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Aging Services
VIRGINIA DEPARTMENT OF SOCIAL SERVICES ADULT SERVICES PROGRAM
The Virginia Department of Social Services (VDSS) Adult Services Program serves those persons aged 60 and over and those aged 18 and older and who have a disability, and their families when appropriate. The Adult Services Program provides services to adults so that they can remain in the least restrictive environment (preferably their home) with dignity for as long as possible, thereby avoiding more costly, and more restrictive, institutional placement.
PERSONS WITH DISABILITIES
The concept of “having a disability” has undergone a dramatic transformation in recent decades, responding in part to changing social and legal sensitivity to the range and scope of disability. In general terms, “having a disability” involves having one or more continuing physical and/or mental
condition(s) that limit the performance of some designated activity or activities. A disabling condition is any chronic health disorder, injury, or impairment that contributes to a person’s being limited in social or other activities such as orthopedic and sensory impairments, paralysis, learning disabilities, and mental retardation (Disability Statistics Abstract No. 16, 1996, US Department of Education).
FUNCTIONAL LIMITATIONS
Most adults lead independent lives. However, assistance may be needed when illness or trauma limits their ability to carry out basic self-care tasks or household chores. Such care involves the most intimate aspects of people's lives--what and when they eat, personal hygiene, dressing, and toileting (A Profile of Older Americans, American Association of Retired Persons (AARP), 2001).
Estimates of the number of older persons with some type of functional limitation vary. However, about 5.3 million noninstitutionalized persons in the U.S. aged 65 and older need some assistance with an ADL (activity of daily living) or an IADL (instrumental activity of daily living). ADLs include the following:
- Eating
- Dressing
- Bathing
- Toileting
- Transferring
- Continence (bowel and bladder)
IADLs include cooking, shopping, managing money, using the telephone, housekeeping, and laundry. Just over one million persons in this group needed assistance with three or more IADLs (User’s Manual: Virginia Uniform Assessment Instrument, April 1998). Many people do not receive formal services, but rely instead on family and friends who provide care informally (Home and Community-Based Long-Term Care, Center on Elderly People Living Alone, American Association of Retired Person’s Public Policy Institute, 1994).
Most older persons have at least one chronic condition, and many have multiple conditions. The most frequently occurring conditions in the older population include
- Arthritis
- Hypertension
- Heart disease
- Hearing impairments
- Orthopedic impairments
- Cataracts
- Sinusitus
- Diabetes
(A Profile of Older Americans, AARP, 2000):
HOME-BASED SERVICES PROVIDED BY the Virginia Department of Social Services (VDSS)
Long-term care services provided through the VDSS Adult Services Program have been an integral part of the long-term care delivery system for over twenty-five years. Services are provided at the local level to assist an individual to remain in his or her own home and to be as independent as possible for as long as possible. The provision of adequate home-based services decreases the risk of institutional placement, decreases overall costs for long-term care in the Commonwealth, and ensures that appropriate services are provided.
The emphasis on local partnerships includes strong networking for service provision with public, private, and non-profit providers including community services boards, departments of health, hospitals, physicians, the faith community, civic groups, community action agencies, area agencies on aging, and other service providers.
WHO MAY APPLY FOR SERVICES?
Anyone wishing to do so has the opportunity to apply for services. The applicant, someone authorized by the applicant (such as a family member), or someone acting responsibly on the applicant’s behalf completes the Service Application at a local department of social services. A case is opened based on eligibility, determination of need, and the availability and intent to deliver the service. Financial eligibility requirements as designated by the local boards of social services must also be considered.
ASSESSMENT AND CASE MANAGEMENT
Local departments of social services provide a statewide system of case management, assessment, and prevention and protective services for persons 18 and over with a physical or mental impairment and for those persons 60 years of age and over. Local departments serve as the focal point for delivery of services through eligibility determination and needs assessment. Assessment is an integral part of case management, and the process includes an assessment of both individual and family needs.
Local departments of social services provide case management to individuals with a variety of needs. The case management process is a systematic approach essential to effective service delivery that actively involves the service worker and the individual and his or her family in developing, achieving, and maintaining meaningful goals. The purpose of case management is to structure the service worker’s focus and activities and to assist the adult in reaching his or her goals and to assure that the adult receives appropriate services in a timely manner.
