DAR File No. 28190

Human Services, Aging and Adult Services

R510-401

Utah Caregiver Support Program

NOTICE OF PROPOSED RULE

DAR File No.: 28190
Filed: 09/01/2005, 09:14
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

The change clarifies some provisions in the current rule, increases the authority of the Area Agencies on Aging to waive certain expenditure limitations without approval of the Division, and adds an additional acceptable use for certain funds used to augment care giver supportive services.

Summary of the rule or change:

The change will permit the Area Agencies to exceed certain expenditure limitations without approval of the Division of Aging and Adult Services, provides authority to the Division to annually establish expenditure limitations, clarifies some of the provisions of the current rule and expands upon definition of supplemental services to increase flexible nature of the program

State statutory or constitutional authorization for this rule:

Subsection 62A-3-104(5) and 63A-3-104(4)

Anticipated cost or savings to:

the state budget:

It is anticipated that the changes will not affect the overall cost of the program. While certain expenditure limits can be waived by Area Agencies on Aging, past instances of waivers have been few and each Area Agency on Aging is limited as to their total expenditures. The care giver support program does not establish an entitlement to services.

local governments:

The program is funded with federal and state funds. No local funds are required nor is an entitlement established. Therefore, there are no costs or savings to local government.

other persons:

All funding for the program is provided with federal and state funds. The rule does not require recipients of service to contribute to the cost of the program.

Compliance costs for affected persons:

Compliance costs are included in the ongoing appropriation of the Division of Aging and Adult Services. The rule does not increase compliance activities.

Comments by the department head on the fiscal impact the rule may have on businesses:

No fiscal impact is projected since the changes reflect clarification and redefinition of compliance requirements that have been discussed at length with the affected Area Agencies on Aging. Lisa Michelle Church, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Direct questions regarding this rule to:

Mike Bednarek or Sheldon Elman at the above address, by phone at 801-538-3922 or 801-538-3921, by FAX at 801-538-4395 or 801-538-4395, or by Internet E-mail at mjbednarek@utah.gov or selman@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

10/17/2005

This rule may become effective on:

10/18/2005

Authorized by:

Lisa-Michele Church, Executive Director

RULE TEXT

R510. Human Services, Aging and Adult Services.

R510-401. Utah Caregiver Support Program (UCSP).

R510-401-2. Definitions.

(1) "Adult" means an individual who is 18 years of age or older.

(2) "Agency or Area Agency on Aging (AAA)" means the agency designated by the Division of Aging and Adult Services (DAAS) to coordinate and provide services for a defined geographical area.

(3) "Agency Director" means the director of the Agency.

(4) "Caregiver or Family Caregiver" means an adult family member, or another adult individual, who is an informal provider of in-home and community care to an older individual who is:

(a) 60 years of age or older; or is a

(b) caregiver 60 years of age or older who is caring for persons with mental retardation or related developmental disabilities; or is a

(c) grandparent or older individual who is a relative caregiver of a child not more than 18 years of age.

This definition excludes agency and privately-paid supportive service providers.

(5) "Care Receiver" means an adult 60 years of age or older who receives assistance from, or is dependent upon, another for care and is:

(a) unable to perform at least two activities of daily living without substantial human assistance, including verbal reminding, physical cueing, or supervision; or

(b) due to a cognitive or other mental impairment, requires substantial supervision.

(6) "Companion Services" means non-medical, basic supervisory services which are provided to the eligible care receiver in his home on a short-term, intermittent basis. Companion Services provide respite to a caregiver who is caring for eligible care receivers who do not require any personal care assistance, medical assistance, or housekeeping services during the time when companion services are provided.

(7) "Child" means an individual who is not more than 18 years of age.

(8) "Counseling, Support Groups, or Caregiver Training" means provision of advice, guidance, and education about options and methods of caregiving to provide support to caregivers in an individual or group setting.

(9) "Director" means the director of the Division of Aging and Adult Services (DAAS), Utah Department of Human Services).

(10) "Division" means the Division of Aging and Adult Services (DAAS), Utah Department of Human Services.

(11) "Formal Resources" means an entity or individual that provides services for a fee or reimbursement.

