Veteran’s Directed Home & Community Based Services Veteran’s Participation Guidebook Important Phone Numbers How can this Area Agency on Aging of Central Texas guidebook help 254-770- 2357 1-800-447-7169 ext. 2357 you? Financial Management Service ______________________________________________ This guidebook will help you to use The Veteran’s Directed Home and Phone:_______________________________________ Community Based Services (VD- My Service Coordinator/Consultant HCBS) available to your through a partnership program with the Area ______________________________________________ VD-HCBS Service Coordinator/Consultant Agency on Aging of Central Texas and the United States Department of Phone:______________________________________ Veterans Affairs. You will get some new information, and it may be hard to 1-800-447-7169 ext _________ remember everything. You will be able Other Numbers to refer to your guidebook for help. It explains who is available to assist you. Self-direction doesn’t mean doing things all by yourself — people are available to support you along the way. There is a section that talks about who does what. There are ideas and tips for when you develop your own service and support plan and budget. It also explains your rights and responsibilities in the Veterans Directed Home and Community Based Services (VD-HCBS). Please think carefully about the information in this guidebook. With the Veteran’s Directed Home and Community Services program, choice, and flexibility come with responsibilities. TABLE OF CONTENTS What Is the VD-HCBS Program........................................................................................................................ 2 What Does Self-Direction Mean?..................................................................................................................... 2 My Responsibilities in VD-HCBS..................................................................................................................... 3 Do I Have to Do This by Myself?.................................................................................................................. 4-5 • Consultant/Service Coordinator ............................................................................................................................... 4 • Financial Management Service.................................................................................................................................. 5 What Does It Mean to Be an “Employer of Record”?.................................................................................... 6 Creating My Service and Support Plan and Budget.................................................................................. 7-15 • Why do I need a service and support plan and budget?.......................................................................... 7 • How much money will be available for services, supports and goods?................................................ 7 • Getting started.......................................................................................................................................... 7- 8 - Deciding what is important - How to get my needs met • Making my plan and budget................................................................................................................... 9-10 - In making my plan and budget, how should I start? - What should my proposed plan and budget include and how will I get what I need? - Are there specific plan and budget approval guidelines? • Services, supports and goods I MAY choose to buy..........................................................................11-15 - VD-HCBS services, supports, and goods - Examples of Other services, supports, and goods - Special purchases • Services, supports and goods NOT COVERED in VD-HCBS................................................................. 15 • Submitting my plan and budget for approval .................................................................................... 15-16 • What If My Plan and Budget Aren’t Approved?....................................................................................... 16 Making It Happen - Arranging for Services, Supports and Goods........................................................... 7-24 - How to hire help - How to place an ad - How to do an interview - How to do a background check and check references - How to purchase participant-delegated goods and services - How to make sure VD-HCBS is working the way I want - How to change my approved plan and budget - Annual plan and budget review - Health and safety What If VD-HCBS Isn’t Working for Me? ..................................................................................................... 25 Additional Contacts........................................................................................................................................ 25 Appendices................................................................................................................................................. 26-48 A. Glossary of Terms………………………………………………………………………………………………………………..… 26-29 B. Frequently Asked Questions…… ………………………………………………………………………………………………….. 30-31 C. Reference Range of Agency Fees by County………………………………………………………….………………………….… 32 D. Sample Service and Support Plan, Budget and Worksheets………………………………………………………………….… 34-44 E. Orientation Forms Employer…………………………………………………………………………………………………………... 45 F. Orientation Forms Employee…………………………………………………………………………………………………………... 46 G. Information Sheets to help You with your Employees………………………………………………………………………………… 47 1 What Is the Veteran’s Directed Home and Community Based Services? The VD-HCBS is a pilot program for a new Veteran’s directed approach to home and community services. VD-HCBS is designed to assist you in directing your own services and supports. What Does Self-Direction Mean? In the VD-HCBS program, self-direction means you decide: • What services, supports and goods you need • When the services and supports are provided • Who provides those services and supports • Where the services and supports are provided • How the services and supports are provided Self-direction means you have more: • Choice • Control • Flexibility • Freedom With self-direction, you: • Are in control of your life and how you live it • Can get support with what you need in the way you need it • Make choices about your services and supports • Hire the people to provide your services and supports Self-direction also means: • Money gets approved for you to use to hire workers and buy supports and goods, called a budget, according to a plan you create • You are responsible for following the Veterans Directed Home and Community Services rules. 