HCS Highlights - Winter 2019 - Issue 1

HCS Highlights WINTER 2019

ISSUE #1

HCS Highlights | Winter 2019

CONTENTS 2

BEA’S MESSAGE

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2019 ROAD SHOW UPDATE

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REGIONAL UPDATES

7

CLIENT PROFILE

10 EQUITY, DIVERSITY & INCLUSION 11 PARTNERSHIPS: HEALTH HOMES 13 HCS TEAM SPOTLIGHT: HOUSING 16 GOOD NEWS 17 FINAL THOUGHTS

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HCS Highlights | Winter 2019

BEA’S MESSAGE

Thank you for taking the time to open our first edition of HCS Highlights. This newsletter is something I have been considering for a long time as a way to increase and improve communication within HCS and I’m excited to finally roll out our first edition.

Bea Rector Director, Home and Community Services

For a number of years, many of you have indicated on the employee survey that you do not receive the information you need. I have also heard that some employees feel the information they receive is inconsistent: messages may be unclear or vague and may only reach some people. I wanted to create a tool that would allow us to increase communication, support our culture of teamwork and collaboration, and create opportunities to share information and news across the division.

Based on this feedback, I worked with HCS leaders at headquarters and in the regions, as well as our ALTSA communications team, to develop what we hope is a user-friendly way to communicate with all of you around the state. This newsletter is one of several strategies intended to improve how I and the other HCS leaders communicate with you. I hope this newsletter will better convey what is driving our decision-making, provide clear and consistent messages, and give everyone the opportunity to hear what is going on.

We plan to release a new issue four times a year. In each issue, we will feature content that demonstrates our successes, our internal and external partnerships and collaboration, and how we engage our clients and use their feedback to improve our services. I hope through this content, you will better understand how our work is connected and how we learn from one another. At the same time, I hope you also come away feeling better informed on and inspired by our work.

As you read through this inaugural edition of HCS Highlights, please think about what ideas you have to improve this communication tool so it better serves you and your HCS colleagues. If you have ideas for content or suggestions for changes, please reach out to Meghan Erkkinen, HCS’s communications consultant, at meghan.erkkinen@dshs.wa.gov or 360-725-3550. We also want to hear about your successes, big and small. Send Meghan your kudos, congratulations and good news and you may see something about it in a future issue.

I hope this first edition informs and inspires you, and I look forward to hearing more feedback and positive stories in the coming months.

Bea Rector

HCS Vision and Mission

A lot has changed since we have reorganized Home and Community Services. In the spirit of that reorganization and looking forward, we want to review our division’s mission and vision statements to ensure they are still capture the spirit and intent of our work in HCS. Keep an eye on your email for a survey that will be going out to all HCS staff with two options for a revised statement. We’d like your feedback on which you feel best fits our division’s work.

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HCS Highlights | Winter 2019

2019 ROAD SHOW UPDATE Kristin Byrne, Deputy Director, Field Operations Bea and I have had the opportunity these last couple months to travel around the state as part of our annual road show to learn more about your successes, struggles, questions and concerns. Below I have listed a few of the common concerns we heard and what we plan to do to address them.

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Infants at Work: ALTSA divisions are working together to identify and address the physical space requirements and evaluate the potential impacts and considerations relating to business operations, differing job duties, safety and potential work load impact.

Telework expansion: Regions will continue to monitor telework implementation to ensure adequate office coverage and timely communication access for clients, representatives and community partners. So far, teleworking has been expanded for financial staff. We are evaluating expanding telework from 2 to 3 days for social services staff and are evaluating whether expansion to positions such as supervisors is feasible.

FTE and growing caseloads: We recognize the need to address the growing number of referrals and the increasingly complex needs of many of our clients. Although the workload model does generate additional FTEs as the number of clients accessing our services grows, it does not take into consideration changes in acuity or complexity. We continually evaluate ways to effectively measure the impact of changes and the number of staff we have appropriated to do our work.

