In the existing health care delivery system, services for persons with disabilities or functional limitations are typically piecemeal and reactive. In reality, people living with Special Needs must grapple with needs that are both acute and long term, requiring care and support from multiple providers and settings of care.
According to the U.S. Census, as of 2005, almost 20% of the country’s population is disabled to one degree or another.
These disabilities range from mild to catastrophic. People living with disabilities are a diverse group, including children, adults of all ages, people with vision or hearing loss, as well as people with physical, mental health, developmental, or intellectual disabilities. They may have limitations in learning, understanding, remembering, reading, speech, or mobility.
Meeting the needs of this population requires special attention to an individual’s expectations of independence and autonomy, as well as his or her participation in work, school, and community or social activities. So, rather than focusing on a diagnosis, disability-competent care focuses on providing care and supports for maximum function and addressing the barriers to integrated, accessible care.
For example, rather than focusing solely on a diagnosis — such as spinal cord injury, multiple sclerosis, or mental illness — disability-competent care focuses on providing care and supports for necessary to maintain health, wellness, and life in the community as the participant chooses. Disability competent care recognizes and treats each individual as a whole person, not a diagnosis or condition.
The model, therefore, is structured to respond to the participant’s physical and clinical needs while considering his or her emotional, social, intellectual, and spiritual needs.
Disability -Competent Care is essentially wholistic care for those living with Special Needs.
The Individualized Plan of Care (IPC) is the guiding document that identifies all the care, services, and supports for each participant. It is a living document, referenced and revised over time, depending on the needs and goals of the participant. Disability-competent organizations ensure that accountability and time frames are built into the IPC and can serve as triggers for automated reminders to IDT members.
Disability-competent care is interdisciplinary team-based care with core competencies in primary care, behavioral health, LTSS, and nursing. Operating in close communication with the participant and external providers, the interdisciplinary team (IDT) is responsible for ensuring the participant receives the care and supports he or she needs to achieve his or her goals and maximize independence.
The core care team is composed of staff with competencies in primary care delivery, nursing, behavioral health, and community-based service supports. Primary care practitioners might include physicians, nurse practitioners, or physician assistants. Nursing practitioners might include Advance Practice Nurses, Registered Nurses, or Licensed Practical Nurses. Behavioral health practitioners might include social workers, psychologists, chemical dependency specialists, or other comparably trained practitioners. LTSS practitioners might include social workers, mental health therapists, community health workers, and care aide staff.
Disability-competent organizations provide their staff with specific training and coaching to be sensitive to any participant disagreement or resistance of care needs and goals specified in their IPC. Staff are trained to work with participants to ensure concerns are addressed.
CertifiedCare.org offers an accredited education and care aide certification program designed for the Special Needs community (disabled community) based upon the Aspirational Model of disability-competent care. The care aides learn how to participate in the development and implementation of disability-competent care plans for their clients, a care aide education service that is very unique indeed.
The aspirational model of disability-competent care is derived from the “lived” experiences of persons with disabilities and over 20 years of experience from the following three programs:
- Community Medical Group/Commonwealth Care Alliance in Massachusetts
- Community Health Partnership in Wisconsin
- Independence Care System in New York
Inherent in the model of disability-competent care is the need to engage the individual in defining their care goals and needs.
As health care delivery systems are increasingly challenged to meet the expectations of the Triple Aim (improved population health, improved consumer experience, and cost containment), both payors and providers alike are expected to assume greater responsibility for the health, well-being and financial stewardship of all their customers. The result is new delivery systems where care is integrated across providers and settings of care, with a focus on prevention and primary care management.
The CMS Medicare-Medicaid Coordination Office is encouraging interested providers and health care professionals, front-line staff with health plans and practices, and stakeholders to introduce and explore the many uses of the Disability-Competent Care (DCC) Model. The DCC model is a resource for providers, health plans, and healthcare organizations to enhance capacity to integrate care for adults with disabilities. Get the full overview here for the implementation of disability competent care in the residential care environment.… [ https://www.cms.gov/medicare-medicaid-coordination/medicare-and-medicaid-coordination/medicare-medicaid-coordination-office/downloads/dccassessmenttool.pdf ]
Contributed by Dr. Cathleen V. Carr, JD MscD, Executive Director, CertifiedCare.org
CERTIFIEDCARE.ORG is a membership organization focused on elder care education, research and certification to improve quality of care for the aged, reduce attrition in care agencies, improve customer satisfaction, and improve quality of career for the professional caregiver and quality of life for the primary family caregiver. Only caregivers certified by CertifiedCare become members of the organization.
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