ADULT FAMILY CARE
- For Adult Family Care, must be at least 16 years of age
- For Visiting Adult Family Care, must be at least 22 years of age
- Must require daily assistance or cueing and supervision with one ADL throughout the task
- Must be under the care of a Primary Care Provider
- Program participation must be ordered by a Primary Care Provider
- Must live in a safe home environment
- Must have one of the following insurances: MassHealth Standard, MassHealth CommonHealth, Accountable Care Organizations, One Care (Commonwealth Care Alliance, ) Fallon Navicare.
- Must be at least 18 years of age
- Can be related to the person needing care or a friend, but cannot be the legal spouse or guardian
- For Adult Family Care, must live with the member requiring care
- For Visiting Adult Family Care, must be able to travel to the member requiring care
- Can spend time away from home or working if there is an informal support
- Must be invested and understand the needs, health, and wellness of the member
- Must be deemed physically and mentally fit to provide care by a Primary Care Provider or Medical Doctor
Admission Process Adult Family Care (AFC)
1. Phone Interview to Start Admission Process
To start the admission process a member of the intake team will call you to complete an application for you and your caregiver. The intake team member will be your main point of contact throughout the intake process and will be able to answer all your questions. The team member will ask for a picture of your photo IDs, proof of your address and will also help you sign a Release of Information for your primary care provider; you or your caregiver will need access to email.
2. Request Medical Documentation
Next, the intake team member will reach out to your primary care provider to gather baseline medical information (medication list, diagnosis list, and notes from recent office visits). Make sure if you have not had a physical in the last 12 months you call and schedule one with your PCP. While notes from specialists can be helpful, we need to get a copy of your last physical from your primary care provider. Intake will also send a letter to your caregiver’s primary care provider; the PCP needs to sign the letter telling us that your caregiver is healthy and able to perform the care needed.
3. In-Person Registered Nurse and Case Manager Assessment
Once intake receives the notes from your primary care provider, the team member will schedule a home visit with a registered nurse and case manager. The registered nurse will complete an assessment (the assessment is a conversation) during which they will confirm that you qualify for the program and determine which level you qualify for. Level one means you are more independent and require less physical assistance. Level two means you are less independent and require more physical assistance. Level 2 is the higher stipend amount for the caregiver. The case manager will ask you to show them around the house. The case manager needs to confirm that the home is safe, clean, and an appropriate setting for you to receive care. We ask that you make sure you have working safety equipment in the home for this visit (a first aid kid, fire extinguisher, CO2/smoke alarms). If you are a SCO member, this visit will require a pre-authorization from your SCO case manager, make sure you tell them you want to join Loved Ones Care AFC.
4. Submit Order to Client’s Primary Care Provider for Signature
Once the registered nurse completes the paperwork, the RN will send an order for this service to your Primary Care Provider to sign.
5. Submit to Insurance for Authorization
Then, the intake team member will submit the paperwork and Primary Care Provider order to the insurance company for approval.
6. Admission Visit with Registered Nurse and Case Manager to Create Custom Care Plan
Once intake receives authorization from the insurance company, you can start the program right away. The intake team member will schedule an admission visit with the registered nurse and case manager. Loved Ones Care will sign a contract with the caregiver and an agreement with you. This is when the stipend goes into effect.