HCS Highlights SUMMER 2021
SEPTEMBER IS PAIN AWARENESS MONTH
CONTENTS 04
BEA’S MESSAGE
06
REGIONAL UPDATES
10
EQUITY, DIVERSITY AND INCLUSION
12
WELLNESS
13
PAIN AWARENESS MONTH
14
A CLIENT’S STORY
15
TEAM SPOTLIGHT
17
PARTNERSHIPS: OSPI
BEA’S MESSAGE Home and Community Service (HCS) staff and their contributions are instrumental to the division’s continued success in serving individuals in their homes or community settings. In August, DSHS did a Strategic Plan spotlight on Strategic Objective 1.1: Serve individuals in their homes or community-based settings. This objective is one of HCS’s longest-standing objectives. It shows “How we prepare for Aging Washingtonians,” one of DSHS’s six priorities.
Bea Rector Director, Home and Community Services
The hallmark of Washington’s long-term services and supports system is that, whenever possible, individuals are allowed to live and receive services in their own home or a community setting. Developing home and community-based services and ensuring individuals have timely access has meant Washingtonians have a choice regarding where they receive care. This has produced a most cost-effective method of delivering services and resulted in a better quality of life for clients, with control over the choices they exercise in their daily lives. Our spotlight series provides an overview of the measure, shares data, and showcases the importance and what innovations have contributed to the success of our longterm services and supports. In addition, we share personal stories that bring the action plan to life, and we discuss who plays a role in our continued success. To serve clients in their home or community setting is extremely important. We do a monthly caseload of over 63,000 individuals in Medicaid community-based long-term care. Over 47,000 are receiving services in-home and are offered care planning and case management through Washington’s 13 Area Agencies on Aging. We are innovative, creative, and flexible in our efforts. We are indeed a national leader in-home and community-based services. It is not an easy task, and each one of us plays a vital role. One key element is our Person-Centered Care planning. It is a planning process that includes the wants and needs of a client, rather than the service delivery system’s requirements, and is used to create a care plan for the future. Practicing person-centered planning has made us more aware that there needs to be a consistent emphasis on provider networks and resources.
The last year has been challenging to say the least. The COVID pandemic impacted how individuals accessed services and how providers delivered them. The pandemic pushed us even more, to be innovative in our approaches to serve. During this year, we remained dedicated, and our drive never faltered. We continued to strive to reach our measured goals. Here are a few highlights: HCS maintained an average of 72 transitions per month from a state psychiatric hospital to a community setting. HCS averaged 134 individual diversions per month from state psychiatric hospitals to community-based settings. HCS averaged 263 individual relocations per month from nursing homes to community-based settings. HCS maintained an average of 10 months that an individual remained in a community-based setting after discharge from a nursing facility. HCS maintained an average of 94% of individuals without reinstitutionalization within the first 30 days of community transition. HCS averaged 670 individual transitions per month from an acute care hospital setting to a community-based setting, and 74 % of the transitions were within 30 days of discharge date. HCS served an average of 4,000 individuals per month in Medicaid Alternative Care, and Tailored Supports for Older Adults programs. HCS maintained above 97% of timely initial assessments and service planning completed within 45 days (with delay reasons). HCS maintained above 93% of timely financial eligibility determinations completed within 45 days (with delay reasons). I hope that you have an opportunity to read our spotlight and that you find the work you do highlight in these personal stories. The spotlight can be found here.
