DOEA Form 701C Assessment Training

1. DOEA Form 701C Assessment Training July 13, 2010 Elder Options

2. Assessment Training Overview • Handouts/materials • DOEA Assessment Instructions • (DOEA Form 701D, September 2008) • DOEA Congregate Meals Assessment • (DOEA Form 701C , September 2008) • 06:PR:13 High Nutrition Risk Referral • DOEA Form 701C Assessment Training July 13, 2010 Power Point Presentation

3. 701C Test and Purpose • 701C test • 10 multiple choice questions • Requires a score of 80% or higher to pass • Open book (701D, notes, and other handouts) • The purpose of the 701C is to assess for congregate meals and/or nutrition counseling. This form is used for assessment and annual reassessment, and significant updates, of these clients.

4. CIRTS • CIRTS is the Department of Elder Affairs’ statewide Client Information Registration and Tracking System • CIRTS is the client database where the client’s assessments, enrollments, and units of service are entered • Accuracy is, obviously, very important

5. Nutrition Score • A Nutrition Score is generated at the top of the 701C when the assessment is entered into CIRTS • A Nutrition Score is the only score generated by the 701C

6. DOEA Form 701COwner, Provider, Assessor, and Sections • Owner versus Provider • Primary or only provider of service = Owner • Secondary provider of service = Provider • Assessor • The person completing the assessment with the client or potential client • ## identifies items that must be entered in CIRTS • A 701C is comprised of a Demographics and a Nutrition section

7. Developing Rapport • Explain to the client what you will be doing • Take a little time to talk about the assessment before you actually begin asking the questions • Explain the importance for the client to take the time to go through this process • Be professional and friendly • You want the client to be comfortable and to feel reassured

8. Consider… • The person you are assessing may be (or become) confused, evasive, or angry or may be hard of hearing, blind, illiterate, etc. Be as prepared as you can to adapt to such circumstances. • It may be helpful to read the answer choices with each question or let them have a copy of the assessment to look at while you go through the questions and document their answers.

9. Demographic InformationItems for focus • All items on the assessment form must be answered • Write additional information that may be useful on the 701C • Always ask for a Middle Initial • Ask to see their Social Security card so you can get the number directly from it • If you are unable to acquire a SSN, see the 701D for the process to create a pseudo SSN

10. Creating a pseudo SSN • Janice E Knorr dob 08/14/1935 • JEK-08-1435 • Willie Jones (no known middle initial) dob 03/03/1933 • WXJ-03-0333

11. Demographic InformationItems for focus continued • A Medicaid Number is 10 digits in length • The client’s gold card has an access number, which is usually 8 digits in length • Consumer Type • Elder Recipient if an older person applying for services • Caregiver if a person who cares for someone 60+ or a child/grandchild • Both Elder Recipient and Caregiver may be checked

12. Demographic InformationItems for focus continued • Caregiver of a grandchild question • You may answer this question as the client answers it, but CIRTS will only allow an answer of Yes if Consumer Type of Caregiver was selected* • *This may change shortly • Addresses • Physical Address must be completed • Mailing Address is only needed if different than Physical • Assessment Date is the date the assessment is completed with the client

13. Demographic InformationItems for focus continued • Assessment Site • Use Senior Center if the assessment was completed at a center or meal site • Use Other if at any other location • Assessment Type • Use Congregate Meals if you are assessing or reassessing a person for congregate meals • Use Update if there has been a significant change in a client’s situation and the information needs to be documented, but it is not yet time for their annual assessment

14. Demographic InformationItems for focus continued • Race, Ethnicity, Primary language, Marital Status • Do not make assumptions, ask the client • Imminent Risk of nursing home placement • Any person or agency can designate a referral as Imminent Risk, this includes you as the assessor

15. Demographic InformationItems for focus continued • Per DOEA • “A primary caregiver is any person who cares for someone on a regular basis and: • can be depended on to provide help as needed with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs); • may or may not live with the consumer; and • does not include operators of ALFs, nursing homes, Adult Family Care Home (AFCH) sponsors, home health agencies or service provider staff.”

16. Demographic InformationItems for focus continued • Assistance needed to evacuate • Answer No if the person needs no assistance • If the person has a plan to evacuate themselves or for someone else to assist them, they need no assistance • If the person indicates that they do need assistance and they are not registered with the County Special Needs Registry, they should be provided with information and/or assistance to register with the County Special Needs Registry

17. Demographic InformationItems for focus continued • Income • Gross Income • All clients should be asked for their Individual, and Couple (if applicable), Monthly Income • Clients who will receive only OAA services are able to refuse to provide their Income

18. Demographic InformationItems for focus continued • Food Stamps • This question will be answered as Yes or No, based upon whether or not the client receives food stamps • In addition to answering the question, if you have reason to believe the client needs food stamps and they are not receiving them, you should provide them with information that will help them in applying for food stamps and/or attempt to find a way to assist them in applying for food stamps

19. Demographic InformationItems for focus continued • Assets • Exclude worth of client’s or couple’s home, one car, and $2,500 (for individual) or $5,000 (for couple) designated in burial assets • All clients should be asked for their Individual, and Couple (if applicable), Asset information • Clients who will receive only OAA services are able to refuse to provide this information

20. Income and Assets: Refused • A person receiving OAA services may refuse to provide their income or asset information. It is against federal law for a person’s income or assets to be used in determining eligibility for OAA services.