(12) "Grandparent or Older Individual who is a Relative Caregiver" means a grandparent or step-grandparent of a child, or a relative of a child by blood or marriage, who is 60 years of age or older and:

(a) lives with the child;

(b) is the primary caregiver of the child because the biological or adoptive parents are unable or unwilling to serve as the primary caregiver of the child; and,

(c) has a legal relationship to the child, such as legal custody or guardianship, or is raising the child informally.

(13) "Informal Resources" means family, friends, neighbors, community organizations or others who offer resources and support and are not assigned by formal agencies or organizations, irrespective of any payment received.

(14) "Multifaceted Systems" means a variety of systems of support for the caregiver including but not limited to those described in the required five service categories of the (NFCSP), Title IIIE of the Older Americans Act, as amended in 2000.

(15) "National Family Caregiver Support Program or NFCSP" is the federal program enacted as P. L. 106-501, Title IIIE of the Older Americans Act, P. L. 89-73, 42 USC Section 3001 et seq., as amended in 2000.

(16) "Relief" means ease from or lessening of discomfort, anxiety, fear, stress, or burden.

(1[9]7) "Respite or Respite Care" is [considered to be ]temporary, substitute supports or living arrangements to provide a brief period of relief or rest for caregivers as outlined in the service plan developed by a case manager following a formal assessment. It can be in the form of in-home respite, adult day care respite, or institutional respite for an overnight stay on an intermittent, occasional, or emergency basis. Respite can be provided for a caregiver for no more than 12 consecutive months from the date of enrollment and shall not exceed [$1,500 for that time period]the annual service expenditure limit per client, as established by the Division in consultation the Area Agencies on Aging annually. If either condition is met, the client must come off of the program and then may reapply on the anniversary of the start of services. Temporary respite may not be provided by the twenty percent (20%) maximum supplemental services funds.

(1[7]8) "Service Plan" means a written plan which contains a description of the needs of the caregiver, the care recipient, and the services and goals necessary to meet those needs.

(1[8]9) "Supplemental Services" means other services to complement the care of caregivers, on a limited basis as determined by a case manager through the assessment process and included in a service plan. Supplemental services shall serve to maximize the support of caregivers and shall be flexible, adaptable, and responsive to the needs of the individual caregiver or care receiver [where ever]wherever they reside in the State of Utah. Services provided under supplemental services shall not fall into other categories defined in the UCSP or the NFCSP.

Expenditures for Supplemental Services are not included in the annual established service expenditure limit for Respite.

Necessity for supplemental services shall be specified in the service plan goals. Reimbursement shall include the purchase and/or rental, installation, removal, replacement, or repair of approved items or services for the twelve months that the client is on the program. The case manager will document in the client file all funding resources explored and reasons alternative funding cannot be accessed. Items or services exceeding $250 per purchase must be prior approved by the Agency Director based on a formal written request by the [C]case [M]manager or designee documenting the determination of need and estimated cost. A copy of said approved waiver request will be sent to the Division. A copy will be placed by the Agency in the client file.

(a) "Supplies or Equipment" means durable and non-durable goods purchased and/or rented under supplemental services to provide support and assistance to caregivers in their caregiving responsibilities. Reimbursement shall include the purchase of supplies, and the purchase, and/or rental, installation, removal, replacement or repair of approved equipment.

(b) "Modifications or durable adaptive aids and devices" purchased as supplemental services shall be one-time purchases to provide support and assistance to caregivers in their caregiving responsibilities. Minor modifications of homes shall facilitate the ability of older individuals to remain at home or provide for the safety of the care receiver. Adaptive aids and devices shall assist the caregivers helping care receivers to perform normal living activities, and shall include the cost of any necessary installation fitting, adjustment, repair, and training. Adaptive aids and devices may be fabricated by a professional if the care receiver needs specialized aids and devices.

(c) "Legal, Financial, or Placement Services" purchased as supplemental services shall provide support and assistance to caregivers in their caregiving responsibilities. Services will provide the caregiver with legal, financial, and placement advice, counseling, and representation by an attorney, certified financial advisor, or other person acting under the supervision of an attorney, certified financial advisor, or placement professional.