2 My Responsibilities in VD-HCBS As a VD-HCBS participant, some of your responsibilities will be to: • Assist with establishing your VD-HCBS eligibility through your local VA Medical Center. • Develop a plan and budget • Follow your plan and budget • Let someone know if you need help • Work with your service coordinator/consultant • Work with the financial management service • Arrange to get the services, supports and goods you need and pay for them • Hire and manage the people who will provide services and supports, which may include replacing them if they are not working out for you • Keep records • Follow the VD-HCBS guidelines • Be accountable for the use of VD-HCBS funds Notes: 3 Do I Have to Do This by Myself? You do not have to do this by yourself. The service coordinator/consultant and financial management service can help you. People in your life can also help you with the VD-HCBS; they can participate with you. You may choose people you trust, such as your family, your friends or people who have helped you before. • Service Coordinator/Consultant Everyone who participates in VD-HCBS will have a service coordinator/consultant from the Area Agency on Aging of Central Texas. The consultant is available to you to: In working with your • Help you understand VD-HCBS consultant, here are some • Help you develop your service and questions to think about support plan and budget asking: • Help you evaluate your service and support plan and budget, and how VD- • What days and times are you available to HCBS is working for you meet with me? • Help you understand and complete the paperwork • Help you with problems • Can you come to me when and where I need you? In working with your consultant, you are • Are you located on a bus route and can I responsible for sharing what is important to get to you easily? you and deciding what direction you want your life to go. • Is your location accessible? t • How soon could we meet to get started? • Can you help me do the paperwork? • How familiar are you with community resources? 4 • Financial Management Service Everyone who self-directs in VD-HCBS must have a Financial Management Service (FMS) who is available to you. The FMS will: • Act as your payroll agent and take care of all money issues like timesheets, payroll, taxes and other employer-related Requirements. • Send checks to the people you hire and to the places where you purchase your goods and other services. • Send you a quarterly budget report • Contact you and your consultant if you request something that is not approved in your plan and budget. • Answer questions you and the people you hire may have about payroll matters. NOTES 5 What Does It Mean to Be an “Employer of Record”? In VD-HCBS, you will have some employer-related responsibilities. When you self-direct through VD-HCBS, you become the ―employer of record.‖ You will need to complete certain forms that officially make you an employer. In addition, you will receive training on being an ―employer of record,‖ including how to be in charge of finding, hiring, scheduling and training your own employees; civil rights compliance; workers’ compensation; and other employer-related issues. As an “employer of record,” you will have the following responsibilities: • Complete the employer paperwork. • Help the people you hire complete their employee paperwork (supplied by the FMS). The FMS will process all the paperwork for you. • Review, approve and submit time sheets to the FMA on time, through the mail or by fax, so that your employees get paid for their work on a timely basis.. Note: You will be provided with all the training and tools you need to be a successful employer. What is Next? The next step is to create your Service and Support Plan and Budget, which will put VD- HCBS into action. 6 Creating My Service and Support Plan and Budget • Why do I need a service and support plan and budget? The service and support plan and budget describe the services, supports and goods you need to live in the community the way you want. The plan lists who will provide the services, supports and goods; the budget shows the amount of money you plan to spend. The plan and budget will also help the VA understand why you need the services, supports and goods you chose, and what the plan will cost. • How much money will be available for services, supports and goods? The amount of funding available for you will be determined by the VA contract based upon your level of service required. Your consultant will have this information and will be able to tell you how much money you have to spend. You may use this money to buy what you need to live in the community. Remember, you do not have to spend all the money available to you. It may accumulate in budgeted amounts over several months to acquire something that you need to stay in your home and community in the future. • Getting started Deciding what is important VD-HCBS allows YOU to decide what services, supports and goods will best meet your community living needs. Spend some time thinking about what is most important to you. This information will help you when you write your plan and budget. How to get my needs met In considering what is most important to you, answer the following questions: 7 Q: What services and supports will I pay for? A: Finding things you will pay for takes time and patience. After all, you want to ―shop‖ for the best price but still make sure you get a good value. You want to be sure that what you buy is what you need for community living, whether it is services, supports, equipment or supplies. The more people who know you’re looking for something, the better chance you have of finding it. Be sure to let others know what you need and be specific. Finally, there is a good chance that someone else in VD- HCBS is looking for some of the same help you are. If you are interested in sharing, with permission, what you have found out, let your consultant know. Your consultant can help you exchange phone numbers. Q: Can I get any of the things I need for free? A: Are your friends and relatives aware of your specific needs? Sometimes what is obvious to you is not clear to others. If you have not discussed your needs with your friends and family in a while, it may be worth doing again. Be as specific as you can so people can understand what you need. People close to you may want to help, but they may not know how. If your friends and family cannot help, they may know someone who can. You may be surprised to learn how much you can get for free. Q: Could a local club, civic organization or faith A: organization provide any of the things I need for free? Often the answer to this question is ―I don’t know.‖ What you need is a place to start. Sometimes the best place to start is to call the Texas state information and referral line (dial 211). Sometimes the first call does not get you exactly what you want, but it gets you started asking for help. Have a pencil and paper ready to take notes. 8 • Making my plan and budget Your consultant will have some worksheets to help you list and figure out what is important to you, what services and supports you need, how much these services and supports will cost and what you want to spend. In making my plan and budget, how should I start? 1. Think about what you would like your life to be like and what services, supports and goods would improve your life. What skills would you like to improve? How would you like to spend your time? With whom would you like to spend time? Think about why these changes would make your life better. 2. Think about who might help you make these things happen. 3. Contact your consultant to set up a planning meeting. 4. Write your plan with the help of your consultant and anyone else you might want to help you, including family and friends. What should my proposed plan and budget include and how will I get what I need? You will receive an amount of available funding that you will use to develop your plan and budget for the entire year. It is required that you break the budget down into monthly amounts to help you plan how you will meet your needs throughout the year. In making your plan and budget, think about: 1. What services, supports and goods you will need each month, and those services, supports and goods you may need once during the year or just a few times. 2. The types of workers you need to hire to provide the services and supports. 3. The types of goods you may need. 4. How often you will get the services, supports and goods. 5. The amount of money you have and how much money will be needed to pay for the services, supports and goods. 