HCS Highlights - Spring 2021

HCS Highlights SPRING 2021

PLANNING FOR AFTER THE PANDEMIC HCS CLIENT SURVEYS

BEA’S MESSAGE This year’s legislative session adjourned on time at the end of April, and it was a busy one for many ALTSA staff members. We saw a number of successes this legislative season, including the passage of our request legislation around Consumer Directed Employer program clarifications and additional flexibility on COVID-19 policies related to provider training and staffing minimums. These successes are thanks in large part to the work of many of our HCS staff members.

Bea Rector Director, Home and Community Services

The work that HCS staff do each legislative session is exhausting. This year, our staff analyzed more than 50 bills – some only once, but some several times, in cases where bills were updated. When we receive bills to analyze, we send those bills through a rigorous review process. Not only do we send bills through the subject matter experts, but then the bills are reviewed by their supervisors and then to me. This session, we had nearly 20 staff working to analyze bills.

This process takes countless staff hours, but is essential to ensuring we provide thorough and accurate analyses of the impacts of these bills on our clients, providers and staff. It is essential that we note potential consequences of any and all bills that the legislature considers. Not only does this help our legislators make informed choices about how they will vote, but it helps us suggest improvements to language and educates about intended and potentially uninitended consequences the statute could have on those who receive, provide and rely on our services.

Each legislative session, we have the opportunity to guide the vision for HCS and ALTSA through our request legislation and the analyses we provide on any bills that affect our work. This work is vitally important and is one of the many reasons we’re seen as a national leader in long-term services and supports. I want to thank all the staff who contribute to this work, either directly by analyzing bills, or indirectly by providing information, data or other support. I also want to thank all HCS staff for your patience and understanding during busy legislative sessions, when so many of us are immersed in this work.

CONTENTS 3

REGIONAL UPDATES

8

BRIEF UPDATES

10 RETURN TO SCHOOL 11 WELLNESS 12 EQUITY, DIVERSITY AND INCLUSION 14 HCS CLIENT SURVEYS 15 A CLIENT’S STORY 16 PARTNERSHIPS: ENHANCED SERVICES FACILITIES

REGION 1 UPDATES Region 1 SHOUT OUT to Region 1 – Home and Community Services for a SUCCESSFUL 2021 Quality Assurance audit!

The Headquarters Quality Assurance Activities for Region 1 Home and Community Services Social Services and Public Benefits were early on the 2021 schedule. Our Public Benefits audit began January 19, 2021 and our Social Services audit began April 14, 2021.

Tami Rucker Region 1 Administrator

There are federal requirements for Quality Assurance and Improvement for home- and community-based programs. We are invested in ensuring quality services are being provided to our clients. Through these quality assurance activities, which are led by Bill McBride and his HQ QA team, we show that we are using our resources wisely and that we are accountable for the funds we receive from CMS. CMS establishes the quality standards by which we must comply and they require us to provide evidence that shows we are complying with their major assurances regarding quality.

When MB H20-112 was published on December 29, 2020 announcing the 2021 quality assurance schedule, our teams began to prepare for the audit.

This year’s audit brought about curiosity, some uncertainty and even anxiety for some of our team members, as to what the audit results may be. Due to the COVID-19 pandemic, there were so many exceptions and adjustments to policy and processes in both Social Services and Public Benefits programs over that last year.

Social Services did have a few compliance changes due to the later start date, focusing on reviewing the waivered programs: CFC+COPES and Residential Services Waiver (RSW). They also reviewed Community First Choice (CFC) Program and only the Centers of Medicaid and Medicare Services (CMS) reportable questions were reviewed during the 2021 calendar review year.