REGION 1 UPDATES It has been a sweltering summer in Region 1, with record-high three-digit temperatures starting much earlier in the season and with more frequency than is usual, causing elevated wildfire concerns early on. Despite that, our Social Services teams, armed with the guidance in the Safe Start Guide, PPE’d up. They forged ahead back into the field on July 12th, enthusiastically reconnecting with their clients in the community. Clients were just as happy to see our staff, and feelings of more “normalcy” were welcomed. Here are a few positive comments from staff who returned to the field in Region 1:
Tami Rucker Region 1 Administrator
Staff (and me) are enjoying seeing the clients and getting to reconnect with them. It’s easier to complete the assessments as we can read body language and see the environment. I am glad to see my clients again. It is also nice meeting the new folks that I haven’t met yet! And – being back out in the field makes the days go much quicker! I think the assessments are better overall if I get to actually see and talk to the clients. Plus getting to go out and about is good for the mental health. The clients are surely glad to see us. Case management staff concur that seeing clients (some for the first time) and reconnecting with providers is the most positive feedback. They all feel it is helping to have a better understanding of client needs, provider needs and getting a FULL picture of who they are working with/case management needs. Seeing my clients and family members and reconnecting with them after not seeing them for a long time has been great. We also got to enjoy life again without a mask mandate over the summer and the wonderful feeling of “normalcy” grew as we visited with friends, family and took in the things we love. As we know, since then, we have had a few hiccups with the COVID-19 Delta variant causing moments of pause to rethink and pivot in our strategy. But as always, our staff have risen to the challenge. They continue to adapt and adjust as needed for the greater good of our clientele and our communities.
As Fall approaches, some unknowns remain. We are uncertain how the Governor’s vaccine mandates will ultimately affect our families, friends, workforce, and the larger community. We have heard the terms “resilient,” “dedicated,” and “committed” often used to describe our staff during the Public Health Emergency, which are certainly fitting. We are all those things and so much more! For example: Region 1 financial monthly reporting shows processing time for financial applications has gone from an average of 41 days in January 2021 to 28 days as of June 2021! One person from every Nursing Facility Case Management unit in the region were surge workers helping the acute hospital effort! Regional State Hospital Discharge/Diversion teamwork and our highly valued partnership and shared vision with Eastern State Hospital. Over time we are seeing an increase regionally in both discharges and diversions per month, along with GOSH (Governor’s Opportunity for Supportive Housing) expansion! This past year, our acute hospital teamwork; the three regions worked together to help meet the need, which was a fantastic collaboration. Region 1 case managers reached outside of their respective teams and joined collaboratively in this vital work, building positive relationships with the Managed Care Organizations and acute hospitals! Continued Residential Support Waiver expansion in the Region with increased Community Stability & Support contracts, Enhanced Services Facility growth, to meet the needs of our behaviorally challenged clientele, and developing the important relationships with our residential providers in the region to support this work! These efforts show more than just commitment to the work we do. More than dedication, it is who we are. And for me, I am so very proud to be part of a group of people in our Region who live out their principles, and who show up every day despite uncertainty and do the best they can each day. Most importantly, the inspiration of our staff gives me terrific hope.
REGION 2 UPDATES Region 2 remains diligent and committed to the clients of Washington State DSHS. The Acute Care Hospital (ACH) and WSH workers continue to persevere in doing rapid assessments and finding difficult placement for these individuals. PBS had their annual QA audit and did an outstanding job. Way to go R2 PBS staff.
Sonya Sanders Region 2 Administrator
We also had some fun in R2. We had 3 staff appreciation events: Mt. Vernon, Everett, and Holgate. Staff did a drive by lunch pick up of burgers, hotdogs, chips, drinks, and desserts. Manager made posters and cheered staff as they drove thru or walk thru the “happy” canopy. We also had a cheerful unicorn and horse applauding staff through the canopy. Kristen Byrne attended the Holgate event and staff commented that they were happy to see her. Here are other comments regarding the events: •I have received a collection of positive comments and input from my staff who attended the events on 08/17 and 08/18. Staff clearly recognized the investments of time and energy that went into the creation and production of this celebration, and it was clearly valued and appreciated by all. Please pass this along to your colleagues who collaborated with you in bringing this concept to life. My staff certainly enjoyed it! •FYI, like many of you I have had a lot of staff express how much fun the employee appreciation events were and how much it meant to them that we put in so much time and effort to make them special! •It was the Best Appreciation of ALL TIME!! THANK YOU!! •It was a Great event, well organized and the food/treats were delicious! Thank you for making HCS Holgate staff feel SPECIAL. Alan Yamamoto
REGION 3 UPDATES The Power of Resilience This last year and a half have been challenging in many ways. Region 3 continues to pull together and shine in everything it does, and there is a reason for that. In addition to our unwavering commitment to clients and the mission of transforming lives, I believe what has gotten us through this time and what continues to get us through day to day is our Resilience!
