Ky.gov
Effective: 6/14/2023

12.18.3 Medically Complex Home

Legal Authority

Introduction

​​​Medically complex foster/adoptive homes provide specialized care for children with complex medical needs who are in the custody of the Cabinet for Health and Family Services (CHFS/Cabinet). Foster/adoptive homes expressing a desire to care for children designated as medically complex must demonstrate the ability and aptitude to provide specialized medical care. Additional training and certification in infant, adult, and child cardiopulmonary resuscitation (CPR) and first aid are required beyond the pre-service training.​​

Practice Guidance

  • The medically complex foster or adoptive home demonstrates access to available supportive services for the approved number of children in the home, unless an exception is granted by the service region administrator (SRA) as described in SOP 12.11.1 Placement Exception Requests.
  • If a child who has diabetes is placed in a residential facility, the SSW should refer to SOP 4.26 Meeting Basic Health Care Needs regarding instruction on how to handle medication administration for that child.
  • An approved medically complex foster or adoptive home cooperates in carrying out the child’s health plan.
  • The specialized medically complex per diem rate is based on the severity of the child’s health condition and is assigned by the Medical Support Section.  


Procedure

​The R&C Worker:

  1. Follows the procedures outlined in SOP 12.18 Specialized Foster Care Services, as well as, the procedures listed below;
  2. Determines whether the applicant home has the aptitude and desire to provide medically complex foster care services and is able to care for a child in the custody of the Cabinet who is determined to be medically complex by designated cabinet staff due to1:
    1. Significant medically oriented care needs related to a serious illness or condition diagnosed by a health professional that may become unstable or change abruptly, resulting in a life-threatening event;
    2. A chronic condition that is expected to be life-long and progressive and to require extensive services;
    3. An acute, time-limited condition requiring additional oversight; or
    4. A severe disability that requires the routine use of medical devices or assistive technology to compensate for the loss of a vital body function needed to participate in activities of daily living and significant and sustained care to avert death or further disability.
  3. Ensures that the primary caretaker in the applicant medically complex foster or adoptive fragile resource home is not employed outside the home unless it is determined that the child’s needs will continue to be met;
    1. Obtains permission (through supervisory channels) from the Division of Protection and Permanency (DPP) director for an exception to this requirement. Permission must occur at the time of placement;
  4. Helps arrange for the applicant to:
    1. Complete the initial medically complex Join Hands Together training (twelve (12) hours) offered by the Cabinet which covers the following topic areas and specific to children with medical complexity: 
      1. Growth and development;
      2. Nutrition;
      1. Documentation of provided care;
      2. Medical conditions; and
      3. Standards of practice (SOP) related to the medically complex home type.
    2. Obtain certification in infant, child, and adult CPR and first aid; 2
  5. Documents completion of the training and certification in the foster/adoptive family’s case file;
  6. Documents when professional experience related to the care of a child with medical complexity substitutes for the initial and annual medically complex training requirements if approved by DPP director or designee and the foster or adoptive parent:
    1. Is a health-care professional;
    2. Is certified in infant, child, and adult CPR and first aid; and
    3. Has completed twelve (12) hours of continuing education focusing on pediatrics within the past one (1) year that will assist the parent in the care of a child with medical complexity.  These training hours must be approved by the Medical Support Section;
  7. Documents that the applicant receives training from a health care professional in how to care for the specific medically complex child and maintains current certification in CPR and first aid;
  8. Ensures that the applicant's home is located within one (1) hour of a medical hospital with an emergency room and thirty (30) minutes of a local medical facility; 
  9. Submits documentation for an approved medically complex foster or adoptive home to receive re-approval by the Cabinet as a medically complex home if the parent:
    1. Completes medically complex ongoing training requirements by the anniversary date of their original approval  These training requirements include:
        1. Twelve (12) hours of ongoing Cabinet-sponsored training related to the care of children with medical complexity that is offered two (2) times per year in a conference setting; and
        2. Ten (10) additional hours of Cabinet-sponsored training and;
        3. Maintains current certification in infant, child, and adult CPR and first aid; and
    2. Continues to meet the requirements as a medically complex foster or adoptive home;
  10. Authorizes:
    1. The basic medically complex foster or adoptive rate to a foster or adoptive home approved to care for a child who is determined to be medically complex by the Medical Support Section;
    2. The advanced medically complex foster or adoptive rate to a foster or adoptive home parent who has been approved for one (1) year and is approved to care for a child who is determined to be medically complex by the Medical Support Section;
    3. The degreed medically complex foster/adoptive rate to a foster/adoptive home parent who is a registered nurse, nurse practioner, physician's assistant, or physician is approved to care for a child who is determined to be medically complex by the Medical Support Section; and  
    4. The specialized medically complex foster or adoptive rate to a foster or adoptive home with a parent, who provides for the care of a child with medical complexity determined by designated cabinet staff to meet specialized medically complex criteria due to a required higher level of medical care or oversight, which may also include behavioral or emotional needs related to the medical condition.  The specialized medically complex rate can only be provided to medically complex homes that are advanced or above. 
  11. Documents in TWIST the approval (if approval is granted) by the addition of a new resource recommendation.




​Footnotes

  1. Such services would be provided to a child who meets medically complex criteria, as determined by the Medical Support Section.
  2. The preferred method of obtaining this training is in a group setting; however, if the foster parents cannot locate or attend group training, online certification through the American Red Cross or American Heart Association in first aid and CPR for infants, children, and adults will be accepted.






Documents

Revisions

​6/14/2023 Addition: 

B. The advanced medically complex foster or adoptive rate to a foster or adoptive home parent who has been approved for one (1) two (2) years and is approved to care for a child who is determined to be medically complex by the Medical Support Section;​