HCS Highlights SPRING 2020
ISSUE #2
BEA’S MESSAGE The last few weeks have been difficult for all of us, both professionally and personally. Usually spring is time for enjoying the outdoors, making plans and getting together with friends and loved ones. Because of the COVID-19 outbreak, this spring has been different. We’re living in a period of uncertainty. You may we wondering, when will my job be back to normal? How can I keep myself and my loved ones healthy? When will I be able to see my friends and family members again?
Bea Rector Director, Home and Community Services
It’s easy in a time like this to lose focus, which is why I am continually impressed with the flexibility and continued commitment to our work and our mission that all of you have shown. The amount we have accomplished over the last month is incredible. We’ve implemented policies to protect our providers and employees while ensuring our clients continue to receive vital care. We shifted 95% of our HCS staff to telework while ensuring our essential, mission-critical functions continue. We worked with the federal government to get needed flexibility in the wake of the ongoing outbreak. Those are only a fraction of the many projects you have taken on to address the impacts of COVID-19 on our employees, our clients and our providers. Our work has been profoundly impacted by COVID-19. All the changes and uncertainty can leave us feeling drained and anxious. I encourage you all to practice self-care and self-compassion. If you’re looking for ways to stay connected to others, see our tips on page 8. The Employee Assistance Program has also put together resources specifically related to COVID-19 and can provide one-on-one support. Although these are difficult times, they are temporary. I look forward to when we can all once again meet face to face. Until then, please continue to take care of yourselves, your families and one another. Thank you for all you do.
HCS MISSION STATEMENT I’m pleased to announce that we have a new HCS mission statement. You may remember that we decided to revisit our mission in light of our split from Adult Protective Services. We have a clear winner, with nearly 84 percent of our employee votes going to our new mission statement: to transform lives so seniors, people with disabilities and their families receive appropriate, innovative and quality services that maximize independence, dignity and quality of life in their settings of choice. This new mission is in line with ALTSA’s mission and vision, and it clearly communicates the specifics of HCS’s role in the work of our administration. Thank you to the more than 500 of you who took the time to vote in our poll.
The mission of Home and Community Services is to transform lives so seniors, people with disabilities and their families receive appropriate, innovative and quality services that maximize independence, dignity and quality of life in their settings of choice.
CONTENTS 3
REGIONAL UPDATES
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HCS UPDATES
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WELLNESS
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EQUITY, DIVERSITY & INCLUSION
11 HCS CLIENT STORY 13 HIGHLIGHTING PARTNERSHIPS 15 HIGHLIGHTING HCS’S WORK 17 FINAL THOUGHTS
REGIONAL UPDATES UPDATES FROM REGION 1
Tami Rucker Region 1 Administrator
Region 1 was in the unique position of working on Behavioral Health Organization (BHO) conversions for Spokane County from March-December 2019. Ninety-seven individuals who previously had been funded by the BHO who resided in seven assisted living facilities were referred to HCS over the course of 9 months. These individuals’ BHO funding was scheduled to end at the end of December. Ninetyone people were assessed in CARE; only one was determined not functionally eligible for services, and one was not financially eligible. Eighty-nine were referred for Expanded Community Services for behavioral support, and 82 were approved and put on the Residential Support Waiver (RSW). The other seven clients were eligible for Community First Choice. Clients who appeared to meet criteria were also referred to the Managed Care Organizations (MCOs) for funding and ongoing support, and the MCO funded many of the transitioning clients. We had several key staff involved in the conversion to assist with smooth transitions, and many others also stepped in to support these efforts. Kudos to Denise Maroney in the Intake Unit, Courtney Heiser in Financial, case managers Donna Cecchini, Kelly Garrett, Sandi Smith, Shari Olson, Francina Mutombo and Jenni Johnston, and to the wonderful people on their teams who lent a hand to help when needed! These 82 clients are now being case managed by the Behavioral Support Team in Spokane. We held a thank you breakfast on Jan. 24, 2020, to acknowledge everyone involved and celebrate this success. This was a great example of efficient and client-centered collaboration between the BHO, ALFs, MCOs and HCS staff, and represents many, many hours of work!
