Reviewing the IPP

Markley S. Sutton, Ph.D.PHA Consultant

Reviewing the IPP

IntroductionThe IPPThe Significance of Accuracy Review and its PurposesNeeds Assessment based on Past RequirementsFuture ProbabilitiesAssuring your relatives Needs and Services

Introduction

• The reason for this training and template• Overview of the necessity for advocacy• Don’t be overwhelmed• Question until you understand• Know what you can and cannot include• Be accurate• Be bold

The IPP

• The “real” IPP 3 year document at RC• Your relatives IPP at the RC defers to DC• ISP vis-a-vis the IPP• Aspects of the ISP – Living– Services– Work– Recreation

Accuracy

• Everyone “assumes” accurate info in IPP• Most IPP’s are cut & paste documents• There are usually many contradiction• The use of the IPP to meet regulations not the

needs of the individual• The need to know payers & income• Need to meet requirements of US and Cal

requirments

Review and it Purposes

• The IPP is the contract to provide for needs and services that are required

• The purpose of the IPP has been expanded to meet other regulatory requirements

• People are “lulled” by the details• To review the document and the agenda is to

point out inaccuracies, errors, missed needs and requirements

Review and its Purpose (cont.)

• Meet the requirements of eligibility (MediCare/MediCaid)

• Provide for all necessary care while it is needed and available

• Provide for all assessments required• Provide for all preventive intervention• List all necessary services, supports & staff

Prevention

• Review all preventive treatments to be done• Including all vaccinations• Including all tests and labs• Including all dental and vision care/screening• Including all sex related conditions• Including anything from family history

Needs Assessment

• Review all medical conditions and treatments in the last year

• What was required to be done by whom• Even “opened” and “closed” conditions• Note all special services offered by the

residence as a matter of course, eg meals• Note any special services requiring special

staff or transfer to GAC

Needs Assessment (Meds)

Be sure an ask the team to request a medication History from the Pharmacy, especially for any medication behavior problems, mental health issues and for sedation for clinics.You should be able to see behavior, drug, max dose, duration side effects and efficacy.Reviews: how often are the psychotropic medications reviewed and by whom. (n.b. PDR)

Needs Assessment

• Review all Behavior issues treatments, programs, and staff requirements

• Note all psychiatric and psychologist’s actions• Note all “opened” and “closed” issues• Note any special services automatically

provided (covered trashcan issue)• Special training requirements• Special neurological or diagnoses requiring

special approaches

Future Probabilities

Take into account all probable needs and requirements, e.g.– Vision loss– Hearing Issues– Cancer screening

Potential Issues from personal or family historyCourse of any current conditions

Assuring Needs and Services

• Be an Advocate • Do the work to know and request• Ask for assistance if needed• Be accurate and be correct in your requests• Every thing has to be woven back to the needs

and services of the individual• This is the contract to assure

Assuring Needs and Services

• Remember it is about the individual’s needs and services,

• It is not about WHERE a person is or lives• It is about WHAT they receive in supports

• Sometime the supports needed are a clean, quiet, rural, spacious park-like environment and that is what you would say based on specific identified individual needs

The Form• Individual Program Plan (IPP) Review Template (Adult)

• Identification Information• Name: (First, Middle, Last)________________________________________ Correct __• Date of Birth: Month ___________ Day ___ Year _______ Age _______ Correct __• Birth Place _________________________________________• Birth Certificate _____________________________________ Original or Copy (circle)• Social Security Number _______________________ _Card: Original or copy (circle)• California ID: __________________________________ Card: Original or copy (circle)• Gender: ______________________ • Current Picture or Picture ID inserted in document or attached (circle)• Hair color: ______________________ Eye color: ________________________• Height: _________________________ Weight: ___________________________• Check all that apply:• Blind: ____ Hearing Impaired: ___ Disabled: ____ Age > 65: ____• Parent MediCare eligible or recipient: ____• Health Insurance: __________________________________________• MediCaid (MediCal): ______ MediCare: ______ Other: __________________• Dental Coverage: ___________________________• Vision Coverage: ____________________________• Urgent Care Available if necessary:• Legal Status: Conserved: ______ Non-conserved: ________• Letters of Conservatorship: Date: _________ Available: _____• Living Arrangement: NF: ____ ICF: ____

The Form (cont.)

