ENHANCED RESPITE SERVICES

PURPOSE

The enhanced respite services (ERS) program enables DDA-enrolled clients to access short-term stabilization in a DDA-contracted and licensed staffed residential setting. ERS is intended to help the client stabilize in a community-based setting and work on habilitative goals while giving their primary caregiver a short-term break in caregiving.

DEFINITIONS

"Backup caregiver" means an identified secondary person who will assume the role of providing direct care to and support of the client in instances of emergencies and in the absence of the primary caregiver who is unable to care for or respond to the client.

"Client" means a person who has a developmental disability as defined in RCW 71A.10.020 and who has been determined DDA-eligible under chapter 388-823 WAC.

"DDA" means the developmental disabilities administration within the department of social and health services.

"Habilitative goals" means the identified goals intended to assist the client to acquire, retain, and improve upon self-help, socialization, and adaptive skills.

"Habilitation" means services that assist persons with developmental disabilities to acquire, retain, and improve upon the self-help, socialization, and adaptive skills necessary to reside successfully in home and community-based settings.

"Individualized team" means the group of people who work together to provide formal and informal supports to a client. A typical team includes the client, the client's primary caregiver and legal representative, ERS staff, the client's case resource manager, managed care organization care coordinators, and any other service providers working with the client and the client's primary caregiver.

"Legal representative" means a parent of a client if the client is under age 18 and parental rights have not been terminated or relinquished, a court-appointed guardian if a decision is within the scope of the guardianship order, or any other person authorized by law to act for the client.

"Primary caregiver" means the person who provides the majority of the client's care and supervision and lives with the client.

"Provider" means the contracted provider of enhanced respite services.

ELIGIBILITY

A person may be eligible to receive stabilization services from an enhanced respite services (ERS) provider if:

(1) The person is age eight to 17, or age 18 to 20 and enrolled in school or a vocational program;

(2) The person is DDA-eligible under chapter 388-823 WAC;

(3) The person is eligible for stabilization services under WAC 388-845-1100;

(4) The person has received medically necessary inpatient treatment for conditions related to behavioral health or autism, if recommended by the client's treating professional, and does not have a current treatment recommendation for a locked or secured facility;

(5) The provider determines under WAC 388-841-0040 that the provider can safely meet the client's needs and that the client does not pose a risk to the health or safety of themselves, ERS staff, or other clients supported by the provider;

(6) The person does not require an intervention prohibited in the setting or that cannot be provided based on staffing levels and credentials;

(7) The person lives at home with their primary caregiver and at the time of application has an identified discharge setting to return to, such as the primary caregiver's home or other residential setting; and

(8) The primary caregiver identifies a backup caregiver to respond in an emergency if the primary caregiver is unavailable.

To determine whether they can safely meet a client's needs, the enhanced respite services provider reviews client information, such as:

(1) The client's referral packet and any additional requested information;

(2) Interviews with the client and primary caregiver, collateral contacts, or case manager; and

(3) Composition and needs of clients currently supported by the provider.

A staffed residential home may become an enhanced respite services (ERS) provider if licensed under chapter 110-145 WAC and contracted with and certified by DDA to provide services through the ERS program.

The enhanced respite services provider must be certified by DDA under chapter 388-825A WAC.

(1) To be certified, the provider must participate in site visits as required under chapter 388-825A WAC.

(2) During a site visit, DDA reviews the provider's service site for the following safety requirements:

(a) The common areas of the home are unrestricted.

(b) All entrances and exits are unblocked.

(c) The home is in good repair and maintained in a sanitary manner.

(d) The home has a storage area for flammable and combustible materials.

(e) Every floor of the home has working smoke and carbon monoxide detectors.

(f) The home has a fire extinguisher that meets requirements for the residence type. There must be a fire extinguisher in the kitchen and at least one on every floor of the home.

(g) The home has a stocked first-aid kit.

(h) The home has a working and accessible telephone.

(i) The home has a working and accessible flashlight or alternative light source.

(j) Emergency contact information is available and accessible in the home (e.g., 911, poison control, nonemergency 911, adult protective services, child protective services).

(k) The contact information for the developmental disabilities ombuds is available and accessible in the home.

(l) The water temperature at the home is 120 degrees Fahrenheit or less.

