HCS Highlights SUMMER 2020
ISSUE #3
BEA’S MESSAGE Governor Jay Inslee announced at the end of May his Safe Start plan for a gradual, phased reopening of Washington state. Since then, leaders at DSHS, ALTSA and HCS have been working hard to develop our reopening plan for how and when to resume normal operations. Although we do not have details as to what this will look like, we know that, like the governor’s plan, it will be slow, conscientious, and based on all the available information and data.
Bea Rector Director, Home and Community Services
We have been and will continue doing what we can to help reduce the risk of COVID-19 infection for our staff, providers and clients. As you probably saw in the message from Chief of Staff Don Clintsman, DSHS has made the decision to continue teleworking as our main mode of operation through December 31, 2020. If you are currently teleworking, you will continue to do so, and you should be teleworking if your job responsibilities do not require you to be in the office. We will continue to deliver our eligibility, assessment and service planning work remotely whenever we can while still meeting our business needs. At the same time, we will accommodate requests from clients seeking in-person assessments and will provide personal protective equipment for staff members who need to meet with clients face-to-face. We are distributing a one-time package of personal protective equipment to our individual providers and adult family homes, using funding from the Families First Coronavirus Response Act. Although we are still seeing high numbers of COVID-19 infections, we are beginning the process of crafting specific standards and guidelines around the re-opening of facilities and services. During this process, we are taking into account the feedback we’ve received, both informally and through surveys with our staff, providers and clients, about what is working well and what should be addressed. Counties are in very different places in terms of the prevalence and risk of COVID spread, but DSHS as an agency is looking at a state-wide approach to shifting back toward normal operations. In the meantime, you can stay updated on the current policies and best practices for our clients in facilities by reviewing the Residential Care Services provider letters. The ongoing furloughs present a challenge for all of us, as they are reducing the time we have to perform our critical work. With your teams, I ask all of you to prioritize your work and offer assistance where necessary to ensure we continue to meet the most pressing needs of our clients and providers. The COVID-19 pandemic will continue to affect our business operations, social interactions and home life for the foreseeable future. Your resilience and dedication will see us through this situation. I want to thank you for demonstrating, once again, why we are able to transform lives every day.
Bea Rector
CONTENTS 3
REGIONAL UPDATES
5
ADULT ABUSE AWARENESS
6
WELLNESS
9
COVID-19 RESPONSE
13 HIGHLIGHTING PARTNERSHIPS 15 HIGHLIGHTING HCS’S WORK
REGIONAL UPDATES UPDATES FROM REGION 1 When I look back at the last 3 months, I am reminded of why I choose to work in this amazing agency, DSHS/ALTSA/HCS-Region 1. I have seen resilience by all of our staff in one way or another as we have navigated COVID-19. Everyone has had to modify some part, if not all, of their work process to continue providing quality service to our clients. We have accomplished this TOGETHER!
Tami Rucker Region 1 Administrator
In early March 2020, the regions began working with HQ leadership in development of the Acute Hospital Surge Project. The goal of this project has been to increase discharges and reduce the length of stay for Medicaid clients in acute hospitals, which would help to increase the bed capacity for patients needing hospitalization due to COVID-19. This 90-day project began March 18 and ended June 18. I want to take this opportunity to recognize the excellent work on our regional planning, led by Valentina Karnafel and Jessie Rangel. Because of their coordination, collaboration, communication and team work, we got this project off to a great start and were able to develop our regional teams. The teams consisted of three acute hospital supervisors, seven acute hospital assessors, six surge leads (which include Public Benefits Program Manager Gary Olson), and 22 case managers who were willing and able to take on any role or responsibility asked of them to assist clients to transition from the acute hospital to the community-based setting of their choice. You know who you are – THANK YOU! We could not have done this work without the support and coordination that we have received from HQ leadership! In this short amount of time we have participated in policy/process updates related to acute hospital transitions. This amazing work will make a significant difference in our future processes, to reduce long lengths of stay for clients in an acute hospital after COVID-19 is long gone. It has enhanced our communications and collaboration with our acute hospital partners as well as contracted providers in community-based programs. I am pleased to share that in 62 days, as of May 18, the Region 1 Acute Hospital Surge team assisted 199 clients to transition from the acute hospital to their community-based setting of choice. As we have navigated COVID-19, staff have been flexible and creative in their process to communicate and coordinate with acute hospital discharge planners and other community partners. Thank you to our AMAZING staff for trusting the process, being a part of this project and demonstrating one more way that Home and Community Services transforms lives.
