SERVICE PLAN DEVELOPMENT

Development of “consumer-centered” service plans is the core function of our service coordinators. To assure All Care Registry is putting each individual and their needs as top priority we begin our work with the “Needs Assessments” performed during the enrollment process. This gives us information on what a person’s strengths and goals are we identify areas that could propose a threat to living safely in the community.

All Care Registry makes each individual and their needs a top priority.

Our service coordinators care about you & your family’s health

It’s our job to find resources regardless of the funding source that mitigate those risk and make the goal of living independently a reality.We follow guidelines recommended by the Office of Long Term Living to assure all of our staff is in compliance. During all of our ISP visits, we ensure our consumers and their families are

 

  • Educated about OLTL programs, services, and participant rights and responsibilities by reviewing the participant information materials developed by OLTL.
  • Informed on how to request for changes to their services, and providing family members information on how to request meetings to revise service plans whenever necessary.
  • Informing participants of their right to choose service providers before services begin, at each reevaluation, and at any time during the year when a participant requests a change of providers
  • Informing the participant and/or representative about the full range of HCBS services and supports that are available to achieve the participant’s identified goals.
  • Informing participants of the opportunities to engage in community activities of the participant’s choice. This may include shopping, attending religious services, etc. The participant’s cultural preferences must be acknowledged and reflected in the planning process.
  • Informing participants on fair hearing and appeal rights and assist with fair hearing and appeal requests as appropriate.
  • The SC will consider all participant needs for the entire ISP plan year and the ISP development process should include a participant’s routine activities that may occur throughout the year in order to ensure an appropriate amount of services and supports are coordinated.
  • Ensuring that the ISP incorporates an emergency back-up plan (emergency preparedness plan) for serious emergencies that might cause a disruption in routine services being delivered to the participant for an extended period of time. Examples include severe storms, floods, or any type of community-wide disaster.

 

SERVICE PLAN MONITORING

During our ISP Visit, we will establish a schedule for monthly or quarterly visits or monthly or bi-monthly phone calls. This agreement allows our consumers to choose how often that would like All Care to make direct contact with them or their loved ones. While we do take consideration to the preference of the caregiver we as a company will make contact at least once per month to assure all services are being delivered in the type, scope, duration, amount, and frequency as authorized and approved in the Individual Service Plan.

Consumers to choose how often they would like All Care to make direct contact with them or their loved ones.

Our service coordinators care about you & your family’s health

As a bonus to wellness calls and visits we encourage our consumers to set goals each month in addition to their overall goals identified in the initial service plan visit. Ensuring they are documented in the participant’s own words, with clarity regarding the amount, duration, and scope of services that will be provided to assist the person to achieve the identified goals.

One example participant’ goals are related to employment and volunteer opportunities, including any supports available to assist the participant in achieving employment goals. This includes benefits counseling, Employment skills development, Job Coaching, Job Finding and Career Assessments. As well as exploring transportation options to ensure the participant has access to needed community activities.

Our Monitoring is done to ensure

  • Health and safety are maintained
  • Level of care still requires needed services
  • Plans meet the needs goals and preferences of our consumer
  • Providers are qualified
  • There is no duplication in services.
  • Identifying and coordinating any employment or housing needs identified by the participant and/or representative.
  • Providing ongoing assistance in gaining access to needed State Plan and HCBS services, as well as needed medical, social, educational, and other services, regardless of the funding source.

State regulations require that each participant is seen and assessed for changes in their care at least annually.