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Service Coordination Clarification

Date: 03/09/18

Community Partners,

On Tuesday, March 6, 2018,  several Service Coordinators participated in a brief training that was intended to address questions we have received around:

  • Expanded service requests,
  • Direct care workers, including family members employed by individuals that self-direct care and have regularly been submitting high overtime, and;
  • Health and safety concerns as the result of care giver burn out and fatigue - when individuals that receive high levels of care are provided by a single person.

We wanted to inform you that some of the information, while intended to provide clarity, was inaccurate and incomplete. Please understand that the intention was to remind Service Coordinators about state requirements and MCO processes for approving service plans.

Here are the messages that were intended to be conveyed:

  1. PHW recognizes that families are a valuable resource and solution to fill the gap in a declining direct care workforce pool.  When utilized, service plans should identify who is providing the care and at what number of hours, in order to prevent caregiver burnout.
  2. PHW recognizes that the self-determination model is the right of every participant and an option that some participants may wish to employ.  With that said, hours of service must be managed within the approved levels and all efforts should be made to minimize overtime.
  3. Person Centered Plans are individualized AND based on the assessment of need, not want. Service Coordinators are to build plans that accurately reflect the needs of the participant, taking into consideration natural supports that exist, in addition to paid support.
  4. Service plans are created to address the needs of people with functional limitations who require assistance with everyday activities, like getting dressed or bathing. The services enable people to stay in their homes, rather than moving to a facility for care. PHW cannot fund companion services and/or sitter services.
  5. Requests for high levels of care will require an Integrated Care Team review process. Requests for 24/7 care must be clearly documented to identify the physical health needs of an individual and the care required in the home.
  6. PHW intends to work with community partners (PCIL, HCA, AAA’s and SEIU) over the coming months to look at gaps in the direct care workforce that impact overtime, and develop an action plan to resolve issues associated with overtime requests.
  7. Home Health Agencies operate under the traditional agency model. They are not a self-determination model and, therefore, the slide addressing Home Health Agencies was inaccurate.

We apologize for any confusion that may have been caused by the communication. If you have any additional questions, please feel free to contact Anna Keith, Senior Director, Strategic Partnerships, anna.m.keith@pahealthwellness.com, or our PHW PC Team at 844-626-6813.