3
UPDATES FROM REGION 2 I continue to be amazed and impressed by regional staff in Region 2. In spite of the uncertainties of COVID, changed regulations, teleworking and distancing, staff continue to show up and show out in completing their assignments. I am eternally grateful for the acute care hospital staff who have discharged long-term clients into lesser care facilities. Region 2 had a client in the hospital for over 400 days and the hospital team was able to find appropriate placement for this individual. This is only one of many success stories.
Sonya Sanders Region 2 Administrator
Equally impressive, we have been discharging difficult-to-place clients from Western State Hospital during their surge as well and will continue to press forward to meet our goals. There is no rest for the weary as the nursing home units continue to assist with nursing facilities closures in the region. Within this past year, Region 2 staff members have assisted in several nursing facilities closures, with two more facilities on the horizon for closure. Our work does not show signs of slowing down. We encourage staff to stay home, stay healthy and practice self-care, while being faithful in complying with the mission and values of ALTSA and DSHS.
UPDATES FROM REGION 3 What a whirlwind the past few months have been, and at the same time it feels like time has slowly crawled by at a snail’s pace as we have stayed at home over the past few months.
Debbie Willis Region 3 Administrator
Even in tough times, there is a lot to be grateful for. I am grateful for the wonderful team in Region 3, especially as I have watched them work hard to support each other and continue to exceed expectations in the face of all of the change and upheaval. Here are just a few of the things we have implemented in record speed: • Full-time teleworking plan with the support of our awesome IT team • Hospital Surge – by the end of May, Region 3 discharged 703 clients, this equated to 49% of the total statewide discharges! • Western State Hospital surge started in April – the team helped 26 clients transition between then and the end of May! • Self-attestations • Telephonic CARE assessments • Numerous policy, procedural and process changes I anticipate that 2020 will continue to challenge us in many ways and I know that Region 3, as well as the rest of ALTSA, will rise to the challenge and continue to provide the services and supports our clients need, while also taking care of each other! That is what we do. I am grateful to work for ALTSA and with the wonderful people in Region 3 and the larger ALTSA team. Together we will continue to get through this and serve some of Washington state’s most vulnerable.
4
ADULT ABUSE AWARENESS
UNDERSTAND & RECOGNIZE ADULT ABUSE As mandatory reporters, it is essential for each of us to understand and recognize the signs of adult abuse so we can reduce the prevalanece through our assessment, care planning and provider qualification process. We all play a role in protecting vulnerable adults. Washington state has a rapidly increasing number of vulnerable adults. In 2019, Adult Protective Services (APS) received more than 70,000 reports of suspected mistreatments. The number of reports reflects a sharp increase from 60,000 reports in 2018 and 48,000 reports in 2017. Did you know that: Financial exploitation is the most common form of vulnerable adult mistreatment. According to National Adult Protective Services Association (NAPSA), 1 out of every 20 seniors has experienced financial exploitation in the recent past. Ninety percent of financial exploitation abusers are a family member or trusted individual to the victim. Talk with your family members, neighbors and loved ones about protecting themselves against financial exploitation. Having plans in place can help reduce the risk of misused funds. Self-neglect is the second most common form of vulnerable adult mistreatment. In 2019, APS received 12,139 reports of self-neglect. Self-neglect is general term used to describe a vulnerable adult living in a way that puts his or her health, safety, or well-being at risk. Signs include poor hygiene, inadequate clothing, not enough food, water or heat, and hoarding. By working together, we can help protect vulnerable adults. Simple things you can do to help protect others include: Checking in on neighbors, relatives and loved ones. Social isolation is often a contributor to abuse and neglect. Phone calls, letters, visits and use of technology are easy ways to stay connected. Spread the word. Tell others about the signs of vulnerable adult mistreatments and how to report suspected cases. Report. If you feel like something isn’t quite right, submit a report and APS will take care of the rest. As an employee of DSHS, you are a mandatory reporter. APS relies on mandatory reporters to be their eyes and ears. Report online or by phone at 1-877-734-6277 if you believe someone needs help. Visit the APS website for more information.