Debbie Willis Region 3 Administrator
As a team, not only have we persevered through these challenging times, but we have been incredibly resilient through all of this as well! Resilience is defined as: the capacity to recover quickly from difficulties.
Resilience doesn’t mean it has been easy or that there are no tough decisions and painful experiences. The power of Resilience is about our capacity to recover and come out stronger than we were before, with more knowledge, experience, and a deeper understanding of what we are capable of persevering through or accomplishing. As a Region and as individuals, we continue to do the hard things. We continue helping our clients, helping our co-workers and our own families through hard things while in the midst of one of the hardest things we have ever experienced….a worldwide pandemic. We have shown Resilience and commitment through every hard step, and it shows in our work and in the lives, we continue to transform. On that note, I want to say THANK YOU and congratulations to our amazing social service teams and financial teams for their outstanding QA results this year! What an accomplishment! Financial Services met every proficiency except for one, and Social Services achieved 100% proficiency for ALL CMS reportable questions. This is an AMAZING achievement that is even more praiseworthy and outstanding given all the changes and added work with the pandemic! I also want to thank the teams that support them in meeting these proficiencies because it genuinely does take a team effort. Thank you to our clerical team who takes care of all the behind-the-scenes work of taking calls and serving our clients, getting them to the right person for help, making endless copies and mailings to make the jobs of others easier, contracting IPs, and working through all the difficult day to day things that come up that were never outlined in your job description! Thank you to our supervisors and SHPCs who spend endless hours training, mentoring, coaching, auditing, advocating, helping, and supporting our financial and social service teams to succeed! Thank you to the executive team for all you do to advocate for our teams, ensuring they have what they need to do their jobs and supporting them through the good and the tough times. We have a fantastic team in Region 3, and it takes all of us, doing our part, to be successful. Thank you for all you do, every day, to make others’ lives better!
EQUITY, DIVERSITY & INCLUSION
WHAT IS RHETORIC: A WORKING DEFINITION
We often question new information or things that act to the contrary of held beliefs. However, we tend to not ever question the information that was first presented to us on various topics. Examples include the following: • • • • • • • • • • • • • • • •
Matters of race Sexual Orientation and Gender Identity Political beliefs Workplace norms (new ways to complete old tasks) Telework Programs designed to enhance workplace experiences General status quo that upholds the structures of White Supremacy Views about marginalized people Senior citizens Military Combat Veterans Hearing, Visually, and Physically Challenged Persons Persons with a serious and Persistent Mental Illness (SPMI) Persons with Cognitive Impairments Gamblers and Substance Abusers Autism Spectrum Persons Gifted and Talented Persons
• Persons Living in Poverty • Sex Offenders • The Homeless • Felons Rhetoric is the way in which you communicate in everyday life. These communications can be persuasive in nature and can consist of text, images, video, or any other type of media. Rhetoric requires an understanding and control of language and knowledge of culture; the rhetorical situation which includes the purpose, audience, topic, writer, and context, genre; and other aspects to achieve an intended purpose. In many cases, rhetorical appeals (ethos, pathos, logos) can also contribute to this intended purpose. Different Modes of Persuasion •
Logos, an appeal to logic
•
Pathos, an appeal to emotion
•
Ethos, an appeal to ethics/character
•
Kairos, an appeal to the opportune time
Rhetoric and Media
In addition, somethings to avoid with rhetoric are:
Divisive rhetoric or bad rhetoric are terms we often hear in today’s media sources, which often gives a negative perception of rhetoric even if someone may not understand what it exactly is. They focused on persuasion techniques and speech rather than written text. Now, rhetoric encompasses not only speeches and written works, but also visual rhetoric such as images and film.
• Relying on single sources for information • Failure to question those things presented to you which have no basis in facts • Not listening to another’s experiences or perspectives because they challenge your sense of “normalcy” or “hierarchy” • Looking for oppressions where there are merely inconveniences Rhetoric is everywhere and can involve any form of speech, written word(s), images, movies, documentaries, the news and media etc. It can be verbal, non-verbal, and written form. Rhetoric can be a tool, a system, and a way for people to convey information, promote the effectiveness, and efficiency of communication. By understanding rhetoric and how the modes of persuasion work will create a framework to help you think critically and creatively.
