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A. Definitions
Abuse: means infliction of or threat to inflict physical pain or injury on or the imprisonment of any incapacitated adult or resident of a nursing home or other residential facility.
Adult Emergency Shelter Care Home: means a home that is available on a short-term, emergency basis for residential care type clients for whom no other appropriate alternatives currently exist, agreeing to accept placement on a twenty-four (24) hour basis.
Adult Emergency Shelter Care Provider: means an individual or family unit that has been certified by the Department of Health and Human Resources to provide support, supervision and assistance to adults placed in their home at any time on short notice.
Adult Family Care Home: means a placement setting within a family unit that provides support, protection and security for up to three individuals over the age of eighteen.
Adult Family Care Provider: an individual or family unit that has been certified by the Department of Health and Human Resources to provide support, supervision and assistance to adults placed in their home for which they receive payment.
Assisted Living Facility: referred to in state law as a “Residential Care Community”, is any group of seventeen or more residential apartments, however named, which are part of a larger independent living community, for the express or implied purpose of providing residential accommodations, personal assistance and supervision on a monthly basis to seventeen or more persons who are or may be dependent upon the services of others by reason of physical or mental impairment or who may require limited and intermittent nursing care but who are capable of self preservation and who are not bedfast.
Cognitive deficit: means impairment of an individual’s thought processes.
Emergency: means a situation or set of circumstances which present a substantial and immediate risk of death or serious injury to an incapacitated adult.
Incapacitated Adult: means any person who by means of physical, mental or other infirmity is unable to independently carry on the daily activities of life necessary to sustaining life and reasonable health.
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Neglect: means the failure to provide the necessities of life to an incapacitated adult or resident of a nursing home or other residential facility with the intent to coerce or physically harm such incapacitated adult or resident of a nursing home or other residential facility or the unlawful expenditure or willful dissipation of funds or other assets owned or paid to or for the benefit of an incapacitated adult or resident of a nursing home or other residential facility.
Personal Care Home: A group living facility licensed by the Office of Health Facilities and Licensure and Certification (OHFLAC) providing 24 hour awake supervision of activities of daily living.
Personal Care Home Provider: A individual, and every form of organization, whether incorporated or unincorporated, including any partnership, corporation, trust, association or political subdivision of the state licensed by OHFLAC as a Personal Care Home Provider.
Residential Board and Care Home: A group living facility licensed by the Office of Health Facility Licensure and Certification to provide accommodations, personal assistance and supervision for a period of more than twenty four (24) hours to four or more individuals.
Residential Board and Care Provider: Any person and every form of organization, whether incorporated or unincorporated, including any partnership, corporation, trust, association or political subdivision of the State licensed by OHFLAC to maintain and operate a RB&C.
Physical deficit: means impairment of an individual’s physical abilities.
B. Introduction and Overview
Adult Emergency Shelter Care homes are placement settings for adults that provide support, supervision, protection and security in a family setting. This may be an appropriate option for individuals who are no longer able to safely remain in their own homes due to physical, cognitive, and/or emotional deficits. Although an individual may be experiencing deficits in one or more of these domains, the deficits are not significant enough to warrant the level of care provided in a nursing home.
The Adult Emergency Shelter Care provider must be certified by the Department of Health and Human Resources, Office of Social Services. Once certified, the provider may provide care for no more than a total of three adults. If a home is approved as a combination AFC/ESC home, the combined total of adults placed in the home shall not exceed three. The provider receives payment from the department for the care provided.
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C. Eligibility Criteria
In order for an applicant to be approved as an Adult Emergency Shelter Care Provider they must
meet all following criteria:
C Age twenty-one (21) years of age or older;
C Submit a completed application packet;
C Willing and able to accept placements on a twenty-four (24) hour, seven (7) day a week
basis; and, C Meet all applicable standards for this type of setting.
Note: Approved Adult Emergency Shelter homes are expected to be available for three consecutive months followed by one month off. Payment of the monthly subsidy will continue uninterrupted.
