doea form 701c assessment training july 13, 2010 elder options

DOEA Form 701C Assessment Training

July 13, 2010Elder Options

Assessment Training Overview

Handouts/materials DOEA Assessment Instructions

(DOEA Form 701D, September 2008) DOEA Congregate Meals Assessment

(DOEA Form 701C , September 2008) 06:PR:13 High Nutrition Risk Referral DOEA Form 701C Assessment Training July

13, 2010 Power Point Presentation

701C Test and Purpose

701C test 10 multiple choice questions Requires a score of 80% or higher to pass Open book (701D, notes, and other handouts)

The purpose of the 701C is to assess for congregate meals and/or nutrition counseling. This form is used for assessment and annual reassessment, and significant updates, of these clients.

CIRTS

CIRTS is the Department of Elder Affairs’ statewide Client Information Registration and Tracking SystemCIRTS is the client database where the client’s assessments, enrollments, and units of service are enteredAccuracy is, obviously, very important

Nutrition Score

A Nutrition Score is generated at the top of the 701C when the assessment is entered into CIRTSA Nutrition Score is the only score generated by the 701C

DOEA Form 701COwner, Provider, Assessor, and Sections

Owner versus Provider Primary or only provider of service = Owner Secondary provider of service = Provider

Assessor The person completing the assessment with

the client or potential client

## identifies items that must be entered in CIRTSA 701C is comprised of a Demographics and a Nutrition section

Developing Rapport

Explain to the client what you will be doing Take a little time to talk about the

assessment before you actually begin asking the questions

Explain the importance for the client to take the time to go through this process

Be professional and friendlyYou want the client to be comfortable and to feel reassured

Consider…

The person you are assessing may be (or become) confused, evasive, or angry or may be hard of hearing, blind, illiterate, etc. Be as prepared as you can to adapt to such circumstances.It may be helpful to read the answer choices with each question or let them have a copy of the assessment to look at while you go through the questions and document their answers.

Demographic InformationItems for focus

All items on the assessment form must be answeredWrite additional information that may be useful on the 701CAlways ask for a Middle InitialAsk to see their Social Security card so you can get the number directly from it If you are unable to acquire a SSN, see the

701D for the process to create a pseudo SSN

Creating a pseudo SSN

Janice E Knorr dob 08/14/1935 JEK-08-1435

Willie Jones (no known middle initial) dob 03/03/1933 WXJ-03-0333

Demographic InformationItems for focus continued

A Medicaid Number is 10 digits in length The client’s gold card has an access

number, which is usually 8 digits in length

Consumer Type Elder Recipient if an older person applying

for services Caregiver if a person who cares for

someone 60+ or a child/grandchild Both Elder Recipient and Caregiver may be

checked


Caregiver of a grandchild question You may answer this question as the client

answers it, but CIRTS will only allow an answer of Yes if Consumer Type of Caregiver was selected* *This may change shortly

Addresses Physical Address must be completed Mailing Address is only needed if different than

Physical

Assessment Date is the date the assessment is completed with the client


Assessment Site Use Senior Center if the assessment was

completed at a center or meal site Use Other if at any other location

Assessment Type Use Congregate Meals if you are assessing or

reassessing a person for congregate meals Use Update if there has been a significant

change in a client’s situation and the information needs to be documented, but it is not yet time for their annual assessment


Race, Ethnicity, Primary language, Marital Status Do not make assumptions, ask the

client

Imminent Risk of nursing home placement Any person or agency can designate a

referral as Imminent Risk, this includes you as the assessor


Per DOEA “A primary caregiver is any person who

cares for someone on a regular basis and: can be depended on to provide help as needed

with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs);

may or may not live with the consumer; and does not include operators of ALFs, nursing

homes, Adult Family Care Home (AFCH) sponsors, home health agencies or service provider staff.”