UPDATES FROM REGION 2
Sonya Sanders Region 2 Administrator
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Region 2 HCS ended 2019 with a nursing facility closure and we began 2020 with a nursing facility closure. Staff have been busy assessing clients and meeting with families and providers while finding appropriate placement for residents. Facility closures are difficult for all parties involved, especially clients. Part of our job in relocating clients is to keep them calm and respect their decisions. I am proud of Region 2 staff for the work they are accomplishing in this process. For over a year, Region 2 HCS established the WMS/Supervisor Q&A. The purpose of these sessions is to allow an informal forum for supervisors and WMS managers to discuss issues regarding personnel, leadership, team building, etc. Each session has a blend of WMS managers, seasoned supervisors and new supervisors. The goal for these sessions is that all managers in attendance will learn from one another and seasoned managers will provide insight and encouragement to new managers.
UPDATES FROM REGION 3
Debbie Willis Region 3 Administrator
The past year felt like a whirlwind of activity in Region 3 and our team’s innovation and commitment to truly transforming lives is going strong. We implemented multiple pilots unique to Region 3 to improve services and supports to our most vulnerable clients. These included but are not limited to: • Houseless pilots in Tumwater and Vancouver: These pilots were inspired by the good work in the original Tacoma pilot. The pilots include social services and financial services working together to coordinate efforts and stationing staff in the community to support clients where they are to create better access to our services. • NFCM/Hospital/Financial Pilot: This pilot assigns financial staff to work only NFCM and hospital cases to help improve workflow, communication and customer service to our clients and the nursing facilities and hospitals. • Housing Search Pilots: We are piloting two different housing search tools, one created by Region 2 being piloted in Vancouver and another in Tacoma provided by a company call AIDA. Both of these tools help our staff find available homes that match the needs of our clients and save our staff time. All pilots require additional work to get up and running and those making it happen have done an outstanding job! These efforts take a “village” which includes all disciplines: clerical, financial, NFCM and in-home/residential, as well as extra work for supervisors/program managers/FSAs. This good work does not go unnoticed. I am proud of all our region has done and continues to do.
Do you have a photo you’ve taken of Washington’s scenery? Submit it to meghan. erkkinen@ dshs.wa.gov and it might be featured in an upcoming issue! Clark County, WA
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HOME & COMMUNITY SERVICES UPDATES
HCS LEADERSHIP RETREAT
HCS leaders meet to review 2019, look forward to 2020 The senior leadership of Home and Community Services participated in a management workshop on Feb. 4 at the Lacey Community Center to discuss the division’s achievements and goals for the coming year. Participation included the director, deputy directors, office chiefs and regional and deputy regional administrators. Among the many accomplishments noted for 2019, participants recognized the successful separation of Adult Protective Services and HCS, the hard work done to address nursing home closures and the success of several pilot projects aimed at finding better ways to serve clients and their caregivers. In addition to program goals, themes identified for 2020 include focusing on giving and receiving feedback, creating opportunities for staff to grow through delegation and supportive coaching, fostering a Lean culture of learning, and building trust with staff, stakeholders and other key partners in our service delivery system. Representatives from ALTSA’s Lean Engagement and Innovation team facilitated the full-day workshop. “It’s an honor to work with people who are deeply dedicated to this mission-driven work,” said Amy Besel, Organizational Development Administrator.
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LEGISLATIVE UPDATE
The legislative session wrapped up last month and we saw several bills signed into law that will affect our work. • The home care agency vendor rate bill allows the rate calculation to reflect the average home care agency employer tax rate. It also eliminated the electronic time keeping requirement for home care agencies since a new federal requirement of electronic visit verification will take effect in 2021. Although this is a technical bill, it will help home care agencies to receive funding they need and to reduce what would have been duplicative administrative requirements. • Another bill modifies the admission criteria for enhanced services facilities to align with current admission and eligibility criteria and to describe the offerings at ESFs as supportive services instead of treatment. This will help us counter some of the stigma associated with enhanced services facilities so we can support people seeking to open new facilities around the state. • The new budget adjusts the nursing facility Medicaid payment rates based on inflation. • The legislature also passed a bill allowing adult family homes to expand from 6 to 8 beds. This is a positive development, allowing us to grow our community capacity to serve more individuals in the settings of their choice. • A bill on long-term care worker safety requires home care agencies and the Consumer-Directed Employer to adopt and maintain a comprehensive written policy about how they will address instances of discrimination, abusive conduct and challenging behavior to protect employees and work to resolve issues impacting the provision of personal care. The Adult Protective Services bill that would have allowed individuals to petition for removal from the Aging and Disability Services Abuse Registry did not pass. ALTSA may try to run this legislation again next session. You may also have heard that the governor used his veto authority to trim the supplemental budget in anticipation of likely decreases in revenue caused by the COVID-19 pandemic. A few of our items were among those vetoed, including the increased administrative rate for home care agencies and funding for dementia education.
