The Assessment, Evaluation and Review Services Program performs in-home assessments for individuals who are seniors, are frail, or who have functional disability to determine if they qualify for any programs that may assist the individual to remain in the community or the least restrictive environment possible. Our goal is to connect individuals with information about resources and programs that can help them to remain independent.
Evaluations are conducted by a licensed registered nurse or social worker and translation services are available.
AERS also performs evaluations for the federally mandated program, PASRR (Pre-Admission Screening and Resident Review), for clients who have an Intellectual Disability (ID) or Mental Illness (MI).
A referral to our AERS program is recommended in the following situations:
- A frail individual needs information and assistance on accessing community services, like assisted living, in-home aid services, medication assistance, and other support programs.
- A person who is already in a nursing facility and also on medical assistance needs help accessing services that will allow them to return to the community (Community Options Waiver or Community First Choice services).
An AERS evaluation is required for the following individuals:
- A person with a developmental disability, a history of mental illness, or both is seeking placement in a nursing home.
- A person who is 65 or older who is referred for admission to a Maryland psychiatric facility
- Must be a Caroline County Resident
- Individuals with active Medicaid as primary insurance
- Individuals over the age of 65 who meet the income criteria
- Individuals must require support with activities of daily living (showering, dressing, etc).
Home visits are performed to assess the help that may be needed. The 60-90 minute assessment is free and assesses the following:
- health status
- daily functioning
- behaviors
- supports
- resources
- any concerns or needs they might have.
This assessment helps us to know what programs and services might be most helpful to them, and we share information with that person and/or their family so that they can choose which programs to contact on their own after we leave.
Individuals with active Medicaid may qualify for Community First Choice (CFC), Community Personal Assistance Services (CPAS), Home and Community-Based Options Waiver (CO Waiver). The assessor will submit a formal assessment electronically to the Maryland Department of Health. If an individual qualifies for the Community First Choice, Community Personal Assistance Services, or Home and Community-Based Options Waiver, the Maryland Department of Health will notify the individual of their eligibility. The individual must choose a Support Planning Agency (SPA). The Support Planning Agency will meet with the individual to develop an individualized Plan of Service outlining the specific services the individual will receive. The Support Planner is the individual’s main point of contact and responsible for altering or revising the Plan of Service based on the individual’s needs. It often takes three to six months or more for any of these services to be implemented. The health department is responsible for performing the assessment only and does not have the ability to speed up service implementation.
Individuals over 65 who qualify for an assessment may be referred to Senior Care for case management through the Department of Social Services (ages 65+). The individual must consent to the referral.
The program does not provide ongoing case management services, and is not an emergency service. Assessments are generally performed once per year. The assessor will provide information about other programs and make some referrals, as eligible. Assessments are voluntary and the individual must consent to an assessment. If you have concerns about neglect, abuse or exploitation of a vulnerable adult, always report those concerns directly to Adult Protective Services at 410-819-4500.
Referrals for AERS services can be made directly by potential clients, as well as their relatives, staff from agencies, and any concerned individual. Referred clients or their representatives are contacted by AERS staff to schedule an evaluation in their home or present location. Assessments are voluntary, free, and confidential. Referrals to other agencies are not made unless a consent form is signed.
To make a referral you may also:
- Email mdh.atp@maryland.gov; or
- Call 410-479-8129 or 410-767-1739; or
- Dial 7-1-1 to place a call through Maryland Relay.