Health Advocacy ProjectHealth Advocacy Project

Improving the Health of Improving the Health of Residents in Board & Residents in Board &

Care Facilities Care Facilities

A Project of A Project of Protection & Advocacy, Inc.Protection & Advocacy, Inc.

Funded by the California EndowmentFunded by the California Endowment

California Board & Care HomesCalifornia Board & Care Homes

Intended to insure a level of care and services in the community Intended to insure a level of care and services in the community which is equal to or better than that provided by the state hospitals.which is equal to or better than that provided by the state hospitals.

Intended to provide safe, high quality, supervised living Intended to provide safe, high quality, supervised living environments with services necessary to meet the residents’ environments with services necessary to meet the residents’ identified, specific needs.identified, specific needs.

Intended to insure continuity of care between the medical-health Intended to insure continuity of care between the medical-health elements and the supportive care-rehabilitative elements of elements and the supportive care-rehabilitative elements of California’s health systems.California’s health systems.

History / BackgroundHistory / Background

Licensed FacilitiesLicensed Facilities

StatewideStatewide

FacilitiesFacilities ResidentsResidents

Adult Residential Adult Residential 4,7514,751 39,444 39,444(Community Care Licensing Data)(Community Care Licensing Data)

Adults w/ Mental DisabilitiesAdults w/ Mental Disabilities 2,7002,700 28,000 28,000(CRCA Data)(CRCA Data)

San Diego CountySan Diego County

Adult ResidentialAdult Residential 448 448

Adults w/ Mental DisabilitiesAdults w/ Mental Disabilities (estimated) (estimated) 84 84

• There is no separate licensing category for adults with Mental Disabilities.There is no separate licensing category for adults with Mental Disabilities.• CRCA report relies upon data from 2000, source unknown.CRCA report relies upon data from 2000, source unknown.

EthnicityEthnicityof Board & Care Residentsof Board & Care Residents

% of M/H % of B&C% of M/H % of B&C

Population Population PopulationPopulation

African AmericanAfrican American 18.2%18.2% 21.3%21.3%American IndianAmerican Indian .7% .7% .7% .7%AsianAsian 1.6% 1.6% 3.2% 3.2%CaucasianCaucasian 56.4%56.4% 48.2%48.2%HispanicHispanic 13.9%13.9% 20.3%20.3%OtherOther 9.2% 9.2% 6.3% 6.3%

24% (N=170) of residents surveyed had complained of a 24% (N=170) of residents surveyed had complained of a physical illness, yet received no follow-up to their physical illness, yet received no follow-up to their complaint. complaint.

56% (N=200) had not seen a physical health doctor since 56% (N=200) had not seen a physical health doctor since living at the facility.living at the facility.

46% (N=167) reported that there had been physical 46% (N=167) reported that there had been physical violence in the home.violence in the home.

14% (N=150) reported that sexual abuse had occurred in 14% (N=150) reported that sexual abuse had occurred in the home.the home.

83% (N=175) reported no involvement in house rule 83% (N=175) reported no involvement in house rule making or problem solving.making or problem solving.

Surveys of ResidentsSurveys of ResidentsAccording to 1999 report to the San Diego Coalition for According to 1999 report to the San Diego Coalition for Mental Health:Mental Health:

Surveys of ResidentsSurveys of Residents According to a California Network of Mental Health Clients survey of 215 According to a California Network of Mental Health Clients survey of 215 residents in 16 Southern California homes:residents in 16 Southern California homes:

> 50% of the residents had not been allowed to visit the > 50% of the residents had not been allowed to visit the home prior to being placed there.home prior to being placed there.

> 50% of the residents had been placed in the home from > 50% of the residents had been placed in the home from a hospital, without benefit of a discharge planning process.a hospital, without benefit of a discharge planning process.

> 60% of the residents were unaware that they could > 60% of the residents were unaware that they could register a complaint with Community Care Licensing.register a complaint with Community Care Licensing.

> 50% of the residents did not know how to contact the > 50% of the residents did not know how to contact the local Patients’ Rights Advocate.local Patients’ Rights Advocate.

