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Functional Needs Assessment Overview. June 2013. Why is this assessment required?. Federal Regulations require annual assessment of an individual’s need for services.
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Functional NeedsAssessment Overview June 2013
Why is this assessment required? • Federal Regulations require annual assessment of an individual’s need for services. • This requirement extends to existing state plan and waiver services. Oregon is required to adopt a functional needs assessment as part of the remediation of our last CMS audit findings, as well as for implementation of the “K Plan.” • Planned adoption of “K Plan” has necessitated an expedited timeline for implementation of a functional needs assessment tool and process.
Purpose of the Assessment • Assess the need for support (Medicaid services may be provided to meet assessed needs.) • Assessment gathers information about needs, preferences and goals and becomes an information source for service planning. (Medicaid requires that needs identified in the assessment must be addressed in the service plan.)
But, I heard this was going to be used for rate setting… • SIS and SNAP will continue to be used for rate setting in out of home placements. • FNAT will result in a determination of support needs and the services necessary to meet those needs for individuals living in their own or family home. • It will not set a funding amount. The funding authorized will depend upon the services chosen by the individual to meet the needs assessed in the FNAT. (This happens in service planning.)
Who conducts the assessment? • The functional needs assessment is completed by the “person centered plan coordinator” • A Personal Agent or Services Coordinator or DHS Case Manager (i.e. CIIS)
Who will be assessed? • All new individuals enrolled in case management at either a CDDP or Brokerage must have an assessment prior to authorizing services. • All currently enrolled individuals must have an assessment as part of the development of their next annual plan (before authorizing services under a renewed plan.). • Individuals may request assessment or re-assessment at any time. (Assessment must be completed within 45 days of the request.)
The Assessment Process • Must include a face-to-face assessment • Individual/guardian may determine how much they wish to participate (at a minimum, you must observe the individual) • Individual/guardian decides who else participates in an assessment interview • Must include a review of the individual’s file • May include information from other sources
Assessment Information sources • Assessment is not based only on interview response. Consider info from other sources such as observation, client file. • PA/SC must ASSESS the level of need based on their professional judgment. • In some cases, observation and documentation may result in an assessed level of need that differs from the support level reported in interview.
Planning an Assessment • Conduct the assessment in the person’s home whenever possible. Assessments may be conducted in an alternate location, such as the CDDP office, when necessary. • Unlike the SIS and SNAP, it is not necessary to convene a single “valid respondent group” for a single meeting. The individual/guardian chooses who participates and the PA/SC obtains additional information, as necessary. • Materials are being developed for individuals and family members to assist them in preparing for and understanding the assessment process. (These will probably not be available in time for July 1 implementation.)
Until participant training materials are available • DO inform individuals and participants of the purpose of the assessment • Explain the necessity of identifying the true amount of support needed • Make your best effort to communicate the intent of the questions in language the consumer and other participants can understand
Attempt to make the assessment an comfortable communication • It is not necessary for the PA/SC to read each item verbatim during the assessment. (However, a copy of the assessment tool should be made available to all participants.) • Guide a discussion with the individual/guardian and other participants to gather the information necessary to assess the specific support need defined in the section.
Assessment information will feed into service plan development When fully developed the assessment tool will include service planning tools: • Summary of support needs and narrative description of supports and preferences • Personal goals document that lists all personal goals identified during the assessment for discussion in service planning. • Risk document that identifies potential need for nursing assessment, protocol development, behavior support plan, etc.
This is the “Donut Tire” version • The initial version of the tool is not intended to be the final product. • Development of the Functional Needs Assessment will continue throughout (at least) the next calendar year. • This version needs to essentially work like the final version and fulfill the basic need • The final version will be easier to use, may have adjustments in questions where needed, produce service planning tools (and may whitewalls and steel treads…)
Prior to developing this tool, Oregon reviewed: • Our own existing assessments including goal surveys, rate tools, risk assessments and various program criteria tools • Need assessment tools from other states • CMS guidance on categories that will likely become “required elements” under future regulations
Considerations in tool selection: • Tool needs to cover all assessment categories required by CMS • Adaptable: a tool that Oregon can modify as programs grow and change • Resource issue: Time • Tool needs to be reasonable for completion with current case management resources; • Tool needs to not be an undue burden for individuals and families • Needs to be trainable in a short period of time • Electronic/online entry capability Oregon did not find a tool that completely met the need and chose to develop.