Assistance needed to evacuate Answer No if the person needs no assistance

If the person has a plan to evacuate themselves or for someone else to assist them, they need no assistance

If the person indicates that they do need assistance and they are not registered with the County Special Needs Registry, they should be provided with information and/or assistance to register with the County Special Needs Registry


Income Gross Income All clients should be asked for their

Individual, and Couple (if applicable), Monthly Income

Clients who will receive only OAA services are able to refuse to provide their Income


Food Stamps This question will be answered as Yes or No,

based upon whether or not the client receives food stamps

In addition to answering the question, if you have reason to believe the client needs food stamps and they are not receiving them, you should provide them with information that will help them in applying for food stamps and/or attempt to find a way to assist them in applying for food stamps


Assets Exclude worth of client’s or couple’s home,

one car, and $2,500 (for individual) or $5,000 (for couple) designated in burial assets

All clients should be asked for their Individual, and Couple (if applicable), Asset information

Clients who will receive only OAA services are able to refuse to provide this information

Income and Assets: Refused

A person receiving OAA services may refuse to provide their income or asset information. It is against federal law for a person’s income or assets to be used in determining eligibility for OAA services.

Nutrition StatusThe questions in the Nutrition Status section The questions in the Nutrition Status section are established as a federal screening under are established as a federal screening under the Older Americans Act.the Older Americans Act.

Respond to questions with either (Y) Yes or (N) Respond to questions with either (Y) Yes or (N) NoNo

1.1. Have you lost or gained 10 pounds or more in Have you lost or gained 10 pounds or more in the last 6 months without trying?the last 6 months without trying?

Indicate whether weight was lost or gained. This Indicate whether weight was lost or gained. This weight weight change could indicate a health problem. change could indicate a health problem. If the client isn’t If the client isn’t sure, you might ask whether sure, you might ask whether his/her clothes are his/her clothes are fitting fitting properly. If he/she has had properly. If he/she has had a weight change, ask if the a weight change, ask if the client or caregiver has client or caregiver has notified the doctor. You might have notified the doctor. You might have to help with to help with this contact.this contact.

Nutrition Status

2.2. Do you take 3 or more kinds of medicine a Do you take 3 or more kinds of medicine a day? day? This includes both prescription This includes both prescription medicines and over-the-medicines and over-the- counter health productscounter health products..

3.3. Do you have 2-3 or more drinks of beer, wine Do you have 2-3 or more drinks of beer, wine or liquor almost every day?or liquor almost every day?

4.4. Do you have an illness or condition that made Do you have an illness or condition that made you change the food you eat? Indicate what you change the food you eat? Indicate what type of diets these are in the appropriate type of diets these are in the appropriate box(es). Multiple special diets indicate that box(es). Multiple special diets indicate that the client is at greater nutritional risk.the client is at greater nutritional risk.

5.5. Do you eat at least two meals a day? Ask the Do you eat at least two meals a day? Ask the client about their appetite. Mark the client about their appetite. Mark the appropriate box for good, fair, or poor.appropriate box for good, fair, or poor.

Nutrition Status

6.6. Do you eat some fruits and vegetables every day? Do you eat some fruits and vegetables every day? Fruits AND vegetables, not just one or the other. Ask the Fruits AND vegetables, not just one or the other. Ask the client to describe what they usually eat and drink on a client to describe what they usually eat and drink on a typical day. When asking what the client eats each day, typical day. When asking what the client eats each day, you might want to walk the client through the previous you might want to walk the client through the previous day, from the time he/she woke up in the morning until day, from the time he/she woke up in the morning until he/she went to bed at night. Remember that weekends he/she went to bed at night. Remember that weekends could be different from the rest of the week. Try to could be different from the rest of the week. Try to determine whether the diet is balanced, how much food is determine whether the diet is balanced, how much food is consumed, and when the food is normally eaten.consumed, and when the food is normally eaten.

7.7. Do you have some milk (dairy) products every Do you have some milk (dairy) products every day?day?

8.8. Do you have any problems with your teeth, mouth Do you have any problems with your teeth, mouth or throat that make it hard for you to chew or or throat that make it hard for you to chew or swallow?swallow?

Nutrition Status

9.9. Do you eat alone most of the time?Do you eat alone most of the time?10a.10a. Are you usually able to shop for yourself? Are you usually able to shop for yourself? 10b.10b. Are you usually able to cook for yourself?Are you usually able to cook for yourself?