21. Nutrition Status • The questions in the Nutrition Status section are established as a federal screening under the Older Americans Act. • Respond to questions with either (Y) Yes or (N) No 1. Have you lost or gained 10 pounds or more in the last 6 months without trying? Indicate whether weight was lost or gained. This weight change could indicate a health problem. If the client isn’t sure, you might ask whether his/her clothes are fitting properly. If he/she has had a weight change, ask if the client or caregiver has notified the doctor. You might have to help with this contact.

22. Nutrition Status 2. Do you take 3 or more kinds of medicine a day? This includes both prescription medicines and over-the- counter health products. 3. Do you have 2-3 or more drinks of beer, wine or liquor almost every day? 4. Do you have an illness or condition that made you change the food you eat? Indicate what type of diets these are in the appropriate box(es). Multiple special diets indicate that the client is at greater nutritional risk. 5. Do you eat at least two meals a day? Ask the client about their appetite. Mark the appropriate box for good, fair, or poor.

23. Nutrition Status 6. Do you eat some fruits and vegetables every day? Fruits AND vegetables, not just one or the other. Ask the client to describe what they usually eat and drink on a typical day. When asking what the client eats each day, you might want to walk the client through the previous day, from the time he/she woke up in the morning until he/she went to bed at night. Remember that weekends could be different from the rest of the week. Try to determine whether the diet is balanced, how much food is consumed, and when the food is normally eaten. 7. Do you have some milk (dairy) products every day? 8. Do you have any problems with your teeth, mouth or throat that make it hard for you to chew or swallow?

24. Nutrition Status 9. Do you eat alone most of the time? 10a. Are you usually able to shop for yourself? 10b. Are you usually able to cook for yourself? Note that questions 10a and 10b are scored as half points. These questions were originally a single question which was been split for clarity. 11. Are you usually able to eat without help? 12. Do you have enough money to buy the food you need? Distinguish between need and want.

25. Nutrition Status • The Nutrition Score will be calculated by CIRTS and will appear on the turnaround document. If it is necessary for staff to calculate a Nutrition Score quickly, the values are indicated and the score may be calculated manually. The maximum score is 21. • NOTE: The range of risk for malnutrition is Low=0-2, Medium=3-5, and High=5.5-21. Clients with nutrition scores which are 5.5 or higher show a high risk for malnutrition and may need to be referred to a registered dietician.

26. SUGGESTIONS TO HELP NUTRITION STATUS • Refer client to a Registered Dietician • Refer client to a Food Bank/Food Pantry • Provide PetMeals for Client • Help client with Medication Assistance • Refer client for Food Stamps • Refer client to Commodities • Refer client to Senior Companion Program • Offer additional Meals • Inform client of local organizations who offer assistance (such as churches or restaurants w/food programs)

27. Tobacco Use The following questions are asked of the client. The questions are concerned with use of any tobacco product, including cigarettes, cigars, chewing tobacco, or snuff. • Do you smoke or use tobacco products? Mark the appropriate box for this question. • Have you ever smoked or used tobacco? Mark the appropriate box for this question. Also indicate on the line provided how long the individual has been smoking/using tobacco products. If they used tobacco products in the past and quit, note how long they have been tobacco free. • Do you live with others who smoke? Mark the appropriate box for this question.

28. Food Stamps • Food Stamps • The food stamp question should be answered by the assessor and should NOT be asked of the client. • If a client already receives food stamps, the answer is Yes (compare with the answer to item 16c on page 1 of the assessment) • If the assessor believes the client needs food stamps, the answer is Yes

29. Current Height and Weight • Document this information. • If the client is unsure, get whatever information you can regarding their current or past height and weight. If information is not current, make additional notes to explain.

30. Caregiver/guardian and Summary • Caregiver/guardian of grandchild/child • Complete the questions as asked • Refer the person to local resources, if needed • Summary • Provide any additional information about this person that you feel is important to document

31. Final comments • Keep these tools and your notes handy • Review them from time to time • Refer to them when you have questions • Carefully read the 701D, specifically the Demographic Information and Nutrition Status sections • Remember that the 701D covers all three assessments • 701A, B, and C • Talk to your co-workers and supervisor about different cases and situations – they hold a wealth of knowledge