D. Recruitment of Adult Emergency Shelter Care Providers
With the ever increasing need for supportive living options for vulnerable adults, it is important that the Department continues with recruitment efforts to locate new Adult Emergency Shelter Care Homes. Generally, when the local office receives an inquiry from someone in the community who is interested in becoming an Adult Emergency Shelter Care provider, an adult service worker will give/send the prospective provider an application packet which is to be completed and returned to the local DHHR office within thirty (30) days.
When additional Adult Emergency Shelter Care Homes are needed, the following steps are to be taken to develop a successful recruitment campaign.
C Identify number and type of homes needed; C Plan/develop information to be disseminated within the community to create an interest in the program; and, C Implement recruitment campaign.
There is a great variation from one community to the next, therefore these unique characteristics must be considered when developing a recruitment campaign. Some basic principles which apply generally have been identified and may be helpful in developing local programs. Individuals within the community must be made aware of the Adult Emergency Shelter Care Program and encouraged to seek more information. A variety of methods may be applied. The following are suggested approaches that have proven to be effective.
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Note: In any recruitment initiative staff should follow the local protocol for this activity and should co-ordinate efforts with State Office staff/Office of Communications.
Publicity through newspaper articles is a commonly used method of advertisement. Local newspapers generally are interested in supporting such community efforts. Ideally, there should be an initial article to generate interest and a follow up article a week to ten days later to provide more detailed information. There are various ways to present information in a newspaper such as:
a. Classified Advertising
This approach has not been commonly used because: (1) it tends to emphasize the potential for financial gain and (2) there is generally a cost associated with this option. This option may be useful in those areas where other forms of newspaper publicity have been exhausted. An example of an ad would be: “Are you looking for a new meaning and purpose for your life? Why not open your home to a person who is looking for the care and support of a family? Call the local Department of Health and Human Resources and ask about Adult Emergency Shelter Care Home Opportunities.”
b. News Release
This type of article simply announces the existence of a program and tells a little about it, including pertinent information such as the program name, the name of the agency, the name and phone number of contact person, etc. Also included in this advertizement would be news coverage of presentations to community groups and agencies.
c. Regular Columns
Many newspapers have regular columns on subjects of interest. The columnist usually becomes well-known and develops a following of readers. If the interest of a well-known columnist can be stimulated, he can be of tremendous help in developing community interest, as his approach to the subject will add the human interest touch which is usually lacking in a regular news article. The personal endorsement of the Adult Emergency Shelter Care Home Program will often cause the regular readers to consider it more seriously than they might otherwise.
d. Letters to the Editor
Letters written by local supporters of the program for publication on the editorial page of a local newspaper can be effective. This approach is most effective if it is written by a person who is well known in the community, but not associated with the Department. A local physician, attorney, politician or judge who has an interest in the program would be excellent. The worker, or supervisor, responsible for recruitment may have to seek out and educate them about the program. Often they will agree to have an agency representative draft the letter for their signature.
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e. Feature Article
This is by far the most effective form of newspaper publicity, but it is also the most difficult to obtain. These articles often appear in “Sunday Supplement” or family sections of the newspapers and almost always include human interest items and pictures. They go into a considerable amount of detail and local adult service staff which are fortunate enough to be given this type of publicity should co-ordinate efforts with State Office staff/Office of Communication. This type of article is most effective in locations where some active Adult Emergency Shelter Care and/or Adult Family Care homes are already in operation. Written permission must be obtained in advance and a copy of this filed in the appropriate case(s) record. Location of the of the authorization is to be noted in Document Tracking of FACTS.
Radio exposure can be a useful tool for getting the Adult Emergency Shelter Care story to the community.
a. Spot Announcement
This approach probably reaches the greatest number of people, but often does not stimulate as much interest as is needed. It involves preparing a 30 - second spot announcement designed to encourage listeners to call for additional information. Radio stations will usually donate time several times a day for several days, as well as help with wording the announcement, if requested. The tape can be cut by an agency representative, but usually a professional announcer will be available for this, if needed.
b. Interview or Discussion Program
Most radio stations have time periods set aside during which they interview individuals concerning items of local interest. An agency representative or even a client and or provider in the Adult Emergency Shelter Care Home Program could be interviewed with questions designed to cover important points. A panel discussion is another possibility, using a group of sponsors or community leaders and professionals. The possibilities are endless, but the radio station will not approach the agency. The local agency representatives must contact the station manager.