Residents’ Rights,Residents’ Rights,Service Entitlements, & ResponsibilitiesService Entitlements, & Responsibilities

in Californiain CaliforniaBoard & Care HomesBoard & Care Homes

for adult persons with mental disabilitiesfor adult persons with mental disabilities

Admission ProceduresAdmission Procedures

“No client may be admitted prior to a determination of the “No client may be admitted prior to a determination of the facilities ability to meet the needs of the client, which must facilities ability to meet the needs of the client, which must include an appraisal of his/her individual service needs.”include an appraisal of his/her individual service needs.”

(Title 22, California Code of Regulations, Section 85068.1)(Title 22, California Code of Regulations, Section 85068.1)

Before admission Before admission the following services must be provided:the following services must be provided:

1.1. A A medical assessmentmedical assessment, completed by a , completed by a qualified medical professional.qualified medical professional.

2.2. A A mental health intake assessmentmental health intake assessment, completed , completed by a licensed mental health professional.by a licensed mental health professional.

3.3. An assessment of the client’s need for An assessment of the client’s need for personal assistance and care, by personal assistance and care, by determining determining his/her functional capabilitieshis/her functional capabilities, completed by , completed by the facility staff.the facility staff.

4.4. The facility staff must The facility staff must complete a written complete a written Needs and Services Plan.Needs and Services Plan.

5.5. The person is allowed to The person is allowed to visit the facilityvisit the facility with with his/her family, friends, and/or representative.his/her family, friends, and/or representative.

6.6. The The person is interviewed by the facility staffperson is interviewed by the facility staff and is provided with information about the and is provided with information about the facility, including information contained in the facility, including information contained in the admission agreement.admission agreement.

7.7. An An admission agreementadmission agreement must be obtained. must be obtained.

Admission AgreementsAdmission AgreementsMust Specify:Must Specify:

Basic ServicesBasic Services

Available Optional ServicesAvailable Optional Services

Payment ProvisionsPayment Provisions

Refund ConditionsRefund Conditions

Conditions for TerminationConditions for Termination

Policies for Family Visits and CommunicationsPolicies for Family Visits and Communications

General Facility PoliciesGeneral Facility Policies

Current arrangements with the client regarding the Current arrangements with the client regarding the provision of food service.provision of food service.

Medical AssessmentsMedical Assessments must include:must include:

A physical exam which indicates the primary and A physical exam which indicates the primary and secondary diagnosis, if any.secondary diagnosis, if any.Current medical status.Current medical status.Prior medical services and history.Prior medical services and history.Communicable diseases exam.Communicable diseases exam.Identification of the clients special problems and needs.Identification of the clients special problems and needs.Identification of prescribed medications being taken.Identification of prescribed medications being taken.Identification of physical restrictions effecting the clients Identification of physical restrictions effecting the clients ability to participate in the facility program. ability to participate in the facility program.

Functional Functional Capabilities Assessments must include:Capabilities Assessments must include:

Activities of Daily Living (Eating, Bathing, Dressing, Activities of Daily Living (Eating, Bathing, Dressing, Grooming, etc.)Grooming, etc.)AmbulationAmbulationVision, hearing, communicationVision, hearing, communicationMedical history and conditionsMedical history and conditionsNeed for prescribed and non-prescribed medicationsNeed for prescribed and non-prescribed medicationsMental and emotional conditionsMental and emotional conditionsSocialization and cognitive statusSocialization and cognitive statusPropensity for harmful behaviorsPropensity for harmful behaviorsAbility to manage his/her own financesAbility to manage his/her own finances

** The assessment must be in writing and must be used in developing The assessment must be in writing and must be used in developing the Needs and Services Planthe Needs and Services Plan

Needs and Needs and Services PlansServices Plans

Development of the NSP shall involve:Development of the NSP shall involve:

1.1. The client, or his/her authorized The client, or his/her authorized representative, if any.representative, if any.

2.2. Any relative participating in the placement.Any relative participating in the placement.

3.3. The placement or referral agency, if any.The placement or referral agency, if any.

4.4. The person responsible for facility The person responsible for facility admissions.admissions.

Needs and Services PlanNeeds and Services Plan

The written NSP The written NSP shall include the client’s desires and shall include the client’s desires and backgroundbackground, obtained from the client, the client’s family , obtained from the client, the client’s family or his/her authorized representative, if any, and or his/her authorized representative, if any, and licensed professional, where appropriate, regarding:licensed professional, where appropriate, regarding:

1.1. Entrance to the facility.Entrance to the facility.2.2. Specific service needs.Specific service needs.3.3. Written medical assessment.Written medical assessment.4.4. Mental and emotional functioning.Mental and emotional functioning.5.5. Written mental health intake assessment.Written mental health intake assessment.6.6. Written functional capabilities assessment.Written functional capabilities assessment.7.7. Facility plans for providing services to meet the individual Facility plans for providing services to meet the individual

needs of the clientneeds of the client..