Well, I am proud to report that both, our public benefits staff and social services staff NAILED IT! The R1 HCS public benefits team had 375 total files audited: 226 applications and 149 reviews. The expected proficiency for the public benefits QA questions have a very high proficiency standard, 98% for 3 questions and 95% for 16 questions. Our audit results were great! Out of 19 questions reviewed, 3 questions met 98% proficiency, 14 questions met 95% proficiency, 1 questions did not meet 95% proficiency and 1 question was N/A. The team has already remediated the ONE (1) deficiency within the 30-

day review and have now begun development of the Regional Proficiency Improvement Plan for the ONE (1) question we did not meet proficiency on. This team of 60 public benefits staff, led by 6 skilled and supportive supervisors, SHPC Mark Clark, SME Heather Spies and Program Manager Gary Olson, demonstrated resilience, team work, commitment and dedication, which resulted in their quality work! To all our public benefits team members, THANK YOU for the HARD and AMAZING work you do each and every day serving vulnerable clients, transforming lives!

The R1 HCS social services team had 202 total files audited: 99 full reviews of CFC, CFC+COPES and RSW and 103 focused reviews related to nursing referral and Individual Provider files. The expected social services proficiency is 98% for financial eligibility questions and 86% for all other questions. These are the minimum proficiency standards established by CMS, by which each area is measured. Out of 24 CMS reportable questions reviewed, 1 question met 98% proficiency (1 at 100%), 22 questions met 86% proficiency (12 at 100%), and 1 question did not meet 86% proficiency.

GREAT JOB team! The team has already remediated the one deficiency within our 30 day review period and will soon begin development of our Regional Proficiency Improvement Plan for the ONE (1) questions that did not meet the CMS proficiency standard of 86%.

This skilled and experienced social service team of 126 social service specialists are led by 18 AMAZING supervisors! A shout out to our SHPCs, Linda Garcia, Misty Zamora, Joannie Hanson and Tiana Ghoreishi. Thank you for the trainings and support you provide to our team! To our social service executive team, Teri Bichler, Jessie Rangel, Valentina Karnafel, Marci Benefiel and Amanda Zahller, THANK YOU for the great leadership, support and direction you provide to your team members.

This successful 2021 HQ QA audit is thanks to not only our wonderful leadership, but the teamwork of all the direct staff (SSS2/3s and PBS4) who contributed directly to these successful audits. This last year, despite all the upheaval and changes related to COVID-19, these staff were still able to put together these amazing results, which demonstrate quality service!

REGION 2 UPDATES Region 2 Region 2 has been busy during this last year. We, like others had to adjust to several regional and agency changes. Although we have been teleworking, the work does not stop and we continue to forge ahead.

Sonya Sanders Region 2 Administrator

Michelle Joseph, our EDI Program Manager (along with R1 & R2 EDI PMs) continues to offer “A Moment with EDI” for all staff, which highlights some basic EDI principles and connects with staff on a multi-dimensional level.

She is working on a project that will create an approved list of facilitators within the region to assist in conversations around EDI. PBS staff continues to have high caseloads but diligently works hard every day for our joint clients. Region 2 just got the 2021 QA Audit results back for the PBS units and Wendy Wendell, PBS PM, feels they have done an amazing job once again! Stay tuned for the final results.

PBS staff were given laptops so they could participate in virtual meetings with a camera. Since then staff have just blossomed! They use Zoom, Skype and Microsoft Teams all the time for virtual meetings, case staffings, huddles, etc. Ty Ramsey, a PBS 5 out of our Bellingham and Mount Vernon offices, has begun having virtual lunch get-togethers. In March, we had our first virtual Region 2 North PBS all-staff meeting and we had a fabulous time.

Over the past year, the Region 2 Training Team has worked tirelessly to create and adapt trainings for the virtual world. The team has success providing training via Skype, Teams, Zoom and webinar! The Training Team has continued to provide our new employee training series (Applied Practice), Motivational Interviewing training, regional LTC manual trainings and policy change training that are engaging, impactful and informative. The team also created an interactive virtual training in Articulate for new staff to complete CARE Application training.

The Region 2 Acute Hospital team has been doing an exemplary job during the COVID-19 pandemic. For over a year, we have been in a “surge” mode.

