Home Care Service Plans

Home Care Service Plans

Home care providers must give clients a written service plan. Minnesota laws require that a home care service plan contain the following of pieces of information to ensure that consumers of home care services, their families and caregivers, and providers and their employees are all informed about the plan. The service plan and any revisions to it must be entered into the client’s record. Staff providing home care services must be informed of the current written service plan.

Information Required in a Home Care Service Plan

  1. The signature or authentication by the home care provider and the signature of the client or client’s representative documenting agreement on the services to be provided;
  2. Information on how to contact the Ombudsman for Long-Term Care;
  3. A description of the home care services to be provided;
  4. The fees for services, including updating the service plan when those fees change;
  5. The frequency of each service;
  6. Identification of staff or categories of staff who will provide the services;
  7. The schedule and methods of monitoring reviews or assessments of the client;
  8. The frequency of sessions of supervision of staff and type of personnel who will supervise staff;
  9. A contingency plan that includes:
    1. The action to be taken by the home care provider and by the client or client’s representative if the scheduled service cannot be provided;
    2. Information and method for client or client’s representative to contact the home care provider
    3. Names and contact information of persons the client wishes to have notified in an emergency or if there is a significant adverse change in the client’s condition, including identification of and information as to who has authority to sign for the client in an emergency; and
    4. The circumstances in which emergency medical services are not to be summoned (consistent with chapters 145B and 145C) and declarations made by the client under those chapters.

If services to be performed change based on a client review or reassessment or the client’s preferences, the service plan must be updated. Providers and clients/consumers/families should review the home care bill of rights for additional information about client rights.

Termination of a Service Plan

If a home care provider terminates a service plan with a client, and the client continues to need home care services, the home care provider shall provide the client and the client's representative, if any, with a written notice of termination which includes the following information:

  1. the effective date of termination;
  2. the reason for termination;
  3. a list of known licensed home care providers in the client's immediate geographic area;
  4. a statement that the home care provider will participate in a coordinated transfer of care of the client to another home care provider, health care provider, or caregiver, as required by the home care bill of rights, section 144A.44, subdivision 1, clause (17);
  5. the name and contact information of a person employed by the home care provider with whom the client may discuss the notice of termination; and
  6. if applicable, a statement that the notice of termination of home care services does not constitute notice of termination of the housing with services contract with a housing with services establishment.

Timing of Notification of Service Termination for Home Care Clients in Community Settings

Pursuant to the home care bill of rights, home care providers must give home care clients (excluding assisted living clients) at least ten days’ advance notice of the termination of service by a provider except in circumstances outlined in the home care bill of rights, Minnesota Statutes 144A.44, Subdivision 1 (17) (i-iii).

Timing of Notification of Service Termination for Assisted Living Home Care Clients

Assisted living clients (as defined in section 144G.01, subdivision 3) shall be provided with advance notice of at least 30 days in the event of service termination except in cases outlined in 144A.441 (i-iii).

Requirements of Licensed-only Home Care Providers for Clients Receiving Assisted Living Services

If the client is receiving assisted living services (as defined in section 144G.01, subdivision 3) the arranged home care provider (as defined in section 144D.01, subdivision 2a, who is not also Medicare certified) must also provide a statement to the client that the notice of termination of home care services by the home care provider does not constitute notice of termination of the housing with services contract with a housing with services establishment.

Termination of Services to All Clients

When the home care provider voluntarily discontinues services to all clients, the home care provider must notify the commissioner, lead agencies, and ombudsman for long-term care about its clients and comply with the requirements in 144A.4791, Subdivision 10.

 

Updated Tuesday, December 01, 2015 at 02:59PM