Oregon’s Functional Needs Assessment Tool • Built on the SNAP (Support Need Assessment Profile) platform • The majority of the tool sections are based on SNAP questions for which we have substantial experience. • Most other components are based on a combination of existing Oregon tools for which we have substantial usage history, either in DD or other DHS programs. • Some modifications have been made to adapt language to work for in-home and out-of-home service settings.
Stakeholder Involvement • The initial draft was prepared by a DHS team and shared with a stakeholder group in late May. • Adjustments were made to the overall format and some content based on stakeholder feedback. • Additional feedback is being sought as part of the testing process • Stakeholders will continue to meet and provide input to the tool development.
Support Areas the tool measures • Activities of Daily Living (ADLs) • Instrumental Activities of Daily Living (IADLs) • Medical/Health • Behavior and co-occurring issues that impact ADLs/IADLs or the manner in which support for ADLs/IADLs is provided. • Employment Supports
The FNAT electronic file Microsoft Excel file with multiple worksheets Data entry (no formulas or fancy function knowledge required) Note: Form be built into eXPRS (ODDS’ payment & reporting system) during the next year and then tool will be completed online.
Form layout • Instruction: defines what is included in the support need to be measured • Description: PA/SC enters a brief narrative re: how the activity is accomplished, including any supports • Frequency/Duration (if applicable) • Level of Support (Home & Community) • Preferences • Personal Goals • Acquisition, increase or maintenance of independence
ADL Section • Read the instruction for each topic. • Discuss/review how the activity happens in the person’s life. Be sure to ask if the need for support is different at home and in the community. • For most ADLs, you will need to know how often support is needed and how long support is needed. • If support is not needed all of time, or only for some aspect, measure the amount of time the person is receiving assistance, NOT the amount of time the activity takes. • Mark N/A if an individual is “independent” or the question does not apply (i.e. toileting, if the person does not use the toilet)
ADL Section - children • Score supports needed due to disability • Do not score support need that is essentially similar to a typically developing child, such as: • Incontinence or toileting assistance for a child 4 or younger • Feeding or altering food texture for a toddler or baby • Monitoring/cuing support for any ADL that is consistent with normal developmental milestones, even if it looks different for the child with a disability.
ADLs - Bathing (scoring) EXAMPLE 1: Randy showers every morning on his own. He washes his own hair and body and without help. Frequency = A. “N/A” Level = 1. The Individual can bathe and wash hair without assistance or supervision.
ADLs - Bathing (Randy) Preferences: Yes. Randy likes long showers (30 minutes or more) and does not like tub baths. Goals: No. (narrative blank) Acquiring, increasing, maintaining indep.: No. Note: Randy might have had a goal to maintain his independence, particularly if discussion had included indication that Randy’s ability to bath independently was diminishing. In which case, the last 2 questions would have been marked “Yes”.
ADLs - Bathing (scoring) EXAMPLE 2: Todd initiates his shower every morning on his own. He attempts to wash his own hair and body, but needs cuing for completeness and adequate rinsing. Frequency = C. Daily 15 minutes or less Level = 2. Individual requires minor physical assist, monitoring, cues
ADLs - Bathing (Todd) Preferences: Yes. “Todd does not like anyone other than Mom in the bathroom with him” Goals: Yes. “Todd wants to be able to shower on his own without help.” Acquiring, increasing, maintaining indep.: Yes.
ADLs - Bathing (scoring) EXAMPLE 3: Barb uses shower chair with safety strap. Support needs to be within arms reach at all times when Barb is in the chair as she slips/tips occasionally. She needs someone to bath and wash her hair. Support needs to be within arms reach of Barb. Frequency = D. Daily 16 minutes or more Level = 3. Individual dependent on another person to bath and wash hair.
ADLs- Bathing (Barb) Preferences: No. None known Goals: Yes. Barb wants alone time in the shower. Acquiring, increasing, maintaining indep.: Yes. Note: The PA/SC does not need to assess whether a goal is realistic or what might be needed to attain the goal. In this example, it’s possible that with other equipment Barb would be able to have staff further than arms reach. This is a discussion for service planning.