Television time is often difficult to obtain, but Federal regulations require stations to give some time for community service announcements. Since this time is usually already allocated to particular organizations, it is sometimes easier to enlist the cooperation of the organizations and use the television spots allocated to them. These spots are usually equivalent in content to radio spots, but a poster of some kind will be needed to display on the screen during the announcement.
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Many local television stations have daytime interview programs similar to those on radio. The educational television stations are particularly good for this type of presentation. Local television stations are sometimes willing to put together a special, filmed program on subjects of general interest. Spot announcements on cable TV may be another option.
Religious organizations of all denominations provide an excellent pool of prospective Adult Emergency Shelter Care Homes. Exploration of this area should begin by interviewing local religious officials to inform them of the program and enlist their help in finding ways to present it to the members of their churches. In some churches, the minister may be willing to discuss the program from the pulpit or he can usually recommend specific groups within the church organization who might be interested in knowing more about the program.
There are local organizations around the State that are frequently looking for luncheon speakers and community service projects. The various women’s clubs, garden clubs and service organizations (i.e. Ministerial Association, Community Round Table, Civitan, Lions’s Club, Moose Lodge, Eagles and etc.) are an excellent place to start. Some of these have newsletters and most will welcome agency representatives as luncheon or dinner speakers.
Many times the Adult Emergency Shelter Care Home Program will recruit for itself once a number of good homes have been established and placements made. Providers are considered one of the best sources for new Adult Emergency Shelter Care Homes. This resource is an important one to cultivate when working with providers from day to day.
7. Adult Emergency Shelter Care Promotional Material
Promotional materials must be available in every DHHR county office. It is not intended to tell the whole story, but it can stimulate interest if properly used. Any location where people gather can be considered for distribution of promotional material. Many ministers will allow them to be placed in church lobbies. Local social service agencies and associations may also display this material, such as the local Behavioral Health Center, the Association for Retarded Citizens, Home Health Agencies, Social Security, physicians, dentist’s, etc. A little imagination may produce any number of possibilities.
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Workers may contact the Office of Social Services if additional assistance is needed in recruitment. Publicity is an ongoing process and should be continued even though the program may be well established in a county.
NOTE: It is recommended that an evaluation of the campaign be completed to look at things such as: 1) overall effectiveness 2) most effective strategies 3) least effective strategies, etc.
E. Application Process
When an inquiry is received from a person expressing interest in becoming an Adult Emergency Shelter Care provider, information about the Adult Emergency Shelter Care Program and an Application Packet shall be provided. All inquiries are to be documented in FACTS. The completed application packet must be returned within thirty days (30) or the intake is to be closed. The application packet includes:
| C | Application |
| C | Physician’s Letter (applicant) |
| C | Personal Reference Letters ( two) |
| C | Credit Reference Letter (one) |
| C | Fire Safety Checklist |
| C | Provider Tax Information Reporting Form (W - 9) |
| Note: | The AFC/ESC application packet is available through the Internet at the DHHR Office of |
Social Services web site. Forms may be downloaded, completed, and submitted directly to the
local DHHR office. When an application is received this way, it must be entered into FACTS
upon receipt and the thirty (30) days for completion of the application packet begins on the date
received.
Upon receipt of the application by the local DHHR office, a home study is to be initiated and
completed within sixty (60) days. The study is very extensive and will involve the following at a
minimum:
C site visits;
C interviews;
C checking references; and,
C completion of a Criminal Investigation Bureau (CIB) check.
