Advantage Case Management
The Advantage programs provide home and community based services to persons age 21 and older who qualify for nursing facility care. The Advantage programs are designed to support, not replace family or other informal support or assistance and to aid and enhance the family or caregiver’s ability to provide care for a person. A person must first qualify for Medicaid, a low income service, prior to receiving Advantage. Advantage cannot be provided for children or those individuals with mental retardation.
The Advantage Program is operated under agreement with the Department of Human Services. The service is based on the idea of a family-like relationship with the member. The Advantage Program of the Home-and Community-Based Services provides Medicaid services to help people stay at home instead of going to a nursing home. The program assists frail elders and adults who have physical disabilities. We know that families may not be available, capable, or willing to assist other family members who are sick or disabled.
Case Management uses a collaborative process to assess, plan, implement, monitor and evaluate the options and services designed to meet an individual’s needs. Through this process, individuals served are encouraged to make informed decisions about their care and encouraged to move toward progressive independence.
When referred to Venerate Case Management, a comprehensive assessment form is completed on every client admitted for services. The Case Manager and a Registered Nurse make a home visit to evaluate the client’s needs. The Case Manager obtains the client’s written consent for services prior to performing a comprehensive assessment and continues the admission process of describing the rights and Responsibilities, Complaint Procedure, Advance Directives, Agency Information, on-call procedures, and Consents and Releases.
The Venerate Case Manager will also assess the Physical, functional, nutritional, emotional, psychosocial, environmental status and support systems for the client. The assessment will include, as appropriate, the patient’s medical history, pertinent physical findings, age-specific and gender-specific findings, the patient’s and family’s education needs, abilities and readiness to learn, cultural and religious practices, emotional barriers, desire and motivation to learn, physical or cognitive limitation, communication styles, and language barriers.
It is the policy of Venerate Advantage Case Management to develop an individualized plan of care for each client based on the client’s needs. The plan must be inclusive of all disciplines as well as all relevant community resources available.
The case manager, during all monitoring activities, continues to assess for community potential, level of care and program appropriateness. The case manager monitors the service plan based on the community potential and health status of the Consumer.
Venerate Case Manager assumes the following roles:
- Service Coordinator. The case manager facilitates interdisciplinary team processes to:
- identify Consumer needs and strengths;
- identify and coordinate service delivery;
- arrange for and initiate service implementation, and;
- monitor service delivery;
- An Advocate. The Case Manager ensures that:
- Consumers receive appropriate, quality services;
- Services are modified to meet changing Consumer needs;
- Interventions are made to ensure the system is responsive to Consumers; and
- The plan of care is progressively moving the individual toward self-care and preventing further loss of function;
- Consumer Consultant. The Case Manager:
- Assists Consumers to recognize and identify their service needs;
- Educates Consumers on the quality and appropriateness of services;
- Supports Consumers to take responsibility for their own care to the greatest extent possible; and,
- when necessary, represents Consumers in interactions with DHS program administration; and
- A Gatekeeper. The case manager assures level of care and program appropriateness:
- Only those Consumers appropriate for Medicaid case management receive the service through the DHS programs;
- To the extent possible, methods are built into the service plan to progressively move the Consumer toward independence and the use of informal, family and volunteer services;
- Expenditure of funds is justified; and
- Costs are monitored and contained.
- Ensures Client Rights. Venerate Advantage customers have a right to be notified in writing of their rights and obligations. The client’s family or guardian may exercise the client’s rights when the client has been judged incompetent. Venerate Advantage Case Management has an obligation to protect and promote the rights of the clients. Each client will receive a copy of The Client’s Bill of Rights, grievance policy and procedures, information on abuse, neglect, and exploitation, a paper with the Agency number written in bold, and other materials related to safety and health prior to admission to the agency and shall verify understanding of the same.
- Ensures Care Coordination: All disciplines involved in the individual client’s care maintain communication and coordinate services and treatments for the client so as to ensure the identification of client needs and barriers to care. The client and the client’s care giver are included in the ongoing coordination and communication regarding the client’s care and treatment. Venerate Advantage Case Manager will coordinate with all types of community resources, services and informal supports across all service settings to ensure that care received by clients with multiple disciplines is coordinated appropriately and to ensure that access to community resources available to the client is maximized.
- Risk Manager: The more complicated a client’s health needs are, the higher the risk for inappropriate utilization of services, fragmentation of care and delays in system access. The challenge is to ensure that patients move appropriately from one access point to another in the most efficient, effective manner. The Venerate Case Management Process is designed to meet this challenge. Venerate Advantage Case Management meets quarterly to review the case load and identify high risk customers. For each customer identified, the individualized care plan is scrutinized to ensure it is adequate to meet the customer’s needs in all circumstances.
- Emergency Manager: Venerate home health will network with state and county emergency management officials on an ongoing basis to integrate our agency-specific plan into the broader, formal community and municipal response to disasters and emergencies. Our ultimate goal is the health and safety of our staff and clients.