6. Your backup, or emergency, plan. 7. How you will decide if your plan is working for you. 9 Are there specific plan and budget approval guidelines? Yes. When developing your service and support plan and budget, you must follow the approval guidelines. Your consultant will give you information about the guidelines and explain how they affect your plan and budget. The services, supports and goods that you choose must: • Help you meet your functional, medical and/or social needs; • Help you to reach the goals you may have set for yourself; • Not be prohibited by federal and state laws and regulations; • Not be available through another VA source AND • Do one or more of the following: - Make it easier for you to do things that are hard because of your disability or health issues; - Increase your safety in your home environment; and/or - Lessen your need for other publicly funded services. If you have a change in health or social needs, a short hospitalization with change in health baseline, another assessment may be done. If you are hospitalized for more than 15 days, the VA will disenroll you from VD-HCBS and you will need a new referral and assessment in order to be re-enrolled in the VD-HCBS program. With appropriate justification, approval, and availability of funds, you may be able to receive more funding, should your needs require it. But, for the most part, the amount of funding available to you for the month will not change, so you have to be careful to plan for how you will meet your needs for the whole year. NOTES: 10 • Services, supports and goods I MAY choose to buy You may choose from the following VD-HCBS services, supports and goods: Adult Day Care Caregiver Education and Training Caregiver Support Coordination Chore Maintenance Electronic Monitoring Environmental Services Escort Services Financial Management Services Health Maintenance Homemaking and Personal Care Independent Living Consultant Services Individually identified services Necessary for Independent Living Individually identified Goods Necessary for Independent Living Information and Referral Services In-Home Respite Care Medication Management Nutritional Services Safety Services Shopping or Running Errands Socialization Support Services Transportation Examples of Other services, supports and goods You may also choose to purchase other services, supports or goods.‖When selecting these services, supports and goods, use the following chart showing different categories and some, but not all, examples in each category. 11 Category Example Adult Day Care Adult Day Care Center Program Adult Day Care in another home other than the Veteran’s Caregiver Education and Training AAACT Caregiver support programs The Savvy Caregiver A Matter of Balance Chronic Disease Management Class Monthly AAACT Programs Caregiver Support Coordination comprehensive caregiver assessments Home and phone visit support Referral to caregivers support services Chore Maintenance initial heavy-duty cleaning of home. Removal of trash and debris from the home Yard cleanup Electronic Monitoring Purchase of room monitors Bed alarm Programmable or voice-activated phones Personal alarms Life lines (available through VAMC) Cell phones Environmental Services: installation of grab bars, railings, specialized lighting, etc. Minor home repair Painting (interior or exterior) Plumbing Ramps (If denied by VA) Escort Services Accompanying and personally assisting the Veteran to obtain a needed service. Filling out applications and explaining directions to the veteran Health Maintenance Cooking classes for caregiver Gym or Health Club membership Health Counseling Health Education Massage therapy beyond services traditionally covered by insurance Service/Support Animal Health Public health maintenance programs Structured weight reduction programs 12 Category Example Homemaking Services Light Housekeeping Laundry sweeping and mopping floors dusting changing linens cleaning the bathroom (Toilet tubs/showers, sinks & floors) cleaning the kitchen (loading/unloading dishwasher, hand washing dishes, washing off countertops, sinks, floors, and stovetops as needed). Personal Care Services to assistance in and out of the shower or bath tub, any assistance during the bathing process assistance in getting on/off the toilet brushing teeth/dentures personal grooming tasks and dressing providing verbal prompts to taking medication or placing pills from the medication minder into the hands of the veteran and verbally reminding or physically guiding the veteran to take them. Individually identified services or Goods Upkeep of Service animals required for Necessary for Independent Living veteran to stay independent. What would you feel is needed in your home to keep you independently living not covered by traditional VA programs and services Information and Referral Services Referral to community agencies and programs to improve quality of life Respite Care In-home services can be provided by volunteer or paid help, occasionally or on a regular basis. Respite services may include meal preparation, housekeeping, assistance with personal care and/or social and recreational activities, Out-of-home respite care programs may include contracted short stay at an area nursing home or other specialized facilities, for up to 30 days, that provide emergency and planned overnight services, allowing caretakers 24-hour relief 13 Category Example Nutritional Services Home delivered Standard Meal – the regular menu from the standard menu that is served to the majority of participants. Therapeutic meal or liquid supplement – a special meal or liquid supplement that has been prescribed by a physician and is specifically for the participant by the dietitian (i.e. diabetic diet, renal diet, pureed diet, tube feeding) Safety Services Personal Emergency Response System includes the installation of the individual monitoring unit, training associated with the use of the system, periodic checking to insure that the unit is functioning properly, equipment maintenance calls, response to an emergency call by a medical professional, paramedic, or volunteer, and follow-up with the veteran. Combination key box for the door, this keeps a key available for easy access to the home by emergency personnel Home Safety Evaluation by a professional person to assure safety of travel paths and needed Shopping or Running Errands Shopping with or without the veteran for the veteran Socialization Support Services Caregiver to accompany the veteran to activities such as education or exercise classes, Caregiver taking the veteran to the movies, a Bible Study, or other social engagements Transportation Public transportation like the HOP or VA Van, or other transport required to go for socialization support or medical support activities with the designated caregiver providing escort. A Month Public Transport Pass like the HOP to get around town or the area to go to social activities. An escort to a veteran who has special needs (physical or cognitive) when using regular vehicular transportation. 