5
– Article by Amanda Williams
WELLNESS
6 WAYS TO BOOST YOUR BRAIN HEALTH Your mind is a terrible thing to waste – so make a commitment to keep yours active and healthy! Each summer, we honor Alzheimer’s and Brain Awareness Month, which is a perfect opportunity to make a commitment to boosting your brain health. By making some small, but meaningful, adjustments to your habits, you can keep your mind at the top of its game. If you want to learn more about Alzheimer’s or brain health, or if you want to help raise awareness this month, visit the Alzheimer’s Association of Washington website. KEEP YOUR BODY ACTIVE Research shows that exercising regularly may help reduce the risk of cognitive decline. Choose something that keeps you moving, like walking or water aerobics. Pair it with strength-building exercises for added benefits.
KEEP YOUR BRAIN ACTIVE Challenging your mind may also help reduce the risk of cognitive decline and dementia. So learn a new skill, try a new hobby or take a class!
STAY HEALTHY Prioritize eating well, sleeping enough and getting regular health check-ups. Eat plenty of fruits, veggies, whole grains and lean proteins, aim for 7 to 9 hours of sleep and make time for health-related appointments. FOLLOW YOUR HEART Evidence shows that risk factors for cardiovascular disease and stroke – obesity, high blood pressure and diabetes – negatively impact your cognitive health. Take care of your heart, and your brain just might follow. KEEP TABS ON YOUR EMOTIONAL HEALTH Practice self-care and keep in touch with others. An active social life may contribute to a healthy brain. If you are struggling with symptoms of anxiety or depression, seek help. STAY SAFE FROM BRAIN INJURY Brain injury may increase your risk of developing dementia or Alzheimer’s disease later in life. Protect your head by wearing helmets while biking, skiing and snowboarding and by wearing a seatbelt every time you’re in a car. Adapted from “10 Ways to Love Your Brain.” For more ways to boost your brain health, visit the Alzheimer’s Association.
6
COVID-19 RESPONSE
ACUTE CARE HOSPITAL SURGE COMES TO AN END On March 18, 2020, Home and Community Services implemented a statewide emergency plan focused on expediting the transition of individuals out of hospital care and into home- and community-based settings, including nursing homes. This “acute hospital surge,” as it was called, lasted through the end of June 2020 and accomplished several objectives, including: • Reducing the time to complete eligibility determinations and find transitional settings for clients. • Reducing the overall length of hospital stays for individuals referred to HCS. • Increasing the number of transitions out of acute care hospitals. These objectives were accomplished with the help of some time-limited resources that were appropriated for the purpose of quickly moving individuals who no longer have a need for acute care out of hospital settings to free up hospital beds during the COVID-19 outbreak. Although these additional resources will no longer be available moving forward, there are some things that will help us to continue to build on gains made during the surge, including the ability to conduct telephonic assessment, streamlined eligibility and self-attested disability, and new statewide policies for assessments and transitions. Through this process, we have also forged communication pathways with acute care hospitals that will remain in place going forward.
HOSPITAL SURGE: HIGHLIGHTS ASSESSMENTS COMPLETED
AVERAGE LENGTH OF STAY
24-72 HOURS
29%
CARE assessments were initiated and completed on average within 24 to 72 hours from the date of referral.
The average hospital length of stay for individuals who had a referral was reduced by 29%, from 55 days to 39 days.
INDIVIDUALS TRANSITIONED
LONG LENGTHS OF STAY
> 2,000 More than 2,000 individuals transitioned from acute care hospitals to community settings with assistance from HCS during the surge period.
7
14%
6%
Reduced the number of patients with lengths of stay greater than 100 days from 14% to 6% of clients with referrals.
Debbie Willis, Region 2 administrator, shared the following poem to celebrate the hard work of HCS employees in helping clients transition to community settings during the acute hospital surge.
