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FOOTHILLS GATEWAY, INC. SUPPORTED LIVING SERVICES ANNUAL REPORT

Submitted by: Pat Carney, Foothills Gateway SLS/CES Coordinator July 2007– June 2008


TABLE OF CONTENTS

Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 1 Accomplishments……… . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 1 Statistics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 2 Services and Supports………………………………………………………..… Page 3 Employment: Community Integrated. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 5 Non-integrated Employment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 5 Community Accessibility. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 5 Dental Services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Page 6 Environmental Engineering Home Modification. . . . . . . . . . . . . . . . . . . . . . . . . .Page 6 SLS Sponsored Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 7 Terminations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 7 Number of Participants by Agency/Independent Contractor. . . . . . . . . . . . . . . . . Page 7 Financial Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 8 Goals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 9 Results of Family Satisfaction Surveys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 10 Results of Consumer Satisfaction Surveys. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Page 18


Mission Statement and Philosophy Supported Living Services are intended to assist persons with developmental disabilities to live in their own homes or continue to live with their families in order to promote “independence, inclusion and self-sufficiency.” The focus of these services and supports is to provide an avenue for developing inclusion and connection into the community and to assist persons to increase interdependence, responsibility and choice-making so that their lives are further enhanced and they become a contributing member of their community.

Introduction The purpose of this report is to provide an overview of the statistics, expenditures and performance of the Foothills Gateway Inc., Supported Living Services during the 2007-08 fiscal year.

Summary of Accomplishments for 2007-08  Completed SLS supports intensity scale assessment sample  Conducted monthly health and safety classes for SLS clients  Continued person-centered planning through supported living consultation services  Facilitated rights, sexual advocacy and first aid/CPR classes for SLS clients  Met all contract benchmarks  Quarterly parent forums  Increased overall client satisfaction  Met all identified health and safety needs for participants enrolled in program

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Statistics: The goal of Supported Living Services is to address the needs of a diverse population of individuals with developmental disabilities. In Larimer County, SLS serves both the young and the elderly and a range of those able to live independently to individuals requiring a great deal of assistance with every aspect of life.

 Age 1. Average: 2. Range:

38 years 18-93 years

 Sex 1. Male: 2. Female:

48% 52%

 Total participants served during FY 07-08: Medicaid Waiver: 195 State Funded SLS: 76 Total: 271 Unduplicated Total: 268* *Adjusted for clients enrolled in both the Medicaid and State SLS programs during the year

 Living Arrangements Percentage 07-08

Family members: 143 Alone: 67

53% 25%

With a roommate with developmental disabilities: 20

7%

With a roommate without developmental disabilities: 13

5%

Nursing Home: 12 Assisted Living: 9

4% 3%

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 HUD subsidies FY 07-08: 52 (52% of those living alone or with a nonrelated roommate  HUD subsidies added FY 07-08: 6  Clients living in personally owned homes FY 07-08: 23 (23 % of those living alone or with a roommate)  Clients in HUD home-buying program FY 07-08: 8

SERVICES AND SUPPORTS Supported Living Services offers a wide variety of services and supports. These supports are geared to meet the individual needs of all participants. The graph below illustrates the distribution of the money according to the defined Supported Living Services billing categories.

Expenditure By Category Personal Assistance Dental

Supported Transportation, Employment, 7.30% 6.10% Professional, 1.10%

Habilitation Services Professional Supported Employment

Habilitation Services, 34.70%

Assistive Tech/Home Modifications, 1.10%

Personal Assistance, 49.60%

Transportation Dental, 0.10%

Employment: Community Integrated

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One of the objectives of SLS is to encourage participation in meaningful employment. Foothills Gateway SLS offers support to clients in finding and maintaining community integrated employment.  Number participating in SLS funded community employment programs FY 06-07 FY 07-08 Change Medicaid: 64 (34% of MW part.) 56 (29% of MW part.) State: 25 (32% of State part.) 21 (28% of State part.) TOTAL: 89 (35% of part.) 77 (28%) -7%