Note that questions 10a and 10b are scored as half points. Note that questions 10a and 10b are scored as half points. TheseThese

questions were originally a single question which was been questions were originally a single question which was been split forsplit for

clarity.clarity.

11.11. Are you usually able to eat without help?Are you usually able to eat without help?12.12. Do you have enough money to buy the food Do you have enough money to buy the food

you need?you need?Distinguish between need and want.Distinguish between need and want.

Nutrition Status

The Nutrition Score will be calculated by CIRTS The Nutrition Score will be calculated by CIRTS and will appear on the turnaround document. and will appear on the turnaround document. If it is necessary for staff to calculate a If it is necessary for staff to calculate a Nutrition Score quickly, the values are Nutrition Score quickly, the values are indicated and the score may be calculated indicated and the score may be calculated manually. The maximum score is 21.manually. The maximum score is 21.

NOTE:NOTE: The range of risk for malnutrition is The range of risk for malnutrition is Low=0-2, Medium=3-5, and High=5.5-21. Low=0-2, Medium=3-5, and High=5.5-21. Clients with nutrition scores which are 5.5 or Clients with nutrition scores which are 5.5 or higher show a high risk for malnutrition and higher show a high risk for malnutrition and may need to be referred to a registered may need to be referred to a registered dietician.dietician.

SUGGESTIONS TO HELP SUGGESTIONS TO HELP

NUTRITION STATUSNUTRITION STATUS

Refer client to a Registered DieticianRefer client to a Registered DieticianRefer client to a Food Bank/Food PantryRefer client to a Food Bank/Food PantryProvide PetMeals for ClientProvide PetMeals for ClientHelp client with Medication AssistanceHelp client with Medication AssistanceRefer client for Food StampsRefer client for Food StampsRefer client to CommoditiesRefer client to CommoditiesRefer client to Senior Companion ProgramRefer client to Senior Companion ProgramOffer additional MealsOffer additional MealsInform client of local organizations who offer Inform client of local organizations who offer assistance (such as churches or restaurants assistance (such as churches or restaurants w/food programs)w/food programs)

Tobacco UseTobacco UseThe following questions are asked of the client. TheThe following questions are asked of the client. Thequestions are concerned with use of any tobaccoquestions are concerned with use of any tobaccoproduct, including cigarettes, cigars, chewing tobacco,product, including cigarettes, cigars, chewing tobacco,or snuff.or snuff.1.1. Do you smoke or use tobacco products? Mark the Do you smoke or use tobacco products? Mark the

appropriate box for this question.appropriate box for this question.2.2. Have you ever smoked or used tobacco? Mark the Have you ever smoked or used tobacco? Mark the

appropriate box for this question. Also indicate on appropriate box for this question. Also indicate on the line provided how long the individual has been the line provided how long the individual has been smoking/using tobacco products. If they used smoking/using tobacco products. If they used tobacco products in the past and quit, note how tobacco products in the past and quit, note how long they have been tobacco free.long they have been tobacco free.

3.3. Do you live with others who smoke? Mark the Do you live with others who smoke? Mark the appropriate box for this question.appropriate box for this question.

Food Stamps

Food Stamps The food stamp question should be

answered by the assessor and should NOT be asked of the client.

If a client already receives food stamps, the answer is Yes (compare with the answer to item 16c on page 1 of the assessment)

If the assessor believes the client needs food stamps, the answer is Yes

Current Height and Weight

Document this information.If the client is unsure, get whatever information you can regarding their current or past height and weight. If information is not current, make additional notes to explain.

Caregiver/guardian and Summary

Caregiver/guardian of grandchild/child Complete the questions as asked Refer the person to local resources, if

needed

Summary Provide any additional information about

this person that you feel is important to document

Final comments

Keep these tools and your notes handy Review them from time to time Refer to them when you have questions Carefully read the 701D, specifically the

Demographic Information and Nutrition Status sections Remember that the 701D covers all three

assessments 701A, B, and C

Talk to your co-workers and supervisor about different cases and situations – they hold a wealth of knowledge

doea form 701c assessment training july 13, 2010 elder options

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