14 Special Purchases In making your plan and budget, keep in mind that your annual available funding must cover your needs for a whole year. This includes planning and budgeting for a special, higher-cost item, as well as, services you will need on a regular basis. • Services, supports and goods NOT COVERED in VD-HCBS • Services already being provided to a veteran or their family caregiver(s) by or through the Department of Veterans Affairs. • Services, supports or goods provided to or benefiting persons other than you • Room and board, including rent and mortgage payments • Personal items and services not related to your disability • Experimental treatments • Vacation expenses (except for the cost of the services you may need while you are on vacation) A sample plan, budget and worksheets are included in the Appendices at the end of this guidebook. In developing your budget and considering what you want to pay for services, your consultant will have information about current rates paid to agencies in the area for traditional homecare and provider services. These will give you an idea of how much agencies currently charge for their services to help you determine a good ―market rate‖ when determining how much you will pay for your employee. In Appendix C you have a reference to total budget cost with taxes included for specific in wages offered for services. • Submitting my plan and budget for approval Your plan and budget must be approved before services under VD-HCBS begin. Once you have prepared your plan and budget, your consultant will work with you to help get the plan and budget submitted to the Financial Management Service. 15 Make sure your plan and budget focus on your long- term service needs and help you: • Live at home and in the community the way you want; • Reach your personal, social, physical or work- related goals; • Be involved with your family, friends and community in the way you want; • Increase your independence to the extent possible; • Decrease your need for other publicly funded services AND be sure your budget follows the budget approval guidelines. Your consultant can help you understand these guidelines. What If My Plan and Budget Aren’t Approved? If your plan and budget, or a part of your plan and budget, are not approved, work with your consultant to figure out your options, including help to request reconsideration of the decision. Final disapproval decisions will be sent to you in writing, including steps to follow if you disagree with the decision. Also, you always have the right to appeal the decision and ask for a Fair Hearing. 16 Making It Happen: Arranging for Services, Supports and Goods While you are waiting for the approval of your plan and budget, you can begin to work on getting the services, supports and goods in your plan and budget. However, you cannot actually hire someone and begin services until your plan and budget are approved. • How to hire help You may hire your own service workers, a family member, or a friend. Here are some things to think about when hiring: • What do I need the service provider to do? • How do I want it done? • How often do I want help? Part-time or full-time? • What time of day do I want help? • Do I want help on the weekends and/or during the week? • Do I prefer someone who is male or female? • Do I prefer someone of a particular age? • Does the person who helps me need to be strong? • Does the person who helps me need to be able to drive? • Does the person who helps me need to have his or her own car? • Do I need more than one person to help me? • Do I need different people to help me with different things? • What do I want the people who help me to know about me? • Do I want the people who help me to be friends, neighbors, family members or a formal provider? • Would the person I want most to help me be the best person for the job? • How much am I willing to pay for the help I need? 17 Once you know what type of service provider you want to help you, you will need to find that someone to do the job. Good places to look are: • People you already know • Local organizations for people with disabilities • At your church • With your doctor • Employment agencies • Local newspapers • Bulletin boards at local organizations • Local colleges or universities If you can’t find the help you need through those places, you may want to place an advertisement. • How to place an ad You may have to place an ad in a newspaper, on a bulletin board or on a radio station to find help. Check ads in each of those places to see what they are like and how much they cost. The cost of an Ad may be included in your plan and budget if you so wish. Make sure you include important information in your ad like: • What hours you want someone to work • A general description of what you want them to do • How to contact you or your contact person You need to be careful about the type of information you put in the ad. Do not include your address or that you live alone. You need to be careful that when you hire someone, they will treat you the way you want to be treated. One way to do this is to talk with them over the phone before you meet them. 18 • The Telephone Screening Interview 1. Ask questions: name, address, phone number and how they would get to work. 2. Talk about the job duties, and then ask about things that might be hard for them, like lifting or personal care. 3. Ask about their experience in working with people who have disabilities. 4. Make sure they provide references. 5. Thank them for calling, and tell them you will call them back if you want to interview them in person. ***As with other parts of VD-HCBS, your consultant can help you if you have questions. • How to do an face to face interview Think about where you want to do the interview — at home or some other place nearby. If you interview someone, you might want to do some of the following: Take notes during the interview, or have someone there to help you remember what is said Introduce yourself Tell them about the job and what you want them to do Give them an application and ask them to fill it out Ask about how they will get to work Talk about when you need help Talk about VD-HCBS and how the Financial Management Service will be writing their checks and ensuring that their payroll taxes and workers’ compensation are handled Talk about what the job pays Ask them why they want to work with you Ask them why they think they would be good at working with you Tell them you are required to do a criminal background check and ask for proof of citizenship/legal resident status Ask them for references Thank them and tell them you will call when you make your decision 19 • How to do a background check and check References - Once the interview is over, you will need to check their references and do a background check. - To do a background check, the AAACT will conduct a background check on the public access program of the Texas Department of Public Safety for you. - To check references, call the people listed as references and ask about the applicant. Some good questions are: 1. What are the applicant’s strengths? 2. What are the applicant’s weaknesses? 3. Would they recommend the applicant to work with you? 4. Do they show up on time? 5. Do they do the job required? 6. Do they show up regularly? 7. Do they call when they will be late, or may not be able to work? 8. Do they bring personal problems on the job? 9. Do they drink or do drugs on the job, or come to work impaired? Ask questions about the qualities you want in someone. For example, is the applicant honest? Does the person respect other people? Now that you have learned about the applicant, make the best decision you can about whether the applicant is right for you. Call and let the individual know you want to hire him/her for the job and restate what the job pays. If accepted, contact your Consultant who will meet with you as the employer and the employee to provide an orientation for the employee, fill out the necessary forms for the employee, and decide on a starting date. The consultant will forward required documents to the Financial Management Service to start payroll and tax requirements. 