The Resource
Spring 2006

The Home Care Assistance Program staff encourages consumers to call with questions or concerns regarding homemaking services.

Home Care Assistance Program Staff

Betty Maher Director

Felix Jordan Supervisor
Angela Cipriano Supervisor

Case Managers

Marian Burns Boston (A-H) and Brookline

Debra Visocchi East Middlesex County, Cambridge and Somerville

Eloise Cruz Boston (I-M) and surrounding towns

Jodi Watson Plymouth County, Cape and Islands and New Bedford

Maria King Boston (N-Z), Chelsea, Winthrop, Everett and Revere

Robin Kellett Essex County and surrounding towns

Liz Morin North-Western MA and North Worcester Counties

Katherine Chesebro East Norfolk and Bristol Counties

April Anderson South Worcester, West Middlesex and West Norfolk Counties

Vacant South-Western MA

Paulina Mauras Intake Coordinator

Support Staff

Lilly Lau Accountant
Edward Loring Accountant
Christine Rinaldi Administrative Assistant
Christina Perez-Rivera Clerk

Director's Notes, "What I did my first year…"
Betty Maher, MRC-HCAP Director

It is hard to believe that I have been in "the director's chair" here at HCAP for a full year. It is fitting that one of the themes of this newsletter is change, as this has been a time of many changes, both for me personally and for the program.

Some of the changes in the program have included hiring new staff and re-allocating caseloads. Some other changes involved making new connections such as welcoming student interns from Wheelock College, meeting with the Department of Mental Health and mental health consumer organizations, and enhancing existing connections with our providers. Another important change has been in regard to the financial stability of our program.

Starting with staffing, during the past year we have hired new Case Managers, Liz Morin and Maria King; made two promotions, Jodi Watson (from Intake Coordinator to Case Manager) and Angela Cipriano (from Case Manager to Unit Supervisor); and, hired a new Intake Coordinator, Paulina Mauras. At the time of this writing, we are posting for the Case Manager position vacated by Angela Cipriano. Of more immediate concern to our consumers, we have completed a re-allocation of caseloads because of tremendous growth in some areas of the state, particularly in Western Massachusetts. If you were directly impacted by this, you should have already received a letter from your newly assigned Case Manager.

Regarding new connections: we now have two student interns from Wheelock College working with us two days a week for the whole school year! Michelle James and Katie Denissoff are both seniors in the School of Social Work and have been actively assisting all staff here in locating resources, taking applications, and managing small caseloads. Having students giving us feedback helps keep us on our toes!

We have also been working hard with the Department of Mental Health and several mental health consumer organizations including the National Alliance for the Mentally Ill, M-Power, The Empowerment Center, and Ad-Lib to develop a training curriculum for our providers on the impact of psychiatric disabilities on independent living. We hope to strengthen the homemakers' ability to work effectively with our consumers with psychiatric disabilities.

We have had several Provider Forums throughout the state. The goals of those forums were to become better acquainted with staff (many of us only know each other via phone conversations and mail), to review the program's Independent Living Philosophy, including the importance of self-direction and choice, and to introduce a new initiative around quality assurance that enables us to quantify (via input from consumers and staff) the positive and negative aspects of our providers' performance. This will help us in planning future trainings and communications. More information will be forthcoming and I welcome your input.

Finally, regarding financial changes, HCAP was hit hard this year by a reduction of Medicaid reimbursement amounting to an $800,000+ loss to the program. Beginning in July, we had to institute an indefinite waiting period for all new applicants until new revenue sources could be determined. This was a very difficult time for the program as we worked hard to define the problem and determine the best solution. Our staff was diligent in gathering the data needed to illustrate the importance of our services as they impact our consumers' ability to remain at home and the cost-effectiveness of financing such a program.

Artist, Mary Engelbreit said, "If you don't like something, change it; if you can't change it, change the way you think about it". This has been my guiding philosophy this past year, as I have worked to improve the way we do things and to see opportunities in situations that at first appear to be crises. I hope that you too find wisdom in these words as you work to make your life fulfilling despite the challenges that are presented to you.