TEAMWORK Attributed to Edgar A. Guest
It’s all very well to have courage and skill And it’s fine to be counted a star, But the single deed with its touch of a thrill Doesn’t tell the man you are; For there’s no lone hand in the game we play, We must work to a bigger scheme, And the thing that counts in the world to-day Is, How do you pull with the team? They may sound your praise and call you great, They may single you out for fame, But you must work with your running mate Or you’ll never win the game; Oh, never the work of life is done By the man with a selfish dream, For the battle is lost or the battle is won By the spirit of the team. You may think it fine to be praised for skill, But a greater thing to do Is to set your mind and set your will On the goal that’s just in view; It’s helping your fellow man to score When his chances hopeless seem; It’s forgetting self till the game is o’er And fighting for the team.
8
COVID-19 RESPONSE
RAPID RESPONSE
FROM THE ROSE ROOM
]
[
How the Long-Term Care Incident Management Team is leading ALTSA’s COVID-19 response
Most of ALTSA’s buildings remain nearly empty as most employees work from home. But each day for the last several weeks, the Rose Room of Blake East, at ALTSA’s Lacey headquarters, buzzes with activity. From this room, the Long-Term Care Incident Management Team (LTCIMT) oversees a fast-paced operation that is at the heart of ALTSA’s COVID-19 response. The LTCIMT has tackled many of the key challenges of addressing the COVID-19 outbreak in long-term care facilities. The team tracks critical data, helps coordinate communications and procures and disseminates critical personal protective equipment (PPE) and other supplies. Last month, the LTCIMT coordinated the collection and distribution of nearly 500,000 cloth face coverings to long-term care facilities, home care agencies and individual providers around the state.
“
We’re able to respond to the realtime needs of what’s happening within the long-term care arena. Time is of the essence when it comes to something like this. – Edgar Rivera, LTCIMT logistics chief
An incident management team is a management structure used nationwide to respond to natural disasters and other emergencies. The team works on-site to facilitate rapid response to emerging challenges and needs during an emergency. “We’re able to respond to the real-time needs of what’s happening within the long-term care arena,” said Edgar Rivera, logistics chief at the LTCIMT. Edgar recently stepped into the role of Organizational Development Manager at HCS, but temporarily is working full-time at the LTCIMT. “Time is of the essence when it comes to something like this. We’re talking about people’s lives and health. Trying to meet needs such as PPE is obviously a very huge part of this mission.” The LTCIMT is staffed mostly by ALTSA employees, along with a handful of contractors and DSHS employees. The incident commander is Sue Bush, who spent her career in emergency management and came out of
9
retirement to oversee this work. The LTCIMT manages six different branches of support: one each for ALTSA’s three largest divisions (APS, RCS and HCS), along with branches for distributing PPE, providing family support, and providing infection control training to long-term care facility staff. Among its major responsibilities, the LTCIMT tracks data on COVID-positive clients and long-term care facilities with COVID cases; supports families of long-term care residents with a website, call center and contracted family liaisons; and receives orders for and distributes PPE. Now that the team has finished distributing cloth face coverings, they are turning their focus to distributing PPE such as masks, gowns, gloves and face shields to adult family homes and individual providers. They also are taking steps to help control future infections. The recently established infection control branch will send volunteers into facilities without positive cases to teach about infection control and the proper donning and doffing of PPE. “I’m super thankful for the opportunity to be a part of this team,” said Dawn Williams, who is serving as operations chief in the LTCIMT. Dawn normally serves as a special executive assistant for HCS Director Bea Rector. “The LTCIMT is a structure put in place to keep everything moving forward. This way, we can all work together as a state to get something done.”
The LTCIMT at work: Distributing cloth face coverings The Long-Term Care Incident Management Team, or LTCIMT, coordinated the procurement and distribution of nearly 500,000 cloth masks to long-term care facilities, home care agencies and individual care providers around Washington. Two dozen volunteers from several agencies and the community spent three weeks preparing more than 50,000 shipments.
10
COVID-19 RESPONSE
PROVIDING CARE IN THE AGE OF COVID-19
How providers and clients are adapting to telehealth visits In an effort to reduce the spread of COVID-19, some of Washington’s long-term care, medical and behavioral health providers have switched to providing some, or even all, of their services remotely. In March, Home and Community Services directed most providers to offer services by phone or other technology, except in cases when services needed to be done in-person. Since then, many providers and clients have adapted to a new way of giving and receiving services. Shelly, a home care aide in Pierce County, said she’s gotten into good patterns with her clients. By doing some tasks, such as providing medication reminders, doing laundry, grocery shopping and cooking in her own home, she is able to cut in half the number of in-person visits with clients.