Rhetoric can enhance a composition, make speeches more engaging, persuasive, memorable, and create trust. However, if it is not used properly or responsibly could cause problems or have adverse consequences. For example, when used to convince others to think a certain way or to take a certain side in a debate or discussion. Also, be mindful of the audience, the situation, the tone, and choices of word as they can have consequences and different impacts.
WELLNESS
ARE YOU CONSIDERING A COMPLEMENTARY HEALTH APPROACH? Millions of Americans use complementary health approaches like acupuncture, meditation, or dietary supplements. Like any decision concerning your health, decisions about whether to use complementary approaches are important. Here are some things to consider: • Be informed. Find out what scientific studies have been done on the safety and effectiveness of any health approach that interests you. • Discuss the information and your interests with your health care providers before making a decision. • Choose a complementary health practitioner as carefully as you would choose a conventional health care provider.
• Choose a complementary health practitioner as carefully as you would choose a conventional health care provider. • Before using any dietary supplement or herbal product, make sure you find out about potential side effects or interactions with medications you may be taking. • Tell all your health care providers— complementary and conventional—about all the health approaches you use. • Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.
SEPTEMBER IS
PAIN AWARENESS MONTH September is National Pain Awareness Month, a time to raise awareness about pain and pain management. It is a time to create an overall understanding among health care professionals, individuals, and families struggling with pain management and that pain is a severe public health issue. It is also a time to highlight chronic pain to be more readily recognized, better understood without the traditional stigma attached, and more fittingly treated and managed. What You Can Do The key to raising awareness is to get involved. There are many things you can do to help promote Pain Awareness Month. Talk with Friends & Family: Let them know that September is Pain Awareness Month.
Watch the Pain Matters documentary to learn more about Chronic Pain
Talk with your Healthcare Provider: Share the tools below to better communicate with your healthcare team: Going to the ER
Take care of yourself! Take time out for yourself this month. Tools to help take care of yourself are below:
Pain Management Programs
Relaxation Guide Video
Resources
Resources and tools to increase your interaction with your health care professional
FAQs
Medication Safety Video
Videos
A CLIENT’S STORY
OVERCOMING CHRONIC PAIN A female client who had overwhelming chronic joint pain due to osteoarthritis and obesity stated, “I am so heavy that it hurts to move.” Her pain was so unbearable that she could not visit her family and friends or enjoy life. She struggled with depression, helplessness and was overwhelmed with the amount of pain she was experiencing. Her diabetes was poorly controlled, and she stated, “she just did not know how to begin to change her life.” She often missed appointments with her primary care provider (PCP). She felt it was useless to see him, and she thought he discounted her complaints of joint pain. She was also depressed about how much she relied on her caregiver to do things for her. The client agreed to enroll with the Health Home Program and discussed wanting to improve her well-being; to end the pain and sadness. Along with her Care Coordinator (CC), they discussed a list of barriers, current needs, and action steps. The client felt that if she could control her pain, many other aspects of her health would also improve. She felt the pain was so limiting to her in moving forward. The client created a Health Action Plan with help from the Care Coordinator. Since managing her pain was a top priority, they worked to address things she would like to have happened to control her pain. With some coaching from her Care Coordinator, she talked with her care provider about the pain. The provider agreed to try a pain patch in addition to the pain pills she had been taking. Another action step on her plan was to review online information from pain specialists and see what she felt she could do. She felt yoga and other relaxation techniques would help. She also asked her PCP for a brief referral for physical therapy so she could learn some exercises that she could easily do at home. The client took to heart all the step-by-step information and began to make changes in her lifestyle. Within the first month, the client started to feel the benefit of the pain patch. After more time, she continued feeling the benefits. She followed the daily exercises she worked on during Physical Therapy. She found that she was now able to think about her diet and take daily walks. She began to eat differently, thinking more positive thoughts about herself. She began to feel empowered, and by consistently walking and doing daily relaxation, her pain level decreased while losing weight. She began to look forward to her “twice around the park walks.” In the nine months since starting to work with her CC and her PCP, the client has established reasonable pain control and has lost over 40 pounds. Her pain medication and insulin doses have decreased. She also feels more confident in speaking to her PCP about things as she feels not discounted in her complaints as she previously felt.