Homemaking Vendor Showcase: Bayada Nurses
Submitted by Beth Guenette, RN, Bayada Nurses

Bayada Nurses employees have a special purpose….to help people have a safe home life with comfort, independence, and dignity despite illness or disability. Many times families need help and support in caring for someone at home. They need skilled, caring, and reliable home care. These are Bayada ideals. Bayada employees assist with skilled nursing, personal care, therapy, meals, laundry, homemaking, and companionship. Our goal is to give the finest home care services available to people in need.

Founded in 1975, Bayada Nurses is one of the largest home health care providers in the United States. We employ more than 10,000 RNs, LPNs, home health aides, and therapists in more than 100 offices in 15 states. The offices in Massachusetts are located in Falmouth, Hyannis, Quincy, and Plymouth. All of our caregivers have their credentials and references checked and are fully insured. Bayada Nurses meets the stringent standards of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

Bayada Nurses are on call always….24 hours a day, 7 days a week. We accept referrals directly from families, physicians, nurses, case managers, social workers, and therapists. We accept reimbursement from private health insurance, auto insurance, HMOs, Medicaid, Medicare, and other governmental programs.

Bayada Nurses is committed to fair and equal employment and access to home care services. Bayada Nurses show sensitivity to the cultural beliefs of clients, fellow employees and the community. We respect the customs of all people and maintain an environment that is open and accepting of everyone.

Survey Results from Home Care Assistants and Consumer Survey
Submitted by June Hailer, Consumer Consultant

Several months ago Home Care Assistants (HCAs) and the consumers who hire them were sent separate surveys to complete regarding quality of care and the results are in!

Twenty-one out of forty-nine HCAs responded to the survey. The majority of the hired HCAs are initially contacted by the consumer who is eligible to receive homemaking services. Most consumers and HCAs are aware of the program guidelines through provided written material and, therefore, adhere to them. The majority of HCAs have been providing services for more than 12 months, work an average of 6 hours per week (some HCAs have more than one client), and are aware of the authorized tasks provided by the program. HCAs are also aware of what tasks are not provided by MRC-HCAP. The HCAs are aware of the need to provide universal precautions and maintain confidentiality, report abuse, and report cancellations directly to the consumer. The HCAs also know they must track hours on a calendar and keep records of timesheets, submit timesheets at the end of the month, and report income to the IRS via 1099 forms.

About half of the HCAs responding stated they would work for other consumers in their geographic area and half stated they would not. Some of the HCAs suggested the following improvements to the program: increasing wages, adding annual raises, increasing service hours, and advertising the program. The HCAs would also like taxes taken from their wages, adding additional homemaking tasks to the program, and more guidance on work arrangements. The HCAs would also like to have self-addressed stamped envelopes sent along with payment vouchers and time sheets so they do not have to pay for postage (this was immediately implemented).

Twenty-nine out of fifty-one consumers responded to the survey. Most consumers found out about the option of hiring a HCA via their Case Manager. The need to consider this option was mostly due to dissatisfaction with homemakers by agencies in the area and no availability of homemakers in the area. The HCAs they hired are usually a neighbor or a friend who has worked for their prospective client for more than 12 months at an average of 4.75 hours per week. The consumers like the flexibility in schedule that an HCA can offer.

The majority of the consumers agreed with their HCAs stating that the HCAs complete all assigned tasks within the service hours, they need more time for additional tasks, use universal precautions, document completed hours on timesheets, and track hours by using a calendar. They also maintain confidentiality and are aware of the mandates to report abuse. The consumers concur that HCAs send in timesheets and payment vouchers at the end of the month and notify them when they need to cancel an appointment. Consumers and HCAs believe that the MRC-HCAP services keep people with disabilities living more independently in their community.