20 • How to purchase participant-delegated goods and services Some of what you may want to spend your budget on might be things that would make it easier for you and mean that you would need less help from others. For example, a fax machine will be offered for purchase to you to help facilitate a timely submission of time sheets for your employees. Or perhaps a microwave oven might make it easier for you to prepare your own meals. You might also want to buy a service, like someone to repair your car so you can get to the doctor when you need to. Review the list of categories in this guidebook for examples. When you buy something other than hiring someone to help you, you need to: • Find what it is you are looking to buy • Find out if it is the best price for you • Get a quote, which is a written document showing how much the service or item will cost, including tax and delivery or setup fees, if they apply • Find out if the business will accept a check from the FMS • Send the quote with a request for a check to the FMS • Find out if the item is covered – the FMS will pay the people selling what you want so you get the item or service Notes... 21 • How to make sure VD-HCBS is working the way I want Once you use the services and supports in your plan, how do you make sure they are really helping you? Only you will really know if something needs to change. You might want to ask yourself questions like: • Does the person I hired do what we agreed he/she would do? • Am I happier now? • Do I spend more time doing the things I am good at and enjoy? • Do I spend time with the people I care about and like? • How could my life be better? If you want to talk with someone about these questions, think about asking your family, friends or others you trust. You can also contact your consultant to talk these things over. NOTES: 22 • How to change my approved plan and budget When you want to make any changes in your plan or budget, you must contact your consultant first to discuss the change and, if necessary, get approval. Depending on the change(s) you want to make, you may have to amend your plan and budget and get them approved. Here are the rules for making changes: You DO have to amend your plan and budget and ask for another approval if: • You want to make a big change, such as changing your worker’s pay rate or spending more on a service or item. You will have to revise your plan and budget and have them approved, because the change(s) mean(s) that you will have to spend less on something else. • You want to add a new need to the plan and buy a new service or good. Again, remember, when you add a new service or good, you will have less to spend somewhere else, and you will have to adjust your spending. You DO NOT have to amend your plan and budget and ask for another approval if: • You want to increase or decrease slightly the amounts you spend on the approved purchases. • You have unexpected assistance and will be spending less than you planned that month for a service or support. • You want to redistribute your workers’ hours among your workers (when you have more than one worker) while keeping the total number of hours the same. • You want to change a purchase from an approved service or good to an alternate service or good that could address your needs in a similar or better way with little change in your approved budget. Remember, when you want to make any change in your plan and budget, you must contact your consultant first to discuss the change and, if necessary, get approval. 23 • Annual plan and budget review In month 12 of your VD-HCBS program, you will be reassessed to renew your VD- HCBS eligibility each year. During this reassessment, you will also review your plan and budget and decide if they are working for you. You can also review the plan and budget more often, if needed. When you review your plan and budget, you may want to make changes, especially if your needs have changed. Contact your consultant and follow the guidelines described in the previous section for making changes in your approved plan and budget. • Health and safety The Department of Veterans Affairs and the Area Agency on Aging of Central Texas wants to make sure that you are receiving the services and supports you need in VD-HCBS to live successfully at home and in the community. Officials from the Texas Department of Aging and Disability Services (DADS) and the Department of Veterans Affairs (VA) will look at the program to make sure VD- HCBS policies and directives are being followed and that VD-HCBS participants are receiving the services and supports they need. If you suspect abuse, neglect or exploitation, please call Adult Protective Services at 1-800-252-5400 or via the internet at www.txabusehotline.org NOTES 24 What If VD-HCBS Isn’t Working For Me? If you decide that VD-HCBS is not working for you, you can disenroll from VD-HCBS and instead return to services through other VA programs. Contact your consultant, and you and your consultant can arrange a plan for this if you want. Additional Contacts If you have questions that have not been answered in this guidebook, there are other places to find the answers. These include the consultant or the financial management service. My Consultant: • My VD- HCBS Agency is : My Financial Management Service: 2180 North Main, Belton TX 76513 254-770-2357 1-800-447-7169 ext. 2357 25 Appendix A. Glossary of Terms Adult Day Care: Daytime care of any part of the day, less than 24-hour care. The program provides a structured, comprehensive program that is designed to meet the needs of adults with functional impairments through an individual plan of care by providing heath, social, and related support services in a protective setting other that the veteran’s home. Area Agency on Aging of Central Texas (AAACT): The AAACT holds a contract with the Department of Veterans Affairs, hires individual consultants and trains these consultants to work at the local level and provide supports to individual VD-HCBS participants. Budget: The amount of available funding for each individual participant. The participant’s consultant receives the individual budget from the VAMC and informs the participant when he/she is deciding whether to select self-direction over traditional VA services and during the planning process. Any requests for adjustments to the budget, based on a change in the veteran participant’s needs, are initiated by the participant through his/her consultant. Caregiver Education and Training: Access to a resource library, informational resources, support groups, seminars and focus groups, individual or group counseling. And education services to caregivers of Veteran. Caregiver Support Coordination: Care givers of Veterans often give more hours than they are paid for in additional service to the Veteran. Caregiver support coordination begins with comprehensive caregiver assessments through home or office visits and phone follow up. A plan of care is created based on the assessment and staff assist in coordinating necessary care and services to include caregiver trainings and support groups to help support caregivers in their roles. This may also include individual or group counseling services to assist caregivers with problem solving and emotional support. Chore Maintenance: Initial and/or periodic heavy cleaning chores. Some initial assessments may reveal that a home is unhealthy due to prior neglect of Household chores by the veteran. Chore Maintenance allows a heavy-duty level of cleaning to get the home into a healthy environment for the Veteran. This may include removal of trash and debris from the home, heavy cleaning (scrubbing floors, washings walls, washing outside windows) moving heavy furniture, yard clean-up, and walk maintenance and repair. Consultant – A trained individual who assists individual