Standards for private organizations

2020 Edition

Home Care and Support Services (HCS) 9: Case Closing and Aftercare

The organization works with individuals and family members when appropriate, to plan for case closing and, when possible, to develop aftercare plans.
2020 Edition

Currently viewing: HOME CARE AND SUPPORT SERVICES (HCS)

VIEW THE STANDARDS

Purpose

Individuals who receive Home Care and Support Services obtain a maximum level of independence, functioning, and health, and extend the time it is possible to live safely at home and in the community.
1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,   
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • In a few instances, the organization terminated services inappropriately; or  
  • Active client participation occurs to a considerable extent; or
  • A formal case closing evaluation is not consistently provided to the public authority per the requirements of the standard.
3
Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Services are frequently terminated inappropriately; or  
  • Aftercare planning is not initiated early enough to ensure orderly transitions; or
  • A formal case closing summary and assessment is seldom provided to the public authority per the requirements of the standard; or  
  • Several client records are missing important information; or
  • Client participation is inconsistent. 
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing. 
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Case closing procedures
  • Aftercare planning and follow-up procedures
  • Relevant portions of contract with public authority, as applicable
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Persons served
  • Review case records

 

HCS 9.01

Planning for case closing:
  1. is a clearly defined process that includes assignment of staff responsibility;
  2. begins at intake; and 
  3. involves the care provider, persons served, and others as appropriate to the needs and wishes of the individual.

 

HCS 9.02

Upon case closing, the organization notifies any collaborating service providers, including the courts, as appropriate.

 

HCS 9.03

If an individual has to leave the program unexpectedly, the organization makes every effort to identify other service options and link the person with appropriate services.

Interpretation

The organization must determine on a case-by-case basis its responsibility to continue providing services to individuals whose third-party benefits are denied or have ended and who are in critical situations.

 

HCS 9.04

When appropriate, the organization works with persons served and their family to: 
  1. develop an aftercare plan, sufficiently in advance of case closing, that identifies short- and long-term needs and goals and facilitates the initiation or continuation of needed supports and services; or 
  2. conduct a formal case closing evaluation, including an assessment of unmet need, when the organization has a contract with a public authority that does not include aftercare planning or follow-up.
NA The organization has a mission and mandate that dictate the provision of early stage services only.

 

HCS 9.05

The organization follows up on the aftercare plan as appropriate, when possible, and with the permission of the individual.
NA The organization has a mission and mandate that dictate the provision of early stage services only.

NA The organization has a contract with a public authority that prohibits or does not include aftercare planning or follow-up.