D-1000 Intake and Assessment for Services

D-1010 Overview

Revision 21-0; Effective January 15, 2021

Area Agencies on Aging (AAAs) and subrecipients must ensure compliance with eligibility, reporting, and other requirements of the Older American Act (OAA) and the Texas Health and Human Services Commission (HHSC). This section provides information about forms and processes used for intake, and assessments required for specific services.

 

D-1020 Intake

Revision 21-1; Effective December 1, 2021

An intake is the initial contact with a person. It helps identify potential needs and collect information to determine eligibility and coordinate appropriate services. Services include the person’s demographic and contact information, other information needed for the coordination of services and data required for the State Program Report (SPR). 

The intake also documents eligibility for nutrition services for a person under 60 years old, such as the spouse of an eligible person who receives a meal.

Use the information collected during the intake process to determine priority populations and ensure preference is given to OAA targeted populations without excluding others from participating in a service when possible.

The income information (low, moderate and high) collected at intake also helps identify target populations, inform outreach strategies and allows HHSC to report on the number of people with 'income below poverty level' receiving certain services, such as:

  • care coordination;
  • chore maintenance;
  • day activity and health services;
  • home delivered meals;
  • homemaker; and
  • personal assistance.

Complete Form 2276, Intake, before service authorization for each new person requesting services.

Form 2276 captures the following information:

  • indication that the Client Rights and Responsibilities and Release of Information were explained;
  • date of intake;
  • name (last name, middle initial, first name);
  • gender;
  • date of birth;
  • home address:
    • city;
    • state; and
    • ZIP code;
  • county;
  • phone number;
  • ethnicity;
  • race;
  • if the person lives alone;
  • if the person is in poverty; and
  • the reason for eligibility for nutrition services for person under 60.

Use ‘Unknown’, ’Not Reported’ or ‘Don’t Know’ for any field on the Form 2276 only if a person refuses to provide the information.

The intake process must be flexible and adapt to the needs of:

  • a homebound person;
  • a patient awaiting hospital discharge;
  • people of widely varying ethnic and cultural characteristics;
  • people who speak languages other than English; and
  • people with widely varying disabilities.
     

Face-to-face contact with the person requesting a service is not required during the intake process. The intake may be conducted with a caregiver or authorized representative. The name of the staff member completing Form 2276 is required, but not their signature.

Additional information may be collected during the intake to meet agency specific business requirements. 

Completion of Form 2276 is not required for Information, referral and assistance services. 

Documentation

Documentation must include the name of the AAA or service provider, the date completed, and the name of the person completing Form 2276. Complete all required information for every person receiving a service.

Reporting

Report required information using HHSC's information management system at initial intake and for periodic updates.

Related Policy

Eligibility, F-1120
Eligibility, F-1220

 

D-1030 Caregiver Intake

Revision 21-1; Effective December 1, 2021

Each person requesting Caregiver Support services must be screened to document eligibility and collect data required for the SPR. 

Complete Form 2270, Caregiver Intake, prior to service authorization for each new person requesting Caregiver Support services. 

Form 2270 captures the same information as the standard intake and additional information required for caregiver services, including:

  • relationship to care recipient(s) who is 60 years or older;
  • relationship to care recipient(s) who is 18 years or younger and the caregiver is 55 years or older and is an older relative caregiver;
  • relationship to care recipient(s) who is 18 to 59 years with a disability and caregiver is 55 years or older and is an older relative caregiver;
  • care recipient’s date of birth; and
  • name, date of birth, gender and relationship to caregiver for each child cared for by an older relative caregiver.

Use ‘Unknown’, ’Not Reported’ or ‘Don’t Know’ for any field on Form 2270 only if a person refuses to provide the information.

The name of the staff member completing Form 2270 is required, but not their signature.

Additional information may be collected during the intake to meet agency specific business requirements.

Completion of Form 2270 is not required for Information, referral and assistance services.
 

Documentation

Documentation must include the name of the AAA or service provider, the date completed, and the name of the person completing Form 2270. Complete all required information for every person receiving a service.

Reporting

Report required information using HHSC’s information management system at initial intake and for periodic updates.

Related Policy

Home Delivered Meals for Caregivers, F-1230

 

D-1040 Consumer Needs Evaluation

Revision 21-0; Effective January 15, 2021

The Consumer Needs Evaluation (CNE) form documents a person’s need for care coordination, caregiver respite, chore maintenance, day activity and health services, home delivered meals (HDMs), homemaker, and personal assistance. Complete the CNE form to determine a person’s functional impairments and eligibility to receive services. The CNE also collects necessary Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) information required for the State Program Report.

