Homecare Agency Key Issues

Home care
1) How are incidents of abuse, neglect, exploitation or injury reported internally?
The agency seeks to promptly respond and solve issues of abuse, neglect, exploitation and injury. It is the responsibility of the client/member to report any incident to the agency through the administrative office or through the immediate supervisor. Members are given contact information like agency phone numbers, email address, and fax. Incidents must be reported immediately in order to allow the agency to respond to the situation immediately. It is the responsibility of the supervisory board to assess any incidents and come up with a reasonable solution to the situation. Members are allowed to verbally communicate any incidents as well. Family members can walk into the agencies premises within 24 hours of an incident and report it. Any incident is recorded in the Incident Report DD-191 form.
The form captures details of the type of incident that took place, the direct service provider involved, the time the incident took place, the consequences that resulted from the incident and the immediate action taken by the direct service provider after the incident happened. After the incident has been captured in the incident report form the immediate supervisor will be assigned the responsibility of assessment. The immediate supervisor will investigate the factors that contributed to the occurrence of the incident. It the incident was an injury or accident better protection measures will be put in place. Where the incident involves neglect, abuse or exploitation of the member by the direct staff immediate action will be taken to prevent future occurrence. The prevention plan may include a change of the direct staff and immediate disciplinary action. Where injuries are suffered due to the fault of the direct staff the agency will bear the cost of repairing the damage.
All incidents reported verbally through phone calls or through a visit to the agencies premises must be documented in the incident report form. Follow up measures will be instituted to reassess whether the prevention measures put in place are effective. The supervisory board is charged with making sure that the services offered are effective.
2) How are incidents of abuse, neglect, exploitation or injury reported externally?
There are incidents whose nature is beyond the scope of the agency to handle. Incidents of violence against the member or the agency’s staff that is assessed as requiring legal action shall be reported to the police. Where a member is abusive to the direct staff or exploits them the incident shall be reported to the family or guardian. Incidents of non-compliance with the standard conditions and terms for the qualified vendor shall be reported to the DES/DDD support coordinator. Where a member reports abuse, exploitation or neglect by the direct staff the agency can forward the incident report to the protective services. All the incidents of exploitation, injury, neglect and abuse should be reported immediately to the agency through the direct supervisor or the administrative staff. Members, their family or guardian can choose to pursue legal action parallel to the action taken by the agency.
All incidents communicated must be documented in the incident report DD-191 form. Incidents should only be communicated to the police only when cases violence, abuse and/or exploitation are encountered. The police should be able to immediately respond to a 911 call to subdue any emergency situation. Protective services should be sought if incidents of emotional, physical, sexual and verbal abuse are experienced or discovered. Incidents of neglect can also be reported to the protective services. The protective services are put in place to make sure that the rights of individuals to quality care and services are upheld. The adult protective services are put in place to protect adults dealing with considerable disabilities from abuse, exploitation and neglect.
If the agency is unable to promptly deal with any incident of abuse, neglect, or exploitation them the guardian or family member has the legal right to contact the adult protective services. The protective services are administered by the state or local regulatory or gaining departments. They use multidisciplinary approaches in their objective of assisting older adults who are victimized.
3) Describe the internal review process for incident reports, including trending, and how corrective action is implemented.
Incidents reports to the agency are handled and resolved by the supervisory board and disciplinary boards. After an incident is reported to the immediate supervisor or the administrative unit immediate action is taken. The first responsibility is to evaluate the incident and ascertain that indeed what the member, their family or guardian has reported is verifiable. The investigations will involve the parties involved in the incident including the direct staff, member and a physician where injury, emotional or physical abuse are involved. After this the immediate supervisor will report to the supervisory board with the investigation outcomes. The supervisory board will apportion responsibility for the incidents reported and institute measures necessary to avert the occurrence of such incidents again.
The supervisory board may recommend performance improvement measures, better monitoring tools and processes, advanced staff training, changes in staff policies or even termination of a direct or supervisor. The supervisory board is charged with ensuring that the agency delivers outstanding services to the members at all times. This is made possible by alleviating any incidents. To make this possible the supervisory board will institute incident prevention measures, treatment for injured members, and legal action for physically and emotionally abusive, negligent and exploitative staff. Internal incident reviews must be completed within two weeks of reporting. The agency will also conduct a monthly review of the recurrent and trending incidents with a view of identifying the areas that need better improvement. Any protective measures instituted are subjected to monitoring. The objective is to find out whether the measures instituted are effective.
