Adult Residential Care 525-05-30-16

(Revised 9/1/12 ML #3347)

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Purpose

To provide an array of services to an individual in a 24-hr setting. Adult residential programs specialize in care of individuals with chronic moderate to severe memory loss or an individual who has a significant emotional, behavioral, or cognitive impairments. It is also a service in which assistance with ADL’s/IADL’s, therapeutic, social, and recreational programming is provided. Care must be furnished in a way that fosters the maintenance or improvement in independence of the recipient.

Service Eligibility, Criteria for

The individual receiving Residential Care service will meet the following criteria:

1. Must be eligible for the Medicaid Waiver for Home and Community Based Services.
2. Be at least age 18.
3. Must not be severely impaired in eating, transferring, or toileting.
4. Does not have medical or behavioral needs that require professional evaluation and management on an ongoing basis.
5. Need the services of, independent living skills training, support and training provided to promote and develop relationships, participate in the social life of the community, and develop workplace task skills including behavioral skill building.

• Community Integration is provided to enable the individual to promote independence and alleviate social anxiety. Some activities to be considered are community social events (such as fairs, sports leagues, church functions), volunteer or paid employment, educational/vocational activities.
• Social Appropriateness assists the individual with the development of social skills needed to interact with individuals in the facility or in the community. Such activities include (but are not limited to): respecting others’ space and privacy, non-offensive communication, obeying laws and rules, timeliness, safety/risk procedures;

Or

Require protective oversight and supervision in a structured environment that is professionally staffed to monitor, evaluate and accommodate an individual’s changing needs.

6. Pre approval from the Department of Human Services is required before this service can be authorized.

A rate of no more than the current maximum room and board rate per month shall be paid to the licensed provider by the recipient for board and room costs. Room and Board is the responsibility of the recipient and not included in the provider’s daily rate.

Service Tasks

1. This service includes 24-hour, on-site response staff;
2. Transportation may be provided as a component of this service and included in the daily rate paid to providers. Contact a HCBS Program Administrator to determine if transportation has been included in a rate for a specific residential care provider.
3. Assistance with ADLs and IADLs within the guidelines of the Basic Care licensure standards;
4. Allowable service tasks as identified on the SFN 1699 Authorization to Provide Service

Limits

Limited to the tasks as in agreement between the Department of Human Services and the Residential Care facility provider and as authorized by the County Social Service Board Case Manager.

To avoid duplication homemaker, chore, emergency response system, adult day care, adult family foster care, respite, transitional care, attendant care, environmental modification, and non-medical transportation are not allowable service combinations for individuals receiving adult residential services. Non-medical transportation is not allowed because it included in the rate for adult residential services.

Residential Services is an all inclusive services with the exception of Supported Employment Services for a individual who was determined eligible for Adult Residential Care as a result of a need for the services of, independent living skills training, support and training provided to promote and develop relationships, participate in the social life of the community, and develop workplace task skills including behavioral skill building.

Individual Program Plans

An individual who was determined eligible for Adult residential Care as a result of a need for the services, of, independent living skills training, support and training provided to promote and develop relationships, participate in the social life of the community, and develop workplace task skills including behavioral skill building must have an Individual Program Plan completed by the interdisciplinary team (to at least include the service provider, the individual and/or their legal representative) and the case manager.  

This plan must be completed within 30 days of the arrival of the individual to the residential care facility. The Plan must include how the facility will meet the needs of the client, AND the plan be designed for the promotion of the client’s independence in ADLs and IADLs, social, behavioral, and adaptive skills.

The Plan must also identify the goal or goals of the individual and how the goals will be accomplished. This Plan will be subject to review by the HCBS Case Manager during the initial Plan implementation period and every six months thereafter. At the team meeting, the team will review the goals and progress, and strategies for accomplishing the plan goal or goals.