Gratiot Integrated Health Network
Program Description
Respite
Service Codes: T1005, H0045, T2036, T2037
Program Philosophy: Gratiot Integrated Health Network provides services to build resilience, and to support the recovery or well-being of individuals and the integration of individuals served into the community. Through service provision, symptoms or needs will be reduced and individuals will experience an improvement in level of functioning in their environment. The program strives to continually improve service provision in order that individuals served experience an enhanced quality of life.
Program Goals: Respite services are provided to assist in maintaining a goal of living in a natural community home by temporarily relieving the unpaid primary caregiver (e.g., family members and/or adult family foster care providers) and is provided during those portions of the day when the caregivers are not being paid to provide care. Respite is not intended to be provided on a continuous, long-term basis where it is a part of daily services that would enable an unpaid caregiver to work elsewhere full time.
Services/Scope of Services: Respite services are provided in the following settings:
- Individual’s home or place of residence
- Licensed family foster care home
- Facility approved by the state that is not a private residence, (e.g., group home or licensed respite care facility)
- Home of a friend or relative chosen by the person served and members of the planning team
- Licensed camp
- In community settings with a respite worker trained, if needed, by the family
- Any agency location (e.g. gym, group room, Ferris Rd. Property, etc.)
Populations served include adults with a developmental disability and children who have either a developmental disability or a severe emotional disturbance.
The level of service is based on individual medical necessity and request and may include individual, group, or Respite Camp. Services are provided according to the choices and needs of the person served and may be at anytime seven days a week/24 hours a day. The frequency of the service provided is also determined by the choices and needs of the persons served.
Services will not be denied based on an individual’s inability to pay for services.
Admission/Re-Admission Criteria: An individual, legal guardian, or parent may contact the agency directly or a referral may be made through the access screening process to obtain Respite services. The Access Coordinator, in conjunction with the program supervisor, is responsible for prioritizing the admission/readmission of eligible individuals based on the severity of needs. Amount, scope, and duration of service provision is determined based upon evaluation of medical necessity and will be specified in the individual plan of service. Medical necessity is determined based upon a thorough psychosocial assessment, standardized functional assessment tools (i.e. SIS, CAFAS, LOCUS, etc.), and the clinical judgment of trained professionals. Based upon the aforementioned evaluation, individuals will be assigned a level of care benefit plan, specifying a minimum and maximum range of service units. Exceptions to level of care benefit plans will be reviewed by the Utilization Management department.
It is the policy of Gratiot Integrated Health Network Service Program to provide services to all eligible consumers in a manner that is sensitive to the cultural and socio-economic needs of the individual in a nondiscriminatory and/or non-threatening manner. Services are provided to eligible individuals without regard to race, religion, color, national origin, age, sex, marital status, sexual preference, handicap, juvenile justice status or any other protected status as required by law. The agency endeavors to accommodate individuals with special needs, or refers to providers equipped to meet their needs.
When individuals are found to be ineligible for services, they are given the reason(s) and are directed to alternative or more appropriate services. In addition, when applicable, the family/support system and/or the referral source are informed as to the reason for ineligibility.
Transition/Discharge Criteria: An individual may be transitioned or discharged from Respite services when one or more of the following occur:
- Individual or guardian request
- Individual no longer resides in the family home
- Lack of individual participation
- Completion of treatment goals
- Individual requires a different level of service based on medical necessity
- Individual requires level or type of service not currently available
- Individual is no longer Medicaid eligible
When an individual is discharged or removed from the program for aggressive and/or assaultive behavior, follow-up will occur within 72 hours to insure linkage to appropriate care.
Regardless of discharge status, any individual may reapply for services by contacting GIHN.