Case Studies of Six State Personal Assistance Service Programs Funded by the Medicaid Personal Care Option. V. Support Services Available


A. Attendant Management

1. Attendant Recruitment

West Mont usually does this, although they actively encourage the consumer to recruit their own attendants and refer them to West Mont for hiring and training. The general impression among advocates and providers was that this did not occur very frequently. Consumer choice of attendants is therefore usually limited to the current attendant pool.

2. Attendant Screening

West Mont does an initial screening of applicants.

3. Attendant Interviewing

West Mont does all hiring procedures.

4. Attendant Certification

There is no certification required, although there was some talk of requiring attendant certification in the future.

5. Attendant Hiring

West Mont does all hiring procedures.

6. Attendant Training

An initial 16 hour training is required, but can be waived if the attendant is a certified Home Health Aide or LPN. The training includes orientation to the agency/community services, body mechanics/transfer/assisting patient mobility, personal care skills, care of home/personal belongings, safety/accident prevention, food/nutrition/meal preparation, and health oriented record keeping, including time records. West Mont may also set up one to one training with the consumer in order to learn techniques specific to that individual. Some attendants felt that more of this type of on the job training would be useful. This training requirement is apparently in conflict with the staffing demands in some of the local offices; training occurs on a regular schedule (e.g. monthly) but turnover occurs all the time, so attendants may end up working before they receive training if the nurse supervisor considers them competent.

An additional 8 hours of in-service training are required each year. Four hours are a review of the 16 hour training, and another 4 are in topic specific modules offered throughout the year, e.g., AIDS, death and dying, diabetes, etc.

7. Attendant Supervision

The nurse supervisor is required to make sure the plan of care is being followed. According to nurse supervisors, some informal monitoring may occur among attendants, i.e., since several attendants usually serve each recipient, they can tell whether the attendant who came in before them did the tasks required.

8. Attendant Payment

Attendants are paid an hourly wage and mileage reimbursement by West Mont.

9. Attendant Termination

West Mont is responsible for attendant termination.

10. Conflict Resolution

Recipients can contact the scheduler or nurse supervisor if there is a problem, and West Mont administrators stressed their willingness to respond to consumer complaints. In practice, some advocates say the Tole of West Mont as the single source of attendant services creates a power dynamic where consumers are afraid of "rocking the boat" by complaining about their attendants. The DSRS has a formal appeal process if the recipient is unable to resolve the conflict with agency staff.

B. Consumer Support

1. Consumer Advocacy

There is no formal mechanism for consumer advocacy outside the West Mont and DSRS system, although independent living centers provide advocacy and peer support in some areas. If services are terminated, a detailed explanation is provided for the discharge which also outlines options for appeal. Services are continued throughout the appeal process.

2. Consumer Training

No consumer training is offered.

3. Consumer Outreach

West Mont does some outreach to different professional groups to inform them of the services available.

4. Quality Monitoring

There is a bi-annual state compliance review of West Mont which looks at components mandated by the program, i.e. medical supervision, assessment, training, maintaining attendant pools, billing procedures. West Mont also conducts quarterly interviews with a small subset of service recipients to assess satisfaction level.

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