 Number participating in SLS funded community employment working during FY 06-07 Medicaid: 51 (91% of participants receiving Medicaid funded community employment services) State: 22 (100% of participants receiving State SLS funded community employment services) TOTAL: 73 (95% of participants receiving SLS funded community employment services)

 Total hours of SLS funded community employment worked by participants

--Medicaid: --State: --TOTAL:

FY 06-07 28,007 19,826 47,833

FY 07-08 32,594 19,473 52,067

 Total hours of SLS funded community employment support

--Medicaid: --State: --TOTAL:

FY 06-07 8,854 2,911 11,765

FY 07-08 10,526 3,033 13,559

 Ratio of hours supported to hours worked Medicaid: .32 (for every hour worked, 19 minutes of support were provided) State: .16 (for every hour worked, 10 minutes of support were provided) TOTAL: .26 (for every hour worked, 16 minutes of support were provided)

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 Average/total number of hours worked: 13.72 hours/week  Average wage:

$7.05/hr

Employment: Non-integrated While it is the philosophy of Foothills Gateway Supported Living Services to integrate each client into the community as possible, it is also true that not all participants are able or desire community employment. For these participants, Foothills Gateway SLS offers non-integrated employment. Primarily site-based assembly work, non-integrated employment offers work opportunities in a supervised setting.  Number of participants in non-integrated work

Medicaid: State: TOTAL:

FY 06-07 28 (15% of MW part.) 8 (10% of State part.) 36 (14% of SLS part.)

FY 07-08 27 (14% of MW part.) 8 (11% of Stat part.) 35 (13% of SLS part.)

Change

-1%

 Number of non-integrated hours worked Medicaid: State: TOTAL:

FY 06-07 16,894 9,241 39,647

FY 07-08 19,660 8,483 28,144

Change

-29%

 Average/total number of hours worked: 15.46 hours/week  Average wage: $2.20/hr

Community Accessibility In an effort to foster integration into the Larimer County community, Foothills Gateway offers supported community accessibility. Achieved in both individual and group settings, community accessibility supports the individual in developing new relationships with both peer and non-peer groups.  Number of SLS participants receiving community integration supports FY 06-07 FY 07-08 Change --Medicaid: 130 (69%) 125 ( 64%) --State: 42 (54%) 46 (61%) --TOTAL: 172 (65 %) 171 (64%) -1%

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 Hours of community integration supports

--Medicaid: --State: -- TOTAL

FY 06-07 19,430 hrs. 9,241 hrs. 28,261 hrs.

FY 07-08 34,839 hrs. 11,136 hrs. 45,975 hrs.

Change

+61%

 Number of SLS participants receiving community integration supports and not enrolled in an SLS funded supported integrated or non-integrated employment program or working FY06-07 FY 07-08 Change --Medicaid: 57 (30%) 69 (35%) -- State: 22 (28%) 25 (33%) --TOTAL 79 (30%) 79 (29%) -1%  Average number of hours of supported community accessibility per week FY 06-07 FY 07-08 Change --Medicaid: 2.87 5.36 --State: 4.23 4.66 --TOTAL: 3.21 5.17 +61%

Dental Services: During the fiscal year 2007-08, Foothills Gateway Supported Living Services spent $6,402 on dental services that are directly related to an individual’s disability. The program strives to encourage individuals to use low-cost dental services.

Environmental Engineering: During the fiscal year 2007-08, Foothills Gateway Supported Living Services spent $30,683 for adaptations and engineering to improve the quality of life for SLS participants. The expenditures included:  Van wheelchair lift installation  Bathroom Remodel  Emergency response services: 6 participants  Automated pill dispenser

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SLS SPONSORED ACTIVITIES     

Men’s Group Women’s Group YMCA Weekend Getaway Full Power Self-Advocacy Training Sexual Assault Victims Advocacy Trainings