• The written NSP shall be updated as frequently as necessary to ensure The written NSP shall be updated as frequently as necessary to ensure accuracy and toaccuracy and to document significant occurrences that result in changes in the client’s document significant occurrences that result in changes in the client’s physical, mental and/or social functioning.physical, mental and/or social functioning.

ResidentResident RightsRights

To receive To receive prompt and satisfactory medical and dental prompt and satisfactory medical and dental carecare, including:, including:

– Health and Mental Health services that meet one’s age, Health and Mental Health services that meet one’s age, language and background needs.language and background needs.

– Safe transportation to one’s medical or dental service provider, Safe transportation to one’s medical or dental service provider, arranged by facility staff.arranged by facility staff.

– Attendance at community health and mental health programs of Attendance at community health and mental health programs of one’s choice.one’s choice.

* Facilities are required to develop and implement a plan which * Facilities are required to develop and implement a plan which ensures that assistance is provided to residents in meeting their ensures that assistance is provided to residents in meeting their medical and dental needs.medical and dental needs.

Residents Have the Residents Have the Right:Right:

Residents Have the Right:Residents Have the Right:

To have access to individual storage space for personal use.To have access to individual storage space for personal use.

To have reasonable access to make and receive confidential To have reasonable access to make and receive confidential telephone calls.telephone calls.

To receive unopened mail and correspondence.To receive unopened mail and correspondence.

To practice one’s religion and attend religious services of one’s To practice one’s religion and attend religious services of one’s choice.choice.

To socialize with all other residents in common areas.To socialize with all other residents in common areas.

To participate in recreational activities.To participate in recreational activities.

To a To a clean and pleasant living environmentclean and pleasant living environment with as much with as much freedomfreedom as one’s safety and the safety of others permits.as one’s safety and the safety of others permits.

To be To be treated with respect and dignitytreated with respect and dignity, free from physical or , free from physical or emotional abuse or neglect.emotional abuse or neglect.

To To privacyprivacy in every day life situations. in every day life situations.

Residents Have the Right:Residents Have the Right:

To actively participate in the development of one’s Needs and To actively participate in the development of one’s Needs and Services Plan.Services Plan.

To keep and spend a reasonable sum of money.To keep and spend a reasonable sum of money.

To wear one’s own clothes.To wear one’s own clothes.

To be free from discrimination on the basis of disability, race, color, To be free from discrimination on the basis of disability, race, color, sex, age, sexual preference, marital status, economic and familial sex, age, sexual preference, marital status, economic and familial status.status.

To exceptions or changes to the facility rules, policies, or practices To exceptions or changes to the facility rules, policies, or practices when such exceptions or changes are necessary because of a when such exceptions or changes are necessary because of a person’s disability.person’s disability.

To freely leave and return to the facility, within those time To freely leave and return to the facility, within those time restrictions necessary for the protection of all residents.restrictions necessary for the protection of all residents.

To be provided with oral and written information about one’s To be provided with oral and written information about one’s medication.medication.

Rights that may be limited for those Rights that may be limited for those residents who have an LPS conservator:residents who have an LPS conservator:

To possess and control one’s own money.To possess and control one’s own money.

To refuse medications.To refuse medications.

To receive or reject medical care or health-To receive or reject medical care or health-related services.related services.

To move from the facility (within the terms of the To move from the facility (within the terms of the admission agreement)admission agreement)

Tips for Family and FriendsTips for Family and Friends

From: “ A Mother’s Perspective on Board and Care: An From: “ A Mother’s Perspective on Board and Care: An interview with Barbara Castle “interview with Barbara Castle “

Board and Care Quality Forum Board and Care Quality Forum – Volume 5, Number 5– Volume 5, Number 5 Published September/October 2002Published September/October 2002

Finding a Board and Care HomeFinding a Board and Care Home

Don’t rely on hospital social workers and Don’t rely on hospital social workers and discharge planners.discharge planners.

Make appointments and visit some facilities.Make appointments and visit some facilities.

