Transcript Health Advocacy Project: Improving the Health of Residents

Health Advocacy Project
Improving the Health of
Residents in Board &
Care Facilities
A Project of
Protection & Advocacy, Inc.
Funded by the California Endowment
California Board & Care Homes
History / Background
Intended to insure a level of care and services in the community
which is equal to or better than that provided by the state hospitals.
Intended to provide safe, high quality, supervised living
environments with services necessary to meet the residents’
identified, specific needs.
Intended to insure continuity of care between the medical-health
elements and the supportive care-rehabilitative elements of
California’s health systems.
Licensed Facilities
Statewide
Facilities
Adult Residential
Residents
4,751
39,444
2,700
28,000
(Community Care Licensing Data)
Adults w/ Mental Disabilities
(CRCA Data)
San Diego County
Adult Residential
Adults w/ Mental Disabilities (estimated)
•
•
448
84
There is no separate licensing category for adults with Mental Disabilities.
CRCA report relies upon data from 2000, source unknown.
Ethnicity
of Board & Care Residents
% of M/H % of B&C
Population Population
African American
American Indian
Asian
Caucasian
Hispanic
Other
18.2%
.7%
1.6%
56.4%
13.9%
9.2%
21.3%
.7%
3.2%
48.2%
20.3%
6.3%
Surveys of Residents
According to 1999 report to the San Diego Coalition for Mental Health:
24% (N=170) of residents surveyed had complained of a
physical illness, yet received no follow-up to their
complaint.
56% (N=200) had not seen a physical health doctor
since living at the facility.
46% (N=167) reported that there had been physical
violence in the home.
14% (N=150) reported that sexual abuse had occurred in
the home.
83% (N=175) reported no involvement in house rule
making or problem solving.
Surveys of Residents
According to a California Network of Mental Health Clients survey of 215
residents in 16 Southern California homes:
> 50% of the residents had not been allowed to visit the
home prior to being placed there.
> 50% of the residents had been placed in the home
from a hospital, without benefit of a discharge planning
process.
> 60% of the residents were unaware that they could
register a complaint with Community Care Licensing.
> 50% of the residents did not know how to contact the
local Patients’ Rights Advocate.
Residents’ Rights,
Service Entitlements, & Responsibilities
in California
Board & Care Homes
for adult persons with mental disabilities
Admission Procedures
“No client may be admitted prior to a determination of the
facilities ability to meet the needs of the client, which must
include an appraisal of his/her individual service needs.”
(Title 22, California Code of Regulations, Section 85068.1)
Before admission
the following services must be provided:
1.
A medical assessment, completed by a
qualified medical professional.
2.
A mental health intake assessment, completed
by a licensed mental health professional.
3.
An assessment of the client’s need for
personal assistance and care, by determining
his/her functional capabilities, completed by
the facility staff.
4.
The facility staff must complete a written
Needs and Services Plan.
5.
The person is allowed to visit the facility with
his/her family, friends, and/or representative.
6.
The person is interviewed by the facility staff
and is provided with information about the
facility, including information contained in the
admission agreement.
7.
An admission agreement must be obtained.
Admission Agreements
Must Specify:
Basic Services
Available Optional Services
Payment Provisions
Refund Conditions
Conditions for Termination
Policies for Family Visits and Communications
General Facility Policies
Current arrangements with the client regarding the
provision of food service.
Medical Assessments
must include:
A physical exam which indicates the primary and
secondary diagnosis, if any.
Current medical status.
Prior medical services and history.
Communicable diseases exam.
Identification of the clients special problems and needs.
Identification of prescribed medications being taken.
Identification of physical restrictions effecting the clients
ability to participate in the facility program.
Functional
Capabilities Assessments must include:
Activities of Daily Living (Eating, Bathing, Dressing,
Grooming, etc.)
Ambulation
Vision, hearing, communication
Medical history and conditions
Need for prescribed and non-prescribed medications
Mental and emotional conditions
Socialization and cognitive status
Propensity for harmful behaviors
Ability to manage his/her own finances
* The assessment must be in writing and must be used in developing
the Needs and Services Plan
Needs and
Services Plans
Development of the NSP shall involve:
1. The client, or his/her authorized
representative, if any.