Changing client needs: ALTSA is serving more individuals with behavioral support needs, which may be due to diagnoses of mental illness, traumatic brain injury or dementia. We are exploring ways to address the lack of resource availability and workforce shortages. Specifically, we are examining rates and how to provide adequate behavioral support and access to specialized dementia care, for which we have capital and service investments in the FY2020 budget and DSHS has requested a rate increase to specialized dementia care contracts in the FY2021 supplemental budget.

Centralized intake: Right now, each HCS region is centralized in one or two locations per region. Although Adult Protective Services is centralizing, there has not been any discussion to centralize all of HCS intake across the state. However, we will be working with regional administrators to proactively address increases in referrals and reduce delays in case assignment and assessment where possible.

Compensation: We heard appreciation for the pay increase financial staff received July 1, 2019. The work performed by HCS is recognized as more complex than that performed by Community Service Division Public Benefits Specialists and that is why HCS utilizes Public Benefits Specialist 4s. We will continue to work in partnership with the Economic Services Administration and the Department of Children, Youth, and Families to discuss classification needs.

Resource development and training: We need to continue expanding residential provider training in order to increase provider skills and abilities to serve individuals with behavioral health and dementia care needs. We also need to expand residential settings to serve more individuals with complex needs.

We also received questions on equity, diversity and inclusion at ALTSA. Please see Bea’s message on page 10 for more details on how ALTSA and HCS are making equity, diversity and inclusion a priority.

We will be compiling a Q&A document from the road shows that will be sent out to regional staff. We will also be using future editions of this newsletter to provide updates on areas we discussed during the road shows.

Over the last two months, we visited Tacoma, Everett, Seattle, Spokane, Yakima and Vancouver. I appreciate the time many of you have taken to meet with us and engage in honest and open dialog on the topics that matter to you. I encourage you to continue that dialog, both with Bea and me and in your regions, throughout the year.

Kristin Byrne

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Census 2020

You count.

Be counted.

Census Day

minutes questions years

It takes just 10 minutes to answer 10 questions that will shape investments in your community for 10 years.

www.ofm.wa.gov/2020census

HCS Highlights | Winter 2019

REGIONAL UPDATES UPDATES FROM REGION 1 We have a lot of great things happening in our region! One exciting thing is the Assistive Technology Pilot being led by Elizabeth Adams, HQ Outcome Improvement Specialist. We have 20 In-home/Residential Case Managers in our Spokane office participating. Our partners in this pilot are 20 Case Managers from Aging and Long Term Care Eastern Washington, Georgia Institute of Technology, Washington Assistive Technology Act Program and HQ ALTSA/HCS leadership.

Tami Rucker Region 1 Regional Administrator

The intent of this pilot is to determine if Assistive Technology services are needed/desired by at least a segment of the client population, identify barriers to services usage, develop strategies to address these barriers, develop methods for engaging staff to use services and develop strategies to communicate service options directly to clients.

Stay tuned for the report out as the pilot will end December 2019.

UPDATES FROM REGION 2 I am proud of Region 2 staff. They work hard and live up to the expectations of transforming lives. My Public Benefits Specialist (PBS) staff are truly rocking financial by continuing to get high praise for having valid delay reason codes entered on every pending application that is over 45 days old. Kudos to them. PBS’s continue to be understaffed but it has not deterred them from doing great work and meeting expectations.

Sonya Sanders Region 2 Regional Administrator

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Region 2 has had several nursing home closures as well. The nursing home groups have pulled together to relocate clients to appropriate settings. No matter the challenge, Region 2 employees will pull together. I can’t ask for anything more.

HCS Highlights | Winter 2019 UPDATES FROM REGION 3 Who doesn’t want to have an awesome workplace culture? I think we all do. I also believe it is something that we have to be intentional about. Most of the time it doesn’t just happen. In Region 3 HCS we have gathered our culture champions from each office to set our intentions on creating an awesome culture and we have begun to meet regularly to work towards this goal.

Debbie Willis Region 3 Regional Administrator

One of the fun activities we are implementing is a 21-day challenge of NO COMPLAINING! That means no complaining (about anything) for 21 days and every time you complain, you go back to day one!

