Current through Reg. 49, No. 38; September 20, 2024
(a) Purpose. This
section establishes the requirements for homemaker services, a service provided
under the Older Americans Act and funded, in whole or in part, by
DADS.
(b) Eligibility. A AAA must
ensure that a program participant who receives homemaker services is:
(1) 60 years of age or older; and
(2) functionally impaired in the ability to
perform instrumental activities of daily living as described in DADS Program
Instruction AAA - PI 310 Activities of Daily Living/Instrumental
Activities of Daily Living NAPIS Mapping Requirements.
(c) Type of provider. A AAA may
provide homemaker services as an agency managed service or as a consumer
directed service, or as both.
(1) Agency
managed. Homemaker services that are agency managed are provided only by a
vendor.
(2) Consumer directed.
Homemaker services that are consumer directed are provided by furnishing
vouchers to a program participant, allowing the program participant to select a
homemaker, establish a work schedule and payment rate, and provide the
homemaker information and training on the program participant's
needs.
(d) Informing
program participant of options. If a AAA provides homemaker services as both an
agency managed service and as a consumer directed service, the AAA must inform
a program participant that he or she may choose to receive homemaker services
in either of those two ways.
(e)
Service authorization. Before homemaker services are provided by a vendor to a
program participant, the AAA must ensure that the vendor obtains prior written
authorization for the services from the AAA in accordance with §
83.3(o)(2)(B) of this title (relating to System of Access and
Assistance).
(f) Homemaker
services. Homemaker services include:
(1)
cleaning for the program participant, including:
(A) cleaning after a program participant's
personal care tasks;
(B) emptying
and cleaning a program participant's bedside toilet;
(C) cleaning a program participant's
bathroom;
(D) changing a program
participant's bed linens and making the program participant's bed;
(E) cleaning the floor of a program
participant's living area;
(F)
dusting an area used by a program participant;
(G) taking a program participant's trash to
an outside receptacle and moving the receptacle to a location for
pick-up;
(H) cleaning a program
participant's stovetop and counters;
(I) washing a program participant's dishes;
and
(J) cleaning a program
participant's refrigerator and stove;
(2) doing a program participant's laundry,
including:
(A) washing a program participant's
laundry by hand or machine;
(B)
gathering and sorting laundry;
(C)
loading and unloading the washing machine and dryer in the program
participant's residence;
(D) using
laundromat machines;
(E) hanging
laundry to dry; and
(F) folding and
putting away laundry;
(3)
shopping for the program participant, including:
(A) preparing a shopping list;
(B) going to the store and purchasing or
picking up items;
(C) picking up
medication; and
(D) storing the
purchased items;
(4)
assisting a program participant in organizing and completing a home management
routine;
(5) performing necessary
reading and writing tasks as directed by the program participant;
(6) preparing meals for the program
participant, including:
(A) assisting in
planning menus that are appropriate for the program participant's
needs;
(B) shopping for and storing
food;
(C) preparing and serving
meals; and
(D) utilizing sanitary
practices for handling and preparing food; and
(7) accompanying a program participant to
obtain health care services and other necessary items and services unless
prohibited by subsection (g)(7) of this section.
(g) Prohibited activities. Homemaker services
do not include the following:
(1) personal
assistance services described in §85.305(e)(1) - (2), (4) - (10), and (12)
of this subchapter (relating to Personal Assistance Services);
(2) repairs to the program participant's
residence;
(3) pet
grooming;
(4) yard
maintenance;
(5) moving heavy
objects;
(6) performing services
for members of the household other than the program participant;
(7) transporting the program participant in a
vehicle unless proof of liability insurance covering such transportation has
been verified, in writing, by the vendor;
(8) performing tasks beyond the scope of the
service authorization required by subsection (e) of this section;
(9) accepting gifts from the program
participant;
(10) bringing persons
to the program participant's residence who are not providing homemaker services
to the program participant;
(11)
taking personal property from the program participant's residence; or
(12) assuming control of the
financial or personal affairs of the program participant or his or her estate
including serving as power of attorney, guardian, or conservator.
(h) Staffing qualification
requirements for an agency-managed service.
(1) A AAA must ensure that a vendor that has
a program supervisor for homemaker services requires the program supervisor to:
(A) meet one of the following criteria:
(i) be a licensed nurse;
(ii) have completed two years of full-time
study in social or behavioral sciences at an accredited college or university;
or
(iii) have:
(I) a high school diploma or high school
equivalency certificate; and
(II)
have one of the following:
(-a-) the
equivalent of two years experience as a full-time employee in a supervisory
capacity in a health care facility, health care agency, or other health care
organization; or
(-b-) the
equivalent of one year experience as a full-time employee in a supervisory
capacity in a health care facility, health care agency, or other health care
organization and have completed one year of full-time study in social or
behavioral sciences at an accredited college or university;
and
(B) have experience in:
(i) housekeeping or home management;
and
(ii) meal preparation
activities.
(2)
A AAA must ensure that a vendor requires a homemaker (that is, the person who
provides homemaking services to the program participant):
(A) to be an adult;
(B) to have the ability to follow oral and
written instructions and keep records;
(C) to have previous experience providing
care to a person 60 years of age or older or a disabled adult;
(D) to demonstrate competency to perform
homemaker services;
(E) to not be
the spouse or legal guardian of the program participant; and
(F) to not live with the program
participant.
(i) Training and documentation requirements
for an agency managed service. A AAA must ensure that a vendor:
(1) trains homemakers to recognize and report
changes in a program participant's health condition that may require emergency
procedures or health services;
(2)
maintains documentation demonstrating compliance with paragraph (1) of this
subsection; and
(3) determines the
need for, and requires homemakers to receive, other training as appropriate.
(j) Information and
assistance requirements for a consumer directed service. A AAA must:
(1) give a program participant written
information to assist the program participant in performing the following
activities:
(A) interviewing potential
homemakers;
(B) requiring potential
homemakers to provide references;
(C) checking references of
homemakers;
(D) selecting a
homemaker who meets the qualifications described in subsection (h)(2) of this
section;
(E) deciding upon, in
discussion with the homemaker, an hourly, daily, or weekly rate to be paid to
the homemaker;
(F) informing or
training the homemaker on the specific needs of the program
participant;
(G) ensuring proper
payment for homemaker services by recording the number of hours or days
homemaker is used and the total amount claimed against the voucher;
(H) ensuring federal tax guidelines for
household employees are followed in accordance with IRS Publication 926;
(I) notifying the AAA if the
program participant's address changes;
(J) monitoring the quality of the homemaker
service provided; and
(K) notifying
the AAA if the program provider is dissatisfied with a homemaker; and
(2) assist a program
participant in finding a homemaker if such assistance is requested by the
program participant.