VD-HCBS participants with understanding the VD- HCBS requirements, developing a service and support plan and budget, and identifying where or how the developed service and support plan and budget can be implemented. Consumer Direction: A belief that emphasizes the ability of older persons, persons with disabilities and, where appropriate, with the Veteran’s approval, their families, to decide about their own needs and make choices about what services would best meet those needs. Consumer direction and self-direction are sometimes used interchangeably. Electronic Monitoring: This may include the purchase of room monitors similar to baby monitors to place in the room of the vet and a family member to enable movement monitoring, motion monitors, and other monitor services not otherwise covered by VA or other insurance programs. Environmental Services: Gutter cleaning Home injury Control (installation of grab bars, railings, specialized lighting, etc) 26 Minor home repair (windows, screens, shower pans, etc as indicated by veteran) Painting (interior or exterior) Plumbing Ramps Leaf removal & lawn care (mowing, flower planting, shrub trimming) Specialized lighting (motion sensors, outside lighting, etc) Escort Services: Accompanying and personally assisting the Veteran to obtain a needed service. This may be provided by a paid caregiver, a paid escort, or service provider. It may include assisting the Veteran in understanding and filling out applications for services (i.e. social security benefits, Veterans Benefits, Food stamps, etc) Financial Management Services (FMS): The FMS is under contract with the AAACT to act on behalf of each VD-HCBS participant to handle employer-related functions, pay participants’ workers and help the participant keep track of his/her funds. Health Maintenance: The provision of services, prescription and medications, and/or other assistive devices which will prevent, alleviate, and/or cure the onset of acute or chronic illness, increase awareness of special health needs, and/or improve the emotional well-being of the Veteran. This may include the cost of a caregiver to escort the veteran to facilitate participation as needed. Some health maintenance services include the following. Continued health maintenance and monitoring not available through insurance or veteran’s benefits Cooking classes for caregiver Gym or Health Club membership Health Counseling Health Education Massage therapy beyond services traditionally covered by insurance Pet Therapy Public health maintenance programs (like water exercise classes or cardio-aerobic exercise classes) Structured weight reduction programs Homemaking Services: These include but are not limited to laundry, sweeping and mopping floors, dusting, changing linens, cleaning the bathroom (Toilet tubs/showers, sinks & floors), cleaning the kitchen (loading/unloading dishwasher, hand washing dishes, washing off countertops, sinks, floors, and stovetops as needed). This may also include the preparation of meals, home management, and/or escort services. Individually identified services or Goods Necessary for Independent Living: These services and goods are not covered by traditional VA or other resources but are deemed to be necessary for the veteran to remain independent with the best quality of life as defined by the veteran. Information and Referral Services: Consists of activities such as assessing the needs of the Veteran, evaluating appropriate resources, assessing appropriate response modes, indicating organizations capable of meeting those needs, providing information about each organization to help the Veteran make an informed choice, helping the Veteran for whom services are not available by locating alternative resources when necessary, actively participating in linking the Veteran to needed services and following up on referrals to ensure the service was received or provided. Nutritional Services: Hot, cold, frozen, dried, or supplemental food which provides a minimum of 1/3 of the daily recommended dietary allowances (RDA) as established by the Food and Nutrition Board of the National Academy of Sciences – National Research Council. 27 1) Home delivered Standard Meal – the regular menu from the standard menu that is served to the majority of participants. 2) Therapeutic meal or liquid supplement – a special meal or liquid supplement that has been prescribed by a physician and is specifically for the participant by the dietitian (i.e. diabetic diet, renal diet, pureed diet, tube feeding) Participants in VD-HCBS: All veterans enrolled in the VA Health System are Eligible to participate in VD- HCBS program who meet requirements for the program and state an interest in Consumer Directed services. Where participants have cognitive impairments, the participant may designate a person (family member or trusted friend) to be their ―Designated Representative‖ to make decisions or take action for them.. Personal Care Services: These are service tasks provided directly for the veteran’s person and include but are not limited to assistance in and out of the shower or bath tub, any assistance during the bathing process, assistance in getting on/off the toilet, brushing teeth/dentures, personal grooming tasks and dressing as well as providing verbal prompts to taking medication or placing pills from the medication minder into the hands of the veteran and verbally reminding or physically guiding the veteran to take them. Respite Care: Respite care provides short term breaks that relieve stress, restore energy, and promote balance in caregivers of the veteran. In-home services can be provided by volunteer or paid help, occasionally or on a regular basis. Services may last from a few hours to overnight, and may be arranged directly with an individual, family member, or through an agency. Respite services may include meal preparation, housekeeping, assistance with personal care and/or social and recreational activities, Out-of-home respite care programs include an array of services provided in a congregate or residential setting (nursing home, assisted living center, adult day care center) to the veteran in need of supervision. Services may include contracted short stay at an area nursing home or other specialized facilities that provide emergency and planned overnight services, allowing caretakers 24-hour relief. In addition to supervised services, the facility will be expected to provide meals, social and recreational activities, personal care, monitoring of health status, medical procedures and/or transportation. (limited to 30 days per episode) Safety Services: These may include a Personal Emergency Response System) or a combination key box for the door (keeps a key available for easy access to the home by emergency personnel). Safety Services may include a home safety evaluation by a professional person to assure safety of travel paths and needed durable medical equipment that may create a safer environment for the veteran. 1) Personal Emergency Response System includes the installation of the individual monitoring unit, training associated with the use of the system, periodic checking to insure that the unit is functioning properly, equipment maintenance calls, response to an emergency call by a medical professional, paramedic, or volunteer, and follow-up with the veteran. 