The pros of utilizing the HCA option, as expressed by consumers, include the following: having more than one option for service, hiring someone you know,

feeling a sense of trust, safety, and comfort in their home. The consumers also feel satisfied with the quality of work performed due to rapport-building with the HCA.

The cons of using the HCA option, as expressed by consumers, include the following: HCAs could use some additional training on visible/non-visible disabilities, the contract approval process takes a long time, taxes are not taken from earned wages, no annual raises in pay, and there is no back-up provider when an HCA cancels an appointment.

The MRC-HCAP Rehabilitation Advisory Committee found the results of the surveys to be very informative. You may be assured that any issues brought forth from the survey could positively affect the future of services. The MRC-HCAP will continue to discuss and review concerns and recommendations to the HCA option. Thank you so much for your feedback.

The Benefits of a Home Care Agency
Submitted by Lisa Gurgone, Executive Director of the MA Council for Home Care Aide Services

While some consumers may prefer to hire a Home Care Assistant (HCA) to provide home care, other consumers choose to receive home care from homemaking agencies. Home care agencies that contract with the MRC to provide homemaking services offer a variety of services and safeguards you do not necessarily receive if you hire a HCA to provide you with care.

First of all, home care agencies employ a highly qualified staff of long-term care professionals including health care managers, experienced nurses, trained paraprofessional staff, and professional staff trainers. Home care agency staff is trained to provide consumers with the appropriate level of care to meet their individual needs. Your home care agency will work carefully with your MRC-HCAP Case Manager to develop your individual care plan which will be performed by a homemaker who is trained and certified to meet your needs.

As MRC does for HCAs, home care agencies conduct necessary criminal background checks on all employees who are hired to enter a person's home. They are also required to contact the Department of Public Health's Patient Abuse Registry to make sure a report of abuse, neglect, mistreatment, or misappropriation of funds or property has not been filed against any applicant. Beyond that, home care agencies must obtain two positive references from former or current employers for all potential employees. They also conduct necessary immigration checks and review documentation to ensure each applicant is eligible to work in the United States.

Prior to working with consumers, homemakers must complete training and orientation which includes instruction in communication, home management skills, nutrition, health and safety issues, confidentiality, emergency procedures, and infection control. In addition, homemakers are required to complete up to an additional six hours of in-service educational programs each year. Through these programs, homemakers learn new skills and review the essential components of their initial training.

Homemakers who are employed by home care agencies are supervised both individually and within a group setting on a regular basis by a qualified supervisor. If your homemaker has a question or needs assistance when caring for you, staff from your home care agency, including nurses and social workers, is only a call away. In addition, if your homemaker is not available on a scheduled day, your home care agency will send another individual in his/her place whenever possible.

Home care agencies work in partnership with the MRC-HCAP to ensure consumers are provided with the care they need to remain safely in their own homes. When you use a homemaker to provide your care, you can always be assured that a trained professional will be available to assist you.

Consumer Perspectives: Coping with Change

How to Cope with a Homemaker Change
Submitted by Walter King

I have come to understand that meeting and working with several different homemakers can be an opportunity instead of a problem. It is possible to cope with changing a homemaker because you get to meet many interesting people through the process.

I am always willing to take a chance when it comes to meeting and working with new homemakers. I like to keep a friendly, open mind with respect to someone I do not know. I have determined that it is in my best interest to move forward and concentrate on working with someone new. A homemaker's departure is usually due to unknown circumstances beyond my control and has nothing to do with my newly assigned homemaker.

I have known some wonderful homemakers during the time I have received the MRC-HCAP services. Some were such good people that I still miss them to this day. Having a homemaker has helped me cope with the stress of losing half my leg and has allowed me not to feel so overwhelmed with cleaning my apartment.

I can say that all of the homemakers I have met have helped me learn more about myself and how to better take care of my apartment. Every homemaker has brought a different point-of-view for making me think about these domestic matters. Some experiences have been challenging. However, I have learned to grow and develop as a person. Through my experiences, it has become easier to be at ease with new homemakers.