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STRATEGIC PLAN UPDATE In October 2019, HCS employees had the opportunity to review the ALTSA Strategic Plan and provide feedback on five questions. Your responses have been reviewed and organized, and HCS leadership have begun the task of addressing your comments. Over the last few weeks, they have met to discuss your feedback and update the strategic plan to reflect your comments. Moving forward, HCS will continue scheduling quarterly strategic objective workgroups with the purpose of updating action plan items and reviewing current data. We will also hold quarterly strategic plan webinars, which will provide resources and education pertaining to the feedback you provided, as well as offering an opportunity to ask questions of HCS management. These meetings are open to all HCS staff and will be scheduled for July, October and January. Every staff member at ALTSA contributes in many ways to support individuals to have choice, independence and safety. All of what we do matters. Our Strategic Plan is the blueprint for how we transform lives by ensuring Washingtonians can choose where they want to live and receive longterm care, as well as remain safe and have access to quality services. Our Strategic Plan shows our assessment of areas where we excel, and where we can grow. In addition, it summarizes action plans that we are undertaking to continually improve the way in which we deliver services. The HCS Strategic Plan Feedback Summary is available on SharePoint. HCS’s hope is this document will help you see your role in the Strategic Plan and that your feedback is important.
YOUR VIEWS Which goals align most with the work you do to transform lives? Protection 15%
Quality of Life 30%
Do our action plans align with our objectives and will they help us achieve our goals?
YES 92%
Do you feel the measures we have in place accurately assess our objectives?
YES 89%
Health 15%
Public Trust 19%
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Safety 21%
WELLNESS
STAYING CONNECTED:
Tips for social engagement during the COVID-19 Outbreak As we all adjust to our new normal of social distancing, it can be hard to figure out how we can rearrange our social lives to fit. Whether you’re working from home or still going into the office, the fact is that you’re interacting with fewer people than normal – and likely can’t connect the way you used to with friends, coworkers and family. Even for the introverts among us, staying connected is essential to maintaining our emotional health, particularly in times of increased stress. Here are a few ways you can keep engaged with others during the coronavirus outbreak.
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Stay virtually connected. Check in with loved ones via FaceTime or Skype. Do you have regular get-togethers to celebrate birthdays or other family events? Host your gathering online. Or, start up a virtual book club or weekly dinner party.
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Take up a new hobby. Watch online videos to get started and find forums online where you can discuss your new activity with others.
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Check in on your neighbors. If you’re at lower risk for COVID-19 complications, ask those around you if they need help shopping for groceries or maintaining their yard.
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Go on a virtual outing. Many museums, cultural sites, and zoos and aquariums have virtual walkthroughs and live events. Ask a friend to “visit” with you and discuss what you experience.
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EQUITY, DIVERSITY & INCLUSION
MINORITY HEALTH MONTH April is Minority Health Month and an opportunity to reflect on the disparities that exist between health outcomes for people of different races and ethnicities. Although many of the health disparities have gotten smaller in recent years, gaps in health outcomes still exist. For example, in the United States: • Non-Hispanic black people are more than twice as likely as non-Hispanic Asian or Pacific Islander people to die of heart disease • Non-Hispanic black adults are more likely than adults of other races and ethnicities to have hypertension • Hispanic and non-Hispanic black adults are more likely to have obesity than other races • Mortality rates for Native Americans are almost 50 percent higher than that of their white counterparts This year, the U.S. Office of Minority Health is using National Minority Health Month to encourage all Americans to be active and healthy through their Move Your Way campaign. The campaign encourages Americans to get at least 150 minutes of exercise and two sessions of strength training per week. For more information on the campaign and how you can get involved, visit: https://health.gov/moveyourway.
