TCRC Procedure │ Service Coordination │ Procedure #11603

Accessing Emergency Respite Care Beds

Link to TCADD Policy 11601

SCOPE:

This procedure applies to all employees of Tri-Counties Regional Center. This procedure applies to any individual of Tri-Counties Regional Center for whom out-of-home respite services are needed on an emergency or crisis basis in order to avert a more restrictive long-term response.

Tri-Counties Regional Center seeks to maintain individuals in their home communities through the availability of beds in licensed care facilities that can be used in an emergency for out-of-home respite or crisis services. Such beds may be accessed first before an individual is moved out of the family home or placed out of the area far from their family. It is expected that the individual would be returned to their home living arrangement once the emergency need has passed.

PROCEDURE:

I.

When the individual need for out-of-home respite arises because of an emergency at their home living arrangement, Tri-Counties Regional Center staff assesses whether or not a specialized respite bed is needed and if existing vacancies in certified or licensed facilities are appropriate to meet the need. Similarly, when an individual is experiencing a behavioral crisis and generic or mobile crisis services are unable to resolve the issue(s) in the current living arrangement, staff assesses the probability that a specialized licensed crisis bed can address the need and is available.

1. A list of crisis/respite beds available is kept current by the Resource Developer.
2. The listings are updated at least weekly, preferably by 1:00 PM on Wednesday of each week.
3. The list is available on the Tri-Counties Regional Center network and by hard copy with each Team Manager, Director of Services & Supports, and on-call book for each manager.
4. The Tri-Counties Regional Center on-call manager has the current listing as they start on-call duty at 5:00 PM Wednesday.

II.

The referral for respite or crisis residential services is approved by the assigned Tri-Counties Regional Center Manager on-call after hours. Respite referrals are approved at least 48 hours prior to admission to the facility, whenever possible. The referring manager assigns follow up responsibilities to the appropriate service coordinator or other designee. Verbal approvals are confirmed in writing by the end of the next business day. The manager in whose area the respite facility is located is also informed of the respite placement as soon as possible, but no later than the next business day.

1. The protocol agreed to for the specific crisis facility is available in the Tri-Counties Regional Center on-call books and adhered to in making a crisis placement.
2. On the next business day, the on-call worker will report the activity in accordance with Service Policies & Procedures #9210, After Hours Calls, including notifying the service coordinator and the Team Manager for the individual’s service area.
3. The assigned service coordinator is then responsible for contacting the Tri-Counties Regional Center service coordinator/liaison to the crisis facility and the Team Manager for the area where the crisis facility is located on that first business day.

III.

1. The approving manager or designee contacts the crisis facility staff in accordance with their intake protocol to inform them of:
   1. The intended crisis placement;
   2. From where the individual is being transported;
   3. Who is transporting;
   4. The expected arrival time;
   5. The name and telephone number of the person to contact regarding care of the individual.
2. The family or other person responsible for the individual is kept informed of the placement arrangements and involved in the admission process to the extent possible during the emergency situation.
3. Plans to return to the home living arrangement should be discussed at the time of the admission meeting.
4. The sending facility is invited to attend the discharge meeting, which is held within 48 hours after placement.

IV.

When at all possible:

1. Tri-Counties Regional Center staff ensures that all crisis placements are accompanied by:
   1. Current medications with dispensing directions;
   2. The current Medi-Cal card or other medical treatment insurance card;
   3. Signed consents for emergency medical treatment.
2. For respite placements, in addition to the above, Tri-Counties Regional Center staff also ensure that:
   1. A release of information is signed;
   2. Physician orders regarding medications, serious medical conditions such as seizure disorder and/or special diets are available;
   3. Sufficient clothing and toiletries accompany the individual;
   4. Adequate Personal & Incidental funds are provided;
   5. The authorization for funding the service has been shared;
   6. The current Individual Program Plan is included.
3. For crisis placements, some or all of these latter items may be provided to the facility by the end of the next business day.

V.

During the crisis placement admission process, the receiving facility staff are advised by Tri-Counties Regional Center staff making the referral to complete:

1. A behavioral assessment;
2. Personal property inventory;
3. A summary of the precipitating behaviors leading to the crisis intervention.

VI.

For a crisis placement, discharge planning is coordinated by the referring Tri-Counties Regional Center staff, under the supervision of the referring Team Manager.

1. The facility liaison and the manager overseeing the area where the crisis facility is located are kept fully informed of efforts to return the individual to their home living arrangement or to a new appropriate setting.
   1. A crisis referral should be converted to a respite placement once the individual’s crisis is resolved and they are awaiting return to their home living arrangement; or,
   2. They have been at the emergency bed of the facility for more than 21 days.
2. Tri-Counties Regional Center staff makes it a priority to return individuals as soon as feasible to their long term living arrangement:
   1. To stabilize and support their living arrangement of choice; and,
   2. So that the identified emergency/crisis respite beds at the specialized facilities can be made available to other Tri-Counties Regional Center individuals when they need emergency services.

VII.

Documentation of the emergency respite or crisis services is accomplished by the assigned Tri-Counties Regional Center personnel using:

1. Regional Center Notes;
2. Special Incident Reports;
3. Other reports as necessary.

Revision Date: 12/31/2008