HCBS: Empowering Autonomy and Independence
Every individual deserves the opportunity to live a self-directed life, making choices that align with their personal goals and dreams. Medicaid’s Home and Community-based Services (HCBS) give people a chance to get long-term support in their own homes or community as opposed to an institution. The Federal HCBS Settings Rule, which introduced rules for settings where Medicaid HCBS is offered, was published in March 2014 by the Centers for Medicare and Medicaid Services (CMS). One such rule is that individuals decide how they want to spend their time in any given setting and have the chance to engage in age-appropriate activities.
Independence Association HCBS Policy
Independence Association (IA) is committed to assisting all individuals it supports in exercising informed choice to the fullest extent possible. IA will outline the methods and supports required to guarantee that each person makes the best possible decision in receiving services and in developing or updating their Person-Centered Plan (PCP). Once strategies have been found, IA will assist people in exercising as much self-direction and self-determination as possible daily.
All IA programs will:
Assure that when receiving help outside of the setting, each participant can speak and spend time with whomever they want (assuming mutual interest in spending time together).
When obtaining services outside of the setting, participants may not be restricted in how much time they choose to spend with other participants if there is mutual interest in spending time together.
Provide refresher training as necessary; train all staff on policies, practices, and protocols that support those policies.
Let participants choose who they spend time with within the setting, including who they sit next to during meals, breaks, and leisure time.
Assuming a mutual interest in spending time together, ensure each participant can interact with others in the room.
Make sure everyone can sit with whoever they like (or sit by themselves, if preferred).
If there is a mutual interest in spending time together, refrain from restricting the time a participant may choose to sit with or spend with other participants in the setting.
If a setting is divided into several regions (such as classes), make sure people aren't strictly defined groups that are assigned to specific classrooms without giving them the option to change to be with people who aren't in the same classroom.
Prevent participant separation from one another unless requested by one or more participants or unless a restriction is documented in the person-centered plan.
Best Practice Recommendations
People are encouraged to engage in activities of their choice.
The provider requests feedback from people regarding their daily routines and favorite activities.
The provider helps people acquire new skills by using the natural environment. For instance, if one wants to learn how to shop using money, one goes to the local mall.
Everyday routines vary depending on an individual's hobbies and preferences.
People decide who they want to interact with and do things with.
The provider is adaptable and takes into account changes and activity preferences.
Individuals assist in creating the weekly grocery list and food shopping.
The provider aims to promote interactions and community members' participation in events.
The provider has a community participation policy that reflects the standards and principles of HCBS.
People can participate in many activities but are not compelled or forced to do so if they choose not to.
Evidence of staff training on HCBS standards, practices, and expectations.
Provider encourages people to invite guests and their relatives over to their house.
There is space for people to interact privately with visitors.
People have the option of decorating their bedrooms and living spaces.
Practices to Avoid
Even if an individual declines, the provider still requires them to participate in activities.
Each person must follow the provider's one-posted activity schedule for the week or month.
When scheduling changes occur, the provider does not accommodate the people.
There is no policy, protocol, or method for staff to document attempts to get input from people.
Punishing someone for refusing to take part in an activity
Limiting a person's ability to enter a community.
Limiting a person's ability to meet with a visitor.
The provider makes decorating decisions for their bedroom without the individual's input.
The organization restricts individual initiative, autonomy, and choice.
Conclusion
Through the Federal HCBS Settings Rule, individuals have the freedom to choose how they spend their time and engage in age-appropriate activities. Independence Association's HCBS policy further emphasizes the importance of informed choice, self-direction, and self-determination. Best practice recommendations encourage individuals to engage in activities of their choice, participate in community events, and have control over their living spaces. It is essential to avoid practices that restrict autonomy, such as enforcing participation, limiting community access, and making decisions without individual input.
HCBS has other Federal Settings Rules made to make the lives of individuals better in their chosen care setting. These rules are essential to know to provide the highest quality of care and support to individuals receiving HCBS.
Read more about the different HCBS rules in Ca Care Association’s Care News Section.
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