Consumer-Employer Responsibilities & Indicators for Intervention

Transcription

1 Consumer-Employer Responsibilities & Indicators for Intervention This is not an exhaustive list of tasks, warning signs, and case management interventions. Every situation is unique and may present different warning signs and may require interventions not listed below. This document lays out key consumer employer/representative responsibilities, consumer skills and tasks, warning signs that the consumer is not managing their responsibilities and appropriate actions or interventions for Case managers. Not all skills and tasks should be weighted to the same degree when determining if a consumer or a representative can manager their responsibilities. As an example, many consumers may not have the ability or resources to use the Registry. However, that would not mean that the consumer or representative should not be in CEP. However, a consumer who is sexually harassing their HCWs would mean that they cannot be in CEP. A consumer who is unable or unwilling to manage their service plan to meet their needs may mean that they should not be in CEP. (A) Locate, screen & hire Skill/Tasks: Using the Registry Writing and posting ads Conducting interviews Checking references Developing a job description Verifying driver s license and insurance Reviewing the Task List Developing an employment agreement and having employee sign Plan has been approved but consumer has not hired by indirect/direct contact. When loss of worker there are long gaps in replacing. Consumer relies on Case Manager to find workers

2 Complex consumer hires just enough the meet need no emergency or standby works for back-up Need to exceed weekly cap due to not hiring enough workers Assist client with accessing the Registry via web or paper copy Give the client the Registry & Referral System brochure (SDS 355E) that provides step-by-step information on obtaining a list If client does not have access to the web, provide a list generated by the Registry by entering specific information about the client s service needs Follow-up with the client after the information has been given to ask about progress and whether additional information is needed (ask whether he/she had any difficulty using the registry; whether specific information was entered to find the best match; any difficulty reaching HCWs; difficulty finding an available HCW; whether a new list is needed) Offer referral to Employer Resource Connection (formerly known as STEPS) Provide copy of the Employer s Guide (DHS 9046) Help client identify natural supports who could assist w/process Remind client that use of agency may be an option, if available in local area, until a HCW is hired (B) Supervise and train the HCW Skills/Tasks: Ensuring the work is performed to the client s satisfaction Showing & instructing the employee how the client likes to receive specific services Maintaining employment records Cooperating with workers compensation claims Worker allowed to exceed weekly cap limits (With regards to supervision) Client frequently complains about HCWs coming to work late; frequent absences; poor quality of work (can also indicate that performance deficiencies are not being

3 addressed, which is also a client-employer responsibility) HCW frequently calls Case Manager with complaints/concerns about how to safely and adequately meet service needs, particularly if there are difficult transfers; complex medical needs; special diets; use of medical equipment (oxygen; ventilators; nebulizers); ostomy care; durable medical equipment (sliding boards; hoyer lifts) Workers compensation claims Continual turn-over of HCWs, either because they are quitting or are being fired Refer Community RN, HH, or Respiratory Therapist to assist client with educating and training HCW Suggest HCW attend trainings available through the OHCC (Bathing & Grooming; Blindness & Low Vision; Challenging Behaviors; Dementia & Alzheimer s; Keeping it Professional; Preventing Disease Transmission; Protect Against Sprains and Strains; Respiratory Care: Oxygen to Ventilators) Offer client referral to Employee Resource Connection (formerly known as STEPS) Follow-up with client to see if he/she gave HCW a copy of the Task List that provides guidance on service needs to be provided Provide copy of the Employer s Guide and encourage client to use the Employment Agreement and Job Description and Schedule as a way of communicating job expectations and what services are needed and when they should be provided Help client identify natural supports or representative who may be able to assist w/task Provide HCW with copy of HCW Guide (DHS 9046a) and Safety Manual for Homecare Workers (DHS 9062) Monitor clients with exceptional needs, by visits and phone calls as often as needed, more frequently to resolve immediate, urgent issues. This may range from daily for brief periods of time, to weekly, monthly, quarterly or a minimum once every six months for very stable clients. (C) Schedule work, leave, and coverage

4 Skills/Tasks: Developing a work schedule Finding a relief worker Signing paid leave vouchers Managing non-use of overtime Schedules blocks of times, during which, there are periods there are no needs (For example: Consumer has scheduled two 8 hour days when need is 2 hours daily leaving needs unmet frequently) Service needs are not being provided on a consistent basis due to client s failure to schedule work and, as a result, client s health and physical abilities are declining (medical condition becomes unstable because not receiving medications as scheduled; skin breakdown because assistance with bathing or incontinence is not being provided as needed; weight loss because meals are not being provided as needed) Repeatedly, CM receives phone calls from client s HCW because he/she has postponed using paid leave on multiple occasions because client has not made arrangements for coverage and will not authorize absence CM notified by client or someone in the community that client has gone without assistance on multiple occasions due to HCW s absence and the client s failure to find a replacement HCW is not claiming all of the authorized hours because there isn t a consistent schedule Client or worker is calling frequently to change hours between providers and the hours have not been prior authorized (may signal that either the client or the HCWs are not following a consistent schedule) Discuss with client the risks of not receiving services on a regular and consistent basis and share your observations

