5/5/2017DIRECT CARE WORKER POLICYCLARIFICATION & GUIDANCEPA Homecare Association ConferenceMay 3, 2017Jennifer Burnett, Deputy Secretary, Office of Long-Term Living, DHSSusan Coble, Director, Bureau of Community Program and Licensure, DOHLinda Chamberlin, Chief, Division of Home Health, DOHBackground on Direct Care Worker (DCW) Policy Many individuals, families, DCWs, advocates, and othermembers of the stakeholder community have expressed a strongdesire for the commonwealth to adopt a policy that would clarifythe types of non-skilled home care services/activities DCWs canperform in HCBS settings to enable individuals with disabilities tolive independently. The Pennsylvania Long-Term Care Commission (“LTCC”) FinalReport, recommended the commonwealth explore “enabl[ing]DCWs to provide additional services for long term services andsupports (“LTSS”) consumers.” ADAPT, a national disabilityrights grassroots organization, has also recognized the need forDCWs to provide individuals with assistance concerning activitiesthat individuals could perform themselves, but for their disability.21

5/5/2017Background Continued November 14, 2016 the Wolf Administration issued apolicy clarification through the departments of Health,Human Services, and State that clarifies the types ofnon-skilled services/activities that can be performed byDCWs to assist individuals with disabilities with activitiesof daily living that could be performed independently butfor their disability.3November 14, 2016 Policy Clarification42

5/5/2017February 23, 2017 Department of Health Policy Guidance5Definitions – Ch. 611 Home Care Regulations Direct Care Worker – individual employed by a homecare agency or referred by a home care registry toprovide home care services to a consumer. Home Care Services – encompass the followingactivities:–––––Personal care servicesAssistance with instrumental activities of daily livingCompanionship servicesRespite careSpecialized care Non-skilled services/activities unique to the consumer’s care needsthat facilitate the consumer’s health, safety and welfare, and abilityto live independently.63

5/5/2017Specialized CareThe non-skilled activities/services are specialized care thatare unique to the individual consumer’s care needs thatfacilitate the consumer’s health, safety and welfare, andability to live independently. This applies to consumersregardless of age or nature of disability. These servicesinclude: Assistance with bowel and bladder routinesAssistance with medicationOstomy careClean intermittent catheterizationAssistance with skin careWound care7Consumer Characteristics – Department of HealthA DCW may perform the non-skilled activities/servicesincluded in this policy for a consumer whose characteristicsmeet all of the following guidelines:1.The consumer is capable of directing his or her own care or has ahealth care representative or agent who is capable to makechoices for the consumer about home care services, understandsthe impact of these choices, and assumes responsibility for theresults of the choices.2.The specific non-skilled activity/service provided is of a nature thatthe consumer would be able to perform independently but forhis/her disability.84

5/5/2017Consumer Characteristics – DOH Continued3. The consumer’s service plan documents that the consumerhas a need for assistance with the non-skilled activity/serviceto facilitate the ability to live independently while maintaininghis or her health, safety, and welfare, as defined by theconsumer, the consumer’s health care representative, or theconsumer’s agent.4. The consumer has an order from a health care practitioner,service authorization form, or service plan/agreement thatauthorizes the home care agency/registry to provide the nonskilled service/activity. The order, service authorization form,or service plan/agreement is renewed yearly or when asignificant change in condition occurs.5. The consumer’s health conditions, care needs, and theoutcomes of the non-skilled service/activity are generallypredictable to the consumer.9Home Care Agency/Registry Responsibility Prior to assigning a DCW employee to provide the non-skilledactivities/services included in the policy, the home careagency/registry must evaluate the DCW and document that theDCW has received training and demonstrated competency in anyspecialized care activities/services that the DCW will provide to theconsumer, per 28.PA.Code Section 611.55 Training and demonstrated competency must:1. Be individualized for each consumer;2. Take into consideration the service delivery preferences of the consumer; and3. Emphasize delivery methods that ensure the safety and maintain the dignity ofthe consumer. The home care agency or registry should ensure a consumer meetsthe consumer characteristics defined above after initial assessment.105

5/5/2017Important to Note In addition to the Department of Health’s clarificationrelating to competency requirements, Home Careagencies must also be in compliance with any otherlicensing or Medicaid participation requirements.11OLTL Waivers The service definition of Personal Assistance Services isbroad enough in the OLTL Waivers (includingCommunity HealthChoices) that no changes are requiredto allow DCWs to provide non-skilled activities/services. It will be up to each consumer or health carerepresentative or agent under the participant-directedmodel or home care agency under the agency-directedmodel to decide if and when they want to use DCWs fornon-skilled activities/services.126

5/5/2017Next Steps DHS is currently developing a frequently askedquestions resource that will be distributed to servicecoordinators and posted to the OLTL website DOH will continue to monitor home care agencies’ andregistries’ compliance with Chapter 611 Home CareAgency and Registry regulations relative to the provisionof specialized care to consumers and DCW competencyrequirements through surveys and complaintinvestigations.13147