(d) "Miscellaneous" services shall provide support and assistance to caregivers in their caregiving responsibilities. Miscellaneous services will facilitate the ability to provide services to caregivers that arise from unusual circumstances and shall assist the caregiver in performing their caregiving responsibilities.

([19]20) "Waiver" means an intentional release in writing by the Agency Director or designee[Division], as authorized in the rules, from a program limitation or criterion included in these rules.

R510-401-3. Eligibility for Services.

(1) Services listed in Section R510-401-5 are available to caregivers, grandparents and older individuals who are relative caregivers.

(2) Respite care and Supplemental Services are available to caregivers who are:

(a) caregivers of adults 60 years of age or older

(b) caregivers 60 years of age or older caring for persons with mental retardation or related developmental disabilities; or are

(c) grandparents or older individuals who are a relative caregiver of a child not more than 18 years of age.

(3) To provide respite and supplemental services to caregivers of adults 60 years of age or older, the care receiver must be functionally impaired because the individual is unable to perform at least two activities of daily living without substantial human assistance, including verbal reminding, physical [caring]cueing or supervision[.]; or due to a cognitive or other mental impairment, requires substantial supervision because the individual behaves in a manner that poses a serious health or safety hazard to the individual or to another individual. The caregiver must demonstrate a medium-to-high risk score according to the DAAS Approved Demographic Intake and Screening tool and complete the DAAS-approved Assessment and DAAS-approved Burden score.

(4) [The DAAS-approved assessment tool shall be completed to establish eligibility for Respite and Supplemental Services as stated in Section R510-401-5(3).]In the event that there is insufficient funds to bring an individual on the program the Agency shall maintain a list of potential applicants. All potential applicants will be served in turn by using the DAAS-approved Demographic Intake and Risk Screening tool, and a Caregiver Burden score to determine eligibility for services.

R510-401-5. Program Content.

(1) Each Area Agency on Aging shall provide a multifaceted system of caregiver support services for caregivers and, if funded, for grandparents or older individuals who are relative caregiversto include:

(a) information to caregivers about available services;

(b) individual, one-on-one assistance to caregivers in gaining access to services in the form of information and assistance or case management. Assistance may include but is not limited to such activities as phone contactand home visits;

(c) individual counseling, support groups, and caregiver training to assist the caregivers in making decisions and solving problems relating to their caregiving roles;

(d) respite care to enable caregivers to be temporarily relieved from their caregiving responsibilities; and

(e) supplemental services, on a limited basis, to complement the care provided by caregivers.

(2) The Area Agency on Aging shall use the DAAS-approved Demographic Intake and Risk Screening form and assessment tool to determine eligibility for respite and supplemental services and said tools shall be kept in the client file.

(3) Prior to receiving respite or supplemental services the Area Agency on Aging shall develop a written service plan including goals and objectives for the caregiver, which shall be kept in the client file.

(4) The Area Agency on Aging shall ensure the provision of the full range of caregiver support services in the community by coordinating its activities with the activities of other community agencies and voluntary organizations providing supportive services to family caregivers and, if funded, grandparents or older individuals who are relative caregivers of children.

(5) Older Americans Act information and services shall be provided to family caregivers in a direct and helpful manner. In cases where caregiver support programs already exist within the community, coordination of these programs and the UCSP is essential to maximize the dollars available for family caregivers and avoid duplication of services.

(6) To assure coordination of caregiver services in the planning and service area, the Area Agency on Aging shall convene a minimum of one joint planning meeting annually with other local providers who currently provide support services to family caregivers. As practical, the Area Agency on Aging shall coordinate the activities under this program with other community agencies and voluntary organizations providing services to caregivers.

(7) Funds allocated on an annual basis under the UCSP for services provided by an Area Agency on Aging shall be expended as follows:

(a) Information to caregivers about available services: the Area Agency on Aging may not use less than three percent of the funds allocated under the UCSP to provide these services.

(b) Assistance to caregivers in gaining access to the services: the Area Agency on Aging may not use less than five percent of the funds allocated under the UCSP to provide these services.