TERMINATIONS Death: Transfer to Comprehensive Services: Transfer to another county: Move out of state: Voluntary termination: Transfer from Medicaid to State funding: Transfer from State to Medicaid funding: Loss of Medicaid funding: TOTAL

5 10 1 4 4 1 3 0 27

NUMBER OF PARTICIPANTS BY AGENCY/INDEPENDENT CONTRACTOR Program Approved Service Agencies: Altra Carmel Community Living Center for Community Participation Community Advantage Foothills Gateway Good Shepherd Mosaic REM Colorado Spectrum WINGS Independent Contractors: Access Advantage Adam’s Family Alpha Excellence Assisted Independent Living BoSox Caring By Karen

Participants: 1 19 25 17 141 23 37 9 24 28 Participants: 10 9 1 3 1 1

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Compassionate Care Considerate Care DianeCo Larksong Rise FRED GEAR Solutions Golden Wing HLS Services Hughes Services Jirah Karen Cares Independence Works Individual Solutions JAZ Quality Care Life Works Caregiving Loveall Services Loving Hands Mariposa Lily Mike’s Place OBCO Owl Canyon REACH RFD Support Services SKP SLJ Spears Respite Star Services Successability Sunray Services Trailhead Variations for People with Disabilities Zion

4 6 1 1 1 1 1 1 1 1 1 2 2 6 3 11 1 1 1 1 5 1 7 1 5 5 1 1 2 2 2 2

FINANCIAL INFORMATION  Contract Billed/Available FY 06-07 --Medicaid: $2,135,685 --State: $571,385/$439,684 (130%) TOTAL: $2,707,070

FY07-08 $2,425,101 $598,179/$498,956 (120%)*

Change +12% +4%

*excess $99,223 billed was funded with local dollars

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 Percentage Dollars Used/Allocated: FY 05-06 --Medicaid: 89% --State: 90% TOTAL: 89%

FY 06-07 92% 87% 91%

FY 07-08 87% 96% 86%

Change

FY 06-07 $13,364 $8,828

FY 07-08 $14,910 $10,744

Change +12% -22%

-5%

 Average Plan Cost --Medicaid: --State:

FY 05-06 $13,170 $ 9,109

Goals for 2008-09:  Continue to develop ongoing programs promoting relationship building and sexual health.  Continue to integrate self-determination goals into existing services.  Increased attendance at monthly health and safety classes.  Increased family and client satisfaction indicators  Present system changes to families, clients and families and work towards a smooth transition.

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RESULTS OF FAMILY SATISFACTION SURVEYS FISCAL YEAR 2007-2008 Introduction All families (parents/ guardians/relatives) listed as a primary contact for the individuals receiving services from Supported Living Services (SLS) were encouraged to provide their feedback on the services received by completing and returning a survey. The survey was mailed in July 2008, and 85 of the 244 surveys mailed were completed. This means that more than 3 out of every 10 families (35%) provided feedback. The questionnaire consisted of three parts: Part One asked five questions that addressed the following areas of an individual’s quality of life: 1. 2. 3. 4. 5.

Community Participation, Choice, Relationships, Safety and Development of Independence.

Part Two consisted of five questions that focused on the families’ satisfaction with the staff involved in various services. The areas covered were: 1. 2. 3. 4. 5.

General Satisfaction with the Particular Service, Communication Style, Follow-through, Information on Progress Made, as well as Level of Skills and Competencies Manifested.

Questions were asked separately for each service and, to help parents identify the service, the name of the person or the agency providing the particular service was written alongside the service (e.g., Case management –Chelsea at Foothills Gateway).

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Part Three focuses mostly on the families’ knowledge of the program as well as families’ receipt of the dispute and grievance procedure and receipt of client rights.

The last question was open-ended and asked for suggestions to improve the SLS program. The survey also encouraged families to address any other areas not covered by the questionnaire.

Families were asked to rate their satisfaction using the Likert Scale with numbers from 1-5. The ratings are interpreted as follows: 1=Not at All Satisfied, 2=Poorly Satisfied, 3=Somewhat Satisfied, 4=Satisfied and 5=Highly Satisfied. Families were also asked to provide their comments following each question. The average rating will be presented as an indicator of program satisfaction.

