Individually-Based Limitations Supporting Health and Safety of - PDF document

1/19/2017 Individually-Based Limitations Supporting Health and Safety of Individuals in Home and Community-Based Services Rose Herrera Danelle Moore Alan Lytle 1

1/19/2017 A transcript of this webinar is posted at www.OregonISP .org/training/online/ Who is here today? Respond to our poll questions 2

1/19/2017 What are “Individually-Based Limitations”? Individually-Based Limitations are strategies that restrict an individual from enjoying specific Home and Community-Based Services (HCBS) freedoms. OK, what are HCBS freedoms? Home and Community- Based Service and Setting rules identify basic freedoms for individuals receiving Medicaid services Individuals have the right to Individuals are supported to be integrated in the have lives like everyone community else 3

1/19/2017 HCBS Freedoms Home and Community-Based Services and Settings support individuals to: Work in the community Control personal resources Exercise choice and self-direction Be treated with dignity and respect HCBS Freedoms for Individuals in Residential Settings The HCBS rules include requirements that are specific to “provider-owned, controlled, or operated residential settings” •The individual lives in the home of their provider, OR These rules are for situations where: •There is a relationship between the service provider and the property owner/controller •Foster Homes Provider-owned, controlled or operated •24-Hour Program Settings settings in Oregon include: •Some Supported Living Situations These rules are intended to ensure that individuals living in provider-owned, controlled, or operated settings have community living experiences similar to persons not receiving Medicaid-funded services 4

1/19/2017 HCBS Freedoms for Individuals in Residential Settings The setting is physically accessible to the individual There is a Residency Agreement in Place for each individual addressing protections for the individual and the eviction and appeal process Each individual has privacy in his or her unit/bedroom HCBS Freedoms for Individuals in Residential Settings Individuals Individuals Bedrooms have In shared Individuals have the have the lockable doors, Individuals may bedrooms, have the freedom and freedom and with only the have visitors of individuals freedom to support to support to have individual and their choosing have a choice decorate their control their access to staff having at any time in roommates bedroom personal personal food keys schedule at any time 5

1/19/2017 Supporting Individuals Persons supporting individuals have an important role in introducing HCBS freedoms to individuals Teams should work How concepts are with the individual introduced to to identify healthy, individuals can have positive lasting implications opportunities for for individual the individual to success enjoy HCBS freedoms Supporting Individuals Person-Centered planning focuses on what is important to the individual Teams work with the • When and how things may occur individual to identify • Identifying resources needed and who may be responsible optimal opportunities for • How to be safe and respectful of others enjoying freedoms, • Potential outcomes of choices including: 6

1/19/2017 Back to Individually-Based Limitations… Individually-Based Limitations should only be There may be situations Teams should always focus considered when: when an individual needs on positive proactive restrictions placed on •There is an active threat approaches to address requiring intervention from a HCBS freedoms because of health and safety risks caregiver, AND health and safety risks. •There are no other less restrictive alternatives available Individually-Based Limitations • Lockable bedroom door When a restriction is • Choice of bedroom roommate placed on the following HCBS freedoms, this is • Access to personal food considered an • Control of schedule Individually-Based • Visitors at any time Limitation, or IBL: • Decorating bedroom A restriction or limit may only be placed on the HCBS freedoms identified above, AND The required process for planning and documentation must be in place. 7

1/19/2017 Requirements for Individually-Based Limitations • The need justifying the limitation • Positive interventions used prior to the limitation, including what has been tried but didn’t work • A description of the limitation that is proportionate to the assessed need The Individual Support • A plan for regular collection and review of data to measure the Plan (ISP) must ongoing effectiveness of the limitation document the following: • Time limits for reviews of the limitation to determine if the limitation remains necessary (minimum annual basis) • Consent of the individual (or the individual’s guardian) • An assurance the limitation will not cause harm Individually-Based Limitations in the Planning Process The “Individual Conversation The Risk The newest ISP Consent to HCBS about situations Identification Tool version available Limitations” form and risk should (RIT) and Risk in Spring 2017 will must be occur naturally as Management Plan include questions completed and part of the are components of indicating if a attached to the person-centered the ISP that limitation is part end of the ISP if a planning process facilitate this of the plan limitation is indicated 8

1/19/2017 Timelines for Implementing Individually-Based Limitations in the ISP Planning Process Once an individual’s ISP has Individually-Based Limitations been implemented ( effective being proposed or implemented March 2017 or later ), new must be incorporated in the ISP limitations must be addressed as planning process for ISPs the need for restrictive effective March 1, 2017 or later. strategies are identified For existing supports that are considered limitations, these strategies must be identified through the ISP planning process and formalized as ISPs are updated for the new plan year. Requirements for Individually-Based Limitations • The documentation requirements for an IBL must be captured on the ODDS “Individual Consent to HCBS Limitations” form • The “Individual Consent to HCBS Limitations” form may be found on the ODDS HCBS webpage at: http://www.oregon.gov/DHS/SENIORS-DISABILITIES/HCBS/Pages/ODDS.aspx • Additional PowerPoint trainings and examples are also found on the ODDS HCBS webpage under “ODDS Individually-Based Limitations (IBLs)” 9

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1/19/2017 Completing the “Individual Consent to HCBS Limitations” form • The “Individual Consent to HCBS Limitations” form must be completed for each Individually-Based Limitation proposed • This means using a separate form for each limitation • Limitations falling under the same category may put together on the same form • A form should also be completed for limitations proposed, but not accepted by the individual (meaning the team has identified the limitation as the only possible option to keep the individual safe and the individual rejects this support. Please note-the individual cannot be overridden and the limitation applied anyway, but the completed form provides critical documentation) Individuals (or their guardians) must consent to a limitation In Oregon, individuals are presumed to have capacity unless otherwise determined by a court If an individual has a guardian, then the individual’s guardian may consent to a limitation Supported decision-making may be used to assist the individuals in understanding and consenting to a limitation 12

1/19/2017 Individually-Based Limitations Do’s and Don’ts Individually-Based Limitations may not be implemented when the: IBL is being Alternative, less IBL results in implemented Individual (or IBL is not intrusive barriers to other for convenience their guardian) supported by a methods of individuals in or as a means to does not health and addressing risks the home who avoid consent to the safety need of have not been do not require implementing IBL the individual explored and such restrictive HCBS ruled out supports requirements Individually-Based Limitations Do’s and Don’ts When the intervention that Providers may respond to results in a barrier to HCBS emergency situations and freedoms becomes routine, reasonably unanticipated then an Individually-Based events that affect health and Limitation must be identified safety as situations arise and the requirements put in place 13

1/19/2017 Limitations vs. Variances In most circumstances, an Individually-Based A variance is a An Individually- Limitations should Department- Based Limitation is not require a approved exception focused on the variance. from a regulation individual’s need for typically granted to intervention to address necessary address health and There are some limited non-compliance on safety in regards to exceptions such as when the part of the no lock is installed on a HCBS freedoms provider bedroom door of an adult individual due to the individual’s identified health and safety needs; this situation would warrant an IBL and a variance. Resources Please visit the ODDS HCBS webpage for “Individual Consent to HCBS Limitations” forms and resource material: http://www.oregon.gov/DHS/SENIORS- DISABILITIES/HCBS/Pages/ODDS.aspx For questions or comments, please contact us at: HCBS.Oregon@state.or.us 14