I find it helpful to get through changes by having structure and a routine for cleaning my apartment. I have the basic needs met by my homemaker: someone to go to the grocery store, the pharmacy, clean and do laundry. That way, I don't get tired or overwhelmed by having to do everything myself.

My homemaker and I plan ahead as much as we can for my weekly grocery shopping and take extra care to keep an eye on food expiration dates. Grocery shopping is a very important task because I find it hard to go by myself to the store. My homemaker makes sure I won't go hungry by helping me keep a well-stocked kitchen.

I feel most fortunate to have someone to help me for a few hours a week who works well with me. It is certainly better than having no help at all! I try to work with my homemaker during my allotted service hours. I like to help someone as much as I can who helps me. It makes me feel good.

The most essential thing is that I have a good person to help me with the important housework and grocery shopping. I appreciate how the homemakers make the rest of my week go by so much easier.

Coping with Change
Submitted by Michelle Faison

I have had many changes in my life; of course, some good changes and some bad changes. Some big changes happened early in my life. For instance, instead of spending summers at home, I spent the summers at camp in Maine from ages 13-15 years old. Instead of going to High School in Winthrop, I went to preparatory school in Connecticut. Instead of attending a local college, I went to the University of Pennsylvania and lived in a dormitory.

It is a minor miracle I finished college at all because I was plagued with medical illnesses throughout the entire time. I was in constant pain and all I kept hearing was, "yes, there's something wrong but we don't know what it is". Then I had to change all of my doctors after I finished school because I was no longer covered by student health insurance. That change turned out to be a good thing because I was finally diagnosed properly and received appropriate treatments. Unfortunately, I will always be under constant medical and psychiatric follow-up.

When I was working, my health problems kept me from working in the high stress areas of ERs and ICUs, which I loved, on a permanent basis. Currently, I am not working as a nurse at all and I do miss it. However, my volunteer job keeps me working with the elderly in a nursing home setting so I am still in the field! It did take a major adjustment to go from being in charge to reporting to a nurse in charge but I have made it. I also keep up with the changes in the field by reading nursing journals. I don't envy new nursing students- there is so much more to learn than when I was in school.

How did I cope with all the changes in my life? The most important thing I did was find one or two best friends at each new place I went: someone I could count on no matter what. Another thing I did was get myself "adopted " into a second family. Finding things to do that I enjoyed helped me to cope in new situations. During junior high and preparatory school, I threw myself into work. I also enjoyed sports, foreign languages, music, creative writing, and reading-anything I could get my hands on.

However, I continue to crochet and read. Both my family and my therapists have helped me adjust to being a part-time volunteer instead of working as a nurse. It took a while, but I've come to like being a volunteer and the freedom that I have to set my own schedule.

I am also part of the MRC-HCAP Rehabilitation Advisory Committee which helps keep my psyche active. I also play games and do jigsaw puzzles on my computer.

So, I guess the secret to coping with change is to find someone you love and can lean on, find some new activities to keep your mind alert and busy, replace what you lose with new things, and find the positives that come out of new experiences.

COMMUNITY RESOURCES

Resources from the North East Assistive Technology Expo (NEAT) 2005
Submitted by Robin Kellett

Sue Lin, M.S., Rehabilitation Engineer at the MRC's Assistive Technology Program, presented on the topic of Assistive Technology Funding Options at the 2005 N.E.A.T. Expo held in Lowell, MA in May. MRC's Assistive Technology Program (ATP) is part of MRC's Community Services Department. The goal of the ATP is to improve the ability of individuals with significant disabilities to live independently through the use of Assistive Technology. Assistive Technology (AT) devices and services help to maximize an individual's control over their environment and achieve self-determined goals. Individuals served under this program are those with independent living goals. Individuals with employment goals are provided services through MRC's Vocational Rehabilitation Services program.