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Upon receipt of the completed application packet the social worker is to begin the assessment
process. The assessment is the process the social worker goes through to determine if the
provider and the provider’s home meets all required criteria. A thorough evaluation of the home
and family must be completed within sixty (60) days. Only in very extenuating circumstances
will requests be considered for extensions to be granted beyond the original sixty (60) days in
which the home study was to have been completed. The local supervisor may grant an extension
of an additional thirty (30) days. An extension should only be considered if the applicant has
demonstrated active progress toward meeting the application requirements. Some examples of
situations where it may be appropriate to request an extension are as follows:
C The CIB but has been requested, but the results have not been received;
C Due to circumstances beyond their control, the applicant could not schedule the required
medical exam within the time frame; and, C A minor emergency home repair cannot be completed within the sixty (60) days.
Receipt of required documentation is to be recorded in FACTS. This will include, but is not limited to, documents provided to the applicant, including the application form, physician’s letter, reference letters, etc. The assessment process must include: interviews of household members, record check, reference check, CIB, evaluation of the home, etc. The assessment process must be completed before the home can be approved. In addition, required pre-service training must be completed before any placements may be made in the home.
1. Initial Interview
Upon receipt of the completed application, the worker will arrange an appointment to meet with the applicant. This initial interview is to be conducted in the applicant’s home with only the applicant, the applicant’s spouse and the worker present. This interview shall involve an intense discussion of all of the items contained in the outline for the AFC/ESC Home Study Summary and the standards for Adult Emergency Shelter Care homes as outlined in this policy. The worker must make a thorough inspection of the home and its grounds during this visit. This inspection shall include, but not be limited to, all areas that are required for completion of the Annual Fire and Safety Review and all required physical standards for Adult Emergency Shelter Care Homes. It is the worker’s responsibility to bring to the applicant’s attention, at this time, the obligations which he/she will be assuming in caring for adults who need care, supervision and/or protection. The worker must also explain to the applicant the agency’s standards and requirements for all Adult Emergency Shelter Care Homes in regard to the care of clients placed in their home. The worker must also inform the potential provider about what he/she can expect from the agency. The worker must explain the agency’s responsibilities with regard to the client and the provider. Because of the amount of information to be covered, it may be necessary to complete the interview in more than one visit
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2. Interviews with Individual Family Members
Upon completion of the initial interview with the applicant and inspection of the physical facilities of the home, the worker will make arrangements to interview all other household members individually. Because Adult Emergency Shelter Care involves all household members and not just one member of the household, it is essential that the worker evaluate each individual member. A thorough description of each member is to be documented in the Adult Family Care Home Study Summary focusing on appearance, interests, attitudes, occupation, temperament, physical and mental health, relationship with other household members and attitudes about the family caring for Adult Emergency Shelter Care clients.
If, on the Application to Provide AFC/ESC, it is indicated that “someone in the immediate family has ever been arrested for or ever been involved in any criminal activities”, this must be explored thoroughly when interviewing this particular household member. This exploration must include determining 1) what the person was arrested for 2) what criminal activities he/she was involved in and 3) the reason(s) for this person’s actions. If the behavior was violent in nature, constituting harm to another person, the worker will give careful consideration as to whether the behavior is likely to occur again. If a strong possibility of reoccurrence exists, the application to become an Adult Emergency Shelter Care provider must be denied and written notification of the denial sent. The Negative Action letter is to be used.
3. Record Check
The social worker must complete a record check in FACTS and any existing paper files to insure that there is no prior CPS or APS involvement. The record check must be completed for every adult household member excluding clients. If any of the adult household members, who would be responsible for providing care, has had prior employment in a nursing facility, the worker must also check the Nurses Aide Abuse Registry by contacting OHFLAC.