MOVE YOUR WAY Want to improve your health? The U.S. Office of Minority Health encourages Americans to get 150 minutes of exercise and two sessions of strength training per week. For more information, visit https://health.gov/ moveyourway.
HCS ORGANIZATIONAL DEVELOPMENT Have you ever asked yourself: • What do I need to do as a new employee? • How can my team grow together to be more efficient and effective? • How can I continue to learn and grow in my position? • How can I promote within my division? • What can I do to feel more engaged at work? • How does my work fit into ALTSA’s strategic plan, mission, vision and values?
If you have, there’s good news! HCS has partnered with Adult Protective Services to recruit a full-time organizational development employee who will work on improving our organizational effectiveness, maximize employees’ potential, work to create positive change and more. Edgardo (Edgar) Rivera was selected for this position and will work collaboratively with the Equity, Diversity and Inclusion team to implement toolkits and workshops that foster a culture of diversity and inclusion for team building, peer learning, work/life balance and trust-building. Edgar possesses a strong background in organizational development and is a Certified Associate in Project Management (CAPM®) and a Six Sigma Lean Black Belt Professional. For over 20 years, he has held management, operations and training positions within the United States Army, which has prepared him to thrive in a complex environment. He comes from the Wellbeing, Improvement and Nursing (WIN) Unit in HCS where he served as an Outcome Improvement Specialist and Lean practitioner. In that position, he developed practical measures and best practice methodologies and disseminated evidence-based practices to increase effectiveness and efficiency. Before WIN, Edgar worked as a Continuous Improvement Manager at Western State Hospital, where he managed implementation, training and deployment of hospitalwide continuous improvement projects.
HCS CLIENT STORY
VANCOUVER HCS CLIENT FINDS
STRENGTH THROUGH FAMILY Each issue, we will spotlight someone who receives HCS services and demonstrate how individuals are taking action to improve their lives and their communities. Through her family, Jenny, a Home and Community Services Client living in Vancouver, has found the strength to tackle her mental health and substance use issues. Jenny grew up in Battle Ground, near Vancouver, with her parents and a brother and sister. Her brother and sister still live in the Vancouver area, along with Jenny’s 11 nieces and nephews who range in age from 2 to 18. “They mean everything to me,” Jenny said of her nieces and nephews, who she refers to as “my kids.” She visits her family and her two dogs, who currently live with her sister, every weekend. Jenny spends the time catching up and playing soccer and basketball with her nephews. Jenny’s parents also lived in the area until they both died two years ago. Her mom was, and still is, her rock, and Jenny said she is still coming to terms with her mother’s death. “I just really miss my mom,” she said. “She did everything for those kids. She taught them so much stuff, to bake, to do a little bit of gardening. She was just a really good grandma and mom. Whenever I don’t feel good, I just have to think of her.” Jenny’s family keep her grounded and serve as a reminder of why she’s working so hard on her health. After she was laid off on her birthday one year, she had what she describes as a “complete breakdown.” Her parents sent her to Eastern State Hospital, where she stayed for 3 months. In the years following, Jenny sought further mental health treatment and treatment for her drug abuse.
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Jenny was diagnosed with schizoaffective disorder, which has the symptoms of schizophrenia and mood disorder. She described feeling like the government was watching her and hearing voices 24 hours a day, while also experiencing extreme anxiety.
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Two years ago, after a stay at Western State Hospital, Jenny went to live at Orchard Highlands Enhanced Services Facility in Vancouver. Enhanced services facilities are a relatively new category of licensed residential facility in Washington state and they are intended to provide care for individuals like Jenny, who need assistance with personal care and behavioral health and who also want to live in a community setting.
