Chapter Three

Pg. 13

RE: “service plan identifies the following: tasks that the attendant will perform on a daily basis, or as needed.”

Based on DMAS-487, I don’t see where “as needed” is able to be notated. Either that needs to be added to the 487 OR the “as needed” needs to be deleted from the EOR Manual, page 13.

I would like to comment on something that would only apply to teenagers on the waiver. As I understand, there are certain ADL’s and IADL’s that individuals under the age of 18 are unable to include on their Service Plan/Plan of Care and on the DMAS 7A, specifically Meal Preparation, Grocery Shopping, and Transportation.

My daughter is eligible for Department of Aging and Rehabilitative Services (DARS) services at the age of 14. The public school system also begins to work with students at 14 years of age as they begin to shift the focus to transitioning to adult life. For teens ages 14-18, there are many of those transition skills that the Attendant could help with would be beneficial and helpful as it will make the recipient all the more independent. However, we cannot utilize the Attendant for such as we’ve been told that anyone under 18 cannot have those sections as part of their plan. These ADL's are indeed an important part of our daughter’s Plan of Care she is able to learn how to create a healthy lunch, make a shopping list, and go grocery shopping. These are skills that will inevitably keep her out of a facility and perhaps independently living on her own.

While Transportation is N/A to my daughter right now, and while she may never drive, I guarantee that learning the local public transportation system will be part of her plan of Care before she is 18. And that means that I send her and her Attendant out to navigate the local public transportation routes for them to get to the Library or the Mall. Again, I feel this needs to be revisited and looked at as an exception for those working towards transitioning to independence.

Additionally, another area that individuals under the age of 18 are unable to include on their Service Plan/Plan of Care and on the DMAS 7A, is Clean Areas Used by the Recipient. We are teaching our teenage daughter independent living skills. She has a service dog that assists her with picking things up that she has dropped, turning lights on and off, carrying things for her, and pulling objects such as laundry baskets. Our daughter has to be a responsible pet owner and clean up after her pet, which involves sweeping. Her chore is to sweep the dog hair, and therefore, it is the PCA's job to oversee that she is keeping her area clear of pet hair by utilizing a broom from her wheelchair and learning to manipulate a hand held vacuum on the stairs.

I would like to suggest that this be an exception for recipients who are actively pursuing Transition Services with DARS, or who have specific independent living skills listed in the service plan. Specifically Cleaning Areas Used by the Recipient, Grocery Shopping, and Meal Preparation as the IADL categories.

Additionally, the Service Plan needs to be more considerate of the timeframes when care is required/needed. It is unrealistic to put specific hours on the service plan and not to deviate from those hours. With all of the various factors that affect the schedule of a special needs family  (doctor’s appointments, illnesses, therapies, summer schedules, Spring Break Schedules, family appointments, school, community activities, etc…) it is difficult to pin point specific times that the Attendant is needed in the Plan of Care. For our family, we have a rough idea listed in the Service Plan however, this can change week by week and sometimes day by day, depending on what is going on. I would like for the Recipient and EOR to be able to have flexibility with the Plan of Care hours and altering them as their schedule needs. I don’t like that I’m told that I can only have my attendant clock in and out during the hours designated on my Plan of Care. If my POC states 12-5 but I need to take my daughter to a DR appointment at 1pm, and could benefit from the Attendant working 3-8, I want to have that flexibility. I’d like to be able to schedule based on the current need vs what the POC dictated 6 months ago when it was written.