After the initial assessment, complete CNE reassessments annually, within 30 days of the anniversary of the person’s initial assessment date. An earlier reassessment may be needed if circumstances indicate a significant change in the person’s condition. Do not alter the content of the required form.

Significant changes requiring a reassessment include a:

  • change in functional status such as an accident or illness or hospitalization;
  • change in living situation;
  • change in the caregiver relationship;
  • loss, damage, or deterioration of the home living environment;
  • loss of a spouse, family member or close friend; or
  • loss of income.

An impairment in ADLs is the inability to perform one or more of the following six activities of daily living without personal assistance, stand-by assistance, supervision, or cues:

  • eating;
  • dressing;
  • bathing;
  • toileting;
  • transferring in and out of bed or chair; or
  • walking.

An impairment in IADLs is the inability to perform one or more of the following seven instrumental activities of daily living without personal assistance, or stand-by assistance, supervision, or cues:

  • preparing meals;
  • shopping for personal items;
  • managing medication;
  • managing money;
  • using the phone;
  • doing light or heavy housework; or
  • transportation ability (transportation ability refers to the individual’s ability to use available transportation without assistance).

Conduct the CNE assessment and reassessment face-to-face in the person’s home or by phone.

To qualify for a HDM, a person must have a minimum score of 20 on the CNE form. Refer people who do not meet the score of 20 to the congregate nutrition programs, when such programs are available.

If a caregiver provides help to an older person, the care recipient must be “frail” to qualify for respite funded by Title III-E. Frail means the care recipient:

  • is unable to perform a minimum of two activities of daily living; or
  • due to a cognitive or other mental impairment, requires substantial supervision because the older person behaves in a manner that poses a serious health or safety hazard to self or another person.

The CNE form and instructions are available on the HHSC AAA web site. Do not alter this required form.

Documentation

Documentation includes the name of the AAA or subrecipient, the name of the person conducting the CNE assessment, the date completed, and the name of the person assessed. Answer all questions for every person receiving service.

Reporting

AAAs and subrecipients must report responses for the CNE form using the HHSC information management system for the initial assessment and all reassessments.

Related Policy

Eligibility, F-1220

 

D-1050 Caregiver Assessment Questionnaire

Revision 21-0; Effective January 15, 2021

The Caregiver Assessment Questionnaire (CAQ) documents a caregiver’s needs and identifies:

  • possible barriers to carrying out caregiver responsibilities;
  • existing resources and supports for the caregiver; and
  • the level of caregiver stress.

Complete the initial assessment at intake for all caregivers receiving caregiver support coordination funded through Title III-E of the OAA. Complete a new assessment if more than 12 months have elapsed since the date of the previous assessment.

Complete the CAQ during a face-to-face interview or by phone. Staff must discuss the questions with the caregiver. The results of the assessment inform the type of services the caregiver needs.

Documentation

Documentation must include the name of the person conducting the CAQ assessment, the date completed, and the name of the person assessed. Answer all questions for every person receiving caregiver support coordination service.

Reporting

AAAs and subrecipients must report responses for the CAQ form using the HHSC information management system for the initial assessment and all subsequent assessments.

Related Policy

Caregiver Intake, D-1030

 

D-1060 Nutritional Risk Assessment

Revision 22-1; Effective March 1, 2022

Complete a nutritional risk assessment annually for every person receiving congregate meals, HDMs or nutrition counseling. HHSC uses the DETERMINE Your Nutritional Health checklist as the nutritional risk assessment tool. 

The DETERMINE Your Nutritional Health checklist:

  • is a nutrition screening tool used to identify people at risk of poor nutritional health or those with malnutrition; 
  • must be completed at intake for all people receiving congregate meals, HDMs or nutrition counseling;
  • must be completed annually, within 30 days of the anniversary of the person’s initial risk assessment date; and 
  • cannot be altered.
     

People at high nutritional risk are those who score six or higher on the DETERMINE Your Nutritional Health checklist. Use the checklist to measure a person’s change in level of nutritional risk over time and assess the need for nutrition counseling. Overall nutritional scores help evaluate the effectiveness of the nutrition program and trends inform topics for future nutrition education events.

The person requesting congregate or HDMs can complete the DETERMINE Your Nutritional Health checklist. If needed, staff can complete the checklist through an interview with the person. After the assessment, provide the person with a copy of Form 2272, Determine Your Nutritional Health Handout with the date of the screening and the assessment score. If the assessment is conducted by phone, both the completed checklist and handout must be provided to the person assessed.

Documentation

Documentation must include the name of the AAA or subrecipient, the name of the person screened, and the date completed. Answer all questions for every person receiving meals.

Reporting

Report responses for the DETERMINE Your Nutritional Health checklist using HHSC’s information management system for the initial assessment and all reassessments.