The team is averaging approximately 332 intakes, 130 assessments, and 208 discharges per month. Many of the staff is brand new to state service and this is a testament to the Supervisors’ (Kristin Ott, Rebecca Howard, and Jackie Lee) and SHPC’s (Kirn Flores) leadership and commitment to transforming lives.

Our regional operations staff keeps our facilities operational. We have had pipes explodes, break-ins in offices and cars vandalized, but Region 2’s Regional Operations Team, Julie Long, Danielle Kelly, and Kerrin Livingston, never missed a beat while working with internal and external community and business offices to keep our facilities in top shape.

REGION 3 UPDATES Region 3 The word “communication” appears to be such a simple concept. We hear things like “just communicate what you want to say” and “tell them how you feel”, what could possible go wrong?

Debbie Willis Region 3 Administrator

Maybe it would be easy if all we had to say is “Wow, you did a great job!” But what about those trickier conversations when things are not going well, or when we have to communicate something that is not easy for us to share, like how we feel when someone is not doing their fair share of the work or when we feel like we are not being included in something we should be?

I don’t know about you, but these conversation do not feel easy…ever! No matter how many times I have them and no matter how many times I practice and prepare myself, they never get easy. But they are necessary for a healthy environment – especially at work.

In the book Crucial Conversations, they say, if you do not talk it out, you will act it out. We have all seen that play out at work and at home. It spirals quickly!

One of the things we are working on in Region 3 is improving communication.

We are doing this in a few ways: • Gathering feedback at our all staff meetings about how we can improve communication within the Region and identify pain points that can be improved. Once we have gathered these we will create an action plan for improvement. Communication in this sense is a long-term and ongoing plan because it is something we will always want to check in on and recalibrate as needed.

• Meeting with teams who are struggling with communication to help build skills they can use when things get tough. The two things that often cause communication issues: 1) When things are left unsaid, and 2) When things ARE said, but the WAY they are said is not helpful. One of my “go to” tools for almost every crucial conversation is the STATE tools (from Crucial Conversations).

• Offering a full-day Crucial Conversations workshop (outside of our Leadership Workshops) to help staff who are interested learn the skills and tools to navigate those tough conversations.

Communication is not easy. The key is to continue to work at it, listen to each other and make improvements. It will pay off.

“Effective communication requires more than an exchange of information.

When done right, communication fosters understanding, strengthens relationships, improves teamwork and builds trust.” – Liz Papadopoulos

BRIEF UPDATES AARP Highlights Washington’s Adult Family Homes The AARP highlighted Washington’s adult family homes in a recent report comparing adult family care around the country.

The report highlights the various ways states have implemented these care settings and provides guidance for establishing or expanding this type of care.

“Washington and Oregon, which have long led the way in developing and promoting AFCs, provide a clear roadmap for using the regulatory process to encourage the growth and acceptance of AFC facilities,” the report reads. “A common thread in both states is the creation of targeted tools and resources for providers and consumers to address the financial complexities as well as the case management aspects of caring for those in need of LTSS.” Washington and Oregon were the first states to establish adult family care options more than four decades ago. As the report highlights, Washington has since been a leader in demonstrating how this type of smaller residential setting can provide additional choice and independence to people who need long-term services and supports.

To read more about the report or download a PDF, visit the AARP website.

Latest Generations Journal issue focuses on home-and community-based services

The spring 2021 issue of the quarterly Generations Journal, published by the American Society on Aging, focuses on home- and community-based services. The issue features more than a dozen articles on topics ranging from the basics and practice of care management to future directions.

The issue’s focus comes at a time when home- and community-based services are receiving national attention, thanks to the Biden Administration’s push for solidifying the U.S. care economy by creating jobs and improving wages and benefits.

The issue is called As the World Turns: Care Management’s Continued Role in an Ever-Changing Delivery System. HCS Director Bea Rector and Region 2 Administrator Sonya Sanders contributed to the issue, co-writing an article on Care Management from a State’s Perspective.

