CNA logoKey to Managing Risk

According to the Centers for Disease Control and Prevention, the number of Americans over 65 years old is expected to double between 2000 and 2030, while the number of family members available to assist seniors hoping to “age in place” will increase by only one quarter. As home care providers expand their staffing and service offerings in response to this swiftly growing demand, new exposures arise. These require the implementation of well-defined guidelines for critical processes, including client screening, assessment and selection, service planning and monitoring.

Client Screening.
An effective screening procedure reduces the risk of inappropriate client admissions by ensuring that clients are suited for non-medical care as defined by the provider and applicable state laws and licensing regulations and that requested services are non-medical in nature. Assign an experienced and knowledgeable employee to interview prospective clients and families, screening for the following:

  • medical and cognitive status, including medical diagnoses, allergies, presence and stage of Alzheimer’s/dementia, behavioral patterns, recent surgeries/hospitalizations, and existence and level of pain
  • fall risk and fall history, with and without injury
  • physical limitations, including limits on activities of daily living, bladder and bowel continence, toileting assistance requirements, ambulation/transfer needs, assistive devices used, upper extremity weaknesses and visual impairment
  • medications, including all current drugs taken and self-administration abilities
  • skin integrity, including detailed description of wounds or other skin-related issues
  • nutrition needs, including prescribed or special diet, feeding abilities, and meal planning and preparation requirements
  • safety of the home environment and necessary modifications

Interviewers should also ascertain prospective clients’ interests and hobbies as well as expectations and desired services (e.g., companionship, home help, personal care).

The admissions team should then review and discuss the information obtained through the screening process to determine if the organization can safely meet the prospective client’s non-medical needs.

Client assessment, selection and reassessment.
After screening but prior to commencement of services, assign a qualified staff member to visit the client’s home in order to complete a comprehensive assessment, identify care needs, verify the client’s suitability for non-medical care and obtain necessary information for developing an individualized service plan. This assessment process should be repeated at least every six months and any time the client’s condition changes. All assessments and reassessments must be clearly documented, including the assessor’s name and the date of completion.

Service planning.
Once gathered, assessment data should be incorporated into an individualized service plan. The service plan should be developed by a qualified staff member in collaboration with the client’s family and the direct caregiver, and revised whenever the client’s condition changes. It should delineate goals and objectives, services to be provided and client monitoring guidelines. As open, ongoing communication is essential to successful care delivery, create a process to ensure that all parties are kept informed of the services being provided and notified of any perceived change in the client’s condition and/or needs.

Monitoring services and client condition.
Schedule regular reviews to determine staff compliance with the service plan and evaluate whether the client’s needs are being met or a higher level of care is required. Reviews should include evaluation of records and assessments, as well as unannounced visits to the client’s residence during and after home care sessions, in which inquiries are made regarding the client’s and family’s level of satisfaction and any changes in condition or needs. If it becomes apparent that additional services are required or non-medical services are no longer appropriate, the next step is to inform the client and family so that the service plan may be modified or the client discharged and transferred to an appropriate service provider, as necessary.

The strategies described here—thorough pre-admission screening followed by comprehensive assessment and ongoing service planning and monitoring—are critical to protecting clients and minimizing liability.

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