2) Combination key box for the door, this keeps a key available for easy access to the home by emergency personnel 3) Home Safety Evaluation by a professional person to assure safety of travel paths and needed Durable medical equipment that may create a safer environment for the veteran Self-Determination: A broad concept that means veteran participants have overall control of their lives and ability to take part in society. The Veteran has the ability to succeed or fail on his/her own decisions. Self- determination rests on five basic principles: 1) freedom to lead a meaningful life in the community; 2) authority over dollars needed for support; 3)support to organize resources in ways that are life-enhancing and meaningful; 4) responsibility for the wise use of public dollars; and 5) confirmation of the important leadership that self-advocates must hold in a newly designed system. 28 Self-Direction: A process whereby older persons individuals with disabilities and, where appropriate, families have high levels of direct involvement, control and choice in identifying, accessing and managing the services they obtain to meet their personal assistance and other health-related needs. Self-direction and consumer direction are sometimes used interchangeably. Services and Supports Plan: A participant plan that contains the services that the participant chooses; the service(s)’s projected cost, frequency and duration; and the type of provider who furnishes each service. The plan also includes other services and informal supports that complement services in meeting the participant’s needs. Shopping or Running Errands: Shopping with or without the veteran. If the caregiver uses the veteran’s private vehicle, no mileage is paid. If the care provider uses their own private vehicle for travel, mileage and travel may be reimbursed as agreed upon with the veteran. Socialization Support Services: Caregiver to accompany the veteran to activities such as education or exercise classes, support groups, movies, or other social engagements as indicated by the veteran. Counseling and support advisory counseling is provided that is beyond services traditionally reimbursed by VA or other insurances. Transportation: The HOP, Medicaid Van, or other transport required to go for socialization support or medical support activities with the designated caregiver may be reimbursed as agreed upon with the veteran. Provision of transportation assistance may include an escort to a veteran who has special needs (physical or cognitive) when using regular vehicular transportation. Veteran Directed Home and Community Based Services (VD-HCBS): The VD-HCBS is a pilot partnership program with the Area Agency on Aging of Central Texas and the United States Department of Veterans Affairs through which eligible participants will have the option to control and direct services, supports and Medicaid funds, using the essential elements of person-centered planning, individual budgeting, participant protections, and quality assurance and quality improvement. 29 Appendix B. Frequently Asked Questions 254-770- 2359 1-800-447-7169 ext 2359 (Toll Free) Q. How can Veterans A. All veterans enrolled in the VA Health System are Eligible to qualify for VD-HCBS? participate in VD-HCBS program. The Veteran must state an interest in consumer directed care, be determined to be ―in need of Nursing home care‖ defined by the VAMC. Q. Who is the leader A. The veteran participant is the leader. He/she decides if family in VD-HCBS? members or any other persons should be involved. Q. What services are A. The participant decides what services he/she needs. This included? means the participant may choose to buy any services, supports or goods if those services, supports or goods: • Help the individual to meet his/her functional, medical and/or social needs and live life successfully; • Help the individual to reach the goals he/she has set for himself/herself; • Are not prohibited by Federal and State laws and regulations; • Are not available through another source; and • Do one or more of the following: - The service or item would make it easier for the individual to do things that are hard because of his/her disability; - The service or item would increase the individual’s safety in his/her home environment; and/or - The service or item would lessen the individual’s need for VA or other publicly funded services. Q. How much funding is A. The amount of funding available for you will be determined by available for services the VA contract. Based on your assessment you will be rated as and who decides how Basic, Intermediate, or Extensive Service levels. Your consultant it will be spent? will have this information and will be able to tell you how much money you have to spend. You may use this money to buy what you need to live in the community. Remember, you do not have to spend all the money available to you. It may accumulate in budgeted amounts over several months to acquire a something that you need to stay in your home and community. 30 Q. Who can help the Veteran A. The Veteran participant decides what services he/she needs participant develop a plan and and develops a Service and Support Plan and Budget with the budget? assistance of the consultant and anyone else the Veteran participant wants to be involved, such as a family member or trusted friend. Q. Who hires the service A. The Veteran participant decides what workers to hire and how workers and decides what to much to pay them. The VD-HCBS Financial Management Service pay them? Who pays the (FMS) will pay the workers based on the approved budget, workers? and will handle other employer responsibilities for the participant. Q. Who can help the Veteran A. The Veteran participant’s consultant can help to implement the participant with implementing approved Service and Support Plan. The VD-HCBS FMS will help the approved plan and implement the approved budget by paying the Veteran’s workers budget? and keeping track of expenses. Q. How much flexibility A. The Veteran participant directs his/her services. The Veteran s and control will the Veteran will have flexibility and control over the types of services and participant have about supports they purchase, who will provide the services, where and services? when those services and supports will be received, and how much the workers are paid. Q. What learning and A. The Veteran participant will receive information about training activities VD-HCBS and how it works from multiple sources: are included? his/her consultant, one-on-one learning and peer support. Individuals may also study on their own, using the VD-HCBS Participant Guidebook, worksheets and other materials. 31 Appendix C. Reference Range of Agency Fees by County As an employer, one of the most frequent questions posed often is ―How much should I pay my employee?‖ You will want to provide a fair and just payment for the services that you receive so the worker that you like and is doing the job you want them to do, in the way you want them to do it, to stay in your employ. To assist you we have provided a county by county range of cost survey to show what agencies are currently charging for services in that county. This may be a good place to start in determining a fair market value on the services you wish to procure. It is important to note that the worker is actually being paid less than this amount as the agency has administrative and tax requirements added to the basic salary of the work that factor into this charge for the services. You must remember that as an Employer, when you offer a salary you will also be paying the Social Security and Medicare Taxes for your employees from your own budget. This means for example if you budget $10 an hour for a service, your employee may only receive $9.10 per hour the rest being paid for taxes. Your Financial Management Service will do all of these payments for you but the full charge of these come from your budget. County Respite Services Homemaker Personal Care Bell County $9.94 hr - $16.00 