AARP showcases Washington’s work to combat social isolation

Older Americans Month Every May, we join with the Administration for Community Living to celebrate Older Americans Month, when we recognize the positive contributions that older Washingtonians have on our communities. This year, Governor Jay Inslee signed a proclamation honoring the state’s older residents and proclaiming May to be Older Americans Month in Washington.

This year’s theme was Communities of Strength, recognizing the important role older adults play in fostering the connection and engagement that build strong, resilient communities. In tough times, communities find strength in people – and people find strength in their communities. In the past year, we’ve seen this time and again in Washington as friends, neighbors, and businesses have found new ways to support each other.

Strength is built and shown not only by bold acts, but also small ones of day-to-day life – a conversation shared with a friend, working in the garden, trying a new recipe, or taking time for a cup of tea on a busy day. And when we share these activities with others – even virtually or by telling about the experience later – we help them build resilience too.

The COVID-19 pandemic has had devastating consequences for many older adults, but one risk that goes underreported is that of social isolation.

A recent University of Washington report described the coronavirus lockdowns as a “double pandemic” for older adults that contributes to depression and suicide risk and also often disrupts needed care.

ALTSA representatives have been serving on a Social Isolation Work Group along with representatives of other organizations and entities such as AARP and long-term care providers. The work group was launched to determine what has been working to fight loneliness and isolation and whether it can be replicated, both during the pandemic and after the crisis ends.

Read more about the work of the Social Isolation Work Group on the AARP website.

THE RETURN TO SCHOOL PROJECT

HELPING KIDS RETURN TO THE CLASSROOM AFTER A TBI

For kids who have suffered a concussion or traumatic brain injury, returning to school can be a challenge. They may struggle with new cognitive or emotional issues that they haven’t experienced in the past, and most teachers are not knowledgeable enough to assist kids in making a smooth transition back into the classroom.

Many occurrences can lead to TBIs in kids and teens, but some of the most common ways they sustain head trauma are in motor vehicle accidents and sports injuries.

Whether the impacts of their injuries are mild or severe, and whether they are temporary or permanent, kids often need support returning to school and other activities.

A study conducted by the University of Washington and the Seattle School District in 2014-2015 found that teachers felt they did not have enough information to help kids make the transition. This prompted several organizations, including the University of Oregon’s Center on Brain Injury Research and Training, the University of Washington, the TBI Council of Washington and the Aging and Long-Term Support Administration, to partner on a project to train teachers on how best to support their students.

The Return to School project is reaching out not only to K-12 teachers, but also to daycares, universities, teaching colleges, youth sports organizations, and other entities.

It is being funded through the TBI account funds, which are collected as a $5 charge on every traffic infraction in Washington.

David Minor, TBI Council and Fund Coordinator, and the DSHS TBI council staff have led the work at ALTSA and the roll-out of the Return to School project at the beginning of April. The project consists of online training, free events, conferences and tools to help educators and parents. Already, several hundred educators have signed up to take the online classes. The first conference, held May 21, had over 400 of registrations.

“A brain injury can change the way a student behaves, moves, thinks and learns,” David said. “If we know how to support the student or the child early on and if they understand not only the child but the family, we can make a lifetime change.”

Although the project already has many resources available, new items will continue to be added to the website, including the Safe Kids Academy, a virtual summer program for kids, and the Brain Injury Management toolkit, which provides schools a template for setting up a brain injury management team to help a child return to school.

Return to School trainings and resources are available for free of charge to everyone. The information may be helpful not only to those who work with children, but to anyone who knows or works with people who have TBIs. To learn more, take trainings, explore resources or sign up for future events, visit the Return to School website.

Additional information about TBI, supporting people with TBI and other programs and resources can be found on the DSHS website.

WELLNESS

LOOKING FORWARD TO SUMMER

Last summer did not go as planned for many of us, who saw vacations and family reunions cancelled as the COVID-19 pandemic reached new and alarming heights. This year, although the pandemic is far from over, vaccines and the hope for reopenings of businesses and recreational activities mean that many of us can look forward – at least tentatively – to some of our favorite warm-weather activities.