Sue Lin provided the following list of funding resources for AT:

Federally Funded Resources

U.S. Dept. of Education - Individuals with Disabilities Education Act (IDEA) - the Mass. Dept. of Education provides a guide on AT devices and services for students with special needs. You can access the guide online at www.doe.mass.edu/edtech/toolkit/students/atguide.pdf. For more information call (781) 338-6935 (voice) (800) 439-2370 (tty).

Independent Living Services Title VII Part B - Funds for the purchase of equipment and services for those not eligible for any of the services from MRC. There is a long waiting list for this program and it is considered a program of last resort. Contact your area ILC for more information.

State Funded Resources:

MRC Vocational Rehabilitation Program- Rehabilitation Technology Dept. - Funds for those pursuing vocational goals for use in home modification, adaptive technology assistance, and adaptive driving/vehicle modification services. For info and to find the MRC area office near you contact (800) 245-6543 (voice/tty).

Independent Living Assistive Technology Services - Funds for those with independent living goals. For more info contact Sue Lin at MRC (800) 223-2559 x4 (voice), (617) 204-3815 (tty).

Home Modification Loan Program - Low or no interest loans to modify the homes of elders, adults, and children with disabilities. For more info contact Steve Scarano at MRC (617) 204-3724 (voice), (617) 204-3815 (tty).

The Massachusetts Assistive Technology Loan Program (MATLP) - Low interest loans to purchase assistive technology devices or services. For more info contact Jason Luciano at Easter Seals (508) 751-6431 (voice), (800) 564-9700 (tty) or Karen Langley at MRC at (617) 204-3851 (voice), (617) 204-3815 (tty).

Statewide Head Injury Program (SHIP) - May be able to share the cost of assistive devices with eligible consumers when other funding is not available. For info contact (617) 204-3852 (voice), (617) 204-3817 (tty).

Massachusetts Division of Medical Assistance - funding for medically necessary durable medical equipment. For info contact customer service at (800) 841-2900 (voice), (800) 497-4648 (tty).

Other Resources

Reasonable Accommodations Provided by Employer - Employers are required to provide reasonable accommodations under the Americans with Disabilities Act and the Rehabilitation Act of 1973. For info contact the Job Accommodation Network (JAN) (800) 526-7234 (voice), (800) 526-7234 (tty).

Verizon Specialized Consumer Premises Equipment Program - special telephone equipment for those qualified and eligible for the program. For info contact (800) 974-6006 (voice/tty).

Private Health Insurance and HMO's - funding for assistive technology may be available if your insurer covers medically necessary durable medical equipment, speech therapy, physical therapy, occupational therapy, or rehabilitation services.

Society for Human Advancement through Rehabilitation Engineering (SHARE) Foundation, Inc. - custom designed assistive computer technology. For info contact Beverly Thorn (508) 999-8482 (voice).

Central Bank Special Needs Loans - fixed rate loan program provides funding for purchase of special equipment, and retrofitting motor vehicles and homes. For info contact the loan origination department at (617) 629-4000 (voice).

Disability Specific Organizations

Autism - (781) 329 - 4244 (voice)
Brain Injury - (508) 475-0032 (voice)
Cerebral Palsy - (617) 926-5480 (voice) (617) 926-8051 (tty)
Down Syndrome - (800) 664-6372 (voice)
Mental Retardation- (781) 891-6270 (voice) (781) 891-6271 (tty)
Multiple Sclerosis - (800) 493-9255 (voice)
Spina Bifida - (888) 479 - 1900 (voice)

This listing is not all inclusive. For more assistive technology resources contact your case manager.

Massachusetts Commission for the Deaf and Hard of Hearing (MCDHH)-

Communication access, technology and training services. Contact Debra Lobsitz at 617-740-1668 (voice), 617-740-1768 (tty).

Massachusetts Division of Medical Assistance-Funding for medically necessary durable medical equipment. For information contact Customer Service at 1-800-841-2900 (voice), 1-800-497-4648 (tty).