hr $10.36 hr-$16.00 hr $10.61 hr- $16.00 hr Milam County $9.94 hr - $16.00 hr $10.36 hr-$16.00 hr $10.61 hr- $16.00 hr Coryell County $9.94 hr - $16.00 hr $10.36 hr -$16.00hr $10.61 hr- $16.00 hr Lampasas County $9.94 hr - $14.02 hr $10.36 hr -$16.00hr $10.61 hr- $16.00 hr San Saba County $10.36 hr-$16.00 hr $10.36 hr-$16.00 hr $11.82 hr-$16.00 hr Mills County $10.36 hr-$16.00 hr $11.36 hr-$16.00 hr $11.17 hr-$16.00 hr Hamilton County $10.36 hr-$16.00 hr $10.36 hr-$16.00 hr $11.17 hr-$16.00 hr 32 Place holder for Appendix D pp33-44 33-44 Appendix E. Orientation Forms Employer In this appendix are located the forms that are specific to the Veteran Employer entering the VD-HCBS Program. These Forms will be filled out in a meeting with your Consultant. The forms are: AAA 2060 Assessment Form and Criteria (VD-HCBS ) Form 1581 VD-HCBS Veteran’s Directed Home and Community Based Services Overview Form 1581 SRO Veteran’s Directed Home and Community Based Service / Service Responsibility Option (SRO) Overview Form 1582 VD-HCBS Consumer Directed Responsibilities Form 1584 VD-HCBS Consumer Choice Form Form 1720 VD- HCBS Designated Representative Form 1721 VD-HCBS Revocation of Designated Representative Form 1735 VD-HCBS Employer and Financial Management Service Agreement Form 1736 VS-HCBS Documentation of Employer Orientation On Financial Management Services Form 1738 VD-HCBS Rules Acknowledgement Form 1740 VD-HCBS Service Backup Plan Form 1741 VD-HCBS Corrective Action Plan Form 1745 VD-HCBS Service Delivery Log Form 1826-D VD-HCBS Case Information Release IRS Paperwork: Permissions, Form SS-4 EIN, Form 2678, Form 8821 TWC Form C-42 (Appointment of FMS to serve as Veterans Agent with TWC) NOTE: the Veteran’s Directed Home and Community Based Services is adapted from the Texas Administrative Code Title 40 Part 1 Chapter 41 Consumer Directed Service Option which is available upon request. 45 Appendix F. Orientation Forms Employee Form 1583 VD-HCBS Employee Responsibilities Form 1724 New Employee Packet Cover Sheet Form 1725 Criminal Conviction History and Registry Checks Form 1727 Occupational Exposure to Bloodborne Pathogens Form 1728 Liability Acknowledgement Form 1729 Applicant Verification for Employees Form 1730 Wage and Benefits Plan Employee Compensation Form 1731 Employee Work Schedule and Assigned tasks Form 1732 Management of Service Provider Form 1733 Employer and Employee Acknowledgement of Exemption from Nursing Licensure for Certain Services Delivered through Consumer Directed Services Form 1734 Service Provider and Employer Certification of Relationship for Employment Form 1737 VD-HCBS Employer and Employee Service Agreement Form 1739 VD-HCBS Service Provider Agreement Form 1745 VD-HCBS Service Delivery Log Form 1826-D VD-HCBS Case Information Release OMB Form 1615 I-9 Employment Eligibility Verification Form W-4 2009 Employees With Holding Allowance Certificate Form W-5 Earned Income Advanced Payment Certificate 46 APPENDIX G: Information Sheets to help You with your Employees The following information sheets will help you in working with your employees. The Information sheets are: a) Sample Employer Forms 1) Attendant Job Description sample 2) Performance evaluation 3) Tasks, Training, and schedule for Attendant 4) Wages and Benefits Plan 5) Emergency and Other Contact Information 6) Employment Agreement b) Writing Job Ads c) Employment Application d) Training Workers e) Dismissing (Firing) Workers f) Emergencies g) Governmental Websites 47 Information Sheet : Dismissing (Firing) Workers Most people do not like having to dismiss or fire someone. However, sometimes that "perfect" person you hired does not work out. People and situations change. If you find at some point that your worker is not meeting your needs, you may have to fire that person. Keeping a hiring agreement up-to-date and keeping a regular schedule for reviewing your employee’s job performance can help you decide if you have grounds for firing. Some Grounds for Firing The reasons to fire someone will vary. Here are some of the most common reasons: The employee’s work does not meet agreed upon expectations. The employee does not learn fast enough to meet your changing needs. The employee is late or fails to show up too many times. The employee’s personal habits bother you. The employee does not pay attention to your instructions. You find you are having too many arguments. You do not feel safe and comfortable with the employee. The employee has a schedule that is not flexible enough for you. The employee violates your employment conditions, seriously or often. Grounds for Immediate Firing Some actions by a worker may be grounds for firing him right away. You should have put these in your hiring agreement, as we talked about earlier. Hopefully you covered these with your worker when s/he started working for you. These grounds include actions such as: Drinking on the job Using illegal drugs on the job Coming to work impaired by alcohol or drugs Being caught stealing from you Abusing you in any way Violating your confidentiality How to Dismiss or Fire Workers Weigh all your options before you fire a worker. Maybe trying to work things out with the employee might be better. Trying to hire a new one will take time and effort and there is no guarantee your new employee will be a better worker. How you decide to handle firing a worker will depend upon your personality, your employee’s personality, and the situation. You might want to get advice from your Consultant, and make sure your back-up plan is available before you fire your worker. However, if firing is your decision, consider the following questions. - How should you tell the employee you are firing him/her? Doing it by phone or letter may feel safer and/or easier, but doing it "in person" is more respectful. Having a third person, such as your designated representative, tell the employee s/he is fired is also an option. - What reasons should you give the employee for firing him/her? If you have been giving plenty of feedback and doing regular evaluations, the worker should not be surprised. S/He should also know what you have said are grounds for firing. In some cases, something may happen or some very serious problem may arise that you have not addressed in your guidelines or evaluations. In most cases, give the employee some idea of why you are firing him/her, but you do not have to go into great detail. - How will the worker react? Have a neighbor, friend, relative, or consultant in the room with you and your worker if you feel there may be a problem when you bring up the subject of firing. - How much notice should you give your worker? Be fair, but remember that if you give the worker advance notice, you may risk even more problems with his or her work and behavior. - Who will provide your support once you fire the worker? Before you fire your present employee, have at least one backup worker ready to step in right away. - Are you safe and secure? If the worker you fired had access to the keys to your residence or car, get them back on the same day that you fire the individual. - Learn from the experience. After you have had some time to consider the situation, think about what you have learned from it. Would you deal with the situation in a different way? Was there a question you would have asked in the interview process that would have helped you realize that this was not the person for you? Once you fire an employee, contact your Consultant and your Financial Management Service right away. The Financial Management Service will need to make changes to the employee’s work file and to your records.
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