Arizona Case Management Handbook

1 Division of Aging and Adult Services 1789 West Jefferson Street / 950A Phoenix, AZ 85007 Phone: (602) 542-4446 Arizona case Management Handbook Prepared by The case Management Handbook Committee April 2010 Equal Opportunity Employer/Program Under Titles VI and VII of the Civil Rights Act of 1964 (Title VI & VII), and the Americans with Disabilities Act of 1990 (ADA), Section 504 of the Rehabilitation Act of 1973, and the Age Discrimination Act of 1975, the Department prohibits discrimination in admissions, programs, services, activities, or employment based on race, color, religion, sex, national origin, age, and disability.

2 The Department must make a reasonable accommodation to allow a person with a disability to take part in a program, service or activity. For example, this means if necessary, the Department must provide sign language interpreters for people who are deaf, a wheelchair accessible location, or enlarged print materials. It also means that the Department will take any other reasonable action that allows you to take part in and understand a program or activity, including making reasonable changes to an activity. If you believe that you will not be able to understand or take part in a program or activity because of your disability, please let us know of your disability needs in advance if at all possible.

3 To request this document in alternative format or for further information about this policy, call (602) 542-4446; TTY/TDD Services: 7-1-1. Arizona case Management Handbook 3 1. PART ONE: ADMINISTRATION OF SERVICES .. 7 AGING AND LONG-TERM CARE SERVICES .. 7 The Older Americans Act (OAA) .. 7 Arizona s Aging Network .. 11 The Administration on Aging (AoA) .. 11 State Unit on 12 Area agencies on Aging .. 13 Values and Goals .. 14 Summary .. 16 The Continuum of Long-Term Care in 17 17 Programs and Services .. 18 Coordination of Services .. 23 Funding of Programs .. 24 DAAS Policies and Procedures .. 26 Regulations .. 26 DAAS Policy and Procedures Manual.

4 27 Scopes of Work .. 27 Links to Policies and Procedures .. 28 LEGAL AND ETHICAL 29 Client Rights and Responsibilities .. 29 Abuse .. 30 Fraud .. 32 Confidentiality and Privacy .. 32 Wait 34 Service Denial or Termination .. 34 Grievance Procedure .. 35 Cost Sharing and Voluntary Contributions .. 35 Arizona case Management Handbook 4 2. PART TWO: THE case Management INTRODUCTION TO case Evolution of case Management in the United States and Arizona .. 37 Types of case Management .. 38 Arizona Service Definition for Non-Medical case Management .. 38 Objectives of Non-Medical case Management .. 39 The case Management 40 THE case MANAGER ..41 Roles and Responsibilities.

5 41 Values and Ethical Behavior .. 41 Boundaries .. 42 42 Boundary Violations .. 42 Self-Care .. 44 44 Compassion Fatigue and 45 Beware of Helping Too Much: The Drama Triangle .. 45 Professional Qualifications .. 46 KEY CONCEPTS ..47 Person-Centered Practice .. 47 Strengths-Based Approach .. 48 Consumer Choice .. 50 Intake and Screening .. 52 Eligibility, Targeting and Prioritization .. 54 Eligibility .. 54 Targeting .. 55 56 In-Depth Assessment by the case Manager .. 57 Documentation .. 57 Holistic Assessment .. 58 SERVICE PLANS ..61 Developing a Service Plan .. 61 Implementing the Service Plan .. 66 ONGOING case Monitoring of Service Plans.

6 67 Revision of Service Plans .. 68 Arizona case Management Handbook 5 3. PART THREE: SUPPORTING INFORMATION .. 71 SERVICE POPULATIONS .. 71 Care Recipients .. 71 Caregivers .. 71 THE AGING 73 Understanding Aging as a Developmental Process .. 73 Physical / Biological Changes of Aging .. 73 Psycho-Social Aspects of 76 Frequently Seen Health Conditions of Adults Who are Elderly and/or Disabled . 77 DISABILITIES .. 81 Understanding Disabilities .. 81 Overcoming Myths and Stereotypes .. 81 Overview of Disabilities .. 83 COGNITIVE CHANGES IN OLDER 86 DEMENTIA AND ALZHEIMER S DISEASE .. 88 ADDICTIONS AND OLDER ADULTS .. 90 Substance Abuse .. 90 Gambling.

7 92 COMMUNICATION .. 93 The Communication Process .. 93 Why Communication Skills Are So 93 Common Barriers to Communication .. 94 Useful Communication 95 Communication with Clients with Impairments .. 98 Guide to Wheelchair 100 CULTURE .. 101 Culturally Sensitive case 101 Different Cultures in Arizona .. 103 END OF LIFE 109 Advance 109 Palliative Care .. 110 Hospice 110 The Dying Process .. 110 Emotional Issues .. 111 Cultural and Religious Issues .. 112 SAFETY AND EMERGENCY 113 Fall Prevention, Home Safety Assessment and Home Modification .. 113 Emergency Preparedness .. 115 Safety for case Managers and Service Staff .. 117 Arizona case Management Handbook 6 4.

8 SCOPE OF WORK: case Management ..119 SAMPLE: ELDERLY AND DISABLED case Management SERVICE PLAN ..123 FALL PREVENTION AND HOME MODIFICATION ADDITIONAL RESOURCES ..127 EMERGENCY PREPAREDNESS ADDITIONAL Arizona case Management Handbook 7 1. PART ONE: ADMINISTRATION OF SERVICES AGING AND LONG-TERM CARE SERVICES Aging services have a specified organizational structure at the federal, state, and local level. This structure is established through the Older Americans Act of 1965, which authorizes and funds many of the home and community-based services. The aging network is also an important component of the state s long-term care system. Other programs, such as behavioral health and services for individuals with a developmental disability are part of long-term care, along with the state s Medicaid program.

9 This chapter describes the aging network and the long-term care system, programs and services, funding streams, and initiatives to help coordinate services across programs. THE OLDER AMERICANS ACT (OAA)1 The Older Americans Act (OAA) was signed into law in 1965 to meet the diverse needs of the growing number of older individuals in the United States. It was last amended in 2006. The OAA provides the foundation for encouraging, organizing, and coordinating the development or enhancement of comprehensive and coordinated community-based systems. The OAA has seven parts (titles): Title I: Declaration of Objectives and Definitions Introduces the purposes and goals on which the OAA s policies and programs are based.

10 It provides a statement of our nation s commitment to assuring the well-being of older persons. Title I also includes definitions and the major objectives of the Act: 1. An adequate income in retirement. 2. The best possible physical and mental health -without regard to economic status. 3. Obtaining and maintaining suitable housing available at costs older citizens can afford. 4. Full restorative services for those who require institutional care, and a comprehensive array of community-based long-term care services - including support to family members. 5. Opportunity for employment. 6. Retirement in health, honor, dignity. 7. Participating in and contributing to meaningful activity.