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Health Advocacy Project

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.

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Health Advocacy Project

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  1. Health Advocacy Project Improving the Health of Residents in Board & Care Facilities A Project of Protection & Advocacy, Inc. Funded by the California Endowment

  2. 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.

  3. Licensed Facilities Statewide FacilitiesResidents Adult Residential 4,751 39,444 (Community Care Licensing Data) Adults w/ Mental Disabilities 2,700 28,000 (CRCA Data) San Diego County Adult Residential 448 Adults w/ Mental Disabilities(estimated) 84 • There is no separate licensing category for adults with Mental Disabilities. • CRCA report relies upon data from 2000, source unknown.

  4. Ethnicityof Board & Care Residents % of M/H % of B&C Population Population • African American 18.2% 21.3% • American Indian .7% .7% • Asian 1.6% 3.2% • Caucasian 56.4% 48.2% • Hispanic 13.9% 20.3% • Other 9.2% 6.3%

  5. 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.

  6. Surveys of ResidentsAccording 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.

  7. Residents’ Rights,Service Entitlements, & Responsibilitiesin CaliforniaBoard & Care Homesfor adult persons with mental disabilities

  8. 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)

  9. Before admission the following services must be provided: • A medical assessment, completed by a qualified medical professional. • A mental health intake assessment, completed by a licensed mental health professional. • An assessment of the client’s need for personal assistance and care, by determining his/her functional capabilities, completed by the facility staff.

  10. The facility staff must complete a written Needs and Services Plan. • The person is allowed to visit the facility with his/her family, friends, and/or representative. • The person is interviewed by the facility staff and is provided with information about the facility, including information contained in the admission agreement. • An admission agreement must be obtained.

  11. Admission AgreementsMust 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.

  12. Medical Assessmentsmust 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.

  13. 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

  14. Needs and Services Plans

  15. Development of the NSP shall involve: • The client, or his/her authorized representative, if any. • Any relative participating in the placement. • The placement or referral agency, if any. • The person responsible for facility admissions.

  16. 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: • 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.

  17. ResidentRights

  18. 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.

  19. 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.

  20. 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.

  21. 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 health-related services. • To move from the facility (within the terms of the admission agreement)

  22. Tips for Family and FriendsFrom: “ A Mother’s Perspective on Board and Care: An interview with Barbara Castle “Board and Care Quality Forum – Volume 5, Number 5Published September/October 2002

  23. 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

  24. 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?

  25. 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.

  26. Important Telephone Numbersfor 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

  27. Important Telephone Numbersfor 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

  28. Resident Councils

  29. “ 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 -

  30. 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.

  31. 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.

  32. Medi-CalServices and Benefits

  33. 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 Pays For(among other things) :

  34. Fee for Service vs. Managed Care Medi-Cal Choice (For SSI-linked Beneficiaries)

  35. 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.

  36. 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

  37. How do I join a Medi-Cal Health Plan or find out more information? Contact a Health Care Options Counselor • Center City ……………………………………….. (619) 237-8506 • El Cajon ……………………………………………. (619) 441-6664 • Escondido …………………………………………. (760) 480-3402 • Kearny Mesa ………………………………………. (858) 694-8862 • Lemon Grove ………………………………………. (619) 668-3784 • Northeast …………………………………………… (619) 464-5740 • Oceanside ………………………………………….. (760) 754-5860 • South Bay …………………………………………… (619) 409-3296 • Southeast …………………………………………… (619) 266-3963

  38. 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

  39. Fee for Service Choice of doctors, clinics, service providers No referral necessary for specialists Maintain existing relationship with providers Managed Care Provides a “health home” for the person and their family Access to additional services (i.e. 24 advice #’s, member advocate, education programs) Provider directory and referral information readily accessible. Additional rights under Knox Keene Act Positives

  40. 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 Negatives

  41. The best way to stay healthy is to BE AN ACTIVE MEMBER OF YOUR HEALTHCARE TEAM

  42. 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.

  43. Talking With Your Doctor

  44. 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.

  45. 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.

  46. 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.

  47. Medications

  48. 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.

  49. 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?

  50. 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.

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