Know that there aren’t enough homes to begin Know that there aren’t enough homes to begin with, so be proactivewith, so be proactive

Things to Look For:Things to Look For:

LocationLocation – Proximity to public transportation and necessary healthcare – Proximity to public transportation and necessary healthcare services.services.

SupervisionSupervision - Does the facility seem to provide adequate staffing & - Does the facility seem to provide adequate staffing & supervision?supervision?

Structure Structure - Are there structured activities, programs, outings, etc.?- Are there structured activities, programs, outings, etc.?

Are the staff courteous and respectful when interacting with residents?Are the staff courteous and respectful when interacting with residents?

The manager should be open to listening to the residents about conditions The manager should be open to listening to the residents about conditions and things happening in the home.and things happening in the home.

Does the facility welcome/encourage family and friends involvement and Does the facility welcome/encourage family and friends involvement and input?input?

How do the other residents feel about the facility?How do the other residents feel about the facility?

Try to establish good communication and a positive relationship with Try to establish good communication and a positive relationship with the operators.the operators.

Avoid adversarial, confrontation with the staff and/or operator, if at Avoid adversarial, confrontation with the staff and/or operator, if at all possible.all possible.

Spend time at the facility on a regular basis.Spend time at the facility on a regular basis.

Get to know the other residents and their families and friends.Get to know the other residents and their families and friends.

Try to do anything you can to create a supportive, safe environment.Try to do anything you can to create a supportive, safe environment.

Be a positive influence:

Important Telephone NumbersImportant Telephone Numbersfor Complaints/Reports/Informationfor Complaints/Reports/Information : :

Community Care LicensingCommunity Care Licensing …. . …. . (619) 767-2339(619) 767-2339

Consumer Center for Health Education Consumer Center for Health Education and Advocacyand Advocacy ………………… ………………… 1-877-734- 1-877-734-

32583258

Patient Advocacy ProgramPatient Advocacy Program …............ …............ (619) 543-(619) 543-99989998

Adult Protective ServicesAdult Protective Services ……………. ……………. (619) 283-(619) 283-57315731

OmbudsmanOmbudsman ……………….............. 1-800-640-4661 ……………….............. 1-800-640-4661

Protection & Advocacy, IncProtection & Advocacy, Inc………... 1-800-776-5746………... 1-800-776-5746

Important Telephone NumbersImportant Telephone Numbersfor Information and Referral:for Information and Referral:

Info-Line - CentralInfo-Line - Central ……………………. ……………………. (619) 230-0997(619) 230-0997

Info-Line – North CoastalInfo-Line – North Coastal ……………. ……………. (760) 943-0997(760) 943-0997

Info-Line – North InlandInfo-Line – North Inland …………….. …………….. (760) 740-0997(760) 740-0997

Info-Line – OutlyingInfo-Line – Outlying …………………. 1-800-227-0997 …………………. 1-800-227-0997

NAMI Albright Information and Referral NAMI Albright Information and Referral

CenterCenter ………………………………… 1-800-523-5933 ………………………………… 1-800-523-5933

Mental Health AssociationMental Health Association .......................(619) 543-0412 .......................(619) 543-0412

Resident CouncilsResident Councils

“ “ Every licensed community care facility, at the request Every licensed community care facility, at the request of a majority of it’s residents, shall assist residents in of a majority of it’s residents, shall assist residents in

establishing and maintaining a resident oriented facility establishing and maintaining a resident oriented facility council. The council shall be composed of residents of council. The council shall be composed of residents of

the facility and may include family members of residents the facility and may include family members of residents of the facility. The council may, among other things, of the facility. The council may, among other things, make recommendations to facility administrators make recommendations to facility administrators to to

improve the quality of daily living in the facility and improve the quality of daily living in the facility and may negotiate to protect residents’ rights with may negotiate to protect residents’ rights with

facility administratorsfacility administrators.”.”

- Health and Safety Code, Section 1520.2 -- Health and Safety Code, Section 1520.2 -

Resident Council Requirements:Resident Council Requirements:

Facility administration must assist residents in Facility administration must assist residents in establishing and maintaining a council.establishing and maintaining a council.

Facility staff must provide assistance to residents in Facility staff must provide assistance to residents in attending council meetings.attending council meetings.