Community Servings
Submitted by Eloise Cruz

Community Servings is a free home-delivered meal program which delivers 5 days' worth of meals per week. Each day's meal is the equivalent of lunch, dinner, and a snack. Community Servings provides meals to the following towns: Boston, Cambridge, Somerville, Medford, Malden, Everett, Revere, Chelsea, Winthrop, Lynn, Quincy, Braintree, Randolph, and Weymouth.

To be eligible you must be an individual with an acute or life-threatening illness (such as HIV/AIDS, Multiple Sclerosis, Cancer, Lupus, Kidney -Failure, etc.) and unable to cook or shop for yourself. There is no income guidelines but income information is requested for demographic purposes and community data. Your doctor must complete a form to be eligible for the program.

If you think you may be eligible, contact your Case Manager or Community Servings directly at 617-445-7777 (ask for Carolyn Smith). Community Servings is located at 125 Magazine Street in Boston.

Homecare Tidbits

Save on cleaning supplies!

Tips for inexpensive, non-toxic home cleaning

  • Baking soda added to water: this is a great liquid scrubbing solution that you can store in a plastic squeeze bottle. You can scrub the toilet, tub, bathroom and kitchen sinks, and pots and pans.
  • Lavender petals: add lavender petals or potpourri to your vacuum bag or canister. Sprinkle lavender petals into your cat's litter box to add freshness. The natural lavender scent will be released each time your cat scratches and it will not harm your pet.
  • Tea tree oil, eucalyptus oil, peppermint or rosemary oil are all essential oils that contain natural antibacterial properties. Add a few drops to a natural unscented soap bar to create a natural antibacterial soap.
  • Water and vinegar: a great window cleaner and disinfectant to clean your countertops.

(Good Home Company, 2005)

Homemaker Recipe: Lasagna Ziti
Submitted by Henriquieta DoCanto, Homemaker from Abby Rd. Home Care Services, Inc.

Ingredients:

1 package of ziti 1 jar of red sauce

16oz. Ricotta cheese 8oz. Cottage cheese

1 package of shredded Mozzarella cheese 1 egg

Sweet Basil spice

Directions:

Boil the ziti as directed on the package. Prepare the oven at 350 degrees. In a baking pan, place some red sauce. Add a layer of cooked ziti. Sprinkle some Mozzarella cheese. Add red sauce. Add another layer of ziti. Mix the Ricotta cheese and Cottage cheese with the egg and add the sweet basil spice to taste. Place layer of the mixture in the pan. Continue to layer the ziti, the red sauce, the Mozzarella cheese and the Ricotta/Cottage cheese mixture until done. Sprinkle the remaining Mozzarella cheese on top of the last layer of the red sauce. Cover with aluminum foil and bake at 350 degrees for 45 minutes. Remove foil and let stand for 15 minutes.

This recipe may be cut up and kept frozen for later use. Cover with plastic wrap or use a plastic container. Nutritious and delicious!

Inspirational Thought
Submitted by Betty Maher

"I long to accomplish a great and noble task,
but it is my chief duty to accomplish small tasks
as if they were great and noble."

[Helen Keller]

Disaster Preparedness for People with Disabilities

In light of Hurricane Katrina, we now understand how important it is to be prepared for a natural disaster. For disaster planning fact sheets and information on how you can develop a personal disaster plan, log onto www.prepare.org (click on disabilities link).

Massachusetts Rehabilitation Commission
Home Care Assistance Program

27 Wormwood Street
Boston, MA 02210-1616
1-800-223-2559 or 617-204-3853
www.mass.gov/mrc

Mitt Romney
GOVERNOR

Kerry Healey
LIEUTENANT GOVERNOR

Ronald Preston
SECRETARY

Elmer C. Bartels
COMMISSIONER

John A. Chappell, Jr.
DEPUTY COMMISSIONER, COMMUNITY SERVICES


This information is provided by the Massachusetts Rehabilitation Commission.