TEAM SPOTLIGHT
RESOURCE SUPPORT AND DEVELOPMENT The Resource Support and Development (RSD) unit responds to the evolving and dynamic work of supporting vulnerable adults in our communities. It is unique, exciting, and creative work that directly addresses gaps and the changing needs of individuals who receive services in their own homes and community residential settings. The unit connects and collaborates with numerous community partners and develops policies and contracts that impact specialized populations within the long-term care system. The RSD unit is based out of Headquarters with the team members stationed throughout the state in the regions: Annie Moua (R1N), Mika Greathouse (R1S), Lisa Suchsland (R2N), Betsy Jansen (R2S), Debra Knutson (R3N), Dawn Okrasinski (R3S), and Unit Manager Jamie Tong (HQ). This unit is part of the Community Living and System Support unit. Development of Specialty Contracts Recent work has been in support of the Mental Health Transformation efforts to assist individuals transitioning or diverting from state hospitals. This work continues to expand to include supporting individuals transitioning from acute hospitals. It is rich and varied and includes connecting with developers and providers, creating policies and processes, and communicating the availability of new resources to staff.
Lisa Carlock, Executive Director of The Cottages of Lacey, a SDCP Plus facility, shared a recent note sent to her by a resident’s son:
“I can’t even begin to tell you how pleased I am with your facility and staff. I cannot remember the last time I saw my father this happy and well. Please accept my most sincerest gratitude.”
Attend the quarterly State Hospital Discharge and Diversion (SHDD) webinars to learn about the current and upcoming resources!! Two of the new contracts: Community Stability Supports (CSS) provides an elevated combination of personal care, nursing, behavioral support, and activities. Each client is reviewed by a HQ committee to determine which level of support they need to remain stable in the community. The contract has two tiers, and the HQ committee reviews medical and behavioral acuity, risk factors and staff time associated with providing care in each of these categories. Specialized Dementia Care Plus (SDCP Plus) provides an elevated combination of medical and therapeutic services to assist individuals who need the support of a specialized dementia care facility with increased staffing to address challenging behaviors associated with dementia.
Medicaid Provider Support Network and Regional Efforts Adult Family Home (AFH) Development – In an effort to build AFH capacity in rural areas, as well as highlight the opportunities for career advancement for Individual Providers, RSD offers a monthly presentation on the ins and outs of opening an adult family home. This presentation is not a required training for new providers but is intended to serve as an entry point for those interested in working for themselves and growing their careers. We highlight underserved and rural areas during our presentation to expand the AFH network across the state.
Regional Support – RSD staff live and work in the regions that we support, allowing us to serve as a bridge between Headquarters and regional leadership. We help to bring new trainings to staff, assist with complex case staffings, and respond to a wide range of targeted requests specific to the needs of our communities.
CCG Quarterly Meetings: Across the state RSD offers regular CCG meetings to support our contracted providers to network with our social service staff, as well as provide new information and resources.
Tribal Development Support – Our outreach work is intended to build strong relationships with tribes to help support them to address the specific needs of their communities. In collaboration with the Office of Indian Policy and the ALTSA Tribal Liaison, we have created a presentation highlighting the long-term care options on tribal land. This presentation will be available to all recognized tribes in the state of Washington and delivers an overview of residential settings and a wide range of service options, including home care agency, independent housing, and healing house which offers in-house, transitional care, and caregiving services.
AIDA Search Tool – RSD partners with AIDA to assist in making transitions easier for clients and our social service staff. More than 2100 AFHs are currently registered to receive referrals in AIDA, and they offer a weekly training to help providers understand how to utilize the platform to promote their services. AIDA is also available to provide staff trainings upon request. Check out this great resource today! Contact RSD today to set up a staff training!!
New Adult Family Home Outreach –RSD reaches out to newly contracted adult family homes with a welcome letter and resource guide to build connections, offer support, and ensure new providers are aware of resources to support them in serving Medicaid clients.