It was chaos inside my mind. That’s gotten better, a lot better. – Jenny, HCS client
Through hard work, therapy and medication, Jenny feels like she has improved a lot. She took up crochet as a way to deal with her anxiety – it was either that or pace and smoke, she said. One year, she crocheted 50 hats that she gave to her nieces and nephews. She focused on improving her health and wellness, and found that socializing helped her with her symptoms.
“It was chaos inside my mind,” Jenny said. “That’s gotten better, a lot better.” These days, Jenny has settled into life at Orchard Highlands. She works about 15 hours a week at Taco Bell, where she does dishes, fries chips and takes out the garbage. She is hoping to improve on her high school Spanish so she can talk with her Spanish-speaking co-workers. She is also setting goals for the future, both in the short term and the long term. She wants to start crocheting again and plans to go kayaking in the Deschutes River this summer. She used to jet ski, but decided to try kayaking instead, since it’s better for the environment. She would like to quit smoking. In the longer term, Jenny hopes someday she can work with people who have had similar struggles to her own. She’s not in a rush, though. “I think it’s going to be a while before I take that first step,” she said. “This place is supposed to get you used to being in society again.” When reflecting on the progress she has made, there’s one person Jenny wishes she could talk with, and that’s her mom. If they could have one last conversation, Jenny said she would tell her, “I’m off drugs, I’ve been going to church, I have a job and I’m happy. Most of all, she just wants me to be happy.”
Do you know a client who has an uplifting story and might want to be featured in this section? Reach out to meghan.erkkinen@dshs.wa.gov!
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HIGHLIGHTING PARTNERSHIPS
STRONG RELATIONSHIPS HELP NURSING FACILITIES SERVE COMMUNITIES
In 2019 and 2020 there has been a lot of attention on the role of nursing homes in the continuum of services utilized by individuals in need of long term services and supports. In 2019 and early 2020 there was a lot of media attention due to a number of nursing homes closing. In the 2020 legislative session, additional investments were made to the Medicaid rates of nursing homes. The COVID-19 outbreak that began at the end of February in Washington state once again put nursing homes in the spotlight, highlighting the vulnerability of residents served in these settings. For almost four decades, Washington has worked to ensure that individuals have choice about the setting they reside in. Each year, our staff assist almost 4,000 nursing home residents to transition to community settings, which might lead people to assume that nursing homes are less relevant than they used to be, but that simply is not the case. Nursing homes are a vital part of our long-term care system. Strong partnerships with nursing homes and nursing home organizations will ensure that these facilities continue meeting the diverse and complex needs of Washingtonians.
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“Not only are they providing jobs in the regions they are in, they are providing rehab, skilled nursing, and physical and occupational therapy for people with complicated medical needs,” said Julie Cope, HCS systems change specialist. “I truly do not believe that any nursing facility case manager would say that nursing facilities are obsolete and that they don’t provide a very valuable role in the communities they are in.” One of the key ways in which Home and Community Services partners with nursing facilities is by working with them to adjust their practices to meet the evolving needs of long-term care clients. The more than 100 nursing facility case managers at HCS work directly with the state’s 200 nursing facilities to offer support in the form of training and consultation. Many of the case managers spend part of their work weeks stationed at nursing facilities so they can provide more direct service and focus on building strong relationships with staff members and nursing facility residents.
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“There’s something to be said when you know your facility that well,” Julie said. “When you have that relationship with facilities, a lot of great things can happen.”
There’s something to be said when you know your facility that well. When you have that relationship with facilites, a lot of great things can happen. – Julie Cope, HCS Systems Change Specialist
Nursing facility case managers can offer support on a wide range of topics that impact residents. Not only does HCS work with nursing facilities to problem-solve at the local level, but it also works with nursing facilities organizations and groups to solve problems at the regional and state-wide level. Quarterly work groups address questions and concerns about everything from implementation of new or changed policy to the growing population of residents with behavioral support needs.
This partnership and collaboration is increasingly important as nursing facilities serve clients who are transitioning from acute care hospitals, who have experienced homelessness or who have a complex set of needs. As client needs shift, many nursing facilities offer specialized care to address those needs. As the older population grows and as clients’ needs become increasingly complex, the relationship between HCS and nursing facilities will continue to be important. “It’s good to partner with nursing facilities to solve problems on a local level,” Julie said. “That work will never be done, which is cool.”