Main Findings

Overall Satisfaction

The Overall Satisfaction Index was calculated as the average of all ratings of all questions of the completed surveys. It was 4.5, which indicates high satisfaction with the SLS program. If converted to the traditional school grading system, this is a grade of “A” (92%). This is a slight decrease from the previous year’s score of 4.59.

The range of individual survey rating of overall satisfaction (which is the Individual Family Satisfaction Index) is from 1 (which may be interpreted

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as Not at All or Poorly Satisfied) to 5.00 (which is Highly Satisfied). More than half of the families (n=48, 56%) have satisfaction indices above 4.50. This is interpreted as Very Satisfied. Additionally 82% of the surveys have satisfaction indices of over 4.00 or Satisfied. Seven (7) surveys (i.e., 8% of the total) have a Satisfaction Index less than 4.00 (or below Satisfied). Families Perception of Quality of Life

This section received a Satisfaction Index of 4.4, which indicates general satisfaction. If converted in the traditional school grading system, this is a grade of “B+“ (88%).

Again the area that received the highest rating was Safety (average=4.74). This is a grade of “A” (95%).

The areas that received the lowest rating were the Opportunity to develop and maintain relationships (4.34 or 87%) and Opportunity to be part of the Community (4.3 or 86%). These are both a grade of “B” (85%) and are still well in the Satisfied range. Both these areas show improvement from the prior year survey.

This figure presents the ratings for all aspects:

Quality of Life Comparison 4.9 4.8 4.7 4.6 4.5 4.4 4.3 4.2 4.1 4

FY 06-07 FY 07-08

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Families Perception of Quality of Care 

This section received a Satisfaction Index of 4.5, which indicates high satisfaction. If converted in the traditional school grading system, this is a grade of “A-“(90%).

The highest rated components was the Ease of Communication and Skills and Competencies (average = 4.6) receiving a traditional school grade of an “A” (92%).

Ongoing Information to Parents was rated a 4.4 (88%) This rating was in the region of Highly Satisfied.

The following figure provides information for every aspect and illustrates the differences:

Quality of Care 5 4.9 4.8 4.7 4.6 4.5 4.4 4.3 4.2 4.1

Series1

Supported Living Consultation (SLC) received a high rating again this year (4.57 a school grade of “A“). This is in the region of “Very Satisfied”.

All the results for Case Management services are good overall, with an average rating of 4.56 (91% satisfied).

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The overall satisfaction index for Team Leaders was 4.63, or a traditional grade of “A“(93%). This is an increase from last year’s average of 4.52.

Personal Assistance Services (PAS) providers decreased their ratings this year with an average of 4.39. Again all the average ratings for the different aspects of this service are above Satisfied.

The Activities/Work Program received an overall rating of 4.38 (“B+”).

Overall, independent contractors scored lower than program approved agencies. Families rated independent contractors 4.26 and program approved services agencies 4.47.

Families’ Knowledge of the SLS Program 

This section received a Satisfaction Index of 4.4, which indicates general satisfaction. If converted in the traditional school grading system, this is a grade of B (88%). This is number remains unchanged from the 06-07 Family Satisfaction Survey. In regard to separate programs/supports, families rated all the following in the Satisfied range. Understanding of Supported Living Consultation, (average=4.38), Activities /Work Program (average rating =4.29), Case Management (average rating = 4.41), Team Leader (average = 4.49) and Personal Assistance Services (average= 4.41).

Families were asked if they had been informed of the rights of their child. The average rating for this question was 4.72.

Families were asked if they had been informed of the complaint/grievance procedure and the dispute resolution procedure, instead of the understanding of each. Families rated each aspect 4.65 and 4.62 respectively.

Families rated the overall effectiveness of Supported Living Services 4.53.

