Agora: Some standards to consider
Agora: Some standards to consider
As in ancient Greece, this Agora is both a marketplace and forum for the free exchange of ideas
Editor’s note: Based on the conversations we’ve had over the past few months on the need to standardize private duty care, we’ve gathered enough feedback to propose a draft version of some basic standards for private duty services. The following draft is adapted from standards developed by U.S. Care Inc., a California-based long-term care corporation, for evaluating the quality of nursing homes. We’d like you to review them and let us know how they can be improved, enhanced, or modified.
The following draft protocols were developed by Sam Kaplan, founder and chairman of the board of U.S. Care Inc.:
"Based on these protocols, we rate nursing homes from A through F, and then reimburse them based on the rating they receive," says Kaplan. "A nursing home that rates a D or an F is going to get a heck of a lot lower reimbursement than a B or C. There aren’t many A’s out there. We’ve also just completed protocols on assisted living facilities, which have some of the same definition and lack of standardization problems that private duty home care has."
Think long term
U.S. Care has also developed a provider partnership program that emphasizes long-term contracts (10 years or longer) and a proprietary index that employs patient satisfaction, administrative performance, and clinical indicators derived from on-site visits and regularly submitted data sets. On-site visits involve reviewing all three shifts to measure any degradation in quality and service, a practice that should also be involved in evaluating private duty home care.
When Kaplan convened the Quality Standards Council in 1990, it sparked a new approach to long-term care. This council was chartered to establish tools to enhance the quality of life for all patients suffering from functional disabilities. The council is a multidisciplined group committed to standardizing data sets and assessment tools. Its results have become the cornerstone for quality assessment methods linked to provider rewards and reimbursement. What follows is also the general outline now being considered by the Quality Standards Council for auditing home health agencies. Please note that agency operating practices have been addressed while quality measurement methods are in development.
Draft For Proposed Standards
Organization & Administration
• The organization is an established entity with the legal authority to operate.
• The organization is directed by a governing body responsible for policy-making, management, and accountability.
• There is a designated individual responsible for operating the organization in accordance with all applicable laws and regulations.
• The organizational structure is such that responsibility and accountability for programs are clearly defined.
• There are policies and procedures regarding confidentiality of client information.
• The stated purposes and goal for in-home services are consistent with the mission of the organization.
• The organization complies with all federal, state, and local laws and regulations.
Program/Service Management
• Written descriptions of specific services provided by the program are available to staff, clients, and the community.
• There are written eligibility criteria for the acceptance of clients.
• There are established procedures for dealing with client needs that can’t be met within the parameters of service definitions or the organization’s resources.
• The organization coordinates planning and service delivery efforts with other community agencies.
Personnel
• Written personnel policies and procedures are utilized.
• Qualified individuals are employed in all positions in relation to the delivery of in-house services.
• The organization assures that all employees receive orientation.
• All in-home service staff are supervised by qualified personnel.
• All in-home service staff are evaluated by qualified personnel.
• Fiscal policies and procedures consistent with sound business practices are followed.
• There is an annual budget that includes all projected revenues and expenses.
• There are established rates for all in-home services and procedures for clearly conveying rates to others.
• Written contracts/agreements govern the components of in-home services that are either purchased or sold to another entity resulting in shared responsibility for services.
Client Care Coordination
• An accurate client record is maintained for each in-home service client.
• A client bill of rights is distributed to each recipient of in-home services.
• The program has written policies/procedures relating to advanced care directives.
• Initial and periodic assessments of the need for in-home services are conducted.
• There is a written plan of care and documentation of services for each client.
• There is a designated client care coordinator/case manager for each client.
• There is coordination and communication whenever clients are receiving services from more than one employee or more than one organization.
• The agency has written policies/procedures relating to reporting of suspected abuse or neglect of clients.
Quality/Assessment/Evaluation
• There is an annual quality assessment plan that includes all in-home services.
• Information gained from the quality assessment activities is utilized by the organization.
• Results of quality assessment activities are reported to the governing body.
(Editor’s Note: As an adjunct to the standards above, Private Duty Homecare also wants to develop an accurate and correct list of which states currently require licensing of supportive care services that are paid for privately by the individual or by long-term care insurance. The lists PDH consulting editor Judy Clinco has reviewed thus far are inaccurate. Subscribers are encouraged to e-mail their information to editor Julie Crawshaw at [email protected].)
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