If the applicant, or any adult household member who is going to be providing care, is listed on the Nurses Aide Abuse Registry, the applicant shall not be approved to provide Adult Emergency Shelter Care services unless a policy exception is granted. Additionally, if a record check reveals a history of substantiated APS or CPS, the application may not be approved unless a policy exception is granted by the Office of Social Services. Any exception must first be approved by the local office prior to being submitted to the Office of Social Services for consideration. Exceptions to the above policy may be considered based on the following criteria: . C The specifics of the APS/CPS case, including the relationship of the allegations to the
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individual’s ability to provide services to adults; C The number of allegations which were substantiated against the individual, including an exploration of repetitive occurrences that may indicate a pattern of abuse and neglect; C Circumstances surrounding the allegations, ie., age of the individual, family circumstances or financial problems, etc.; and, C Evidence that would indicate whether, or not, the individual is currently able to provide care to aged and incapacitated adults.
4. Criminal Identification Bureau Check (CIB)
A Criminal Identification Bureau (CIB) check shall be completed on all individuals who provide direct care to adult clients for two or more hours per week. Included are: care givers, adult household members, regular volunteers, substitutes, and transportation providers. (See the CIB Policy of the Social Services Manual.) A records check is not required for transportation providers who are relatives of the client.
Providers are required to notify the agency within 24 hours when the household composition changes, i.e., new adult household members added, excluding clients, or when any household member has been charged and/or convicted of a criminal offense. The CIB check shall be submitted on all new adult household members within five (5) working days of notification by the provider.
CIB checks must be made on new applicants prior to final approval of the home. When a CIB report reveals convictions for any adult household member, the following action must apply:
C The applicant/household member shall not be approved if ever convicted of murder; abduction; kidnaping; sexual offenses, i.e. incest, rape, sexual assault/abuse, preparation/distribution/exhibition of obscene materials, indecent exposure, etc; contributing to the delinquency/neglect of a child; or violent crimes against the person,
i.e. child/adult abuse, neglect, exploitation, etc;C The applicant/household member shall not be approved if convicted of a felony and on parole or probation; C Any applicant/household member with felony conviction(s) whose parole/probation is completed shall not be approved unless an exception is granted; and,
C Any applicant/household member with two or more misdemeanors shall not be approved unless an exception is granted.
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Exceptions to the above policy may be considered based on the factors listed below. Any exception must first be approved by the local office prior to being submitted to the Office of Social Services for consideration.
| C | There is satisfactory evidence that the individual has been successfully rehabilitated; |
| C | The type of crime (s) for which the individual was convicted, would not impair their |
| ability to provide services to adults (i.e. shoplifting, disorderly conduct, etc.) ; | |
| C | The number of crimes for which the individual was convicted, including an exploration |
| of repetitive offenses that may indicate a pattern of criminal activity; and, | |
| C | The circumstances surrounding the commission of the crime, i.e., age of victim; physical, |
| financial or other losses by victim; age of the individual when crime(s) were committed; | |
| family or financial problems of the individual when crimes were committed. | |
| 5. | References |
Reference letters are to be sent to the applicant in the Application Packet. The applicant is responsible for requesting all reference letters be completed and sending them to appropriate parties for that purpose. Three references are required: A) two personal references must be completed, one of which must be completed by a person unrelated to the applicant and B) one a credit reference, to be completed by a current utility provider or bank/lending institution. The social worker must conduct a face to face interview with at least one of the personal references.
Documentation and summarization of all references and reference contacts must be made where applicable on the AFC/ESC Homestudy Summary. All references received in written form shall be attached to the completed AFC/ESC Homestudy Summary and shall be filed in the provider’s record and documented in document tracking.
NOTE: If the worker feels the need for additional references to determine if an applicant qualifies to be an Adult Emergency Shelter Care provider it is permissible for the worker to request additional references. It is not permissible to ask for additional references to replace references that may have given negative feedback. The only time that the additional references may replace one or more of the original references is when these original references refuse to respond.
A group interview is required as the final step in the home study process. All members of the applicant’s household must be present for this final interview. This session will provide the worker with the opportunity to observe interactions between family members and to discuss questions, problems, and /or assurances that the worker has in relation to approval of the home. Improvement and /or changes in the home that are required to bring the home into compliance with agency standards will be discussed at this time.