Kara Sells, our Deputy Regional Administrator, and I were the first to try this out! Well, the first thing I learned: This is WAY harder than it sounds! We eventually reached our 21 days, although it took about 2 months after multiple starts back to day one! But even so, we now have some adventurous souls in our offices that are willing to give it a try!

Just think what a better workplace we would have if we reframed our complaints to more positive expressions! Look for what is good, what is working, what is positive instead of the negative.

Positivity is contagious, just like negativity. Jane Goodall said, “What you do makes a difference, and you have to decide what kind of difference you want to make.” Let’s choose to make a positive difference.

For more on the no-complaining challenge and how you can participate, see page 14.

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HCS Highlights | Winter 2019

‘I STILL HAVE

SO MANY

THINGS TO DO’

One SET member turns his experience with TBI into an opportunity to advocate for others

When Washington State Governor Jay Inslee, seated, signed a bill increasing the brain injury fee for speeding tickets, Isaac, who stands behind the governor, was there to watch the historic event. Isaac, a traumatic brain injury survivor, was a key advocate for the passage of the legislation.

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HCS Highlights | Winter 2019 Each issue, we will spotlight someone who receives our services and demonstrate how we work to understand the impact of our services on those who receive services and how individuals are engaged in creating change.

This issue, we are profiling client and Service Experience Team member Isaac. The Service Experience Team is a client advocacy group created by HCS to increase our ability to provide information, receive input and better understand the impact of our policies and services on the individuals who receive them.

For many people, Nov. 8, 2016, stands out as the day of the most recent presidential election. For Isaac, the date is memorable for another reason. On that day, Isaac, an award-winning investigative journalist and long-time resident of Minnesota’s Twin Cities, had a massive stroke.

“When I came around, I remember I asked a doctor and he said I’d been in the hospital for a month,” Isaac recalled. “He said, ‘to be honest with you, I don’t understand why you’re still alive.’”

The doctor told Isaac he’d had a stroke and that as a result, he had a traumatic brain injury. Laying in the hospital bed, Isaac felt hopeless. He knew he could not return to his former career. The hospital wouldn’t discharge him back to his home in St. Paul, believing he was unable to care for himself. Instead, they put him on a train to Tacoma, where his sister lived.

The next few months were difficult for Isaac. He struggled to walk and speak. He didn’t know what lay ahead for him. Eventually he decided to join a support group, a decision he calls one of the best he ever made. As Isaac struggled to adjust to his new life, the other support group participants encouraged him to start a blog documenting his experiences. Through the help of the support group and his blog, Isaac’s perspective began to change.

This photo of Isaac was taken before his stroke.

“I said, ‘I’m going to recover,’” Isaac recalled. “I don’t have a choice. I still have so many things to do.”

Isaac has used his blog to document many aspects of his journey, from learning about his diagnosis to the advice he would give to friends, family and caregivers of people with TBI. He also used the blog to document challenges he was experiencing finding housing. Shortly thereafter, HCS Social Service Specialist Staci Hinshaw reached out to Isaac to help him find a place to live. Isaac moved into a Tacoma adult family home in July 2017 and has been living there since.

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HCS Highlights | Winter 2019 “She made a huge difference in my life,” Isaac said of Staci. “That’s one of the things, is people have been very sympathetic and empathetic since I had my stroke.”

Isaac’s blog also allowed him to connect with others who had TBIs or were advocates for people with disabilities. At a TBI conference in spring 2018, he met someone doing legislative outreach on TBI. She asked Isaac if he would help.

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Isaac agreed and was soon after meeting with legislators, writing a draft proposal and testifying on legislation that would increase the brain injury fee on speeding tickets and other moving violations from $2 to $5. The money goes to the TBI Council, which uses it to fund projects that support people with TBI and raise awareness about the injury.

You should never underestimate the power of a group of dedicated people committed to a cause greater than themselves.

– Isaac

“I had one senator tell me my testimony convinced him to vote in favor,” he said.

“It was very eye-opening as far as some of the behind-the-scenes stuff.”

The bill passed unanimously in the House and with just one dissenting vote in the Senate. On April 29, 2019, Isaac was there to witness Gov. Jay Inslee sign the legislation into law.