ADLs - Bathing (scoring) EXAMPLE 1: Ellen bathes in the tub twice weekly. One person must support Ellen’s body and monitors tubing while the another washes Ellen’s body and hair. Frequency = B. Less than daily Level = 4. Individual needs two people Note: Documentation is required to support the 2 person scoring, which may already be in Ellen’s file, such as medical evals noting lack of trunk control, nursing assessments, safety plans.
ADLs- Bathing (Ellen) Preferences: Yes. Ellen enjoys tub play and prefers her staff to splash with her before beginning washing. She does not like the shower chair. Goals: No. (narrative blank) Acquiring, increasing, maintaining indep.: No. Note1: Ellen might have had a goal to increase independence, in which case, the last 2 questions would have been marked “Yes” and the goal described. Note2: Not all individuals will identify goals for every item. The PA/SC should encourage individuals to consider whether they have a desire increasing independence in the area addressed by the questions.
IADLs - • Be sure to include assistance provided as a natural support in your measurement of support needs. • IADLs are not federally required for children. Oregon is opting to assess the IADL needs for children to encourage development of life skills.
IADLs – what is an IADL? IADL = Instrumental Activity of Daily Living Such as: • Housekeeping • Laundry • Shopping • Money Management • Transportation • Meal Preparation • Telephone (and other media) (Oregon may add to this list in the future.)
Health & Medical • Safety related issues (communication, recognition and response to hazards, unsafe situations, fire/emergency evacuation) • Medications • Health management
Health Management Support • General: everyday health maintenance and routine medical care, such as responding to a headache or scrape, attending routine doctor visits, recognizing injury or illness and responding • Complex: dependence upon medical treatment without which a life threatening situation would result (tube-feeding, ventilator, insulin dependent diabetes, etc.)
Behavior and co-occurring issues • Identification of behavior concerns and other issues that impact need for support (or how support is provided) • Determine whether the person is safe without supervision or what level of supervision is needed when there is no identified trigger or precursor • Determine what level of supervision is needed once a precursor is identified or when a known trigger is present
Night Support • This sections measures how often the person needs someone to provide hands-on or eyes-on supports during the night. • Discuss sleep patterns and night needs to determine how often the caregiver is needed and must intervene or offer assistance. • If an individual needs someone staying in the home with them in case of emergency, but the support person sleeps and is rarely needed, the support level is considered “independent” • A child under 12 needing a caregiver to respond to typical childhood night issues such as occasional bad dreams or enuresis the support level is considered “age-appropriate”. True incontinence may be scored if it is nightly or more frequent.
Employment • Record current type Employment (or other day program) • Record the individual’s Employment goals for the coming year • Assess the amount of (non-ADL/IADL) employment support (e.g. Job Coaching) the individual needs.
Double check: • Is there an accurate entry in each scored field? Note: Default is “independent”. Double check all “independent” scores before finalizing the tool, to assure none are oversights. • Are narrative sections clear? • Is the demographics page accurate and complete?
Testing, testing… • ODDS needs to complete a rapid testing of preliminary algorithms • June 20th – 21st • Testers will use a modified version of the draft tool • No narratives will be required for the test assessments
If you are asked to participate in the testing… • You will receive a Test version of the tool and minimal instructions (just do the best you can) from your CDDP or Brokerage management. • If possible, participate in the call-in Thursday, June 20th at 8:30 to ask questions about any sections of the tool that you are unsure about, and to hear other PA/SC questions and ODDS responses.
The test version is NOT the complete tool • Test version includes only scored entries • Missing elements include: description of how each activity is completed, preferences, goals, need for skill training/maintenance, identification of behaviors/co-occurring issues and recording of equipment.
Completing a test tool • Identify yourself & your Brokerage/CDDP • Identify the individual your selected (by initials) The above items are necessary in case we need to collect additional information • Identify how much support YOU believe the person actually needs (in your own professional judgment.)
If you are asked to participate in the testing… For each section: • Estimate the frequency/duration (if applicable) • Select the Level of Support based on your knowledge of the person and what you can find in the person’s record • Enter Selections by number or letter in the YELLOW CELLS to the right of the questions. • Double check to assure you have a response in EVERY yellow box.
Return the test … • Provide feedback if desired in the narrative cells at the bottom of the test (these are also yellow) • Your agency will submit tests Friday 6/21 • Late tests: go ahead and send back, however, ODDS will begin compiling test results over the weekend. Incorporation of late tests into initial analysis will depend on time available.