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a. Designated Provider
The family member who will be known as the Adult Emergency Shelter Care Provider must obtain, from a physician, a statement that he/she is physically and mentally able to care for incapacitated adults and is free of communicable disease to the best of the physician’s knowledge. The medical statement must be received and reviewed by the worker before the final approval can be given for their home to begin operating. The statement must not be dated later than ninety (90) days from the date of the application.
b. Other Household Members
If the worker believes it is likely that the home and all household members will meet agency standards and that approval of this home is likely, the worker must request a medical statement for all household members. Medical statements for household members eighteen years and older must include a statement that they are physically and mentally able to care for incapacitated adults if they are to provide any direct care to clients. These statements shall be prepared by a practicing physician who knows the family member and can state that they are free from communicable disease to the best of the physician’s knowledge. (Physician’s Letter is available as a FACTS document. It is also available in the Forms section of this policy for informational purposes.) The statement must be dated not more than ninety days (90) prior to the application date.
Note: If a household member has ever been committed to a mental institution or been treated for severe mental or emotional disturbances, the worker must obtain information to determine the nature of that illness and a statement from an attending physician and/or other involved behavioral health professionals documenting that person’s current status. The worker must consider all characteristics of each household member in determining the family’s ability to care for vulnerable adults in their home.
8. AFC/ESC Homestudy Summary
The results of the social worker’s evaluation of an applicant, his/her home and all household members must be documented on the “AFC/ESC Homestudy Summary” which is available as a FACTS document. It is also available in the Forms section of this policy for informational purposes. At a minimum the worker must document findings/information as outlined in the following sections. The completed Homestudy Summary must be filed, the date of completion
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entered in FACTS , and the location of the completed form noted in document tracking. The completed document must be saved to the file cabinet in the provider’s record in FACTS.
| a. | Identifying Information |
| C | Name of potential applicant |
| C | Physical Address |
| C | Mailing Address |
| C | Phone Number |
| C | Other |
| b. | Neighborhood |
| C | Describe the general location |
| C | Specify whether the area is rural |
| C | Specify if in a congested city area |
| C | Is the location in a business, factory or residential section? |
| C | Evidence of pollution |
| C | Evidence of crime in this community |
| C | Other |
| c. | Accessibility |
| C | Is the home located where it is accessible to necessary resources (i.e. recreational |
| facilities, stores, the local Department of Health and Human Resources, the local mental | |
| health center, physician and pharmacy)? | |
| C | By what means are these facilities accessible (car, bus, walking, etc.)? |
| C | Describe the community’s strengths and limitations |
| C | Other |
| d. | Physical Structure |
| Exterior | |
| C | Describe the house and all other buildings associated with it. |
| C | Do premises appear to be well-cared for? |
| C | Are there areas or objects that could be dangerous to persons who are mentally or |
| physically incapacitated? | |
| C | Is there yard space for recreation? |
| C | Are outside stairways adapted for use by handicapped individuals? |
| C | Are there animals in the home and/or on the grounds and, if so, do they appear to be |
| healthy and friendly? Are all vaccinations current and documented? | |
| C | Other |
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Interior
| C | Number of rooms, number of bedrooms and their location |
| C | Number of bathrooms |
| C | Adequacy of furnishings in all rooms. |
| C | Is there running water in bathrooms and kitchen? |
| C | Is there an approved water source? |
| C | Are wastes disposed of in a sanitary manner? |
| C | Is there clutter in hallways and rooms? |
| C | Are rooms and passageways free from obstructions? |
| C | Describe the general upkeep of the house. |
| C | Is there adequate storage space for client’s personal items in bathrooms and bedrooms? |
| C | Are clients’ beds firm, clean, and adequately supplied? |
| C | Give clear description of room or rooms to be used for the Adult Emergency Shelter Care |
| client. | |
| C | Is lighting adequate for reading, handiwork, and other activities? |
| C | Does the home have a basement? If so, what is it used for? |
| C | Does this home meet all fire safety and sanitary standards as determined on the AFC/ESC |
| Fire and Safety Report and the Annual Sanitary Inspection of AFC/ESC homes? (These | |
| forms are available as FACTS documents. It is also available in the Forms section of this | |
| policy for informational purposes.) | |
| C | Other |
| e. | Arrangements for Adult Emergency Shelter Care Clients |
| Recreational and Educational Outlets |
What activities will clients be encouraged to engage in? (ie ---- household chores, family vacations, reading, playing games, hobbies, and social activities in the community)
Areas Accessible to Clients What rooms in the house will the clients be allowed in? What rooms, if any, will be off limits and why?
