Section 20.32. Assessment and care management

(a) Activities. Assessment and care management services include the following activities:

(1) The assessment of the status and needs of the caregiver, the carereceiver and the caregiving environment.

(2) The development and management of a care plan.

(3) The reassessment of status and needs every 6 months. Reassessment includes ongoing casework as problems arise.

(b) Certification. In addition to the activities provided for under subsection (a), the area agency on aging staff person who carries out the assessment shall secure, at the time of assessment, the signature of the primary caregiver on the certification of accountability required under § 20.22 (relating to conditions of participation). This certification shall make reference to the caregiver’s responsibilities, including compliance with restrictions on the reimbursement of expenses, under the Program and attest to the truth of the information provided by the caregiver. As a witness, the area agency on aging staff person completing the assessment shall also sign it. This certification will serve as the contractual basis for the area agency on aging’s reimbursements for the caregiver’s expenses. It may also be used as a basis for the recovery of reimbursements subsequently determined to be inappropriate under § 20.45 (relating to program violations and penalties).

(c) Standards and procedures. Assessment and care management activities shall be carried out under the following standards and procedures:

(1) In addition to the requirements of this chapter, the activities of assessment and care management under the Program shall be carried out in conformity with the general care management procedures currently in practice with services under Department contracts with area agencies on aging. This includes efforts by area agencies on aging to conserve resources by developing and utilizing screening instruments to target appropriate families for assessment and subsequent services or placement on a waiting list. Waiting list procedures for the Program will establish the priority of service and position on the waiting list by rating factors relating to the status of the carereceiver, the family and the total caregiving situation to determine the situations of greatest need for agency intervention.

(2) An assessment shall be completed on each caregiver family using the current form established by the Department. The assessment provides for the collection of information concerning the caregiver, the caregiver’s burden, the carereceiver and the caregiving environment.

(3) When the carereceiver is an older adult, a clinical determination of the functional dependency of the carereceiver shall be made by the caseworker on the basis of information obtained on the assessment instrument. Special reference shall be made to the carereceiver’s limitations in carrying out the activities of daily living, including mobility; the cognitive limitations of the carereceiver; and the conditions of the caregiving environment that may contribute to the need for the continuous care or supervision of the carereceiver or increase the caregiver’s burden, or both. If the functional dependency of the carereceiver cannot be established, the area agency on aging may not serve the caregiver under the Program.

(4) When the carereceiver is an adult 59 years of age or younger, the area agency on aging shall establish the categorical need for the Program by applying the following provisions:

(i) Through the assessment process, the area agency on aging shall determine that the history of the onset of the carereceiver’s condition indicates an identifiable decline in intellectual function resulting in a cognitive impairment that is severe enough to interfere with work or social activities, or both, and requires the continuous care or supervision of the caregiver.

(ii) The area agency on aging shall require the presentation of written documentation from a physician, or team of physicians, that a medical diagnosis which meets the following minimum criteria indicates that the carereceiver has a chronic dementia such as Alzheimer’s Disease:

(A) It shall document, to the extent possible, that the carereceiver has suffered a decline in intellectual function.

(B) It shall document through the use of a mental status examination or a neuropsychological examination that there is a global loss of cognitive function. Global loss of cognitive function includes memory impairment, the impairment of visio-constructive abilities and at least one of the following:

(I) Impairment of abstract thinking.

(II) Impairment of judgment.

(III) Impairment of other complex capabilities, such as language use, the ability to perform complex physical tasks, the ability to recognize objects or people or the ability to construct objects.

(IV) A personality change.

(C) It shall document testing to establish that the carereceiver was, at the time of diagnosis, in a state of clear consciousness and that other mental states such as acute or subacute delirium, sleep, coma, stupor and intoxication were considered and ruled out. It shall document clinical tests that were administered to insure that the patient’s cognitive impairment is not due to delirium alone and is not due to a reversible loss of cognitive function.

(d) Staff resources.

(1) Assessments and care management shall be carried out by staff persons who meet or exceed the minimum experience and training qualifications for the caseworker classification of the Pennsylvania State Civil Service System.

(2) Consistency in the assignment of casework staff to the Program is required. While this consistency may be achieved with different combinations of shared or dedicated staff, at a minimum, assignments shall provide for the development over time of special staff expertise in the unique aspects of the Program. How the area agency on aging intends to achieve and maintain this staff expertise shall be discussed in the plan required under § 20.12 (relating to administrative functions and responsibilities of area agencies on aging).

(3) Each area agency on aging is required to secure the consultation services of a person experienced in rehabilitation technology to provide consultation, as appropriate, on the agency’s home environment assessments, to help determine if special expertise is needed to assess specific situations (for example, from a rehabilitation engineer), to identify all available resources for responding to the carereceiver’s need for home modifications and assistive devices and how project resources should be utilized for this purpose; and to provide technical assistance to case managers for assessing home environments.

(4) Area agencies on aging shall take special precaution and require disclosure of potential conflicts of interest when using the services of consultants; for example, a consultant who owns, or is employed by, a medical supply company. If a consultant who has a potential conflict of interest is used as a consultant for a specific caregiver case, the area agency on aging shall insure that the arrangement for the consultation precludes the purchase of a recommended item from the consultant.

Notation

Cross References

This section cited in 6 Pa. Code § 20.12 (relating to administrative functions and responsibilities of area agencies on aging); 6 Pa. Code § 20.21 (relating to eligibility for Program benefits); 6 Pa. Code § 20.22 (relating to conditions of participation); and 6 Pa. Code § 20.33 (relating to benefits counseling).