Related Policy

Intake, D-1020
Caregiver Intake, D-1030
Eligibility, F-1120
Eligibility, F-1220

 

D-1070 Determination of Type of Meal – Home Delivered Meals

Revision 21-0; Effective January 15, 2021

The Determination of Type of Meal (DTM) assessment ensures certain meals are appropriate for a person. Meals served daily should be consumed the same day the meal is delivered. The DTM assessment must be conducted by phone or face-to-face, in the eligible person’s home. Do this before the person receives multiple meals in one delivery of chilled, shelf-stable, or frozen meals or under any other condition that lets a person eat the meal at a time other than the day of delivery. Do not alter the content of the required form.

Complete a new DTM annually, within 30 days of the anniversary of the person’s prior evaluation date. An earlier evaluation may need to occur if circumstances indicate a significant change in the person’s condition in accordance with the meal provider’s written policy.

The person receiving multiple meals to be consumed after the day of delivery must be able to consume meals independently or with available assistance. The person must be able to handle, store, prepare and otherwise manage the meal delivery, as well as manage the daily meal, when multiple or bulk meals are being delivered.

Consider the person’s capability, home environment, literacy, cognition, language, caregiver support and other factors to ensure the person’s health and safety. The person may not receive multiple meals in one delivery if the evaluation indicates a barrier exists and the barrier cannot be remedied.

The DTM evaluates areas such as:

  • Home equipment: The person who receives the meals has working equipment and utilities in the home. These include:
    • gas;
    • electricity;
    • a stove with an oven that works;
    • a working microwave oven;
    • a working toaster oven; and
    • a working refrigerator or a freezer.
  • Ability to follow instructions: Consider a person’s ability to follow instructions to safely store and prepare meals or have a caregiver capable of following instructions. The inability to follow instructions can be related to literacy, language, vision or cognition.
  • Ability to physically manage meals: Consider a person’s ability to physically manage meals or who have a caregiver to physically manage meals for them. Manual dexterity and fine motor skills may impair the ability of a person to open, store and prepare meals and overall strength. Evaluate balance and mobility
  • Ability to eat meals: The meal provider should consider a person’s ability to consume a specific type of meal before they discontinue hot meals and other meals that are served on a regular basis. A dental or medical condition that makes it difficult to eat certain types of foods such as hard foods (raw vegetables and nuts), nut butters (peanut butter), fibrous proteins (pork chops or steak), or other foods (granola bars, raisins) might compromise the ability of the person to consume meals.
  • Identification of caregiver: Identify a caregiver who can and will assist with the management of meals, including receiving and accepting the meals, unpacking and storing the meals, and preparing the meals, as appropriate. Maintain the caregiver’s contact information, including the name, address, and telephone number in the eligible person’s file.

The AAA or subrecipient may deny or terminate frozen, chilled, or shelf-stable meals based on the results of the DTM. They may also deny or terminate if an eligible person refuses to discuss or allow a visual observation of the intended home environment where they will deliver appropriate meals.

The AAA or subrecipient must try to remedy barriers to service including referrals to local community resources to coordinate resources such as residential repair, health maintenance, or other services.

The AAA or subrecipient may not terminate nutrition services to an eligible person, including hot meals, because a person cannot manage other types of meals based on the results of the DTM assessment. If a person cannot manage frozen, chilled, or shelf-stable meals, and does not have another person to help, it may be an indicator that the person is frail or isolated, which are targeted populations under the OAA.

If an AAA or subrecipient considers stopping hot meals for an entire area or route and replacing them with chilled, frozen, shelf-stable or multiple meals, they must determine the impact to the people served using the DTM assessment. If they determine a person is too frail or cannot manage the type of replacement meal considered, the AAA or subrecipient must:

  • continue hot meals;
  • identify whether the person has someone available who can manage the meals for them; or
  • assist the person in accessing other in-home services before discontinuing daily hot meals.

Federal law mandates providers must target in-home services to frail, homebound or isolated people. HDMs are an in-home service.

Documentation

Documentation must include the name of the AAA or subrecipient, the date completed, the name of the person conducting the evaluation, the name of the person requesting HDMs, and the type of meals requested.
The AAA or subrecipient must maintain the results of each evaluation to determinate the appropriateness of a meal to an eligible person.
The meal provider must document the date of denial, the reason for the denial, and how they notified the person of the denial when a person is not eligible to receive a meal, based on the DTM.
Document the efforts by the meal provider to remedy barriers to service, including referrals to local community resources to coordinate resources such as residential repair, health maintenance, or other services, in the eligible person’s file.

Reporting

AAAs and subrecipients must report responses for the DTM using the HHSC information management system for the initial assessment and all reassessments.

Related Policy

Eligibility, F-1220