Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › SCOPE AND DEFINITIONS › Section 388-106-0010 - What definitions apply to this chapter?

Current through Register Vol. 24-14, July 15, 2024
"Ability to make self understood"
means how
					 you made yourself understood to those closest to you in the last seven days
					 before the assessment; expressed or communicated requests, needs, opinions,
					 urgent problems and social conversations, whether in speech, writing, sign
					 language, symbols, or a combination of these including use of an alternative
					 communication method:
(1) Understood:
				  You expressed ideas clearly;
(2)
				  Usually understood: You had difficulty finding the right words or finishing
				  thoughts, resulting in delayed responses, or you required some prompting to
				  make self understood;
(3) Sometimes
				  understood: You had limited ability, but were able to express concrete requests
				  regarding at least basic needs such as food, drink, sleep, toilet);
(4) Rarely/never understood: At best,
				  understanding was limited to caregiver's interpretation of client specific
				  sounds or body language such as indicated presence of pain or need to
				  toilet);
(5) Child under three:
				  Proficiency is not expected of a child under three and a child under three
				  would require assistance with communication with or without a functional
				  disability. Refer to the developmental milestones table in WAC
				  388-106-0130.
"Active range of motion"
means exercises
					 performed by the client to maintain their joint function to the joint's optimal
					 range. Exercises may be performed with the assistance of cueing or reminders by
					 caregivers. A formal, active range of motion program needs to be first
					 established by a qualified registered nurse or therapist. Range of motion may
					 be self-directed based upon an occupational or physical therapist assessment
					 and continued without occupational or physical therapist supervision.
"Activities of daily living (ADL)"
means the
					 following:
(1) Bathing: How you took a
				  full-body bath/shower, sponge bath, and transferred in/out of
				  tub/shower.
(2) Bed mobility: How
				  you moved to and from a lying position, turned side to side, and positioned
				  your body while in bed, in a recliner, or other type of furniture you slept
				  in.
(3) Dressing: How you put on,
				  fastened, and took off all items of clothing, including donning/removing
				  prosthesis, splints, either braces or orthotics, or both.
(4) Eating: How you ate and drank, regardless
				  of skill. Eating includes any method of receiving nutrition, such as, by mouth,
				  tube, or through a vein. Eating does not include any set up help you received,
				  such as bringing food to you or cutting it up in smaller pieces.
(5) Locomotion in room and immediate living
				  environment: How you moved between locations in your room and immediate living
				  environment. If you are in a wheelchair, locomotion includes how
				  self-sufficient you were once in your wheelchair.
(6) Locomotion outside room: How you moved to
				  and returned from your immediate living environment, outdoors, and more distant
				  areas. If you are living in a contracted assisted living, enhanced services
				  facility, adult residential care, enhanced adult residential care, enhanced
				  adult residential care-specialized dementia care facility, or nursing facility
				  (NF), this includes areas set aside for dining, activities, etc. If you are
				  living in your own home or in an adult family home, locomotion outside
				  immediate living environment including outdoors, includes how you moved to and
				  returned from a patio or porch, backyard, to the mailbox, to see the next-door
				  neighbor, or when accessing your community.
(7) Walk in room, hallway and rest of
				  immediate living environment: How you walked between locations in your room and
				  immediate living environment.
(8)
				  Medication management: Describes the amount of assistance, if any, required to
				  receive prescription medications, over the counter medications, or herbal
				  supplements.
(9) Toilet use: How
				  you eliminated or toileted, used a commode, bedpan, or urinal, transferred
				  on/off toilet, cleansed, changed pads, managed ostomy or catheter, and adjusted
				  clothes. Toilet use does not include emptying a bedpan, commode, ostomy, or
				  catheter bag. This type of set up assistance is considered under the definition
				  of support provided.
(10) Transfer:
				  How you moved between surfaces, such as, to/from bed, chair, wheelchair,
				  standing position. Transfer does not include how you moved to/from the bath,
				  toilet, or got in/out of a vehicle.
(11) Personal hygiene: How you maintained
				  personal hygiene tasks, such as combing hair, brushing teeth, shaving, applying
				  makeup, washing/drying face, hands (including nail care), and perineum,
				  including menses care. Personal hygiene does not include hygiene tasks
				  completed in baths and showers.
"Age appropriate"
proficiency in the
					 identified task is not expected of a child that age and a child that age would
					 require assistance with the task with or without a functional disability. Refer
					 to the developmental milestones table in WAC
					 388-106-0130 for the specific
					 ages.
"Aged person"
means a person 65 years of age
					 or older.
"Agency provider"
means a licensed home care
					 agency or a licensed home health agency having a contract to provide long-term
					 care personal care services to you in your own home.
"Alternative benefit plan"
means the scope of
					 services described in WAC
					 182-501-0060 available to persons
					 eligible to receive health care coverage under the Washington apple health
					 modified adjusted gross income (MAGI)-based adult coverage described in WAC
					 182-505-0250.
"Application"
means a written request for
					 medical assistance or long-term care services submitted to the department by
					 the applicant, the applicant's authorized representative, or, if the applicant
					 is incompetent or incapacitated, someone acting responsibly for the applicant.