Most of the time incidents occurrence will call for a review of the staff training curriculum. To prevent emotional and physical abuse, exploitation and negligence from the direct staff the supervisory board might have to retain their direct staff and direct supervisors. This might take longer than the two weeks recommended for completion of internal reviews. Any recommended adjustments or changes to the service must be implemented immediately.
4) Describe the complaints/grievances process.
Agency members and staff might have some grievances or complaints in the course of operations. Agency’s direct staff members are advised to forward their complaints to their immediate supervisor if the situation involves the client and the working environment. The immediate supervisor should immediately evaluate the details of the complaint or grievance and identify the need. If the working environment is not favorable due to factors that are beyond the staff’s control the immediate supervisor may choose to reassign the direct staff their duties and reallocate them to a more favorable working environment. At times the client may be troublesome, irritable or exploitative. The communication problem or lack of chemistry between the staff and client may provoke a tense working environment. Troublesome clients may necessitate handling from an experience direct staff member.
Where grievances or complaints relate to staff remuneration or working conditions staff members are advised to forward their complaints and grievances to the human resource department and the directorate. If perhaps the issue is delayed payment of wages the human resource department should be able to issue a comprehensive solution and take immediate action for the release of staff salaries. Internal mechanism for conflict, grievances and complaint resolution are clearly stated in the employment guidelines. The director to the agency has a responsibility of averting any situations that might make the working environment unfavorable for the staff. Staff productivity can be hindered by instances of poor remuneration, poor working conditions such as insufficient equipment (medical supplies, gloves, uniform etc.) and poor coordination of duties. The human resources department will review any staff grievances relating to their working environment and forward any salary related grievances to the finance department. The director has a duty to make sure that all recommendations are implemented immediately with a goal of resolving any situation. The buck stops with the director. Poor communication and coordination in the agency is often to blame for the hitches that provoke complaints from members and staff. The agency coordinator should work towards enhancing capacity to ensure all services are running seamlessly.
5) If your organization has a community advisory group and/or participates in any external advisory groups, describe your company’s involvement. If none, describe your company’s plans to develop, or participate in, a group in the future. (one page)
The agency is actively involved in community affairs. First of all the agency recruits and interviews her staff in collaboration with the community and local government representatives. The company also offers its members to various community advisory groups for projects such as development of sanctuary centers, community security forums, community training initiatives, environmental conservation forums etc. It is the goal of the agency to promote community based activities that look to improve the living conditions of the entire local community. The agency through the coordination board has the necessary expert to offer help in the planning of community events. The agency staff members are also actively involved in community events such as annual cleaning drives, fumigation, sporting activities, local government forums etc.
The agency has an elaborate internal recruitment and hiring process. All the staff members have to go through appraisal processes aimed at enhancing service delivery. The agency uses this expertise to assist the local government and community centers to hire the best fitting candidates for different community positions like the Count Sheriff, community policing unit, environmental conservation agency members etc. The agency also offers its monitoring expertise to the various community agencies for the evaluation of the milestones and progress made in security, environmental conservation etc. The local community regularly holds open forums aimed at receiving feedback from the community. The elaborate interaction between the agency and the local community through family members and guardians to the elderly has allowed it to gain comprehensive knowledge and understanding about the needs of the people. During community forums the agency is actively involved in gathering feedback from the community and asking questions in the open agenda meetings. Overall the agency is able to push for the interests of the elderly as well as offer support to the community through the open agenda forums.
6) Describe any other method used by your organization to provide opportunities for members/member representatives to be actively involved in your organization’s operations. (I.e. staff recruitment, staff training and development, monitoring, social events, etc.)
The agency has an elaborate framework that guides the recruitment and hiring program. The local community and local government representatives are actively involved in the recruitment process. The agency vets several renowned local community representatives and integrates them in the recruitment board. The community members’ responsibility is to push for the interests of the local community in light of the needs of their elderly members. During social events the agency is actively involved through the special advisory groups put in place. If the social event entails entertainment, environmental conservation, a retreat for the elderly or development forums the agency will put up a competent advisory team. The advisory team will help in the planning and running of the social event in collaboration with the coordinator of that social event.