2. Any relative participating in the placement.
3. The placement or referral agency, if any.
4. The person responsible for facility
admissions.
Needs and Services Plan
The written NSP shall include the client’s desires and
background, obtained from the client, the client’s family
or his/her authorized representative, if any, and
licensed professional, where appropriate, regarding:
1.
2.
3.
4.
5.
6.
7.
•
Entrance to the facility.
Specific service needs.
Written medical assessment.
Mental and emotional functioning.
Written mental health intake assessment.
Written functional capabilities assessment.
Facility plans for providing services to meet the individual
needs of the client.
The written NSP shall be updated as frequently as necessary to ensure
accuracy and to document significant occurrences that result in changes in the client’s
physical, mental and/or social functioning.
Resident Rights
Residents Have the Right:
To receive prompt and satisfactory medical and dental
care, including:
– Health and Mental Health services that meet one’s age,
language and background needs.
– Safe transportation to one’s medical or dental service provider,
arranged by facility staff.
– Attendance at community health and mental health programs of
one’s choice.
* Facilities are required to develop and implement a plan which
ensures that assistance is provided to residents in meeting their
medical and dental needs.
Residents Have the Right:
To have access to individual storage space for personal use.
To have reasonable access to make and receive confidential
telephone calls.
To receive unopened mail and correspondence.
To practice one’s religion and attend religious services of one’s
choice.
To socialize with all other residents in common areas.
To participate in recreational activities.
To a clean and pleasant living environment with as much freedom as
one’s safety and the safety of others permits.
To be treated with respect and dignity, free from physical or
emotional abuse or neglect.
To privacy in every day life situations.
Residents Have the Right:
To actively participate in the development of one’s Needs and
Services Plan.
To keep and spend a reasonable sum of money.
To wear one’s own clothes.
To be free from discrimination on the basis of disability, race, color,
sex, age, sexual preference, marital status, economic and familial
status.
To exceptions or changes to the facility rules, policies, or practices
when such exceptions or changes are necessary because of a
person’s disability.
To freely leave and return to the facility, within those time restrictions
necessary for the protection of all residents.
To be provided with oral and written information about one’s
medication.
Rights that may be limited for those
residents who have an LPS conservator:
To possess and control one’s own money.
To refuse medications.
To receive or reject medical care or healthrelated services.
To move from the facility (within the terms of the
admission agreement)
Tips for Family and Friends
From: “ A Mother’s Perspective on Board and Care: An
interview with Barbara Castle “
Board and Care Quality Forum – Volume 5, Number 5
Published September/October 2002
Finding a Board and Care Home
Don’t rely on hospital social workers and
discharge planners.
Make appointments and visit some facilities.
Know that there aren’t enough homes to begin
with, so be proactive
Things to Look For:
Location – Proximity to public transportation and necessary healthcare
services.
Supervision - Does the facility seem to provide adequate staffing &
supervision?
Structure - Are there structured activities, programs, outings, etc.?
Are the staff courteous and respectful when interacting with residents?
The manager should be open to listening to the residents about conditions
and things happening in the home.
Does the facility welcome/encourage family and friends involvement and
input?
How do the other residents feel about the facility?
Be a positive influence:
Try to establish good communication and a positive relationship with
the operators.
Avoid adversarial, confrontation with the staff and/or operator, if at all
possible.
Spend time at the facility on a regular basis.
Get to know the other residents and their families and friends.
Try to do anything you can to create a supportive, safe environment.
Important Telephone Numbers
for Complaints/Reports/Information :
Community Care Licensing …. .
(619) 767-2339
Consumer Center for Health Education
and Advocacy …………………
1-877-734-3258
Patient Advocacy Program …............ (619) 543-9998
Adult Protective Services ……………. (619) 283-5731
Ombudsman ……………….............. 1-800-640-4661
Protection & Advocacy, Inc………... 1-800-776-5746
Important Telephone Numbers
for Information and Referral:
Info-Line - Central ……………………. (619) 230-0997
Info-Line – North Coastal ……………. (760) 943-0997
Info-Line – North Inland …………….. (760) 740-0997
Info-Line – Outlying ………………….