• Financial Status• SSI: Amount monthly _____________________

Transferable ____• Account Total: ___________________________

Transferable ____• Death Benefit: ____________________________

Transferable ____• Available Funds if Placed:

•

The Form (cont.)• Health/Medical Issues• Preventive Care• Vaccinations/Inoculations• Measles: date: _______________ Titer: _________________• Hepatitis A: date: ____________ Hepatitis B: date: _____________• TB status: _____________________ Test: dates: _________________________• Small Pox status: _______________• Tetanus status: _________________• Whooping Cough status: ___________________• 60 Pneumonia Vaccines: dates: ______________________________________• 60 Shingles Vaccine: date: ________________________• Screening for • Vision: Visual Acuity: date: _________recommendation: ______________________• Cataracts: date: _______________recommendation: ______________________• Dental: Caries: date: ____________ recommendation: __________________________• Special Procedures Needed: • Extractions: _____ Crown: _____ X-ray: _______ Other: ______• Colon Health: Fecal Test: ____ Sigmoidoscopy: _____ Colonoscopy: _____________• Bone Health: Dexa-scan: date ______________ result: ____________________• Male: Prostate Health Exam: date: ______________ (See Conditions)• Female: Post-Menopausal: yes ____ no _____ (See Conditions)• Hormone Health: T3/T4; TSH others as necessary (e/g/ FSH): date: _______• Any test for AT RISK individuals based on family history or other information:•

The Form (cont.)

•• Health/Medical (conditions or diagnosed issues in past 12 months)• Issue Treatment Supports

Required• Example• Diabetes Insulin 70/30 2 times a day Must have licensed authorized• Licensed person to inject.•

The Form (cont.)• Behavioral/Mental Health (Issues or diagnoses within last 12 months)• Issue Degree of Impact Requires• Example• Pica Dangerous: Yes Clean environment with hr

sweep• Intensity: Severe Trained health staff to

intervene• Frequency: Hourly Plan designed by Psychologist

The Form (cont.)• Needs Assessment• Training and supports• ADL; Vocational Supports (Work First); Recreation (Need, frequency, staff)• Example• Handwashing 5X a day Staff trained in backward chaining; prompting• Art 2X week Staff trained in providing opportunities; reinforce

The Form (cont.)• Equipment and other supports and activities (used in last 12 months)• Example: • Include required specialists for supports: • Special Hi/Lo bed; modified Wheelchair; Had DME adjust chair 1X;• Oxygen mist adjusted and monitored daily by RN trained in machine.

The Form (cont.)• Staff Interactions: (Frequency, duration, Is it Required ?)• Physician• Type: e.g.: Unit; ENT, Podiatrist, GYN; Psychiatrist;

• Psychologist• Social Worker (LCSW, SWA)• IP Coordinator• Recreation Therapist• OT/PT• Speech Therapist• Vocational Instructor (Classification):• Foster Grandparent/Senior Companion• Staff:• Administrator: US:• Shift manager• LOC: (Type: RN/LVN/PT/PTA/CNA/Other)• Other:

The Form (cont.)• Medication Management (especially Psychotropic Medications)• Be sure and ask for a Drug History from the Pharmacy including specifically medications used for behavior

problems, mental health problems and for sedation for clinics. You should be able to complete the following information history.

• Drug Max Dose Duration SE Efficacy• Example• For Aggression:• Chlorpromazine 300mg 4x a day 2 years ++ 0

• How often are the psychotropic medications reviewed and by whom?• Specifically, the Psychotropic Drug review team meetings and members.

The Form (cont.)

• Summary of all requirements Indicated in Assessment Areas (including training and frequency):

• Summary of all supports outlined in Assessment Areas (including training and frequency):

• Further Essential Requirements for Placement Options

Assuring the Future

Best Wishes in your Plan for the future for your relative.We can only hope that what we do will create a truly full future.Be Bold in your requests, demand the best.