Meaningful Day – RSD provides Meaningful Day Session 1 training to all adult family home providers who are eligible and interested to offer Meaningful Day Activities to their eligible clients. These trainings have resulted in more than 1500 Meaningful Day contracts statewide.
AAA Contracts – RSD collaborates with our local Area Agencies on Aging (AAA) to expand capacity of Medicaid contracted providers to promote client choice. Some examples of these contracts are community choice guides, environmental modifications, moving companies, cleaners, and home care agencies. We are always looking for businesses who are interested in providing services to Medicaid clients.
Reach out to us at: ResourceDevelopment@dshs.wa.gov
PARTNERSHIPS: OSPI Home Care Aide Training Program For High Schools Home and Community Services (HCS) has a long history of building collaborative partnerships that move our work forward in serving DSHS clients in need of care. The Workforce Development team prioritizes partnerships with state agencies, tribes, and schools to create accessible training and employment pathways for those who want to become long-term care professionals. A recent partnership between the Career and Technical Education Department at the Office of Superintendent of Public Instruction (OSPI) and the HCS Workforce Development team has initiated a program to help build a pool of well-trained and skilled long-term care workers to provide quality care to DSHS clients. This partnership builds the workforce and serves DSHS clients. OSPI and the Workforce Development team have designed and developed a 90-hour Home Care Aide (HCA) Training program for high schools. This course prepares students (18 years of age) for employment as a home care aide assisting clients with activities
of daily living and instrumental activities of daily living. The content of this course includes personcentered caregiving, safety habits, mobility, and client rights. Using the academic foundation of medical terminology and knowledge of the life sciences, the students will demonstrate technical skill competency in real-life caregiving situations. Once students display evidence of competency in a classroom laboratory setting, they will participate in a clinical practicum experience learning under the supervision of a home care professional. This supervisor will provide mentorship in an adult family home or assisted living facility demonstrating personcentered care of clients while students analyze and synthesize information to solve problems, make decisions, and record information in the form of charts, graphs, and reports. The program allows students to take the skills exam that, if passed, will enable them to apply for the Home Care Aide licensure with the Washington State Department of Health (DOH). Additionally, the students can earn high school graduation credits as they complete modules within the course.
“OSPI and ALTSA at DSHS, through a strong collaboration and partnership, have developed an opportunity and program for secondary students to begin their career in the health care field. Through the partnership students are given an opportunity to gain the knowledge and learn the skills to a hands-on career working with patients. Our common goal to create and develop a workforce in a high demand area has and continues to be the foundation of the partnership.”- Marianna Goheen, Health Science Program Supervisor, Career and Technical Education (OSPI) The Central Valley School District is the first to offer the HCA program at their NEWTech Skill Center in Spokane as part of its health sector career and education classes. NEWTech is one of 14 skill centers in Washington. The Workforce Development team aims to support the remaining 13 skills in Washington centers by providing home care aide training to students in their health care pathway classes. The workforce development future is full of opportunities with schools, summer programs, and agencies across the state. The Workforce team has started to provide technical assistance to Everett School District to implement the HCA training program at Everett High School. The team will continue supporting other high schools to expand their career and technical education offerings to include a health care pathway. It takes innovation and collaboration to meet the needs of DSHS clients, students, jobseekers, and the community. And without a doubt, the Workforce team has excelled in forming partnerships that will present future opportunities with schools, summer programs, and agencies across the state.
HCA has been instrumental with their continuous support in helping to understand our vision for Everett Public Schools’ Fundamentals of Patient Care students at Everett High School. HCS has helped us tremendously with helping to design, prepare to implement a program that will provide students with opportunities to work toward the Home Care Aide Certification upon turning 18 years of age. This enables our students to leave high school with an industry working credential that they can put to work while on their journey to a career within health care. HCS helped us get in touch with comprehensive training sources for our instructor to help her become better prepared to instruct students in the class.” Corie Gudgeon, CTE Health & Medical Facilitator, Everett HS
Lake with Mount Shuksan Reflection
Do you have a story tip? Want to submit a photo of Washington’s scenery? SEND THEM TO MEGHAN.ERKKINEN@DSHS.WA.GOV!