Aging Services Access Points:
Boston Senior Home Care
The April 2009 CRC Information Session featured guest speakers Katie Bolin, Outreach and Marketing Coordinator and Patricia Burke, Intake Manager from Boston Senior Home Care.
Aging Service Access Points (ASAPs)
There are 27 statewide Aging Service Access Points that provide support services to the over 60 population or younger individuals with chronic disabilities who meet income guidelines and require assistance with daily living needs to maintain independent community living. Services of these organizations are designed to keep at-need individuals within their community while encouraging continued independence through coordinated services rather than institutionalization. To locate an ASAP: www.800AGEINFO.com/map
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Boston Senior Home Care (BSHC)
Boston Senior Home Care is one of three ASAPs that serve the neighborhoods of Boston. BSHC core service area includes: East Boston, Charlestown, North End, Beacon Hill, Chinatown, West End, South Boston, Dorchester, and Mattapan.
Services and Intake Procedure
Initial Intake is done via telephone through the regional ASAP and can be completed by a medical professional, a family member, or the individual themselves. BSHC staff suggests that the person referring have as much detailed information about the client as possible. An intake case manager completes an intense in-home assessment, which takes into account the client’s home environment, functional limitations, and finances to determine service eligibility. For more general program questions Boston ElderINFO (617-292-6211), a free information and referral hotline, is a good resource for potential new-clients, family members, or staff interested in learning about services.
Boston ElderINFO provides the intake services for all three of Boston’s ASAPs and Chelsea, Revere, Winthrop (CRW) home care.
Eligibility
Eligibility varies by program and is dependent upon meeting “critical need” criteria; some programs require that a client have several impairments in addition to a critical need for services. Also as a general rule ASAP services are for low-to moderate income individuals who cannot remain safely in the community without supports. The Massachusetts Executive Office of Elder Affairs establishes income guidelines and cost-sharing for elders who receive home care services. More specifically, the MassHealth income guidelines for seniors, disabled adults, and waivered individuals (final column on second page) are listed at http://www.masslegalservices.org/system/files/library/2016%20FPL%20MLRI%20MassHealth%20Income%20Chart_0.pdf
Payment
Some, but not all, programs require MassHealth or Medicare insurance for agency reimbursement reasons. Most home care payment schedules are a cost-share based on an individual’s income (rather than the number of services) and range from $4 to $105 a month, although some elders’ income is so low that they do not have to share the cost. Additionally, there may be waivers for individuals who are slightly above the income guidelines. Even if an elder is slightly above the income guidelines, it is best to call and inquire about services. For example, if an elder is over-income for home care services and receives care from a family member, they might be eligible for caregiver monetary support.
BSHC Programs
Home Care Basic, ECOP and Community Choices are listed here in order from least to most extensive services.
Home Care Basic
The main program of BSHC is Home Care Basic, which can combine a variety of services as needed to keep an individual safely in his/her home. Such services could include home delivered meals, home making, personal emergency response systems, personal care, transportation, grocery shopping, day care, and home health services. A typical non-MassHealth eligible member might be eligible for personal care 3-4 times a week and a day care program a couple of times a week. For a more complete list: https://bostonseniorhomecare.info/#
Enhanced Community Options Program (ECOP)
The ECOP program is another type of home care available to those clients who require a more substantial care plan than the regular home care program. Eligibility for this expanded program includes that an elder be medically eligible for nursing home facility level of care in addition to basic eligibility for home care. A regular non-MassHealth member in the ECOP program might be eligible for daily home care and daily adult day health. For more information: http://bostonseniorhomecare.info/programs/enchancedcommunity.html
Community Choices (Choices)
The Community Choices program specifically targets the frail elder population who, without a service plan, would not be able to be discharged from a nursing facility due to their complex health condition or cognitive impairment. The program goal is to provide community-based services to elders at a significantly reduced cost than a nursing facility. Under this program they can offer significantly higher services than under ECOP, such that they might be able to provide extensive services throughout the day Elders must be MassHealth members and meet clinical criteria for enrollment. For more information: http://bostonseniorhomecare.info/programs/choicesprogram.html
Home Power (Group Adult Foster Care)
Home Power is a Boston Partners in Care program (a joint venture of Boston Senior Home Care and the Visiting Nurses Association of Boston). It is also known as a Group Adult Foster Care (GAFC) program. Home Power services make it possible for disabled individuals aged 22 and over, including seniors, who live in an assisted living residence or specially designated public or subsidized housing to continue living safely at home. For more information: http://bostonseniorhomecare.info/programs/groupadultfoster.html
Share Living (Assisted Foster Care)
This program, similar to the MGH “Family Care” program, is for adults who need daily help with personal care but want to live in a family setting rather than in a nursing home or other facility. The caregiver provides meals, companionship, personal care assistance, and 24-hour supervision. MassHealth compensates the caregiver for providing care to MassHealth members who otherwise would need institutional care. The trained caregiver can be a family member, but excludes legally-responsible relatives. For more information: http://bostonseniorhomecare.info/programs/adultfostercare.html