1-800-227-0997
NAMI Albright Information and Referral
Center ………………………………… 1-800-523-5933
Mental Health Association .......................(619) 543-0412
Resident Councils
“ Every licensed community care facility, at the request
of a majority of it’s residents, shall assist residents in
establishing and maintaining a resident oriented facility
council. The council shall be composed of residents of
the facility and may include family members of residents
of the facility. The council may, among other things,
make recommendations to facility administrators to
improve the quality of daily living in the facility and
may negotiate to protect residents’ rights with
facility administrators.”
- Health and Safety Code, Section 1520.2 -
Resident Council Requirements:
Facility administration must assist residents in
establishing and maintaining a council.
Facility staff must provide assistance to residents in
attending council meetings.
Notices of meetings must be posted and residents must
be encouraged to attend by staff in a manner appropriate
to the resident’s disability, including but not limited to
verbal announcements.
The council shall be composed of residents of the facility
and may include family members of residents.
Resident Council Meeting Requirements:
The facility must provide space for council meetings.
Meeting notices, meeting times, and recommendations
from the council must be documented.
In order to permit free exchange of ideas, at least part of
each meeting shall be conducted without the presence of
any facility personnel.
*
A facility which fails to provide a resident council at the request of a
majority of the residents, and/or to operate a council in accordance
with regulations, may be subjected to civil penalties.
Medi-Cal
Services and
Benefits
Medi-Cal Pays For (among other things) :
Doctor Visits
Adult Day Health Care
Personal Care (IHSS)
Emergency Services
Transportation to Health
Services
Diagnostic Tests
Surgical Procedures
Nursing Home Stays
(Excluding Institutions for
Mental Disease)
Medical Supplies
Durable Medical
Equipment
Occupational & Physical
Therapy
Outpatient Drug Abuse
Services
Prescriptions
Hospitalization
Dental Services
Medi-Cal Choice
(For SSI-linked Beneficiaries)
Fee for Service
vs.
Managed Care
How a Medi-Cal Managed Care Plan Works
You choose a Primary Care Doctor or Clinic from a list.
You must go to the Primary Care provider first – They will
refer you to a Plan specialist, if necessary.
If you’re not happy with your Primary Care provider, you
can call the Member Service Department and choose a
different provider.
You need to go to a Plan Pharmacy for medications.
A 24-hour, toll free number must be available to call with
questions about your care.
You may leave the Health Plan and choose a different
Plan, at certain times.
There are no costs to you and no co-payments.
Healthy San Diego – Medi-Cal Health Plans
Blue Cross of California
Community Health Group
Health Net
UCSD Health Plan
Sharp Health Plan
Universal Care
Kaiser
How do I join a Medi-Cal Health Plan or find
out more information?
Contact a Health Care Options Counselor
Center City ………………………………………..
El Cajon …………………………………………….
Escondido ………………………………………….
Kearny Mesa ……………………………………….
Lemon Grove ……………………………………….
Northeast ……………………………………………
Oceanside …………………………………………..
South Bay ……………………………………………
Southeast ……………………………………………
(619) 237-8506
(619) 441-6664
(760) 480-3402
(858) 694-8862
(619) 668-3784
(619) 464-5740
(760) 754-5860
(619) 409-3296
(619) 266-3963
Fee for Service Medi-Cal
To Find a Doctor or Clinic, Call
Info-Line:
Greater San Diego ……………….. (619) 230-0997
North County Coastal …………… (760) 943-0997
North County Inland ……………… (760) 740-0997
Other Areas ……………………….. (800) 227-0997
Positives
Fee for Service
Choice of doctors,
clinics, service
providers
Managed Care
Provides a “health home”
for the person and their
family
No referral necessary
for specialists
Access to additional
services (i.e. 24 advice
#’s, member advocate,
education programs)
Maintain existing
relationship with
providers
Provider directory and
referral information
readily accessible.
