(1) A multipurpose senior center shall:
(a) Provide barrier-free access and movement
within the facility pursuant to
45 C.F.R.
85.42 and
85.43;
(b) Be clearly identified with a
sign;
(c) Make arrangements:
1. For the security of facility equipment,
furniture, and files; and
2. To
offer activities at other sites in its service area; and
(d) Be free of physical hazards in accordance
with the DAIL-MSC-01 Multipurpose Senior Center Site Approval
Checklist.
(2) The
facility shall be properly maintained and repaired to meet the safety and
security of staff and participants.
(3) An existing multipurpose senior center
that does not meet the requirements of subsections (1) and (2) of this section
shall comply with a corrective action plan administered by the
department.
(4) The multipurpose
senior center shall have thirty (30) days from receipt of the corrective action
plan to comply.
(5) The department
may withhold funding if the multipurpose senior center does not comply with the
corrective action plan.
Section
8. Multipurpose Senior Center Requirements.
(1) Each multipurpose senior center shall
have a full time director and paid or volunteer staff to administer the
center.
(2) At least one (1) staff
person or the director shall be present at the site during hours of
operation.
(3) At a minimum, a
multipurpose senior center shall be open six (6) hours per day and five (5)
days per week.
(4) A multipurpose
senior center shall provide the following services:
(b) Support Services including:
1. Transportation;
2. Outreach;
3. Information and assistance; and
4. Other services identified in the planning
and service regions area plan.
(5) A multipurpose senior center shall:
(a) Comply with the confidentiality and
disclosure of a client as follows:
1. Adhere
to the confidentiality and disclosure of client information pursuant to
KRS
194A.060 and
5
U.S.C.
552, the Federal Freedom of
Information Act;
2. Not disclose
client information without the informed consent of the person or legal
representative, unless the disclosure is required by a court order or for
program monitoring authorized by federal, state, or local monitoring agencies;
and
3. Not reveal client
information that is protected by attorney-client privilege; and
(b) Refer reports of abuse,
neglect, or exploitation to the Department for Community Based
Services.
Section
9. Satellite Senior Center Selection.
(1) The AAAIL shall designate a satellite
senior center within the planning and service area of each rural community if:
(a) A multipurpose senior center is not
already located in the county; or
(b) Additional satellite senior centers are
needed to provide aging programs to seniors of that area.
(2) The AAAIL shall specify designation of a
satellite senior center within its area plan.
(3) A satellite senior center shall meet the
multipurpose senior center selection requirements of Section 6(2) of this
administrative regulation.
Section
10. Satellite Senior Center Requirements.
(1) Each satellite senior center shall have a
director who is responsible for the administration of the site.
(2) At least one (1) staff person or the
director shall be present at the site during hours of operation.
(3) At a minimum, a satellite senior center
shall be open for eight (8) nonconsecutive hours per week.
(4) An AAAIL shall organize and advertise
activities, services, and schedules of operation in advance.
(5) A satellite senior center shall:
(a) Unless already established in a
multipurpose senior center in the same community, provide access services which
shall include:
1. Transportation;
2. Outreach; and
3. Information and referral; and
(b) Adhere to the confidentiality
requirements of Section 8(5) of this administrative regulation.
(6) A satellite senior center may
provide nutrition services in accordance with
910 KAR
1:190.
Section 11. Approval of a Multipurpose and
Satellite Senior Center.
(1) Supportive or
nutrition services shall be funded at a multipurpose and satellite senior
center if the center has been approved by the department.
(2) A multipurpose and satellite senior
center shall not become operational until an on-site visit by the department
has been completed and approval given by the department.
(3) Prior to approval of a multipurpose and
satellite senior center, it shall be inspected by the following:
(a) The local health department for
compliance with applicable health codes depending on the types of services
provided at the site;
(b) The local
fire department for compliance with fire and building safety codes;
and
(c) An AAAIL inspection using
a:
1. DAIL-MSC-01 Multipurpose Senior Center
Checklist; or
2. DAIL-SSC-02
Satellite Senior Center Checklist.
Section 12. Altering Multipurpose or
Satellite Senior Center.
(1) Prior approval
shall be obtained from the department by an AAAIL which intends to:
(a) Close or open a new multipurpose or
satellite senior center;
(b) Change
the location of the multipurpose or satellite senior center;
(c) Change the method of providing services
in a manner that affects availability of ongoing services; or
(d) Reduce the level or number of
services.
(2)
Justification for the change shall include:
(a) The proposed effective date;
(b) The need or reason;
(c) The number of participants
affected;
(d) Whether this change
is temporary or permanent;
(e) A
cost benefit analysis;
(f) For a
change made to an existing multipurpose or satellite senior center, whether
this facility was altered, renovated, or constructed with Older Americans Act
funds and the date work was completed;
(g) Whether the AAAIL advisory council
recommended this change;
(h) What
provisions are proposed to continue services to the participants; and
(i) For a proposed multipurpose or satellite
senior center, costs involved in meeting local fire, health, safety, and
sanitation regulations.
(3) A request to open a new multipurpose or
satellite senior center shall include copies of completed local health
department inspections and a completed:
(a)
DAIL-MSC-01 Multipurpose Senior Center Checklist; or
(b) DAIL-SSC-02 Satellite Senior Center
Checklist.
(4) If meal
preparation at a new multipurpose or satellite senior center is proposed, the
multipurpose or satellite senior center shall notify the:
(a) Department;
(b) Local fire department; and
(c) Local health department.
(5) The department shall review
the information submitted and determine if an on-site visit is necessary for
approval.
(6) In case of altered
multipurpose or satellite senior center operations due to damages caused by
fire, flood, storm, high winds, tornados, or other safety issues, the
department shall be notified within one (1) business day that emergency
alterations are necessary by:
(a)
Telephone;
(b) Email; or
(c) Fax.
(7) Prior approval shall be obtained from the
department on a conditional basis for emergency circumstances with final
approval pending:
(a) Written documentation of
the proposed change;
(b) Local
fire, health, and safety inspections; and
(c) An on-site inspection by the department
if the department determines a visit is necessary for final approval.
(8) The AAAIL shall specify
alterations of a multipurpose and satellite senior center within its area plan
for department approval.
Section
13. Training and Education. An AAAIL shall implement the following
training and education programs for multipurpose and satellite senior center
providers of service:
(1) An annual program
assessment to identify training needs and develop correlating plans;
(2) An identification and review of resources
available to meet training needs;
(3) The development of a comprehensive
education and training plan;
(4) A
search for additional resources to implement the plan;
(5) The coordination of education programs
with private, public, governmental, and educational organizations and
institutions; and
(6) A plan to
implement staff development initiatives.
Section 14. Monitoring. An AAAIL shall:
(1) Monitor and assess services to determine
compliance with contract requirements and an approved area plan; and
(2) Submit written evaluation of its findings
to DAIL annually.
Section
15. Incorporation by Reference.
(1) The following material is incorporated by
reference:
(a) "DAIL-GA-01, Priority Screening
Tool", November 2014;
(b)
"DAIL-MSC-01, Multipurpose Senior Center Checklist", August 2014;
(c) "DAIL-SSC-02, Satellite Senior Center
Checklist", August 2014; and
(d)
"DAIL-HC 01, Scoring Service Level", April 2014.
(2) This material may be inspected, copied,
or obtained, subject to applicable copyright law, at the Department for Aging
and Independent Living, 275 East Main Street, Frankfort, Kentucky 40621, Monday
through Friday, 8 a.m. to 4:30 p.m.