(c) Individual counseling, organization of support groups, and caregiver training to caregivers to assist the caregivers in making decisions and solving problems relating to their caregiving roles: The Area Agency on Aging may not use less than five percent of the funds allocated under the UCSP to provide these services.

(d) Respite care to enable caregivers to be temporarily relieved from their caregiving responsibilities: The Area Agency on Aging may not use less than five percent of the funds allocated under the UCSP to provide these services.

(e) Supplemental services, on a limited basis, to complement the care provided by caregivers: The Area Agency on Aging may not use more than twenty percent of the funds allocated under the UCSP to provide these services.

(f) The Area Agency on Aging shall spend no more than [10%]ten percent of funds on services provided to grandparents and other individuals who are relative caregivers of children.

If a customer discontinues respite and/or supplemental services before the end of the twelve-month period and before the annual established service expenditure limit per client is reached, the case shall be closed. The caregiver may then reapply subsequent to the case closing but shall do so within twelve months from the original date of enrollment.

R510-401-6. Caregiver Advisory Council.

(1) The Area Agency on Aging shall develop and maintain a Caregiver Advisory Council.

(2) The Caregiver Advisory Council may be a subgroup of the Area Agency on Aging Advisory Council providing they meet the requirements set forth in the rule.

(a) The Caregiver Advisory Council [shall]may be comprised of no less than five members, some of whom [the majority ]shall be caregivers.

(3) The Caregiver Advisory Council shall meet no less than semiannually, and meetings shall be scheduled by each Area Agency on Aging.

(4) The duties of the Caregiver Advisory Council shall include but not be limited to conducting an annual client satisfaction survey for the caregiver program.

(5) The Caregiver Advisory Council shall advise the Area Agency on Aging in determining service needs and developing action plans. When there is a concern over the use of limited resources for Respite Care and Supplemental Services, the Area Agencies on Aging, in consultation with their Caregiver Advisory Council, may further limit the amount of services provided to an individual caregiver. This local policy decision shall be in writing and shall be uniform for all caregivers for the current fiscal year.

(6) The Area Agency on Aging shall be responsible for developing orientations for Caregiver Advisory Councils on caregiver issues and responding to community needs.

R510-401-10. Waiver for Respite and Supplemental Services.

An Area Agency on Aging may request in writing a waiver for Respite and Supplemental Services in order to enable the caregiver to carry out their duties in assisting the care receiver. In requesting a waiver, the Area Agency on Aging must demonstrate that effort has been made to access other sources of services or funds. The Agency Director may grant a waiver for Supplemental Services or Respite on a case-by-case basis provided that such waiver is consistent with the law. A copy of the approved waiver request must be placed in the client file and a copy sent in writing to the Division.[

R510-401-11. Waiver for Respite Services.

An Area Agency on Aging may request a waiver for Respite Services to enable the caregiver to carry out their duties in assisting the care receiver. In requesting a waiver, the Area Agency on Aging must demonstrate that effort has been made to access other sources of services or funds. The Division and the Agency Director may grant a waiver for Respite Services on a case-by-case basis provided such waiver is consistent with the law. This waiver request must be in writing to the Division. If the Agency Director approves the request, the approved written request is submitted to the Division for either approval or denial. The Division has ten working days to respond. The decision of the Division becomes the final decision.]

KEY: caregiver, care receiver, elderly, respite

[April 16, 2003]2005

Notice of Continuation June 22, 2005

63A-3-104(4)

62A-3-104(5)

ADDITIONAL INFORMATION

PLEASE NOTE:

• Text to be deleted is struck through and surrounded by brackets (e.g., [example]). Text to be added is underlined (e.g., example). Some browsers may not depict some or any of these attributes on the screen or when the document is printed.
• Please see the DISCLAIMER regarding information available from state web pages.

For questions regarding the content or application of this rule, please contact Mike Bednarek or Sheldon Elman at the above address, by phone at 801-538-3922 or 801-538-3921, by FAX at 801-538-4395 or 801-538-4395, or by Internet E-mail at mjbednarek@utah.gov or selman@utah.gov

For questions about the rulemaking process, please contact the Division of Administrative Rules (801-538-3764). Please Note: The Division of Administrative Rules is NOT able to answer questions about the content or application of these administrative rules.