“One of the things that everybody should always keep in mind is that you should never underestimate the power of a group of dedicated people committed to a cause greater than themselves,” Isaac said. “The little guy can win sometimes but you have to believe you can. You have to believe in what it is that you’re doing.”

Although the bill he championed has now become law, Isaac is not done advocating for others with traumatic brain injury. Just one of those avenues is through his work with the Service Experience Team, where he can continue being a voice for HCS clients and people with traumatic brain injury.

“When I was in the hospital, I thought my life was over,” Isaac said. “My life is not over. I still have many great things I can do.”

In some ways, Isaac said, he feels lucky he had a stroke. It gives him a unique perspective and the opportunity to speak on behalf of others with TBI who can’t speak for themselves.

“I have the opportunity to speak for a lot of people and advocate on their behalf. For me, I can’t think of a better thing to do with your life,” Isaac said. “I’m really very happy I was given the opportunity to make my little corner of the world a better place.”

To read Isaac’s blog, visit http://www.brainenergysupportteam.org/tag/isaac-peterson/.

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HCS Highlights | Winter 2019

EQUITY

DIVERSITY & INCLUSION You have probably been hearing a lot recently about equity, diversity and inclusion, or EDI. You may have gotten emails or other messages from your leaders or regional EDI specialists about best practices and training opportunities that center around building workplaces and services that are welcoming and inclusive. Although you probably recognize the importance of equity, diversity and inclusion in our work, you may be wondering, why the focus on EDI now?

Strengthening our understanding of equity, diversity and inclusion, both in the workplace and in our work with partners and clients, will allow us to continue innovating in the field of long-term services and supports.

A more inclusive workplace is part of what makes ALTSA an employer of choice – where skilled and passionate people of various identities and from different backgrounds can bring their unique perspectives to our work of transforming the lives of our clients. For those of us working here at ALTSA, a more inclusive workplace means we can all bring our authentic selves to work each day without fear of judgment or discrimination.

By bringing together a range of perspectives and creating an environment where everyone feels free to voice bold ideas, we can continue to transform our services to better support our clients.

Approaching our work with clients with an EDI lens allows us to better understand their needs, desires and motivations so we can more effectively identify the services and supports to help them thrive. At the same time, being able to engage an array of partners from different fields and backgrounds will allow us to tap into new resources and opportunities to serve our clients.

Our regional EDI specialists, who support both our division and Adult Protective Services, are already hard at work developing strategies to support their respective regions. All three regions are wrapping up the “A Moment with EDI” workshops for managers and are developing cultural competency committees in every local ALTSA office around the state.

In the coming weeks and months, I encourage you push yourself to better understand the value of EDI and seek out opportunities to embrace the importance of EDI in our work with clients, with co-workers, our provider network and our community partners. In future issues of this newsletter, we will explore the strategies that are working around the state to build a more inclusive and aware environment.

Thank you for your continuing commitment to supporting one another and improving our practices to support our clients.

Bea Rector

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HCS Highlights | Winter 2019

Highlighting Partnerships:

Health Homes Each issue, we will spotlight one of the many HCS programs that relies on strong partnerships. This issue, we are featuring the Health Homes program.

The Health Homes program is an example of one of the many ways HCS is innovating to better serve our clients while reducing costs. The program, which is jointly administered by ALTSA and the Health Care Authority, is a Medicaid demonstration project that began in 2013 to provide care coordination to individuals with significant needs while reducing Medicare and Medicaid costs. The program seeks to demonstrate that through care coordination and goal-setting, clients can improve their health while reducing costly hospital visits, nursing home stays and other medical interventions. About 10,000 individuals were enrolled in the Health Homes program as of July 2019.

Partnerships with other agencies and organizations have helped make the program possible. The Health Care Authority, the state’s Medicaid agency, holds the contracts with Health Home leads across the state.

“In every aspect of the Health Home program, we have representatives from both sides participating,” said Brendy Visintainer, HCS training and monitoring specialist. “We are all working together with that same goal of providing a program that has high standards for our customers.”