Senior Care Options (SCO) is an insurance program for dually eligible Medicare and Medicaid patients, 65 years of age or older. In addition to health care benefits, members can receive Home Care Services through Boston Senior Home Care. A team of health professionals develops a plan to total individualized care for each client. Services are provided by a network of medical and other professionals (including a primary care doctor, nurses, specialists, and a geriatric social support coordinator). For more information: http://www.bostonseniorhomecare.info/programs/seniorcareoptions.html
Supportive Housing
Supportive Housing is a combination of affordable housing and social support that allows individuals to live independent lives. Boston Senior Home Care co-manages one program at Codman Apartments located at 784 Washington Street in Dorchester, and is co-piloting a second program at Blackstone Apartments located at 33 Blossom Street in Beacon Hill. A benefit of the supportive housing program is that elders are not only engaged in a community, but are also followed by a supportive team of health professionals (the Visiting Nurses Association at the Codman Apartments and MGH Senior HealthWise at the Blackstone Apartments). For more information: http://bostonseniorhomecare.info/programs/supportivehousing.html
Boston ElderINFO (BEI)
As an information and referral center, BEI offers free guidance to any elder, persons with disabilities, caregivers, professionals, family members, or friends on services offered through ASAPS or resources in the community. Additionally, BEI is planning to partner with Boston Center for Independent Living to make the referral process seamless for individuals seeking independent living support.
Free Help Line: 617-292-6211
Caregiver Alliance
The Caregiver Alliance program provides guidance with all aspects of care planning through the assistance of a care advisor who is educated in caregiver resources and eldercare services. The Caregiver Alliance is a collaboration among Boston Senior Home Care, Boston Commission on Affairs of the Elderly, Central Boston Elder Services, Chelsea-Revere-Winthrop Elder Services, and Ethos. Although mainly servicing Suffolk County residents, anyone is welcome to call for assistance. For more information contact: Damon Syphers at 617-443-4370 or at dsyphers@bshcinfo.org
Questions
Will an intake case manager do an in-home visit to simply go over programs?
Yes, a case manager will do a home-visit to explain programs assuming that they have some information supporting that the individual will most likely be eligible for some type of service.
How long does it take from the first intake phone call until a home-visit is conducted and services are put in place?
Guidelines for case mangers state that an individual should be contacted within 1 day of the case manager receiving the assigned intake to schedule an in-home assessment. Dependent upon the schedule of the potential client, an in-home assessment should occur within 3 days of the case manager’s contact and services should start no longer than 5 days after the assessment has been completed. Some services are faster to put in place than others, for example home delivered meals typically only take one day, whereas home-making can take longer because an outside agency must be contacted. Along the same lines, coordinating personal care takes additional time as a second assessment with a nurse is required.
Are there any programs that assist with Transportation?
Typically BSHC refers out to other community resources for transportation. Case managers are educated in and will assist with applications to programs such as the MBTA’s The RIDE program, MassHealth PT-1, and local senior shuttles. On a case-by case basis BSHC has been able to assist with payment for taxis while applications for other transportation programs are under review. Last, under the ECOP program, transportation to “life-sustaining” treatment such as dialysis may be available.
Can an intake assessment be started while a patient is receiving in-home personal care from a VNA-certified health care agency?
The assessment can be completed and services put in place as long as there is no overlap in services.
For persons with home-delivered meals, do doctors need to write a prescription for dietary restrictions?
No, not necessarily. BSHC will coordinate specialty meals through their many contracts with vendors who offer special dietary meals and ethnic meals.
What are the details of BSHC’s Respite Care service?
At the in-home assessment there is a question inquiring if the caregiver needs respite, if answered yes that will be considered the Critical Need (having a critical need AND at least 6 impairments are part of the eligibility criteria). Then, the case manager will use the assessment to determine what program/services the elder is eligible for and those services will provide “respite” for the caregiver. (i.e. , Authorizing home delivered meals so the daughter does not need to go to her mother’s home on her lunch hour to prepare lunch)
BSHC has a service, Respite Bed, which provides a short-term stay while the caregiver is not available (vacation, illness). It is time limited and the elder MUST be an open homecare client. As you can imagine this is an expensive service and is limited to the availability of a bed. BSHC contracts with two facilities for this service.
Prior to authorization, BSHC exhaustively explores other potential arrangements and payment options (insurance). If Respite Bed is the decided choice, BSHC then creates a contract with the caregiver and facility regarding length of stay, and that BSHC would only be responsible for room and board (i.e., if the elder needs to see a physician then would need to bill insurance).
In short, last minute requests for a respite bed would be rather challenging if not unlikely.
-Thanks toKatie Bolin and Patricia Burke for their presentation and help with this article.
4/09