Notices of meetings must be posted and residents must Notices of meetings must be posted and residents must be encouraged to attend by staff in a manner appropriate be encouraged to attend by staff in a manner appropriate to the resident’s disability, including but not limited to to the resident’s disability, including but not limited to verbal announcements.verbal announcements.

The council shall be composed of residents of the facility The council shall be composed of residents of the facility and may include family members of residents.and may include family members of residents.

Resident Council Meeting Requirements:Resident Council Meeting Requirements:

The facility must provide space for council meetings.The facility must provide space for council meetings.

Meeting notices, meeting times, and recommendations Meeting notices, meeting times, and recommendations from the council must be documented.from the council must be documented.

In order to permit free exchange of ideas, at least part of In order to permit free exchange of ideas, at least part of each meeting shall be conducted without the presence of each meeting shall be conducted without the presence of any facility personnel.any facility personnel.

* A facility which fails to provide a resident council at the request of a * A facility which fails to provide a resident council at the request of a majority of the residents, and/or to operate a council in accordance majority of the residents, and/or to operate a council in accordance with regulations, may be subjected to civil penalties.with regulations, may be subjected to civil penalties.

Medi-CalMedi-CalServices and Services and

BenefitsBenefits

Medi-Cal Pays ForMedi-Cal Pays For (among other things) (among other things) ::

Doctor VisitsDoctor Visits

Adult Day Health CareAdult Day Health Care

Personal Care (IHSS)Personal Care (IHSS)

Emergency ServicesEmergency Services

Transportation to Health Transportation to Health ServicesServices

Diagnostic TestsDiagnostic Tests

Surgical ProceduresSurgical Procedures

Nursing Home Stays Nursing Home Stays (Excluding Institutions for (Excluding Institutions for Mental Disease)Mental Disease)

Medical SuppliesMedical Supplies

Durable Medical Durable Medical EquipmentEquipment

Occupational & Physical Occupational & Physical TherapyTherapy

Outpatient Drug Abuse Outpatient Drug Abuse ServicesServices

PrescriptionsPrescriptions

HospitalizationHospitalization

Dental ServicesDental Services

Fee for Service Fee for Service vs. vs.

Managed CareManaged Care

Medi-Cal Choice

(For SSI-linked Beneficiaries)

How a Medi-Cal Managed Care Plan WorksHow a Medi-Cal Managed Care Plan Works

You choose a Primary Care Doctor or Clinic from a list.You choose a Primary Care Doctor or Clinic from a list.

You must go to the Primary Care provider first – They You must go to the Primary Care provider first – They will refer you to a Plan specialist, if necessary.will refer you to a Plan specialist, if necessary.

If you’re not happy with your Primary Care provider, you If you’re not happy with your Primary Care provider, you can call the Member Service Department and choose a can call the Member Service Department and choose a different provider.different provider.

You need to go to a Plan Pharmacy for medications.You need to go to a Plan Pharmacy for medications.

A 24-hour, toll free number must be available to call with A 24-hour, toll free number must be available to call with questions about your care.questions about your care.

You may leave the Health Plan and choose a different You may leave the Health Plan and choose a different Plan, at certain times.Plan, at certain times.

There are no costs to you and no co-payments.There are no costs to you and no co-payments.

Healthy San Diego – Medi-Cal Health PlansHealthy San Diego – Medi-Cal Health Plans

Blue Cross of CaliforniaBlue Cross of California

Community Health GroupCommunity Health Group

Health NetHealth Net

UCSD Health PlanUCSD Health Plan

Sharp Health PlanSharp Health Plan

Universal CareUniversal Care

KaiserKaiser

How do I join a Medi-Cal Health Plan or find How do I join a Medi-Cal Health Plan or find out more information?out more information?

Contact a Health Care Options Counselor Contact a Health Care Options Counselor

Center CityCenter City ……………………………………….. (619) 237-……………………………………….. (619) 237-85068506

El Cajon ……………………………………………. (619) 441-6664El Cajon ……………………………………………. (619) 441-6664

Escondido …………………………………………. (760) 480-3402Escondido …………………………………………. (760) 480-3402

Kearny Mesa ………………………………………. (858) 694-8862Kearny Mesa ………………………………………. (858) 694-8862

Lemon Grove ………………………………………. (619) 668-3784Lemon Grove ………………………………………. (619) 668-3784

Northeast …………………………………………… (619) 464-5740Northeast …………………………………………… (619) 464-5740