(m) There is a safety plan for any body of water more than 24 inches deep at the home.

(n) The home has an evacuation plan and an emergency food and water supply.

(o) The home meets applicable integrated setting requirements under WAC 388-823-1096.

(p) The home has a backup power source (e.g., generator, battery pack) if the provider supports a child or youth who uses life sustaining medical equipment.

(1) To provide services as a direct support professional (DSP), a person must complete:

(a) Training required under chapter 110-145 WAC;

(b) Training and continuing education required under chapter 388-829 WAC; and

(c) Nurse delegation training if delegation is required under WAC 246-840-930 and the DSP will be performing tasks requiring delegation.

(2) The provider must ensure that each direct support professional stays current on their CPR certification, food worker card, and first aid and bloodborne pathogens trainings.

(3) The provider must ensure that a consultant under WAC 110-145-1460 observe and develop client-specific training for direct support professionals.

SERVICE DELIVERY

(1) The enhanced respite services program includes:

(a) Creation and implementation of a habilitation plan and a behavior intervention plan, which must be developed by a consultant under WAC 110-145-1460 in collaboration with the client and primary caregiver;

(b) Opportunities for the client's primary caregiver and individualized team to participate in scheduled intake, mid-stay, and discharge meetings facilitated by the provider;

(c) Discussion of effective environmental strategies, and collaboration on techniques for implementing the client's habilitation and behavior intervention plans; and

(d) Medication administration and medication assistance as needed.

(2) The provider must provide the following to clients:

(a) Three meals per day plus snacks;

(b) Basic toiletries and personal care items;

(c) Bedding and towels;

(d) Access to laundry facilities;

(e) Access to a telephone;

(f) Opportunities for accessing the community;

(g) Transportation to emergency services, as needed;

(h) Transportation to local, scheduled appointments if agreed upon before admission between the provider and the primary caregiver; and

(i) Access to education as agreed upon before admission between the provider and the primary caregiver.

A client may receive services through the enhanced respite services program one time per calendar year for 30 consecutive days.

RIGHTS AND RESPONSIBILITIES

(1) The enhanced respite services (ERS) program is voluntary and does not affect a parent, legal representative, or primary caregiver's rights and responsibilities for the child.

(2) Before the client receives services from the provider, the parent, legal representative, or primary caregiver must:

(a) Meet with the provider to plan for the client's stay;

(b) Arrange with the client's current school district to maintain their school enrollment and a plan for their educational progress while receiving this service; and

(c) Arrange transportation of the client to and from the facility.

(3) While a client is in the ERS program, the client's primary caregiver must:

(a) Maintain regular contact with their child or youth throughout the child or youth's stay;

(b) Participate in the client's individualized team meetings - including, intake, mid-stay, and discharge meetings - to discuss service planning and implementing strategies identified in the habilitation and behavior intervention plans; and

(c) Work with ERS staff to transition the client back home on the established discharge date.

A parent, legal representative, or primary caregiver remains financially responsible for all expenses for their child that the enhanced respite services provider is not required to provide under this chapter.

SAFETY

The provider must:

(1) Maintain the water temperature in the home no higher than 120 degrees Fahrenheit;

(2) Check the water temperature monthly; and

(3) Document compliance with this requirement.

TERMINATION

(1) The provider may decide to stop providing services to a client if the provider determines and documents that the client's behavior jeopardizes:

(a) The client's health or safety; or

(b) The health or safety of staff or other clients the provider supports.

(2) The notice of the provider's decision must include:

(a) The reason for the decision; and

(b) The effective date of the decision.

(3) Before the effective date of the decision, the provider must notify:

(a) The client, if appropriate;

(b) The client's primary caregiver and legal representative;

(c) The client's DDA case manager; and

(d) The ERS contract manager.

ADMINISTRATIVE HEARING RIGHTS

(1) A client, the client's primary caregiver, or the client's legal representative may appeal decisions made by DDA in accordance with WAC 388-825-120 through 388-825-165.

(2) A client, the client's primary caregiver, or the client's legal representative does not have a right to appeal a provider's decision to no longer serve the client.

(3) Once the client has received services for the maximum of 30 consecutive days in a calendar year, the enhanced respite services program is complete. The client, the client's primary caregiver, or the client's legal representative does not have a right to appeal the service end date.