Additional rights under
Knox Keene Act
Negatives
Fee for Service
Difficulty finding
providers who “take
Medi-Cal.”
(Compounded if
second opinion
needed)
Consumer protections
only through State
D.S.S.
Managed Care
Access to specialists
only through Primary
Care doctor
Access to providers
restricted to “Plan”
May need to disenroll
if placed in an IMD
The best way to stay healthy is to
BE AN ACTIVE MEMBER OF YOUR
HEALTHCARE TEAM
Understand Your Responsibilities
Keep your appointments and be prepared.
Follow your doctors instructions.
Take medicine as prescribed.
Keep your doctor informed as to your progress.
Know how to contact your doctor.
Have a plan for what to do if you have problems.
Talking With
Your Doctor
Be Ready to Give Information
Tell your doctor what you think he or she needs to know,
even if it makes you feel uncomfortable.
Bring a “health history” list with you.
Bring a list of any medications you are taking, including
dosage and how often you are taking them.
Bring a list of any herbal products or “alternative
medicines” you are using.
Bring any other medical information, such as test results,
or other records.
Ask Questions and Get Information
If you don’t understand something, speak up.
Make a list of questions ahead of time, with the most
important questions first.
Bring someone with you.
Ask your doctor to draw pictures, and/or write things
down.
Take notes.
Ask if there are any written materials or handouts.
Ask if you can call back later with any questions and find
out to whom you should speak.
After you leave the doctor’s office:
If you have questions, or forgot to tell the doctor
something, call back and speak with someone.
If your symptoms get worse, call.
If you have any problems with your medicine, call.
If you need to make an appointment for tests or to see a
specialist, make the appointment.
Medications
Before starting on any medication, tell your doctor:
The names of all medication you are currently taking,
both over-the-counter and prescription, as well as herbal
or “alternative” types of treatment.
– Make sure your doctor is aware that over-the-counter
medications have to be prescribed in a board and care setting.
Any allergies or adverse effects you have experienced
from any medications you’ve taken in the past.
Any concerns you have about taking medication.
When you are prescribed medication, ask your
doctor:
What is the name of the medication?
What is the medication supposed to do for me?
What is the dosage?
What are the possible side effects and what should I do
if they occur?
What should I do if I miss a dose?
What should I do if I accidentally take too much?
Are there food, drinks, or other medicines I need to avoid
while on the medication?
Can I get any written information about the medicine?
After you’ve started on medication, make
sure to tell your doctor:
How you are feeling on the medication.
About any problems or side effects you have
experienced.
About any new medication another doctor may have
prescribed for you, or over-the-counter drugs you have
taken.
About your medication, remember:
Take only the medicine your doctor prescribes for you.
Don’t take anyone else’s medicine.
Know the major side effects of your medicine and call
your doctor right away if you are having problems. Don’t
wait!
Take the medicine as you and the doctor have agreed,
not how you think it should be taken.
Order refills before you run out. Always plan ahead.
Alcohol and street drugs don’t mix with your medication.
CONFLICT RESOLUTION
What can you do if:
You have a problem with your health plan or
Medi-Cal.
Your care is denied, delayed, or terminated.
You disagree with your doctor about what is best
for you.
You are told you can’t see a specialist, receive
more visits, or get certain medicines.
You have a right to:
Contact your health plan or Med-Cal and complain.
Receive written explanation whenever service is denied,
reduced, delayed, or stopped.
Receive a notice before ongoing services are stopped or
reduced.
Continue to receive benefits while your complaint is
being heard.
Have a hearing before an Administrative Law Judge.
Report the problem to the State.
Change to a new Health Plan.
Important Telephone Numbers
Healthcare Options
(Healthy San Diego Enrollment)
800-430-4263
Managed Care Ombudsman
(State Patient Advocate)
888-452-8609
State Fair Hearings (DSS)
800-952-5253
Important Websites
Knox Keene / Managed Care Information
www.healthconsumer.org/managedcare.ht
ml
www.calpatientguide.org
www.hmohelp.ca.gov