EXECUTIVE OFFICE OF ELDER AFFAIRS: COMMUNITY BASED SERVICES
At the March 2007 CRC Information Session Erin Kelley of the Executive Office of Elder Affairs spoke on community based services available for elders and their families through the Aging Services Access Points (ASAPs).
Jump to desired section:
Overview of ASAPs
Family Caregiver Support Program
Home Care Services- Basic
Home Care Services- Enhanced:
Enhanced Adult Family Care
Additional Executive Office of Elder Affairs Programs (EOEA):
- Ombudsmen -Assisted Living and Nursing Home
- SHINE- Serving Health Information Needs of Elders (insurance advocacy)
- EOEA Nutrition program
- Senior Community Service Employment Program
- Supportive Housing
The 27 local ASAPs throughout Massachusetts, formerly known as Home Care Corporations, provide home care services that enable elders to remain independent and in their homes longer, including: information and referral; interdisciplinary case management; monitoring of service plans; reassessment of needs; clinical screenings for MassHealth programs; and Protective Services.ASAP Case Managers are responsible for authorizing and coordinating necessary home care services for eligible elders to assist them with activities of daily living (ADLs) and instrumental activities of daily living. Home Care programs include an extensive list of services such as adaptive housing; adult day health; bill payer services; chore, companion, or homemaker services; emergency shelter; therapies; transportation; and transitional services.
Clients must be residents of Massachusetts, 60 years or older and must be living in the community (rather than an institutional setting). Clients younger than 60 who have been diagnosed with Alzheimer’s disease or related dementias may receive respite services intended to assist their caregivers.
Financial eligibility: Assets are not counted. Elder individuals with incomes between $10,093 - $22,947, and couples with income from $13,532 - $32, 470 are financially eligible for the Massachusetts Home Care Program. If an elder is living with a family member or friend, other than their spouse, only the elder’s income is counted. Home Care Service packages allow for payment of services up to approximately $260 per month. The costs of services to the elder include co-payments from $7 - $135, except for MassHealth members or Frail Elder Waiver* clients (MassHealth standard member; income at or below 300% SSI), who receive services at no cost.
Clinical eligibility: To be clinically eligible for this program, individuals must require assistance with at least two ADLs OR 6-10 ADLs and/or IADLs (Instrumental Activities of Daily Living, i.e., meal prep, taking medicine). Frail Elder Waiver Clients must meet clinical eligibility for Nursing Facility services.
*What is the Frail Elder Waiver?
The Frail Elder Waiver program is part of MassHealth, designed to provide community based services to delay or prevent nursing home placement. When applying for the waiver, all applicants are considered as single individuals. The elder’s spouse's income and assets are not counted for MassHealth eligibility, which is actually greater protection than if applying for MassHealth for Long-Term Care.
Waiver Eligibility - the applicant must meet all of these criteria:
- Assessed by an ASAP RN as meeting the clinical eligibility criteria for nursing facility services
- 65 years of age, OR at least 60 years of age AND permanently and totally disabled
- Meet other requirements for MassHealth Standard coverage, and
- In need of and/or receiving a waiver program service (homemaker, home health aide, personal care, skilled nursing, transportation, chore service, companion, environmental accessibility adaptation, supportive day care, supportive home care aide, home delivered meals, grocery shopping, laundry, home based wandering response system, transitional assistance or respite).
Enhanced Community Options Program (ECOP)
This program is designed to offer increased assistance in the home to delay or prevent institutional placement. Individuals receiving services from ECOP may receive service packages costing approximately $600 per month. ECOP slots are limited, and are allocated from the ASAPs according to demonstrated need.
Financial eligibility: ECOP financial eligibility is the same as the Home Care program. Waiver clients are also eligible for the ECOP program.
Clinical eligibility: All clients must meet the clinical eligibility criteria for Nursing Facility services.
The Community Choices program is available only to Frail Elder Waiver Clients who also meet additional clinical eligibility criteria. Community Choices can provide the most extensive service packages, which are funded on a cost-reimbursement basis through the local ASAPs.