What is a nursing home? Nursing homes provide 24-hour supervised nursing care, personal care, therapy, nutrition management, organized activities, social services, room, board and laundry.
200+
Number of nursing homes in Washington
20,000+
Number of nursing home beds in Washington
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HIGHLIGHTING HCS’S WORK
HCS NURSING SERVICES UNIT PROVIDES COMMUNITY-BASED NURSING SERVICES TO MORE THAN 10,000 CLIENTS Each issue, we will highlight the work of one of our teams. This issue, we’re taking a look at our nursing services team, which supports ALTSA clients with home- and community-based nursing services. The nursing services unit, housed in the Home and Community Services division, is a small but mighty team of four people who oversee nursing services for more than 10,000 clients around the state. The team, led by Angela Nottage, Nursing Services and Performance Improvement Unit (NPIU) Manager, manages several programs that are designed to allow clients to receive skilled nursing, nursing tasks, nursing assessment and service planning, which they might otherwise only get in acute care hospitals or nursing homes, in their home or the community-based setting of their choice. “I think about my grandmother. She’s spunky and she’s very independent, even at 93. She’s not leaving her home,” said Jerome Spearman, nursing services program manager for well-being, improvement and nursing. “The reason she wants to stay at her home is the memories of her husband, her family, family events. (With nursing services,) we’re still able to transform their lives even at an older age. They’re still able to be present, stay in their own home, be connected to family.” The nursing team oversees several nursing programs that serve clients in community settings and in their own homes. One of those programs – the one serving the most clients throughout the state – is the nurse delegation program. This program connects long-term care workers with nurses who instruct the workers on nursing tasks such as administering insulin or performing blood glucose testing. Historically, such tasks would be performed in a nursing home, but through the nurse delegation program, about 9,500 clients are living in their own homes or communitybased adult family homes and receiving these nursing services.
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Another HCS nursing program that serves people in their communities is the adult day health and adult day care nursing programs. Many clients who receive adult day services in their local community centers can receive nursing services such as vital sign monitoring, as well as the physical and occupational therapy in addition to the socialization that these programs provide. Nearly 1,000 clients are served at 12 locations around the state, mainly in King, Pierce and Spokane counties. The nursing team also contracts to serve clients with complex care needs. Through the private duty nursing program, overseen by Program Manager Whitney Hightower, the state contracts with nurses who serve about 130 clients, most of whom are on ventilators, for as many as 16 hours a day in their homes or in adult family homes. The skilled nursing program similarly contracts with nurses to provide specific nursing tasks, such as injections, wound care and medication management, in the homes of about 100 clients. This small HCS nursing team oversees all of these programs, including rules and regulations, contracts with nurses, and stakeholder relations. It also provides field consultation during the client assessment and a service planning process to determine which wraparound services would best serve the client. “Overall our services, each of them, help people stay in the locations they want to stay,” said Marlo Moss, nurse delegation program manager. “It gives clients choice and it reduces the number of people who would typically be in a nursing home.”
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Not only is this small team managing these programs, but they have big plans for the months ahead. Some of that work will focus on bridging gaps: the team is developing a new nursing curriculum that will break down nursing silos. They also are working with Residential Care Services on a nursing conference for all HCS and RCS nurses. On top of those tasks, the team has to contend with the nationwide nursing shortage and is increasing efforts to recruit nurses to contract with for private duty nursing and nurse delegation.
Overall our services, each of them, help people stay in the locations they want to stay...It gives clients choice. – Marlo Moss, Nurse Delegation Program Manager
Although this team is small, they have a lot on their plates and even more on the horizon. Thanks to their efforts, thousands of clients can live in dignity in the settings of their choice.
“The nurses of the NPIU bring years of nursing experience from a variety of healthcare backgrounds,” Angela said. “I am proud to be on a team of such awesome nurses who, on a daily basis, strive for excellence in what we do so as to improve the quality of lives for the clients we serve.”
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CLOSING THOUGHTS
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When I was a boy and I would see scary things in the news, my mother would say to me, ‘Look for the helpers. You will always find people who are helping.’” – Fred Rogers