Starting December 31, 2025, new waiver requirements go into effect. 

All Attendant Care hours must be documented with more detailed HOURLY service logging. 

Documentation Methods

You may choose one of the two following methods to document your daily services. Both methods require you to log care hour-by-hour.

Method 1: Written Narrative 

Briefly summarize the specific activities performed during each hour of your shift.

Example (4:00PM - 7:00PM):

• • • 4pm: Assisted with dressing, bathing and helped brush teeth

    • 5pm: Played games, took out the trash and completed errands

    • 6pm: Prepared dinner, cleaned up, changed a brief with transfers & mobility support

Method 2: Approved Care Codes 

Use the letter codes from your "Approved Care Codes" list that correspond to the tasks performed each hour.

Example: (Same 4:00PM - 7:00PM shift)

• • • 1:  B, D, O 
      (Codes represent: Hour 1 of the shift - Bathing, Dressing, Oral Care were completed)

    • 2: S, W, R
      (Codes represent: Hour 2 of the shift -Social/Activities, Waste, Running Errands were completed) 

    • 3: M, C, I, Mo
      (Codes represent: Hour 3 of the shift - Meal Prep, Cleaning, Incontinence, Mobility were completed) 

Note: You may use codes alone, or combine codes with brief notes if additional context is needed. Please refer to the Care Code Reference Sheet (in the section above) for a full list of abbreviations.

Important Reminders

• • This requirement applies to ALL Attendant Care Hours

  • Documentation must be all NON-MEDICAL tasks for each client.

  • All hours worked must clearly reflect all of the services provided during the shift.

  • This requirement DOES NOT apply Home & Community Assistance/Homemaker (HCA) Hours

Please use the links below to complete and submit your bi-weekly documentation.

Once you enter your name and contact info, a secure link will be sent to you to fill out and sign your visit form online. 

👉  Start Here:  Request a Biweekly Documentation Form 

🔗 Quick Links 

• Instructions on Completing the Documentation Form

• Limited Signing Authority Form - PRINT

• Limited Signing Authority Form - ELECTRONIC (Client must have their own E-mail address)

• Email Legal Forms to Our Team

⏰ Important Deadline

To receive your stipend on time, forms must be submitted by the end of the day on the Monday before your scheduled payment date (every other Friday).

Reportable unusual occurrences include, but are not limited to, the following:

1.  Alleged, suspected, or actual abuse, neglect, or exploitation of an individual

2.  Alleged, suspected, or actual assault or abuse by an individual

3.  Death of an individual

4.  A residence that compromises health and safety due to:

a.  Significant interruption of a major utility

b. Environmental, structural, or other significant problems

5.  Environmental or structural problems associated with a dwelling where individuals resides that compromise the health and safety of the individuals.

6.  Residential fires resulting in relocation, personal injury, or property loss

7.  Suspected or observed criminal activity by any representative of a provider, a family members, or the individual when care is impacted or potentially impacted

8.  Injuries of unknown origin

9.  Suicidal ideation or suicide attempts with potential for physical harm, injury, or death.

10. A major disturbance or threat to safety created by the individual. This is reportable regardless of whether it occurs in a community setting or inside the individual's residence, and regardless of whether the threat is directed at the general public, bystanders, or staff members.

11. Admission to a nursing facility, excluding respite stays

12. Significant injuries, including, but not limited to fractures, burns greater than first degree, choking requiring intervention, contusions, or lacerations

13. Injuries occurring while an individual is restrained

14. Police involvement resulting in arrest

15. Missing persons

16. Inadequate staff support for an individual, including inadequate supervision, with the potential for endangering the health or welfare of the individual.

All employees are mandated reporters and are required to immediately report any alleged, suspected, or actual reportable unusual occurrence, policy violation, or violation of an individual’s rights.

Family Solutions Home Care will cooperate fully with investigations conducted by the DDARS, APS, CPS, IDOH, law enforcement, and any other authorized entity.

1. Individual Information: Full name, DOB, gender, and last four digits of SSN.

2. Location Details: Residential address, city, state, zip code, and county of the incident.

3.  Program Details: Identify the correct Division (BBA for Aging/PathWays or BDS for Disabilities) and the specific funding source (e.g., PathWays, Health & Wellness, TBI, or CHOICE).

4. Incident Details: A factual description of the event, immediate actions taken to ensure safety, and the names of all parties notified.

   • Timing: Exact date/time of incident and date you gained knowledge.

   • Location: Where the incident occurred (e.g., at home, in the community).

   • Nature of the Incident: Suspected or actual abuse, neglect, exploitation, or death.

   • Specific Circumstances: Indicate if the participant died, was abused, neglected, exploited, handcuffed, or tasered.

i.   In the event of a Death: Provide date/time/place of death; circumstances preceding/following discovery; life-saving measures attempted; preliminary cause of death.

ii.  For allegations of abuse, neglect, or exploitation: Identify any staff suspended, the alleged perpetrator's name, and whether the allegation was substantiated

5.  Narrative: Comprehensive description and plan to resolve immediately and long term.

6. Parties Informed: Document the Name, Phone, and County of the contact, including the Date, Time, and Method of contact for anyone notified.

Immediately upon discovery, you must report all incidents to Family Solutions Home Care at 260.209.4404.  

You may also report the incident to the following agencies:

1. Emergency Services:

   • • Public Safety: Contact local Police or the County Coroner if the incident involves criminal activity or a death.                                                            

2. Protective Services: 

   • • Adult Protective Services - Age 18 and Over: 1-800-992-6978 or online - https://aps-govcloud.my.site.com/APSOnlineReport/s/

     • Child Protective Services - Under Age 18: 1-800-800-5556

3. Ombudsman (Independent Advocate)

   • • Statewide Ombudsman - Under Age 60: 1-800-622-4484, Press 2 or online https://www.in.gov/fssa/ddars/statewide-waiver-ombudsman/

     • Long-Term Care Ombudsman - Age 60+ & In a Facility: 1-800-622-4484, or online https://www.in.gov/ombudsman/long-term-care-ombudsman/contact-information/ 

4. Division of Disability, Aging, and Rehabilitation Services: 

   • • FSSA Incident and Follow-Up Reporting (IFUR) Tool at https://ddrsprovider.fssa.in.gov/ifur.