Project CHOICE is a care-management service operated by the Detroit Area Agency on Aging and available to older adults in the City of Detroit, the five Grosse Pointes, Harper Woods, Hamtramck and Highland Park. It is designed to locate, mobilize and manage a variety of home- care and other services needed by frail elderly persons aged 60 years and older at risk of nursing home placement. After a person is determined eligible for the program, based on a standardized and scored prescreening process, a comprehensive assessment is conducted by a registered nurse to identify needs, existing supports and resources.
In planning care needed for the program participant to remain at home, care managers utilize all available community resources, i.e., friends, neighbors, volunteers or entitlement programs, prior to arranging formal (for fee) services. Care managers and the client jointly determine the frequency and duration of in-home services in planning care. The care managers make specific arrangements and secure services upon client approval. Adjustments are made to the care plan as the client's needs change. The care managers consult with the client's physician for those services requiring a doctor's approval. Participation in the program is voluntary – the client is not required to accept the care manager's recommendations and/or plans, and they arrange only those services that the client approves.
Primary Goals
- To avoid costly or premature or inappropriate institutionalization of the high-risk elderly.
- To define appropriate levels of care to assist frail elderly in maintaining independence utilizing formal and informal supports.
- To provide support for frail older adults to enable caregivers to continue their support for the care-management client.
Target PopulationCare management serves persons age 60 years and older at 'high risk' of nursing home placement. An individual is considered 'high risk' if he/she demonstrates one of the following characteristics:
- Determined medically eligible for placement into a basic or skilled-care nursing or foster-care facility; or
- Functionally unable to provide self-care without assistance due to illness or declining health and without sufficient support for meeting needs; or
- Multiple, complex, and diverse needs; or
- Resides in a skilled or intermediate facility or other institution and no longer requires that level of care, but is unable to obtain needed community services to return home.
Eligibility Guidelines for Care Management ServicesClient's eligibility is determined using a telephone screening tool. Eligibility is based on an individual's abilities and needs in performing activities of daily living. There are no financial eligibility requirements. Participation in the program is not based on a person's level of income, but rather his/her current and expected future need for supportive services.
Service FunctionsCare management performs the following functions to assist the client to remain at home:
- Assessment – a comprehensive in-person assessment of physical and socio/emotional functioning, medications, physical environment, informal support potential and financial status.
- Care Plan Development – a written plan of care which states specific interventions to be secured, the care manager and client establish which services will be secured and provided, as well as the frequency and duration of services.
- Service Arranging – in-home health and social services for the client care are arranged and/or purchased by care managers according to the frequency and duration established by the care managers and client as approved in the care plan. Client-centered advocacy is conducted to ensure access to and appropriate use of community services.
- Follow-Up and Monitoring – on-going periodic contact with clients and service providers is conducted to ensure that care plans are implemented as planned.
- Re-assessment – a standardized in-person reexamination of the client's physical, socio/emotional and environmental status, informal supports and financial status is conducted on a routine basis.
How are Services Paid For Under the Program? Services funded by traditional sources such as Medicare, Medicaid, private insurance, etc., are arranged when appropriate. Care managers are experienced in coordinating these various funding options and can serve as advocates to make sure that the client receives the services and benefits that he/she is entitled to and needs. If a client requires services not covered by existing programs, the team will work with the client to determine available cost-effective care options. When a client's finances allow private payment, he/she is expected to pay for services if existing programs fail to provide adequate coverage.
The Care Management Program may pay for services on the client's behalf. To make certain that limited purchase of service funds are spent on those clients who are unable to pay for their own services, Project CHOICE helps clients to purchase services. Clients targeted are persons with incomes above Medicaid eligibility limits who cannot afford to pay private rates based upon their net monthly income.
Is There A Cost To Participate In The Program? The cost to provide a client with a comprehensive assessment, care plan, and ongoing monitoring is primarily funded by the State of Michigan. A client is asked to share in the cost of the program according to a sliding fee scale. No one is denied participation in the program based on inability to pay. All donations received are used to directly support the program. Care management will not be denied to a client on the basis of financial, social, or religious status.
Are There Other Similar Programs Available?Yes. If your household income is $1,500 or less per month, you have assets of only $2,000 or less, and you have difficulties with activities of daily living, you may qualify for the Detroit Area Agency on Aging's Medicaid Waiver Program.