11
“The biggest help is having good clients you can work with who understand what is going on,” she said. Still, she looks forward to when she can see her clients more often. “It takes a lot of human interaction away,” she said. “In some ways it’s really nice, but some things would be easier going back to the old-fashioned way.” HCS client Sandy said she has found telehealth to be a useful alternative during COVID-19. She receives regular medication reminders and general check-ins by phone. Her caregiver cooks meals, does laundry in her own home and makes deliveries, while still visiting some days to perform tasks that can’t be done remotely. “It’s good and it served its purpose because of what is going on,” she said. “It is for their protection, it is for my protection.” Like Shelly, Sandy said she also misses some aspects of her in-person care. “Personally, I like the hands-on, face-to-face every day rather than on the phone,” she said. “Your caregiver is your right-hand, basically.” At Pathways of Washington, a behavioral health provider serving clients around the state, employees already had a strong basis for telehealth. The organization has been conducting virtual appointments with clients since well before the pandemic began, which made the transition to full-time telehealth easier. Pathways providers noted several positive changes that resulted from the widespread use of telehealth. Missy, a nurse practitioner at Pathways, said telehealth allows her to serve more clients and in a larger service area than she otherwise could. She also noted that as a psychiatric provider, telehealth allows her to respond to client emergencies much more quickly – and in some cases, within minutes.
“
It is for their protection, it is for my protection. – Sandy, HCS client
“I think it is an important utility in the underserved psychiatric population,” Missy said. “We can respond quicker and in the moment for better outcomes and serve this population that typically can go in between appointments for months.” There are some challenges, she noted. Some clients have poor or even no internet connection and some do not feel comfortable using phones or computers. In spite of these challenges, Missy is looking forward to using telehealth more, even after the COVID-19 situation has improved. “Telehealth is helpful in many ways,” she said. Clients may continue receiving telehealth care for the foreseeable future. Clients served under Community First Choice may access tablets and iPads under their assistive technology benefit. For more information, read Management Bulletin H20-062.
12
HIGHLIGHTING PARTNERSHIPS
PROTECTING CLIENTS, HELPING EACH OTHER: How HCS and RCS have partnered during the COVID-19 crisis
The COVID-19 public health crisis has pushed state agencies to develop new partnerships and strengthen existing ones in order to protect the health and safety of clients and employees alike. For Home and Community Services, one of the key partners for ensuring the safety of our clients is Residential Care Services. Both RCS and HCS serve clients in different ways, and when it comes to the COVID-19 outbreak, protecting clients requires even more close contact. “Even before COVID-19, we’ve had a really good relationship with RCS,” said Tami Rucker, HCS Region 1 administrator. “I think we communicate really well, no matter what is going on.” Recently in Region 1, RCS and HCS staff have had to work together to tackle the COVID-19 outbreak in Yakima, which has a large number of the state’s COVID-19 cases. In the case of one adult family home provider, who operated several adult family homes on a single property, RCS and HCS worked together to quickly determine whether the provider could meet the safety needs of clients and employees after several residents and staff members tested positive.
“
The partnership between HCS and RCS is so important because each of us have information to share that is beneficial in making quick and safe decisions for the clients we serve to protect. – Chana White, RCS Community Program Field Manager
RCS and HCS quickly determined the status of clients and, in the case of one client with significant needs, determined that her needs could not be met. They quickly found a space for the client at a nearby nursing facility, where the client will stay until it is safe for her to return to the adult family home.
