Personal Care Assistant Services in Schools

1. Personal Care Assistant Services in Schools Tia Campbell, RN, MSN Ashley Barton, LCSW DMAS/DOE Annual Conference October 6, 2009

2. Personal Care Services • Services provided by the assistant are related to the child’s physical and behavioral health requirements, including: • assistance with eating, dressing, hygiene, activities of daily living, bladder and bowel needs; • use of adaptive equipment; • ambulation and exercise;

3. Personal Care Services • behavioral issues; and • other remedial services to promote reduction of a child’s disabilities. • monitoring of a health related service • i.e.: bus driver aide or monitoring the need for suctioning

4. Categories of Services • Nursing • Practitioners of the Healing Arts • Occupational Therapy • Physical Therapy • Speech Language Pathology • Psychology (Behavioral)

5. Nursing Personal Care Assistants • Must meet minimum qualifications for unlicensed assistive personnel as required by the Department of Education, Virginia School Health Guidelines, VDH and VDOE, 1999 • Must receive training for assisting with meeting the specific health needs of the student as outlined in the Guidelines for Specialized Health Care Procedures Manual, VDH, 2004.

6. Nursing Personal Care Assistants • Must be identified in the student’s IEP. • Must be included in the Plan of Care (POC) prepared by the licensed registered nurse (RN). • Personal care assistants for nursing services must be supervised by a RN. • ADL and IADL services do not require physician order.

7. Personal Care Assistants for Practitioners of the Healing Arts • Specific services must be ordered by a Department of Medical Assistance Services (DMAS) qualified practitioner of the healing arts acting within the scope of their licensure

8. Personal Care Assistants for Practitioners of the Healing Arts • Personal care assistants for the healing arts must be supervised by a DMAS qualified practitioner of the healing arts (OT, PT, SLP, Psychiatrist, Psychologist). • Board of Physical Therapy (18 VAC 112-20-10 et seq.) • Licensed PT can supervise support personnel who are designated routine tasks related to physical therapy; however…supervision must be direct.

9. Authorization for Services • Services must be authorized by the current Individualized Education Program (IEP) • The student shall have a current order from a physician, physician assistant or nurse practitioner for specialized nursing procedures (i.e. tube feedings, catheterizations, and seizure monitoring) • The service cannot be provided by a parent or a step-parent

10. Provider Requirements • Only provide services consistent with the training received. • Guidelines for Specialized Health Care Procedures • Medication Manual for Unlicensed Personnel • Insulin and Glucagon Manual, etc.

11. Provider Requirements • The DOE training manuals may be found on the DOE website at www.doe.virginia.gov under the ‘Board of Education Guidance Documents’. • Services are to assist the child with disabilities in self-sufficiency, communications, and mobility skills

12. Plan of Care MED 14 • Developed by a licensed practitioner of the healing arts within the scope of their license. • A separate plan of care should be developed per discipline based on the services needed. • The plan of care developed by the licensed provider should be consistent with the health conditions and functional limitations documented on the individual’s IEP

13. Plan of Care MED 14 • Medical condition and diagnosis being address • Specific to needs identified in assessment • Goals and objectives • Treatment intervention and which goal addressed

14. Plan of Care MED 14 • Type, amount and frequency of service • Anticipated duration of service • Signed and dated by individual performing service • Reviewed at least annually

15. Student Log MED 15 The personal care assistant shall document: • On a daily basis for non-nursing services • For nursing assistants the documentation is per occurrence • Date and amount of time

16. Student Log MED 15 • Procedure • Comments • N = Normal • V = variance from normal or standard. Include written explanation in ‘Comment’ section • Initials of the assistant • Documentation of supervisory visit signed by applicable supervisor

17. Supervision • Supervision provided by the appropriate licensed practitioner of the healing arts. • Supervisory visits are required as often as needed to ensure both quality and appropriateness of services. • Review the child’s progress and make any adjustment to goals or treatment modalities.

18. Supervision • Visits should be made on-site (direct) every 30 calendar days. • On-site visits may be conducted more frequently than every 30 calendar days depending on the intensity and level of services the child is receiving as well as the license requirements of the supervisor.

19. Supervision • If an on-site visit is not possible every 30 calendar days, then an indirect visit may be conducted via telephone or off-site. • Condition of the child as well as license requirements to determine the requirement for on-site supervision versus indirect and the frequency of supervision visits.

20. Supervision • An on-site visit must be conducted at least every 90 calendar days. • Supervisor shall identify any gaps in aide’s ability to function competently and shall provide training as indicated.

21. Billing • A unit of services equals 15 minutes for no more than 8.5 hours a day • The number of units billed is not to exceed the number of units in a day that the student is in the care of the school • While more than one assistant may attend the student during a school day, the unit for a particular period of the day shall not be billed for the services of more than one assistant.

22. Billing • If the total number of units billed ends up with a fraction of a unit, round to the nearest unit • 50 minutes of care / 15 = 3.33 = 3 units • 100 minutes of care / 15 = 6.66 = 7 units • Regular school year is 180 days • May vary among school divisions • Services during the summer school sessions are billable as well.

23. Resources • Amy Edwards Medicaid in Schools Specialist, DOE 804-692-0150 Amy.edwards@doe.virginia.gov • Ashley Barton, LCSW Maternal & Child Health Specialist, DMAS 804-371-7824 Ashley.barton@dmas.virginia.gov