					 The applicant must submit the request on a form prescribed by the
					 department.
"Assessment details"
means a printed record of
					 information that the department entered into the CARE assessment describing the
					 assistance you may need.
"Assessment or reassessment"
means an
					 inventory and evaluation of strengths and limitations based on an in person
					 interview in your own home or another location that is convenient to you, using
					 the department's comprehensive assessment reporting evaluation (CARE)
					 tool.
"Assistance available"
means the amount of
					 assistance that will be available for a task if status is coded:
Partially met due to availability of other informal
					 support. The department determines the amount of the assistance available using
					 one of four categories:
(1) Less than
				  one-fourth of the time;
(2)
				  One-fourth to one-half of the time;
(3) Over one-half of the time to
				  three-fourths of the time; or
(4)
				  Over three-fourths but not all of the time.
"Assistance with body care"
means you received
					 or need assistance with:
(1)
				  Application of ointment or lotions;
(2) Trimming of toenails;
(3) Dry bandage changes; or
(4) Passive range of motion
				  treatment.
"Authorization"
means an official approval of
					 a departmental action, for example, a determination of client eligibility for
					 service or payment for a client's long-term care services.
"Blind person"
means a person determined blind
					 as described under WAC
					 182-500-0015 by the division of
					 disability determination services of the health care authority.
"Body care"
means how you perform with passive
					 range of motion, applications of dressings and ointments or lotions to the
					 body, and pedicure to trim toenails and apply lotion to feet. In adult family
					 homes, enhanced services facilities, contracted assisted living, enhanced adult
					 residential care, and enhanced adult residential care-specialized dementia care
					 facilities, dressing changes using clean technique and topical ointments must
					 be performed by a licensed nurse or through nurse delegation in accordance with
					 chapter 246-840 WAC. Body care excludes:
(1) Foot care if you are diabetic or have
				  poor circulation; or
(2) Changing
				  bandages or dressings when sterile procedures are required.
"Bowel program"
means a regular, ongoing
					 program, other than oral medications, that must include interventions such as
					 rectal stimulation using the finger, over the counter suppositories, or enemas
					 to facilitate evacuation of your bowels. Regimens only promoting bowel
					 regularity, including oral medications or supplements, nutrition, hydration, or
					 positioning are not considered in this definition.
"Categorically needy"
means the status of a
					 person who is eligible for medical care under Title XIX of the Social Security
					 Act. See WAC
					 182-512-0010 and chapter 182-513
					 WAC.
"Child"
means an individual less than 18 years
					 of age.
"Client"
means an applicant for service or a
					 person currently receiving services from the department.
"Current behavior"
means a behavior occurred
					 within seven days of the CARE assessment date, including the day of the
					 assessment. Behaviors that the department designates as current must include
					 information about:
(1) Whether the
				  behavior is easily altered or not easily altered; and
(2) The frequency of the behavior.
"Decisions"
means your ability (verbally or
					 nonver-bally) to make, and actual performance in making, everyday decisions
					 about tasks of daily living in the last seven days before the assessment. The
					 department codes your ability to make decisions as one of the following:
(1) Independent: Decisions about your daily
				  routine were consistent and organized; reflecting your lifestyle, choices,
				  culture, and values;
(2) Difficulty
				  in new situations: You had an organized daily routine, were able to make
				  decisions in familiar situations, but experienced some difficulty in decision
				  making when faced with new tasks or situations;
(3) Poor decisions; unaware of consequences:
				  Your decisions were poor and you required reminders, cues, and supervision in
				  planning, organizing, and correcting daily routines. You attempted to make
				  decisions, although poorly.
(4) No
				  or few decisions: Decision making was severely impaired; you never/rarely made
				  decisions;
(5) Child under 12:
				  Proficiency in decision making is not expected of a child under 12 and a child
				  under 12 would require assistance with decision making with or without a
				  functional disability. Refer to the developmental milestones table in WAC
				  388-106-0130.
"Department"
means the state department of
					 social and health services, aging and long-term support administration,
					 developmental disabilities administration, or its designee.
"Designee"
means area agency on aging.
"Developmental milestones table"
is a chart
					 showing the age range for which proficiency in the identified task is not
					 expected of a child and assistance with the task would be required whether or
					 not the child has a functional disability.
"Disability"
is described under WAC
					 182-500-0025.
"Disabling condition"
means you have a medical
					 condition which prevents you from self-performance of personal care tasks
					 without assistance.
"Estate recovery"
means the department's
					 process of recouping the cost of medicaid and long-term care benefit payments
					 from the estate of the deceased client. See chapter 182-527 WAC.
"Health action plan"
means an individual plan,
					 which identifies health-related problems, interventions, and goals.
"Home health agency"
means a licensed:
(1) Agency or organization certified under
				  medicare to provide comprehensive health care on a part-time or intermittent
				  basis to a patient in the patient's place of residence and reimbursed through
				  the use of the client's medical identification card; or
(2) Home health agency, certified or not
				  certified under medicare, contracted and authorized to provide:
(a) Private duty nursing; or
(b) Skilled nursing services under an
				  approved medicaid waiver program.