Staff straining and development happens based on the prevalent community needs. Through the elaborate feedback processes the agency is able to gather sound feedback information. The outcome of any complaints, concerns and situation will often necessitate better client services. Based on the needs of the community the agency is able to review the training curriculum and appraise its staff. Family members or representatives are involved in the supervisory board. Their recommendations and suggestions are taken into consideration for the development of the monitoring and staff development programs. The staff development advisory group is charged with the responsibility of looking at the plight of staff members and their professional development. The member representative’s advisory group takes care of the needs of the elders by articulating their situations to the agency. The agency takes into consideration the suggestions and recommendations from this advisory group and uses them to build a stronger workforce.
The monitoring advisory group is charged with helping the agency enhance the consistency and quality of service delivery. This advisory group is focused on evaluating the consistency, timeliness and professionalism with which client services are provided.
7) Describe the process used by the organization to monitor and evaluate the services provided as they relate to the service plan outcome.
The agency has an elaborate monitoring and evaluation process. The detailed feedback gathering processes from members utilizes telephones, emails, fax and walk in feedback gathering methods. The immediate supervisors also do impromptu visits to the homes of agency member for firsthand information. All the feedback received is documented and forwarded to the supervisory board for evaluation. The supervisory board proposes changes and developments to the services provided. It is the responsibility of the supervisory board to monitor the progress and improvements made to the services. The supervisory board holds quarterly staff meetings to discuss the milestones reached. The supervisory board assesses the progress made in service delivery by comparing the outcomes of the same period in the previous years to the performance of the agency in the current year. The staff meetings are meant to benchmark and review the areas where significant improvement has been recorded and the areas where more effort is needed.
During the staff meetings the immediate supervisors can be assigned new monitoring targets and service evaluation standards based on the current needs. The individual support plan (ISP) goals and objectives are standards every direct staff and immediate supervisor are required to have based on the overall expectations from the agency. The staff members are required to hand in written reports capturing the milestones reached in achieving the ISP goals. The agency also avails special evaluation forms to the family members or guardians. The forms capture details about service satisfaction and need assessment. The family members are expected to honestly evaluate the quality of service received by their loved ones and respond to the questions of punctuality, compliance with service definition, and the degree to which the service has been beneficial to the family. This feedback will be used by the supervisory board to further enhance service delivery. The evaluation and monitoring initiative is continuous and at time impromptu. Site visits are conducted twice a month but family members are required to fill the feedback form on impromptu basis.
8) Describe the overall organizational approach toward improving the quality of the services provided. (As part of your response, consider trending incidents, grievance and compliant processes, onsite monitoring and member feedback.)
The agency has set clearly defined milestones based on annual performance records. The scale and depth of member satisfaction is recorded and documented on a quarterly basis. Every year the agency evaluates the client base to see whether the reputation and growth of the service is in tandem with agency objectives. The agency is able to capture the trending needs, complaints and grievances from the staff and members through the regular feedback channels that channel information to the supervisory board. Through onsite visits the agency is able to monitor and evaluate member satisfaction levels and needs. Based on the urgency of the needs and the frequency with which needs are reported the agency is able to formulate improvement programs. Some of the programs might include staff appraisal and training programs, better remuneration, tighter supervisory targets, and better working environment (such as more lenient working schedules supported by the hiring of more direct staff ).
Based on the evaluation of quarterly performance the agency can deduce factual information about the level of improvement or level of deterioration of services. The supervisory board looks at the growth of the client base, the frequency and trends of member complaints and grievances, the staff satisfaction levels and achievement of ISP objectives. The monitoring process checks to see whether any improvements have been recorded in any of the highlighted areas. Change management is fundamental to the enhancement of client services. New working standards and new reporting tools may be introduced to better satisfy client needs. Staff evaluation processes revolve around the set ISP goals and objectives. The immediate supervisor assesses the ISP form and the situation onsite to determine whether activities are geared towards meeting the set objectives. New procedures aimed at satisfying new member’s needs are implemented and assessed through client feedbacks. Client satisfaction, staff satisfaction, service improvement, client base, and revenue managerial reports are generated in every quarter. These tools are quite fundamental in assessing quality of services offered and the progress made in enhancing client services.