Earlier this spring, we sent out a survey asking you what you liked about summer and what you were looking forward to this year. Here are the results.

What is your favorite summer activity?

• Swimming/water sports: 7.5% • Traveling or camping: 35% • Attending outdoor events: 7.5% • Hiking or walking: 20% • Picnics/barbecues: 20% • Relaxing (reading, napping): 5% • Other: 5%

EQUITY, DIVERSITY & INCLUSION

ADDRESSING GENDER IDENTITY BIAS IN OUR IT SYSTEMS

June is Pride Month, in which we celebrate and affirm the identities of LGBTQ+ in Washington and around the world. For the spring issue of HCS Highlights, we are examining how Home and Community Services is working with others in state government to address bias on the basis of gender identity.

One of the primary goals of ALTSA’s Equity, Diversity and Inclusion work is to address the challenges Washingtonians encounter in trying to access our services. Many of our clients and prospective clients face significant hurdles when it comes to receiving needed medical and social services due to their gender identity.

Some may not seek out services because they are afraid they will be mistreated or even experience violence due to their gender identity. Others may worry they won’t receive the care they need because case managers will not understand their needs or situation.

The Sex and Gender Identity (SGI) Workgroup was convened by the Health and Human Services Coalition which is a cross-agency governance structure with representation from DSHS, the Health Care Authority, the Washington Health Benefits Exchange, the Department of Health and the Department of Children, Youth and Families. Representatives from all five agencies sit on the SGI workgroup which is tasked with addressing some of these barriers.

Cathy Kinnaman, deputy director of headquarters operations, represents ALTSA on the workgroup.

The committee was created in response to concerns that applicants and current service recipients were facing unnecessary barriers that, in many cases, resulted in their exclusion from government services.

The committee’s formation followed a complaint the Health Benefit Exchange received from a prospective applicant, who was unable to complete an application for insurance benefits because the individual could not select a gender option to match their identity.

“It’s about respect for our clients, they know who they are and how they want to be addressed,” Cathy said. “It basically re-traumatizes our clients over and over again when we can’t capture information that is important to them about who they are and how they identify themselves.”

Examining the state’s IT systems is one of the primary projects the SGI workgroup is undertaking. At ALTSA, that includes TCARE, CARE, TIVA, ACES and ProviderOne. These systems have different ways of receiving gender information – some only receive binary data (male/female), while others offer more inclusive options. Unfortunately, the inconsistency not only makes it difficult for systems to interface with one another, but it excludes people who cannot select an accurate option.

The workgroup has two goals to address the challenges faced by our IT systems. The first is to develop training materials for staff on how they can accurately capture a client’s gender identity in the various systems, as well as how to respect and affirm a client’s gender identity during conversations.

“For our staff, they want to be helpful, they want to be respectful, they want to serve our clients well,” Cathy said. “We haven’t really given them tools on how to have those conversations with folks in a respectful way.”

As part of the training, many HCS staff have received or will receive desk aids with important reminders. A PowerPoint training developed by the workgroup will also be used to onboard new financial staff during Core Training and in coordination with the Economic Services Administration for field staff.

The second goal is to do an analysis of IT systems to better understand how changes to one system might affect other systems, both within and outside of Washington’s public agencies. The Centers for Medicare and Medicaid, for example, only accept binary inputs of male or female, making it a challenge for Washington’s more inclusive systems to communicate directly with federal systems. The workgroup will map out how these system interactions work to better understand how they impact the clients we serve, with the goal of using this information to improve the systems.

“It’s going to take a long time but people are very passionate about this and very interested in moving this work forward,” Cathy said. “It’s something that’s very high on everybody’s priority list.”

Respecting an Individual’s Gender Identity Whether you’re dealing with coworkers, clients or acquaintances, it is important to respect everyone’s gender identity. Your gender identity is your own internal sense of self as a man, woman, combination of both, neither, or another gender. This is not the same as sexual orientation, which is who you are attracted to.