Furnishings in Client’s Rooms Describe furnishings provided. Are they comfortable, usable, clean, adequate and attractive? If no, describe what changes are needed. Is client permitted to bring personal furnishings?
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Client’s Place in the Family Structure Will client be considered a part of the family? Describe.
Type of Client Preferred by Family Does any family member have certain qualities he/she cannot tolerate? Describe. Does the family understand that most clients placed have mental and/or physical limitations and usually require medication and sometimes treatment?
Care and Welfare of Clients Does it appear that the home will be able to meet all care and welfare, social and nutritional standards as outlined in this policy? If no, explain.
f. Finances and Resources of the Provider
Income
Indicate amount and source(s) of income within the household. Also give occupation/employment history.
Property
Is the home rented, owned or mortgaged? If rented, has/can applicant obtain written authorization from the landlord that it is acceptable for them to operate an Adult Emergency Shelter Care Home on the premises? If the landlord will not approve rental property for use as an Adult Emergency Shelter Care home and provide a written statement to the effect, the home can not be approved.
Insurance
General statement regarding medical insurance carried on each member of the household and real estate insurance (homeowner or rental).
Transportation
What is the provider’s means of transportation? Is this transportation dependable? Is this transportation available at all times? If no, explain.
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Other Resources
Other resources that are pertinent to the family (such as: livestock, farm products, board paid by members of the household)
Financial Security
Does the family appear to be secure financially? Will there be other income in the home besides that paid for the care of the Adult Emergency Shelter Care clients? Will this income cover all of the expenses (utility bills, rent, groceries, etc.) that the family itself incurs each month? If no, explain.
g. The Applicant’s Family
Household Members
Describe each household member thoroughly. Include name, age, appearance, interests and attitudes, achievements in employment, education/training and community and social activities. Is there any evidence of unfounded prejudices, oversensitiveness, irritability, explosiveness, peculiarities or unusual activities? Describe this member’s medical history including illnesses, operations, history of communicable disease, mental illnesses, alcoholism/substance abuse, etc.
Family Relationships
Describe early life experiences of the family and its members that shed light on how they function. Is the relationship between family/household members a good one? If married or residing as a couple, does each partner appear to be happy and satisfied with the other partner? Has either one been married previously? If so, are there stepchildren from these marriages? Does the couple have a good relationship with their children and other relatives? If there are conflicts what are the reasons for them? Are there any agency records (provider or client) that give us information about this family?
Family Attitudes
How do the household members of this family feel about having Adult Emergency Shelter Care clients in their home? How do relatives of the family who do not live with them feel about this?
Relationship of Provider to Client
Is this home being evaluated for the provider to care for a relative? Does the situation meet the criteria for a provider to care for a relative according to policy?
| Social Services | Adult Emergency Shelter Care | |
|---|---|---|
| Manual | Request to Provide Services | Chapter |
| 37,000 | ||
Health Standards
Is the applicant and all family members free from communicable diseases? Is the applicant physically and mentally able to care for an adult(s) placed in their home? Will all household members be conducive to the health and welfare of clients placed there? Does any household member have a debilitating disease or illness? Do all household members receive adequate medical care?
h. Reasons for wishing to be an Adult Emergency Shelter Care Provider
Relate reasons for becoming a provider as expressed by the applicant and the worker’s impression.