Brendy works regularly with four other program staff members, including one at ALTSA and three at HCA, on the Health Homes demonstration to develop policies and procedures, oversee contracts, manage the care coordination network and conduct outreach and engagement activities.

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The Northwest Regional Council provides Health Homes care coordination in Whatcom and Skagit Counties. Pictured (left to right) are: Colleen, Megan, Megin, Brenda, Katie V., Karen F., Sarah, Katie Z., Hannah, Kelly, Lynn, Peter, Silva, Ryan, Ericka, Dave, Allison, Dan and Joanie.

HCS Highlights | Winter 2019 “We all play our roles but we also have to buy into the decision-making,” said Kelli Emans, HCS integration unit manager. “We each bring a different perspective into how something could or could not work. By having those different perspectives, it gives us more inclusive decision-making.”

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The Health Homes intervention is successful because it is built on the premise that individuals can make a difference in their own health.

– Bea Rector

ALTSA and HCA also receive assistance from DSHS’s Research and Data Analysis (RDA), which provides valuable data and analytics to analyze the program’s effectiveness.

The collaboration is paying off. In a letter to state Medicaid directors earlier this year, the Centers for Medicare and Medicaid Services encouraged other states to adopt similar targeted models of intensive care coordination.

Independent evaluations also demonstrate that the program is accomplishing both its outcome and cost goals.

Inpatient admissions of Health Homes participants dropped by 4.5% between the demonstration’s baseline period of 2011-2013 and 2016. Skilled nursing facility use dropped by almost 20% in the same timeframe. Clients in the Health Homes program also had a reduced probability of long-stay nursing facility admission.

“The Health Home intervention is successful because it is built on the premise that individuals can make a difference in their own health,” said HCS Director Bea Rector. “Individuals are encouraged and supported to set goals that are important to them, increase their confidence and skills to manage chronic conditions and mentored to interact more effectively with their doctors and members of their care team. As a result, their health and wellbeing improves and dollars are saved.”

Participants in the Health Homes program are assigned to a care coordinator at one of 82 care coordination organizations throughout the state. These care coordinators help participants develop individualized health action plans and provide ongoing support to implement these plans to improve the participants’ health. Area Agencies on Aging play a critically important role in delivering care coordination by serving as lead agencies and care coordination entities.

“Instrumental to the success of this program are the communitybased leads and organizations that have been out there doing the care coordination,” Kelli said. “We wouldn’t have been able to do this without them. They’re doing the heavy lifting to make this work.”

Strong relationships with state and community-based partners are essential, particularly for serving people who have complex needs. For individuals enrolled in the Health Homes program, these partnerships allow them to take control of their health and wellbeing in meaningful, and sometimes life-changing, ways.

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HCS Highlights | Winter 2019

Highlighting HCS’s Work:

Housing

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HCS Highlights | Winter 2019 Each issue, we will highlight the work of one of our teams. This issue, we’re taking a look at our housing team, which supports ALTSA clients by supporting their housing needs.

One of our most basic needs is a safe, warm place to live.

For many HCS clients, finding and maintaining housing can be a challenge, and an unstable living situation can lead to declining health and other negative outcomes.

Fortunately, the HCS housing team works with HCS and Area Agency on Aging case managers, as well as through many community partners and contracts, to support clients in securing, transitioning to, and keeping a home.

“When people have the choice to live where they want to live their lives, that increases how they do health-wise and is transformative in a lot of ways,” said Samantha Tippery, Region 1 supportive housing specialist. “When people feel stable and supported and have shelter over their heads, they do better with their health all around.”

Sam is part of a small team of 10 headquarters housing staff who work around the state to support ALTSA clients who want to live independently. The team provides policy guidance and technical support to case managers and other ALTSA employees. For example, for clients transitioning from state hospitals or institutional settings, or from homelessness into stable housing, the housing team members can support clients with a variety of housing-focused supports and services.

Through supportive housing services, contractors provide assistance finding housing and mitigating housing issues by helping clients pay rent on time and budget appropriately for household needs. Clients may also receive assistance navigating relationships with neighbors and landlords.

