Sec. 07.02.14.06. Delivery of Service

A. If funds or staff are available, the local department may provide the services by:

(1) Assigning a local department staff member;

(2) Purchasing the services from a private for-profit or nonprofit agency that has contracted with the Administration to provide the service; or

(3) Purchasing the services from a self-employed individual.

B. The local department shall, if funds or staff are available, make available during weekends and evenings as well as during normal working hours, the following services:

(1) Meal planning and preparation;

(2) Personal care services which include:

(a) Help with dressing, bathing, feeding, grooming, and assistance with the bedpan or urinal;

(b) Assistance in and out of bed, with ambulation, and transfers from bed to wheel chair;

(3) Cleaning the eligible individual's bedroom, bath, kitchen, and personal laundry;

(4) Providing transportation to health and shopping facilities as well as other community resources required by the service plan.

C. The local department shall have available, during weekends and evenings as well as during normal working hours, the following therapeutic aide services:

(1) Teaching meal planning and meal preparation; and

(2) Providing therapeutic aide services that include emotional support, introducing the client to neighborhood resources, and reinforcing appropriate self-care and caretaking behaviors, and teaching budgeting and home management.

D. Provision of Additional Services.

(1) The local department may make arrangements for the provision of additional types of in-home aide services including heavy chore services to the eligible individual.

(2) If the case manager documents in the case record that intensive aide service, that is, more than 20 hours of aide service per week, is necessary to prevent imminent nursing home placement, or abuse, neglect, or self-neglect, and funds or staff are or become available, the local department shall provide the number of hours and days of care, including evening and weekend care, necessary to prevent nursing home placement, or abuse, neglect, or self-neglect, subject to the limitations in Regulation .07B of this chapter.

(3) A family with children shall receive intensive aide service, that is more than 20 hours of aide service per week, if funds or staff are or become available, and if the:

(a) Need for the additional amount of service is documented in the case record as necessary to prevent foster care, or to reduce the length of foster care placement; and

(b) Case manager assesses the family as potentially capable of providing adequate and safe care of the child without the use of aide service within the time specified in the service plan for effecting reunification or preventing out-of-home placement.

E. The local department shall establish procedures to ensure the delivery of the aide service as required by the plan for aide service.

F. Status Reports.

(1) Regardless of the method by which service is delivered, the local department shall require the service provider to complete a report to the IHAS supervisor on the client's current situation as often as necessary, and not less than monthly, to record any change in the client's situation. The report is required if the client prevents the aide from performing the tasks agreed to in the plan for aide services or the aide:

(a) Identifies a change in the client's functional capacity;

(b) Identifies a physical deterioration or improvement;

(c) Receives a request for services which are not part of the plan for aide services;

(d) Has a poor relationship with the client, or a household member;

(e) Identifies abuse, neglect, self-neglect, or exploitation of the client;

(f) Identifies a change in the client's environment;

(g) Receives a request from the client to terminate service;

(h) Notes termination or initiation of services from another source; or

(i) Identifies a threat to the aide's well-being because of environmental hazards, contagious disease, or because the client, or a member of the household threatens physical harm or is verbally abusive to the aide.

(2) The IHAS supervisor shall keep the report in the case record in the local department, and shall forward a copy of the report to the case manager.

G. If the aide suspects that the client or a dependent in the client's care is in physical danger, the aide shall report the circumstances immediately to the IHAS supervisor, the case manager, or the local department's after-hours emergency service.

H. Significant Change in Client's Status.

(1) If there is a change in the client's status which the IHAS supervisor determines may affect the case management plan or the plan for aide service, the supervisor shall inform the case manager within 2 working days.

(2) The IHAS supervisor shall send a current report on the client's situation to the case manager with a request that the client be reassessed, and a medical reevaluation and revised personal care plan be prepared if indicated.

(3) The IHAS supervisor, with the case manager, shall develop a new or revised plan for aide services within 5 working days of receipt of the reassessment and personal care plan.

I. The local department may suspend services up to 4 weeks:

(1) While the client is absent from the home; or

(2) If the client requests termination.

J. The IHAS supervisor shall:

(1) Notify the case manager when the client is not at home; and

(2) Notify the case manager if the client has requested termination, and include a copy of the aide's status report.

K. Emergency Suspension.

(1) If the IHAS supervisor determines that there is an immediate threat to the aide's health, safety, or welfare from environmental hazards, or from a client, a member of the client's household, or someone regularly present during times of service, the local department may immediately suspend services on an emergency basis.

(2) If services are suspended on an emergency basis, the notice provisions of Regulation .09B of this chapter do not apply. The local department shall send by certified mail written notice of the suspension to the client stating:

(a) The regulatory basis for the suspension;

(b) That the client is entitled to a hearing within 7 calendar days of a request for a hearing;

(c) That the Secretary's designee shall issue a decision concerning the emergency suspension within 7 calendar days of the hearing;

(d) That if the emergency suspension order is upheld, aide services shall be suspended until it is determined that the health, safety, or welfare of the aide is no longer threatened; and

(e) That the suspension may lead to termination.