| i. | Ability to Care for Incapacitated Adults |
| C | Have the potential providers anticipated how an adult may react when he/she is brought |
| to a new home and meet new people? Explain. | |
| C | What are their ideas and practices in relation to sex education, physical care, |
| responsibilities for a resident, recreation and socialization? Explain. | |
| C | Do they recognize the problems and disappointments involved with caring for |
| incapacitated adults as well as the satisfactions? Explain. | |
| C | How do they accept the possibility of disturbances and difficulties in their home? Are |
| there members of the home who already create disturbances and difficulties? If yes, | |
| explain. | |
| C | How will the provider encourage the client’s cooperation for health and safety sake, as |
| well as contributing to a normal household atmosphere? Will they encourage the client to | |
| become as independent as possible? Explain. | |
| C | What constitutes a problem to this family? If such would arise, how would the family |
| deal with and bring it to a satisfactory conclusion? Explain. | |
| C | Will the family assume responsibility for maintaining adequate clothing(mending, |
| laundry, ironing, purchasing, etc.) for the client, providing transportation for medical | |
| care, providing care during temporary illnesses, and providing supervision at all times, if | |
| necessary? Describe. | |
| C | How will the client be introduced in the community? Does the provider feel that his/her |
| neighbors will have any strong objections to an incapacitated adult being close by? | |
| Describe. | |
| C | Will the provider be able to recognize and handle emergencies? |
| j. | Results of CIB |
Summarize the results of the CIB check for each household member.
If a waiver is being requested, justification for the waiver is to be documented. See the CIB
Section of the Social Service Manual.
| Social Services | Adult Emergency Shelter Care | |
|---|---|---|
| Manual | Request to Provide Services | Chapter |
| 37,000 | ||
k. References
Summarize details of all references received and the required face to face contacts with at least one personal reference.
| l. | Evaluation of Home and Recommendations |
| C | Specify the strengths and weaknesses the family exhibits. Do the strengths greatly |
| outweigh the weaknesses? | |
| C | Are there certain types of adults the worker feels this family could handle better than |
| others? Explain. | |
| C | Are there certain types of adults that could definitely not be placed in this home? |
| Explain. | |
| C | Are there racial or nationality factors that need to be taken into consideration? Explain. |
| C | Does this home meet all standards for Adult Emergency Shelter Care Homes? If not, |
| what are the deficiencies and their affect on the home’s approval? | |
| C | If the home is being recommended for approval, how many adults will the provider be |
| able to adequately care for? | |
| m. | Approval Process |
Approval of a home to provide Adult Emergency Shelter Care is based upon the evaluation of the home by the worker and the review by the supervisor of the AFC/ESC Homestudy Summary recording as well as a determination as to whether all standards for an Adult Emergency Shelter Care Home have been met. No standards for Adult Emergency Shelter Care may be waived by the local office. (See Standards for Selection of Adult Emergency Shelter Care Home for detailed information about applicable standards.)
Written Notification of Decision on Application
C Written notification of the decision on an application must be prepared by the social worker and sent to the applicant within five working days from the date of the decision.
C If the application is denied, the social worker must send the Negative Action Letter within five working days advising the applicant of the denial, stating the reasons for the denial. The Negative Action Letter is available as a FACTS document. It is also available in the Forms section of this policy for informational purposes. This negative action letter also serves as written notification of the grievance procedure which is available to the applicant and should be filed in the File Cabinet for the provider record in FACTS. See Common Chapters Manual for detailed information about the grievance procedure.
C If the application is approved, the Adult Emergency Shelter Care Approval Letter and Certificate Letter must be sent to the applicant. These documents are available as
| Social Services | Adult Emergency Shelter Care | |
|---|---|---|
| Manual | Request to Provide Services | Chapter |
| 37,000 | ||
FACTS documents. They are also available in the Forms section of this policy for
informational purposes. Copies of any approval or denial letters sent to an ESC home applicant must be filed in the paper record set up for this applicant.
Procedures Once Home is Approved
When the worker has received all of the required forms, has completed all steps required in the home study process, and has approved the home to provide Adult Emergency Shelter Care, the following must be done by the social worker:
| C |