Here are some tips for respecting and affirming an individual’s gender identity: • Common pronouns are they/their/theirs, she/ her/hers and he/him/his. There are not the only pronouns with which one might identify, however.

• Do not assume another person’s pronouns based on their appearance.

• In short or one-time interactions, you do not need to ask someone their pronouns. If you are unsure, you can use their name or another word (like “client”) to describe them. You can also use gender-neutral pronouns such as they/ them/theirs or provide your own pronouns so that others may feel comfortable sharing theirs.

• A person’s chosen name may not match the name that is on their legal documents. Using someone’s chosen name when addressing them is about respect and dignity.

• If you mess up someone’s pronouns, name or honorific, do not panic. We are human and we make mistakes. Instead, give a quick apology, correct yourself and move on. Practice using the person’s pronouns to avoid making the same mistake in the future.

HOME & COMMUNITY SERVICES

CLIENT SURVEYS Work began over the summer to conduct a client survey in early November. Launching of this survey involved coordinating with DSHS Research and Data Analysis, data pulls from CARE, creation of call sheets, scripts, and decision trees followed by a call for staff volunteers who were then trained and provided 1:1 support as needed. HCS Outcome Improvement Specialist Montana Salvoni played a key role in managing this with support from ALTSA Organizational Development Administrator Amy Besel.

“Thank you to everyone who volunteered,” Montana said. “We got really positive feedback from our clients, and I heard so many stories about how happy folks were to know that HCS cares this much. We collected really valuable information, and made people feel cared for at the same time – what an awesome accomplishment.”

Given the time commitment needed to get a statistically significant sample, which would have involved over a dozen staff working full time over the course of two weeks to complete the survey, HCS leadership decided to pursue a smaller sample through piloting the survey with a goal of completing 100 surveys. While this is not a statistically significant sample size, it was otherwise valid and random across all settings. Moving forward with the full survey would have been cost prohibitive and likely yielded similar responses. Therefore, HCS leadership decided not to proceed with the larger survey, but to share what we learned from the smaller sample and use it to inform future decision-making around what services we may offer remotely after the pandemic, while balancing the best practice, risk-reducing, value of in-person services.

Here is what we learned: 86.13% of respondents are happy with the services they have received remotely, 10.89% were neutral and only 2.97% were dissatisfied.

75% report ease in getting ahold of their DSHS/AAA case manager when needed, with 16% neutral and only 9% experiencing challenges.

63% want the option to receive some of their services remotely after the pandemic, 16.83% were neutral, and 19.8% do not want remote services.

We also gathered a handful of new clients to join the HCS Service Experience Team, a client advisory group that meets regularly to assist us in improving policy, services and information to those we serve.

Overall, this pilot survey was highly successful, reflecting our staff are doing great work meeting client needs through these unprecedented times.

A CLIENT’S STORY FINDING HOME AFTER COVID-19 Helena is a client in Region 2 who was admitted to a nursing facility in November 2019 for rehabilitation following a knee replacement. In early 2020, just before she was set to be discharged, Helena fell and fractured her ankle. She had to get surgery and stay at the nursing facility for another few months.

Shortly after COVID-19 struck Washington at the end of February, Helena contracted the virus. Although her case was not severe enough to require hospitalization, she had to watch as friends at the nursing facility died or were hospitalized. Staff turnover was very high and visitation was restricted. Although her two daughters made a point of stopping by her window at least twice every day, Helena had a very difficult time not being able to see her family, friends and familiar staff like she was used to.

After a few months, Helena recovered from COVID-19 and was able to bear weight on her ankle again. She resumed physical therapy to continue improving, with a goal of returning home with one of her daughters.

Unfortunately, shortly before Helena, her case manager and her family set up a new discharge date, Helena suffered another fall. In the weeks that followed, she began to decline. Her cognition changed and she was increasingly confused and started to hallucinate. She lost the ability to safely walk up and down stairs, making a return to her daughter’s two-story home difficult.

