Resource: Overnight support for people in their own home

Page posted: 3/9/23

This resource helps lead agencies (including contracted case management partners) develop support plans with people who live in their own home and may have a need for overnight support. It includes information about services through:

· Alternative Care (AC).

· Brain Injury (BI) Waiver.

· Community Access for Disability Inclusion (CADI) Waiver.

· Community Alternative Care (CAC) Waiver.

· Developmental Disabilities (DD) Waiver.

· Elderly Waiver (EW).

· State plan personal care assistance (PCA).

What is the process to select and authorize overnight support?

Selecting a service starts with the person’s informed choice. To make an informed choice, the person must receive the tools, information and opportunities they need to understand their options. They must receive this information in an accessible format and manner that meets their needs. The informed decision-making process must occur at least annually and whenever the person’s needs or preferences change.

When developing the person’s support plan, the lead agency must base the selected service, support instructions, service frequency and other aspects of service delivery on what is important to and for the person. Each service must address the person’s assessed need, and the lead agency must document that need in the support plan for each specific service.

The section of the support plan in which the lead agency documents information depends on the person’s specific need and how that need will be addressed. The lead agency can document the person’s need in any of the following sections of the support plan:

· Support instructions.

· My plan to address safety needs.

· Goals.

· My action item(s).

The person does not need to “fail” at using one service before trying another option. Services should:

· Address the person’s needs in a way that promotes independent living.

· Be provided in the most integrated manner, minimizing disruption of the person’s daily routines, rituals and relationships.

· Be consistent with the person’s choice and preferences.

For some people, this might mean assistive technology. For others, this might mean awake night supervision. DHS provides a variety of services and supports to meet people’s wide range of needs.

Which services could meet a person’s overnight support needs?

A person who needs overnight support in their home has many options, including the following services:

1. 24-hour emergency assistance:

· Available through: BI, CAC, CADI and DD.

· Description: This service includes on-call counseling, on-call problem solving and/or immediate response to provide a person access to supports to address a medical or personal emergency.

2. Assistive technology (waiver service):

· Available through: DD.

· Description: Assistive technology can replace or supplement a person’s staffing and ensure they can control and access their home.

· Note: Assistive technology is available on AC, BI, CAC, CADI and EW through specialized equipment and supplies, described below.

3. Caregiver living expenses:

· Available through: BI, CAC, CADI and DD.

· Description: This service pays for the room and board for a live-in caregiver. As part of this service, a person and their live-in caregiver can develop a plan for overnight support the person needs as part of their support plan.

4. Consumer directed community supports (CDCS) personal assistance:

· Available through: AC, BI, CAC, CADI, DD and EW.

· Description: This service option offers a person the ability to self-design their services to create support that will meet their assessed needs. CDCS policy does not include limits on the time of day support workers may work.

5. Environmental accessibility adaptations – home modifications:

· Available through: AC, BI, CAC, CADI and EW.

· Description: This service provides physical adaptations to a person’s primary home to ensure their health and safety or enable them to function with greater independence.

6. Night supervision:

· Available through: BI, CAC, CADI and DD.

· Description: This service provides asleep or awake staffing for a person who has an assessed area of need overnight for positive support programming, skill development support, assistance with activities of daily living (ADLs) or assistance with instrumental activities of daily living (IADLs).

7. Personal care assistance (PCA):

· Available through: AC, state plan or extended PCA on BI, CAC, CADI, DD and EW.

· Description: This service provides awake staffing for a person overnight who requires covered personal care services.

8. Personal emergency response systems (PERS)

· Available through: AC, BI, CAC, CADI and EW.

· Description: This service covers both (1) an electronic device typically worn as a pendant or bracelet that includes an alert or panic button the person can press in the event of a fall or other emergency and (2) installation and monitoring of the device.

9. Specialized equipment and supplies (includes assistive technology):

· Available through: AC, BI, CAC, CADI and EW.

· Description: This service provides devices (including assistive technology), controls, medical appliances or supplies specified in the person’s support plan. Assistive technology can replace a person’s staffing and ensure they can control and access their home.

· Note: Assistive technology is available on DD through the assistive technology service, described above.

How can a person use assistive technology and/or remote support for overnight support?

A person can use assistive technology and remote support to support their independence in a variety of ways, including, but not limited to, supporting their overnight needs.

When discussing assistive technology and remote support for the person’s overnight needs, the lead agency should consider that the person:

· May choose a combination of assistive technology and remote support to supplement overnight in-person staffing.

· May choose to rely solely on assistive technology and remote supports for their overnight needs.

· Should have overnight supports that support their assessed overnight needs and prioritize their preferences and choices.

Assistive technology is not intended to replace in-person care when the person needs or prefers in-person care. However, the person may use it to supplement in-person care if both of the following are true:

· Assistive technology meets the person’s needs.

· The person makes an informed choice to receive it.

How does a person on AC or state plan PCA receive overnight support?

PCA cannot pay for time when staff are asleep. PCA only pays for covered services, and sleeping is not a covered service. For information about covered PCA services, refer to PCA Manual – Covered services.

PCA can pay for time when:

· The person is asleep, and staff actively perform a covered service.

· The person is awake, and staff actively perform a covered service.

How does a person on CDCS receive overnight support?

The lead agency is responsible to evaluate the person’s need for overnight support on CDCS that fits within the personal assistance category. The lead agency must provide oversight and ensure the person’s CDCS plan identifies the waiver service that staff will provide during overnight support. Staff must actively be providing a covered service. CDCS cannot pay for time when staff are asleep.

CDCS can pay for time when:

· The person is asleep, and staff actively perform a covered service.

· The person is awake, and staff actively perform a covered service.

The lead agency should consider many things when the person uses CDCS for overnight supports, including cost effectiveness. The person’s CDCS budget may not be large enough to accommodate this level of staffing support.

Additional information for BI, CAC, CADI and DD

When should the lead agency authorize night supervision instead of PCA for overnight assistance with ADLs?

The lead agency should authorize PCA when PCA can meet the person’s needs. The person does not need to “fail” at using PCA before trying another service option.

For information about covered PCA services, refer to PCA Manual – Covered services.

The scope of night supervision is broader than the scope of PCA. Night supervision is the assistance and supervision of the person overnight, including assisting with ADLs. If the person has a need for both assistance and supervision, the lead agency should authorize night supervision.

Note: Night supervision is not available on AC and EW.

How do lead agencies transition people to night supervision for asleep staffing?

In 2021, DHS provided temporary guidance for overnight in-home supports for people on the DD Waiver who had supported living services (SLS) daily in their own home before the Waiver Reimagine service streamlining. Now that the asleep option for night supervision is available, people on the DD Waiver must transition to night supervision (if needed) at their renewal. For additional information, refer to the Jan. 4, 2023, eList announcement.

Note: In-home asleep overnight staffing is not an option for people on AC or EW.

Who can provide overnight supports to minor children?

Children younger than age 18 on any waiver can receive overnight support by staff through the following services:

· 24-hour emergency assistance.

· CDCS personal assistance.

· Night supervision.

Children younger than age 18 can also access assistive technology services through the assistive technology service (DD) or specialized equipment and supplies (BI, CAC and CADI).

Parents of minors cannot be paid to provide night supervision or 24-hour emergency assistance to their children. Under CDCS, parents of minors can be paid to provide services for their children (refer to How does a person on CDCS receive overnight support?).

Parents of adult children can be paid to provide night supervision or 24-hour emergency assistance to their adult child when they meet the service requirements. When a parent lives with the adult child (or the adult child lives in the family home), the parent cannot be paid for time the parent is asleep.