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SECTION G -- HUMAN SERVICES
AGING AND DISABILITY SERVICES
NURSING CASE MANAGEMENT
PROGRAM MISSION: To support and empower individuals and families to achieve and
maintain an optimal level of health and well being in the community through
home visits to adults and elderly persons who are disabled or have multiple
chronic illnesses and live in their own homes.
The program impacts the community
at large by maximizing knowledge of health care issues. Services are designed to prevent unnecessary
emergency room visits, hospitalizations, and premature institutional placement. The following are components of the program:
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Nursing Case
Management provides a medical model of case management to persons through
home visits as prescribed by a physician.
The focus is on improving or maintaining the patient's level of
functioning through a comprehensive medical and psychosocial assessment, health
education, monitoring of the patient's medical condition, and coordinating the
provision of needed services in the patient's home. Two major areas of focus are medication management and
nutrition. Joint visits are also made
with Adult Protective Services social workers for an evaluation of critical
medical needs. Consultations are also
provided to the Mental Retardation/Developmental Disability case managers,
social workers and mental health therapists in Adult Services and Senior Adult
Mental Health. Also offered, as a part
of Nursing Case Management, is assistance by Human Service Aides with bathing
and personal care one or two times per week.
The fee for the bathing services is based on the patient's income.
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Community
Outreach activities include liaison with six area hospitals for discharge
planning; conducting state required nursing home and community-based care
pre-screenings for Medicaid; coordinating the flu immunization program,
including outreach to senior centers and buildings with elderly residents; and
presenting health and wellness programs in the community with a focus on
prevention, providing individuals with information and resources they need to
safely manage their health care issues independently in their own homes.
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Cluster Care provides
eligible adults with long-term maintenance or support services enabling
individuals to remain at or return home after hospitalization or skilled
facility discharge. Services may
include personal care, nutritional support, environmental maintenance, and
support services such as grocery shopping and running errands. Services provided are not medical in nature
and, therefore, are not reimbursed by Medicare, Medicaid, or most health
insurance.
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Program Budget
Summary
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FY 2004
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FY 2005
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FY 2006
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% Change:
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Actual
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Adopted
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Proposed
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'05 to '06
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Nursing Case
Management
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783,170
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706,530
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720,632
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2%
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Cluster Care
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1,120,530
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1,718,685
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1,762,551
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3%
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Total Expenditures
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1,903,700
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2,425,215
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2,483,183
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2%
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Total Revenue
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550,950
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1,016,099
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1,046,792
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3%
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Net Tax Support
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$1,352,750
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$1,409,116
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$1,436,391
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2%
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Nursing Case
Management
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FY 2004
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FY 2005
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FY 2006
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% Change:
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Actual
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Adopted
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Proposed
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'05 to '06
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Personnel
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$676,519
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$715,920
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$725,378
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1%
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Non-Personnel
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1,227,181
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1,709,295
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1,757,805
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3%
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Total Expenditures
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1,903,700
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2,425,215
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2,483,183
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2%
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Fees
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5,002
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2,500
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4,000
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60%
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State Share
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208,000
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792,295
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821,488
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4%
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Federal Grants
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337,948
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221,304
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221,304
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Total Revenue
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550,950
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1,016,099
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1,046,792
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3%
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Net Tax Support
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$1,352,750
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$1,409,116
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$1,436,391
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2%
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Authorized FTEs
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11.8
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11.8
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11.7
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Funded FTEs
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11.8
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11.8
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11.7
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SIGNIFICANT BUDGET HIGHLIGHTS:
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Non-personnel primarily reflects an increase in LPACAP funding ($29,193) and local funding ($17,170) for the Cluster Care
Program.
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Fees increased to reflect improved collections
for the Bathing Program ($1,500).
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State share increased to reflect an adjustment
($29,193) in LPACAP funding for the Cluster Care Program.
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FTEs are reduced due to the internal
reallocation of a 0.1 FTE to the Agency on Aging.
PERFORMANCE MEASURES:
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FY 2002
Actual
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FY 2003
Actual
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FY 2004
Actual
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FY 2005
Estimate
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FY 2006
Estimate
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FY 2006
Goal
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Mission Outcome Measures
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Percent of
patients for whom the nurse prepours medications or prefills insulin syringes
who demonstrate compliance or partial compliance with medications after this
intervention
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96%
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93%
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90%
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90%
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90%
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90%
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Percent of
patients with hypertension who maintain blood pressure within established norm for patient 80% of the
time
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88%
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88%
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91%
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85%
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85%
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85%
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Percent
of patients identified as obese, underweight, or with unexplained weight loss
who have improved or maintained weight status
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85%
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87%
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86%
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85%
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85%
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85%
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Percent of patients in bathing program who have maintained
or improved skin condition
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94%
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92%
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97%
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92%
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92%
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92%
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Number/percent of Cluster Care clients
maintained in own home
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N/A
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N/A
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285/80%
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300/75%
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300/75%
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75%
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Customer
Measures
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Percent of patients satisfied with nursing case management service
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N/A
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N/A
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98%
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90%
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90%
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90%
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Percent of clients satisfied with
home-based cluster care services
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N/A
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N/A
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93%
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90%
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90%
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90%
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Percent of Cluster Care staff who have
transitioned to a vendor provider of services that report an average
satisfaction rating of 4.0 based on a 5.0 scale
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N/A
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N/A
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94%
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95%
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95%
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95%
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Workload Measures
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Number of persons served in each
program component:
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Nursing Case Management
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425
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552
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433
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435
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435
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435
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Activities of Daily Living
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80
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78
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71
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75
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75
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75
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Home-Based Cluster Care
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116
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300
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358
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400
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400
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400
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The decrease
in the number of patients receiving Nursing Case Management Services and the
Activities of Daily Living Program in FY 2004 was the result of staffing
vacancies which continue into FY 2005.
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