After meeting with Helena’s case manager, her daughters reluctantly agreed it was not safe for their mom to go home. Instead, they began looking for a local adult family home, where Helena could be near family while receiving the support she needed.

She moved into her new adult family home in August. In the months since, Helena has thrived. She enjoys being outside and especially loves reading books on the deck.

“She loves the adult family home,” one of her daughters said. “The people, she said, treat her like a queen and every time I’m there, it shows.”

Because she is close by, her daughters can visit her often, wearing masks and social distancing on the deck outside the adult family home.

Helena’s daughter also thanked her mom’s case manager, who she called a godsend for the family.

“We were at our wits’ end and she really went out of her way to help not just mom, but to reassure my sister and I and truly, she changed all of our lives for the better.”

PARTNERSHIPS: ESFs How ALTSA’s Enhanced Services Facility team is working with local communities

Washington’s Enhanced Service Facilities, or ESFs, are the newest long-term care residential setting.

ESFs benefit from strong partnerships between ALTSA (both RCS and HCS), developers and local jurisdictions, who work in conjunction to site, develop and monitor new facilities. These strong partnerships ultimately benefit the residents of these ESFs, who, due to their individual needs, may find more success in these facilities than in other types of residential settings.

“When ESFs were established, they really filled a gap in the continuum of care and the array of facilities we have,” said Sandy Spiegelberg, HCS residential support program manager, who oversees the statewide operations and programmatic work of ESFs. “We don’t have as many people going into nursing homes or bouncing back to a hospital setting because they can get their needs met and be part of the community. I think that’s a really necessary service option available for our residents.”

ESFs are community-based residential settings that

primarily serve clients with behavioral support needs and the need for long term services and supports.

The facilities can serve up to 16 residents in singleoccupancy rooms and have a staff-to-resident ratio of 1 to 4. They are not behavioral health facilities and do not provide behavioral health services. Residents are free to come and go, and many have jobs or volunteer in their communities.

“When you walk into an ESF, these clients aren’t sitting watching TV,” Sandy said. “They’re up, they’re out in the community, they’re taking a walk, they’re doing a craft.”

The first ESF opened in June of 2016. Currently, there are six in Washington: three in the Spokane area, one in Everett, one in Vancouver and one in Olympia. One more is scheduled to open soon in Vancouver. About eight others are in the process of being established around the state.

The developer of an ESF chooses the site for their new facility and works with the local planning office

to amend or write new zoning ordinances, if necessary.

Sometimes this requires outreach to the community, particularly if the matter goes before a planning commission or city council.

“We make ourselves available to answer any questions that might be on the table and participate in the conversation,” said Sondra Silverman, long-term care ESF policy program manager in Residential Care Services. “It’s a lot of educating. Often people don’t understand what an ESF is and there can be misconceptions.”

Once an ESF developer gets the go-ahead from the local jurisdiction to begin work, ALTSA works closely with the developer on the next steps.

“That relationship is huge for the actual development of the facility,” said Justin DeFour, HCS resource development program director. “It takes a long time and even longer now because of COVID, to get these up and running. There’s construction, there’s RCS licensing, there’s contracting. Having these partnerships with administrators makes that go a lot smoother and easier.”

These strong relationships ALTSA has with developers and local jurisdictions are crucial to providing a welcoming, supportive home to ESF residents.

We don’t have as many people going into nursing homes because they can get their needs met and be part of the community. I think that’s a really necessary service option available for our residents.

– Sandy Spiegelberg, HCS residential support program manager “It’s kind of like providing a team approach,” Sandy said.

“Our clients for the most part are coming from state hospitals, so if you think about our clients coming back into the community, we want to have strong services and supports for them at the ESFs. I think partnering closely with the ESF provider is so important because for the most part it’s new for them too. Helping them understand the importance of the transition really helps the clients.”

Snoqualmie Falls

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