Oceanside ………………………………………….. (760) 754-5860Oceanside ………………………………………….. (760) 754-5860

South Bay …………………………………………… (619) 409-3296South Bay …………………………………………… (619) 409-3296

Southeast …………………………………………… (619) 266-3963 Southeast …………………………………………… (619) 266-3963

Fee for Service Medi-CalFee for Service Medi-Cal

To Find a Doctor or Clinic, CallTo Find a Doctor or Clinic, Call

Info-Line:Info-Line:

Greater San Diego ……………….. (619) 230-0997Greater San Diego ……………….. (619) 230-0997

North County CoastalNorth County Coastal …………… (760) 943-…………… (760) 943-09970997

North County Inland ……………… (760) 740-0997North County Inland ……………… (760) 740-0997

Other Areas ……………………….. (800) 227-0997Other Areas ……………………….. (800) 227-0997

Positives Positives

Fee for ServiceFee for Service

Choice of doctors, clinics, service providers

No referral necessary for specialists

Maintain existing relationship with providers

Managed CareManaged Care

Provides a “health home” Provides a “health home” for the person and their for the person and their familyfamily

Access to additional Access to additional services (i.e. 24 advice services (i.e. 24 advice #’s, member advocate, #’s, member advocate, education programs)education programs)

Provider directory and Provider directory and referral information readily referral information readily accessible.accessible.

Additional rights under Additional rights under Knox Keene ActKnox Keene Act

NegativesNegatives

Fee for ServiceFee for Service

Difficulty finding providers who “take Medi-Cal.” (Compounded if second opinion needed)

Consumer protections only through State D.S.S.

Managed CareManaged Care

Access to specialists only through Primary Care doctor

Access to providers restricted to “Plan”

May need to disenroll if placed in an IMD

The best way to stay healthy is to The best way to stay healthy is to

BE AN BE AN ACTIVEACTIVE MEMBER OF YOUR MEMBER OF YOUR HEALTHCARE TEAMHEALTHCARE TEAM

Understand Your ResponsibilitiesUnderstand Your Responsibilities

Keep your appointments and be prepared.Keep your appointments and be prepared.

Follow your doctors instructions.Follow your doctors instructions.

Take medicine as prescribed.Take medicine as prescribed.

Keep your doctor informed as to your progress.Keep your doctor informed as to your progress.

Know how to contact your doctor.Know how to contact your doctor.

Have a plan for what to do if you have problems.Have a plan for what to do if you have problems.

Talking With Talking With Your DoctorYour Doctor

Be Ready to Give InformationBe Ready to Give Information

Tell your doctor what you think he or she needs to know, Tell your doctor what you think he or she needs to know, even if it makes you feel uncomfortable.even if it makes you feel uncomfortable.

Bring a “health history” list with you.Bring a “health history” list with you.

Bring a list of any medications you are taking, including Bring a list of any medications you are taking, including dosage and how often you are taking them.dosage and how often you are taking them.

Bring a list of any herbal products or “alternative Bring a list of any herbal products or “alternative medicines” you are using.medicines” you are using.

Bring any other medical information, such as test results, Bring any other medical information, such as test results, or other records.or other records.

Ask Questions and Get InformationAsk Questions and Get Information

If you don’t understand something, speak up.If you don’t understand something, speak up.

Make a list of questions ahead of time, with the most Make a list of questions ahead of time, with the most important questions first.important questions first.

Bring someone with you.Bring someone with you.

Ask your doctor to draw pictures, and/or write things Ask your doctor to draw pictures, and/or write things down.down.

Take notes.Take notes.

Ask if there are any written materials or handouts.Ask if there are any written materials or handouts.

Ask if you can call back later with any questions and find Ask if you can call back later with any questions and find out to whom you should speak.out to whom you should speak.

After you leave the doctor’s office:After you leave the doctor’s office:

If you have questions, or forgot to tell the doctor If you have questions, or forgot to tell the doctor something, call back and speak with someone.something, call back and speak with someone.

If your symptoms get worse, call.If your symptoms get worse, call.

If you have any problems with your medicine, call.If you have any problems with your medicine, call.

If you need to make an appointment for tests or to see a If you need to make an appointment for tests or to see a specialist, make the appointment.specialist, make the appointment.