5 Encourage client to use the Job Description and Schedule from the Employer s Guide, which will specify when specific tasks should be provided (Mon-Sun) Offer referral to Employee Resource Connection (formerly known as STEPS) Offer other service program options Make APS referral if appropriate Help client identify natural supports or representative who may be able to assist w/task See interventions under Locating, Screening, & Hiring (D) Track the hours worked and verify the authorized hours were completed by the HCW Skills/Tasks: Keeping track of the days and hours worked Signing vouchers Using a daily checklist to verify tasks were done Multiple discrepancies between the number of hours the client says the HCW worked versus what the HCW reports (may indicate that the client, HCW, or both are not keeping track of their hours) Multiple occurrences of the HCW submitting vouchers claiming more hours than what were authorized Multiple HCWs submitting vouchers claiming different hours than what were authorized due to frequent schedule changes and client Is unable to verify hours worked Offer referral to Employee Resource Connection (formerly known as STEPS) Provide copy of Employer s Guide Encourage client to use calendar to track hours Encourage HCW to use calendar to track hours Encourage client to use a daily checklist of services provided Help client identify natural supports or representative who may be able to assist w/task

6 Monitor situations where there are multiple HCWs employed at the same time Consider if provider number termination, APS or Medicaid Fraud Referral is appropriate (E) Recognize, discuss, and attempt to correct, with the HCW, and performance deficiencies Skills/Tasks: Conducting performance evaluations Giving positive feedback, as well as explaining areas that could be improved Discussing expectations and preferences Client s condition is declining. May indicate that services are not being provided as required, but HCW is still employed despite deficiencies Frequent complaints voiced by client to the CM about the services being provided, but client does not want to discuss with the HCW Client s family, friends, or someone in the community voices complaints to CM or APS about the quality of services HCW is providing Client continues to employ HCW despite deficiencies voiced by CM, family, friend, or someone in the community and the situation does not improve (may worsen) After concerns are shared with client about the quality of services being provided, the client is still unable to recognize deficiencies Client expresses fear of or excessive concern for personal circumstances of provider (the client may be more hesitant to address performance deficiencies or even consider discharging the HCW because the client feels bad for the worker) Frankly discuss client s decline, share observations and concerns Offer referral to Employee Resource Connection (formerly known as STEPS) Provide copy of Employer s Guide Encourage client to consider representative to assist with task Offer to be present during HCW s performance evaluation (but not participate in the evaluation)

7 Review Task List with client as a way of discussing how well each task is being provided Encourage client to review Task List with HCW Remind client of program intent (to assist client, not HCW) and of client s right to hire and fire at any time for any reason (F) Discharge unsatisfactory workers Skills/Tasks: Arranging a final work date Reporting terminations to the local office Signing the final voucher Hiring a replacement worker See (E) Client asks the CM to fire the HCW CM Interventions Offer to be present when client is discharging HCW Help client identify natural supports or representative who may be able to assist w/task Offer referral to Employee Resource Connection (formerly known as STEPS) Assist client with accessing Registry to find new HCW prior to termination Make APS or Medicaid Fraud reports as appropriate Other Warning Signs that may indicate intervention and/or rep: Workplace is not safe from harassment CM receives repeated complaints from the HCW re: personality conflicts; consumer being too bossy; communication difficulties; being asked repeatedly to perform tasks not on the Task List; unrealistic expectations HCW s are frequently ending employment relationship with consumer due to difficulty working with consumer (safety issues < loaded guns in the home that are not locked up; refusal to use a hoyer lift for difficult transfers; sexually inappropriate remarks or actions; verbal or physical abuse towards the HCW>; personality conflicts; consumer s unrealistic expectations)

8 Even after Employee Resource Connection (formerly STEPS) training, the consumer is relying on mentor to serve as employer Even after Employee Resource Connection (formerly STEPS) training, the consumer is demonstrating the above warning signs Consumer is frequently late with making monthly pay-in or paying bills; repeated utility shut-off notices; difficulty gathering information for recertifications (May indicate a problem with tracking and organizational skills) Frequent turn-over of representatives CM Consideration of Representatives Reliability (ability to follow-through; respond to concerns; timeliness; consistency) Relationship with consumer (strained? Advocate?) Ability (any concerns about cognitive abilities? Unable to train based on own physical limitations?) Geographical location & Availability (inability to supervise, train, and track hours if too far away) Paid provider Substantiated APS complaint Appears to be a barrier to reaching consumer directly Documentation Expectations The record must demonstrate this is a pattern of inability and not an isolated incidence (chronic versus acute) CM must: o Document observations and interventions o Document consumer s response to suggestions (e.g., the consumer is agreeable to interventions, consumer has agreed to participate in Employee Resource Connection (formerly STEPS); consumer is refusing interventions) o Document the outcome of interventions (e.g., there is improvement after Intervention (be specific); Continued monitoring and discussions with consumer are critical. Increased contact beyond monthly is likely.