13
“They’re looking at it from their perspective, and we’re looking at it from our perspective,” Tami said. “Together, we’re communicating on what the best thing for that client is.” RCS looks at situations from a regulatory perspective, determining whether a long-term care provider can meet regulations and licensing requirements to meet the needs of the clients they serve. HCS, meanwhile, determines from a client’s perspective whether a facility can meet the needs of an individual client, while supporting the client’s choice in where to live. “The partnership between HCS and RCS is so important because each of us have information to share that is beneficial in making quick and safe decisions for the clients we serve to protect,” said Chana White, Community Program Field Manager for RCS in the Yakima region. “The partnership made several recent situations that required quick action during COVID situations in facilities go smoothly and decreased the stress on the clients and providers.” During the COVID-19 crisis, HCS and RCS have used their unique roles to respond to COVID-19 cases in longterm care facilities. But they have partnered in other ways, as well. RCS, for example, has shared personal protective equipment with HCS when the supply for field workers ran low. They also share valuable data: RCS tracks cases in long-term care facilities, while HCS alerts RCS to COVID-positive clients who are living in those facilities. Together, by sharing information, they can more effectively address cases in long-term care facilities. “I think we’re really thankful we have this good relationship with RCS,” Tami said. “I don’t expect anything different, and I think we will continue to move forward from here. I think we may even build those relationships better than they were before.”
HCS & RCS: WHAT’S THE DIFFERENCE?
Home & Community Services HCS determines eligibility for Medicaidfunded services, assesses client needs, develops plans of care, authorizes payment, provides case management, and assists clients with transitions to qualified providers.
Residential Care Services RCS regulates residential facilities, investigates complaints and ensures provider practice meets regulatory requirements, regardless of a facility’s funding source.
14
HIGHLIGHTING HCS’S WORK
HCS PAYMENT TEAM
TAKES ON CHALLENGE OF ISSUING COVID-19 PAYMENTS TO PROVIDERS Each issue, we will highlight the work of one of our teams. This quarter, we’re taking a look at our payment team, which issues payments to our providers. In the wake of COVID-19, many of us at ALTSA have been challenged with finding innovative ways to support our clients and providers. For the HCS payment team, they faced the unprecedented challenge of figuring out how to disburse additional federal funding appropriated in state fiscal year 2020 to providers in ways that mitigate the impacts of COVID-19 – all on a much quicker timeline than usual. “It’s not as easy as it may appear to give money to the providers on the scale we were talking about,” said Alec Graham, Chief of the Office of Home and Community Programs. “It was millions of dollars in additional funding.” The additional money comes from a federal funding increase for Medicaid programs that was part of the Families First Coronavirus Response Act, or FFCRA. The payment team, with the support of others within ALTSA and across agencies, was tasked with not only disbursing the money but amending policies to govern the payouts. Typically, such a process would take months, but the team disbursed the FFCRA money within weeks. The team had the added challenge of making emergency policy amendments, carefully and within the parameters of the funding requirements, so HCS is not in the position of having to pay back much-needed money.
15
“It was one of those collaborative efforts,” Alec said. “It was in combination with a lot of staff who worked really hard at HCS, but also at the Health Care Authority and CMS. It was really an across-the-board effort.” The team developed a three-pronged approach that would offer muchneeded support to providers of longterm services and supports. First, they created a series of new pandemicrelated extraordinary service codes that would pay providers, particularly home care agencies and in-home providers, for all the extraordinary measures they have had to take in response to the pandemic. This might include increasing staffing and paying for additional cleaning supplies and PPE.
“
It’s not as easy as it may appear to give money to the providers on the scale we were talking about. – Alec Graham, Chief of the Office of Home and Community Programs
Second, they developed a retroactive rate increase for providers, such as home-delivered meal providers, who have seen a sharp increase in demand for their services, or who have been called on to a greater extent than before, but who needed funds to grow their capacity. Finally, they created retainer payments to providers who were dramatically negatively affected, such as adult day service or adult day care providers and all the residential providers who lost clientele. The payment team created a retainer payment that would “hold” the spot for clients who are not currently receiving services due to the pandemic, allowing providers to maintain their operating expenses and employees, while also meeting increased demands for staffing and equipment. Although this round of payments has been disbursed, the team has a new challenge ahead. The Office of Financial Management and the state legislature have approved the use of increased federal match funding for July-September to support increased rates and retention payment for some providers. The payment team is in the process of determining what those rate add-ons will be and working to implement those payments.
16
THERE IS NO EXCUSE FOR ADULT ABUSE SEE. STOP. REPORT. June is Adult Abuse Awareness Month Neglect, self-neglect or physical, sexual, mental and financial abuse is not always obvious. Help protect our vulnerable adults and report suspected cases to Adult Protective Services (APS). Call 1-866-END-HARM or visit www.dshs.wa.gov/altsa/reportadultabuse to report suspected abuse or neglect.
15