“Our ALTSA clients have access to benefits through our state plan and waivers that help them find, keep and maintain independent housing,” said Jonnie Matson, Region 2 housing program manager. “Finding and keeping housing is a pretty big deal.”

HOUSING TEAM

FAST FACTS ALTSA CLIENTS WHO FOUND HOUSING: 643 Since 2012, the ALTSA housing team has helped 643 individuals with federal subsidies find housing. The number of federal subsidies available to us increases every year as partnerships grow.

ALTSA CLIENTS WHO RECEIVED SUBSIDIES: 255 Since 2012, 255 individuals have received ALTSA housing subsidies as they wait for federal subsidies.

ALTSA CLIENTS WHO RECEIVED EMERGENCY ASSISTANCE: 476 Since 2014, 476 individuals have received emergency rental assistance.

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HCS Highlights | Winter 2019 The housing team stays focused on client choice. Supportive housing clients may choose where to live and have few barriers to receiving housing supports. They are not required to abstain from drug or alcohol use, but providers can offer harm reduction and other methods for substance use disorder treatment. If a client enters a hospital or institution, they continue to receive housing and transition support.

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When people feel stable and supported and have shelter over their heads, they do better with their health all around.

– Samantha Tippery

The efforts of this team have not gone unnoticed: they are often invited to present at statewide housing conferences that focus on ending homelessness and creating more affordable housing resources. The legislature also recognized the importance of the team’s work and allocated money for a new capital development position.

The person who holds this position will work with affordable housing builders and developers to develop more permanent, affordable housing options for ALTSA clients.

The ALTSA housing team currently administers Non-Elderly Disabled (NED) Vouchers in partnership with several public housing authorities across the state and partners with Washington State Department of Commerce in referring eligible DSHS clients to the 811 project-based voucher program. ALTSA has also worked to create its own housing voucher to assist clients who are currently in institutional settings transition into independent housing with in-home long-term services and supports.

In the spirit of supporting client choice, the team encourages other ALTSA employees to reach out on behalf of clients.

“Some case managers aren’t aware of all the resources we have,” Sam said. “For whatever housing question or inquiry they have, they can reach out to us. If we don’t have the answer, we can research it for them and help them find answers.”

FINDING HOME: One Client’s Housing Story HCS client Roland wanted to transition from his skilled nursing facility into independent housing, but needed support due to his history of homelessness, mobility issues and a traumatic brain injury. Through the Supportive Housing program, Roland was able to find affordable housing and receive ongoing support to maintain housing stability. Roland works actively with his Supportive Housing provider to reduce his alcohol consumption, reconnect with his family and become more involved in his local community. Keeping a consistent schedule also helps Roland feel more stable.

“He is getting out into the community more often to visit his family as well as to become more familiar with the local bus system so he can get around,” his provider said. Roland spends more time with his son, gets out of his home more frequently to practice his faith and keeps his apartment in good shape.

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HCS Highlights | Winter 2019

YOUR GOOD NEWS The 21-Day No-Complaining Challenge: In Region 3, Debbie Willis, Regional Administrator, and Kara Sells, Deputy Regional Administrator, recently completed a 21-day “no complaining” challenge. Are you interested in doing your own 21-day challenge?

Find instructions on the ALTSA SharePoint site: https://teamshare.dshs.wa.gov/sites/altsa/ organizationaldevelopment/wellness/Shared% 20Documents/21%20Day%20Challenge.pdf

CFD Regional Update: The Tumwater office has been hard at work this fall raising money for the Combined Fund Drive. The annual office breakfast kicked off the drive, earning $1,348. Many Tumwater staff also participated in the Haunted Cube Decoration competition, which wrapped up at the end of October. Pictured are just some of the spooky cubes staff put together. This year, the Tumwater office’s highlighted charities were A Milk for Starving Infants Fund and the Tacoma Humane Society.

Send us your updates! Do you have an accomplishment you want to share? A program you think should be highlighted? Let us know about it! Send a brief description (no more than 200 words) and a photo, if you have one, to meghan.erkkinen@dshs.wa.gov.

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HCS Highlights | Winter 2019

FINAL THOUGHTS

The key to success is to focus on goals, not obstacles.

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