The Virginia Uniform Assessment Instrument (UAI) is the comprehensive assessment developed for use by all public human services agencies providing long-term care services in the Commonwealth. Completion of the UAI is the first step towards receiving services through the local departments of social services. Required assessment areas, as based on the
UAI, are:
- Functional Status
- Physical Health
- Psychosocial (Mental Health) Status
- Support Systems
- Physical Environment
HOME-BASED SERVICES
Each of the 121 local departments of social services is mandated to provide case management and at least one home-based service to the extent that federal and state matching funds are available. Each local department is authorized, as fiscal agent acting on behalf of the customer, to recruit and approve home-based providers, using uniform provider standards. Approved home health and other local service delivery agencies may also be used in the provision of home-based care services.
Home-based care consists of three primary services:
- COMPANION SERVICES include activities performed to assist older adults and adults with a disability with activities of daily living such as toileting, eating, dressing, bathing, light housekeeping, meal preparation, and shopping.
- HOMEMAKER SERVICES include instruction in or the provision of activities to maintain a household. Services may include personal care, home management, household maintenance, nutrition, and consumer and health care education.
- CHORE SERVICES are non-routine, heavy home-maintenance tasks that may include window washing, floor maintenance, yard maintenance, painting, chopping wood, snow removal, and minor repair work in the home.
COMMUNITY-BASED SERVICES
Services that are coordinated by the local departments of social services include the following:
NURSING HOME PREADMISSION SCREENING (NHPAS) is performed by the local departments of social services in cooperation with the local departments of health. The Code of Virginia requires that all individuals who will be eligible for community or institutional long-term care services as defined in the state plan for medical assistance shall be evaluated to determine their need for nursing facility services. Nursing home preadmission screenings are used to divert clients from institutional placements, when possible, and to access various Medicaid waiver services, such as personal care services, in order to prevent institutionalization.
The screening team consists of a nurse, social worker, and physician who are employees of the Department of Health or the local department of social services. In FY 01, local departments of social services, in coordination with local departments of health, received reimbursement for the completion of 8,207 nursing home preadmission screening assessments (Division of Finance data).
ASSISTED LIVING FACILITY (ALF) ASSESSMENTS are performed by the local departments of social services. Before admission to an ALF, the adult must be assessed using the UAI to determine his or her level of care needs. The Department of Social Services promulgated regulations effective February 1, 1996, that require all residents of and applicants to ALFs, regardless of payment status, be assessed using the UAI to determine the need for residential or assisted living services. For public pay individuals (i.e., those receiving an Auxiliary Grant), the following public human services agencies are authorized to complete the assessments and provide Medicaid-funded targeted ALF case management where necessary:
- Local departments of social services
- Community services boards
- Area agencies on aging
- Local departments of health
- Centers for independent living
- Department of Corrections medical units
The local department of social services is the agency of last resort if no other assessor is willing or able to provide the service. Local departments of social services typically complete over 85 percent of all ALF assessments. In FY 01, local departments of social services performed more than 1,096 full ALF assessments and close to 10,003 short ALF assessments.
ADULT FOSTER CARE provides room and board, supervision, and special services to an adult who has a physical or mental health condition or emotional or behavioral difficulties. The adult must be assessed as being incapable of independent living or unable to remain in his or her own home. Adult foster care homes are approved by the local departments of social services using standards approved by the State Board of Social Services. In FY 01, 87 approved adult foster care homes provided care to 96 adults.
DAY CARE FOR ADULTS is the purchase of adult day care from a provider approved by the local department of social services or a licensed adult day care facility for a portion of a 24-hour day. Day care includes personal supervision of the adult and promotes social, physical, and emotional well-being through companionship, self-education, and satisfying leisure-time activities. Eligible persons must meet state and local board policy and must be assessed using the UAI as needing assistance with
ADLs, IADLs, and/or supervision or be in a family situation where people normally responsible for care are not available.
NUTRITION programs provide meals and/or staple goods to adults who meet state and local eligibility requirements. Available programs vary from locality to locality.
CASE MANAGEMENT is provided by local departments of social services for residents of assisted living facilities
(ALFs) who need this service. Specific services may include coordinating with the adult to meet his or her complete care needs, assisting in re-establishing contacts with friends and relatives, and working cooperatively with the facility's staff, if applicable, to provide supportive services.
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