MedicationsMedications

Before starting on any medication, tell your doctor:Before starting on any medication, tell your doctor:

The names of all medication you are currently taking, The names of all medication you are currently taking, both over-the-counter and prescription, as well as herbal both over-the-counter and prescription, as well as herbal or “alternative” types of treatment.or “alternative” types of treatment.– Make sure your doctor is aware that over-the-counter Make sure your doctor is aware that over-the-counter

medications have to be prescribed in a board and care setting.medications have to be prescribed in a board and care setting.

Any allergies or adverse effects you have experienced Any allergies or adverse effects you have experienced from any medications you’ve taken in the past.from any medications you’ve taken in the past.

Any concerns you have about taking medication.Any concerns you have about taking medication.

When you are prescribed medication, ask your When you are prescribed medication, ask your doctor:doctor:

What is the name of the medication?What is the name of the medication?

What is the medication supposed to do for me?What is the medication supposed to do for me?

What is the dosage?What is the dosage?

What are the possible side effects and what should I do What are the possible side effects and what should I do if they occur?if they occur?

What should I do if I miss a dose?What should I do if I miss a dose?

What should I do if I accidentally take too much?What should I do if I accidentally take too much?

Are there food, drinks, or other medicines I need to avoid Are there food, drinks, or other medicines I need to avoid while on the medication?while on the medication?

Can I get any written information about the medicine?Can I get any written information about the medicine?

After you’ve started on medication, make After you’ve started on medication, make sure to tell your doctor:sure to tell your doctor:

How you are feeling on the medication. How you are feeling on the medication.

About any problems or side effects you have About any problems or side effects you have experienced.experienced.

About any new medication another doctor may have About any new medication another doctor may have prescribed for you, or over-the-counter drugs you have prescribed for you, or over-the-counter drugs you have taken.taken.

About your medication, remember:About your medication, remember:

Take only the medicine your doctor prescribes for you. Take only the medicine your doctor prescribes for you. Don’t take anyone else’s medicine.Don’t take anyone else’s medicine.

Know the major side effects of your medicine and call Know the major side effects of your medicine and call your doctor right away if you are having problems. Don’t your doctor right away if you are having problems. Don’t wait!wait!

Take the medicine as you and the doctor have agreed, Take the medicine as you and the doctor have agreed, not how you think it should be taken.not how you think it should be taken.

Order refills before you run out. Always plan ahead.Order refills before you run out. Always plan ahead.

Alcohol and street drugs don’t mix with your medication.Alcohol and street drugs don’t mix with your medication.

CONFLICT RESOLUTIONCONFLICT RESOLUTION

What can you do if:What can you do if:

You have a problem with your health plan or You have a problem with your health plan or Medi-Cal.Medi-Cal.

Your care is denied, delayed, or terminated.Your care is denied, delayed, or terminated.

You disagree with your doctor about what is best You disagree with your doctor about what is best for you.for you.

You are told you can’t see a specialist, receive You are told you can’t see a specialist, receive more visits, or get certain medicines.more visits, or get certain medicines.

You have a right toYou have a right to::

Contact your health plan or Med-Cal and complain.Contact your health plan or Med-Cal and complain.

Receive written explanation whenever service is denied, Receive written explanation whenever service is denied, reduced, delayed, or stopped.reduced, delayed, or stopped.

Receive a notice before ongoing services are stopped or Receive a notice before ongoing services are stopped or reduced.reduced.

Continue to receive benefits while your complaint is Continue to receive benefits while your complaint is being heard.being heard.

Have a hearing before an Administrative Law Judge.Have a hearing before an Administrative Law Judge.

Report the problem to the State.Report the problem to the State.

Change to a new Health Plan.Change to a new Health Plan.

Important Telephone NumbersImportant Telephone Numbers

Healthcare Options Healthcare Options 800-430-800-430-42634263

(Healthy San Diego Enrollment)(Healthy San Diego Enrollment)

Managed Care Ombudsman Managed Care Ombudsman 888-452-888-452-86098609

(State Patient Advocate)(State Patient Advocate)

State Fair Hearings State Fair Hearings (DSS)(DSS) 800-952-800-952-52535253

Important WebsitesImportant Websites

Knox Keene / Managed Care InformationKnox Keene / Managed Care Information

www.healthconsumer.org/managedcare.htwww.healthconsumer.org/managedcare.htmlml

www.calpatientguide.orgwww.calpatientguide.org

www.hmohelp.ca.govwww.hmohelp.ca.gov