In addition to meeting the clinical eligibility criteria for Nursing Home care, the elder must meet ONE of the following criteria:
- have required nursing facility care within the last six months,
- have recently experienced a serious medical event, cognitive or physical regression,
- have been discharged from a nursing facility within the last thirty days,
- or is at risk for nursing facility admission.
AND the client must also have one or more of these clinical characteristics:
- need 24-hour health condition supervision
- experience a significant cognitive impairment,
- be unable to manage medications,
- experience frequent episodes of incontinence,
- or require assistance with multiple ADLs.
Massachusetts Family Caregiver Support Program
The Massachusetts Family Caregiver Support Program is designed to provide services for the elder’s family or primary caregiver. These services include access assistance; one-on-one caregiver assistance including help making decisions and problem solving; training and support groups; respite care options; and supplemental services on a limited basis, including subsidies for durable medical equipment, home modification, and personal care supplies.
While there are no financial eligibility requirements for this program, priority is given to caregivers with the greatest socio-economic needs. Clinically, priority is given to caregivers over 60 years old, older caregivers of individuals with Alzheimer’s Disease of any age, and grandparents or relatives over age 55 who are caring for a child related by blood, marriage, or adoption.
The Enhanced Adult Family Care program now allows certain family caregivers to receive payment for providing care that prevents or delays nursing facility care. The Enhanced Adult Family Care program not only allows elders and persons with disabilities to move into a caregiver’s home, but also allows a caregiver to move into the individual’s home. Participants must be 16 years or older and meet MassHealth financial and clinical eligibility standards. Caregivers may be any friend or family member other than a spouse, parent, or legally responsible relative (guardian) and must meet qualifications specified by the state.
Eligibility is also based on physical assistance requirements. The applicant must require physical assistance with:
- at least three of the following activities: bathing, dressing, toileting, transferring, ambulating, eating; OR,
- with two of the activities above AND management of behaviors that require caregiver intervention such as wandering, verbally abusive behavioral symptoms, physically abusive behavioral symptoms, socially inappropriate or disruptive behavioral symptoms, or resisting care.
-Adapted from “Enhanced Adult Family Care at MGH” – MGH Community News, January 2007.
Assisted Living and Nursing Home Ombudsmen: Both Assisted Living and Nursing Home Ombudsmen are available for assistance in picking an alternative living situation by providing complaint reports and other information on specific facilities.
SHINE: Similarly, the SHINE (Serving the Health Information Needs of Elders) program helps elders make decisions regarding health care coverage and prescription coverage. SHINE counselors also answer complex questions about Medicare, long term-care insurance, and public benefits.
The EOEA Nutrition Program: The EOEA Nutrition Program helps ensure elders receive at least one nutritious meal a day, provided through congregate meal sites and home-delivered meals throughout the state. This program is available to elders 60 years and old and their spouses, as well as to some younger disabled individuals.
Senior Community Service Employment Program: The SCSEP helps to employ individuals age 55 or older who have incomes lower than 125% federal poverty income guidelines, by placing them in temporary training assignments to help them gain the experiences necessary to gain work in the private sector. Participants are paid minimum wage and are placed at training sites for 20 hours per week. Seniors who participate in this program are enrolled in the One-Stop system, which assists with job training, resume assistance, and job searches.
Supportive Housing: To promote independence and aging in place, the EOEA also offers services to elders living in public housing that is similar to what they would receive in assisted living facilities. Home Care program eligible elders may receive some or all of the following services in senior housing at no additional cost:
- service coordination
- case management
- 24-hour personal care/on-site, on call
- homemaker services
- medication reminders
- social activities
- at least one meal per day
For additional information on any of programs and services, contact 800-AGE-INFO or visit www.800ageinfo.com, or contact the appropriate ASAP- in IRis under keywords: Inhomecare/StateFunded or Info/ASAP&AAA.
-Special thanks to Erin Kelley for her presentation and assistance in editing this article.
3/07