Comparison with Last Year’s Results

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The following table presents the data for both years and the differences:

Return rate Total Satisfaction Index Satisfaction Index of Consumers’ Quality of Life Satisfaction Index of Quality of Care Knowledge of Program/Particular Services

2007 36% 4.59 4.48 4.49 4.4

2008 35% 4.50 4.40 4.50 4.40

Please see the following table for more specific data for the primary services/supports for both years as well the differences:

Program/Support

2007

2008

Difference

Case Management Team Leader SLC PAS Activities/Work Program

4.58 4.52 4.55 4.58 4.45

4.56 4.63 4.57 4.39 4.38

-.02 +.11 (+2%) +.02 -.19 (-4%) +.07 (-2%) (+(.(+3%)

TRENDS These trends have been prepared with data from the surveys administered in years 2002 through 2008 (for Fiscal Year 2007-08).

Trend of Overall Satisfaction Index

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Overall Satisfaction Index 4.65 4.6 4.55 4.5 4.45 4.4 4.35 4.3 4.25 4.2 4.15 4.1

4.58 4.49

4.51

4.48

4.5

4.378 4.29

FY 0102

FY 0203

FY 0304

Series1

FY 0405

FY 0506

FY 0607

FY 0708

Trend of Families’ Perception of Individual’s Quality of Life

Quality of Life 4.6 4.5 4.4 4.3 4.2 4.1 4

4.46

4.48

4.42

4.45

4.38 4.24 4.16

Series1

FY 01-02 FY 02-03 FY 03-04 FY 04-05 FY 05-06 FY 06-07FY 07-08

Trend of Families’ Perception of Quality of Care

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Quality of Care 4.6

4.58 4.55

4.55

4.55

4.49

4.5

4.46

4.45

4.45 4.37

4.4

Series1

4.35 4.3 4.25 FY 0102

FY 0203

FY 0304

FY 0405

FY 0506

FY 0607

FY 0708

Trend of Families’ Relevant Knowledge

Relevant Knowledge 4.45 4.4 4.35 4.3 4.25 4.2 4.15 4.1 4.05 4 3.95

4.4

4.4

4.4

4.36

4.12

FY 0102

4.12

FY 0203

FY 0304

4.14 Series1

FY 0405

FY 0506

FY 0607

FY 0708

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RESULTS OF CONSUMER SATISFACTION SURVEYS FISCAL YEAR 2007-2008 Introduction All individuals receiving services from the Supported Living Services (SLS) were encouraged to provide feedback on their services by completing a questionnaire either by themselves or with assistance from family or staff. Surveys were completed in the period July 2007 through June 2008. All surveys were completed prior to each individual’s Individualized Plan. The total number of surveys entered in the database and analyzed was 206.

The questionnaire consisted of different sections, each section focusing on one main area such as: community inclusion, choice, and health and safety. The questions asked for yes/no responses, with yes acknowledging a positive experience. At the end of each section, space was provided for comments. Only the yes and no responses were considered valid and the average percentage reported was calculated based on them.

Main Findings

Community Inclusion: An average of 82% of responses is positive, indicating good community inclusion. This number is higher than last year, and results of the survey indicate that SLS clients are participating in a variety of different activities in the community. The lowest scoring question in this section was “Would you like to know more things to do?” Forty eight (48) percent of clients indicated that they would like to have more information about community activities.

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Choice/Self-determination: Most of the responses, an average of 88.8%, are positive, indicating that SLS participants are given choices in regard to residence, employment, entertainment, routines and the services they need in SLS, day program and transportation. Additionally, 95% of individuals feel they choose activities they would like to participate in most of the time. When asked if they get to choose the supports that they need, individuals responded positively 98% of the time. The majority of the clients (98%) also replied that they chose the staff that supported them. When those participants not currently working were asked if they would like to work, 50% responded they would.

Health and Safety: An average of 92% of clients responded positively in this section. This means that individuals are feeling safe in their homes, neighborhoods, and activities/work programs. Of those surveyed, 98% feel they know someone who can help them in case of an emergency or when they are sick. The lowest indicator of feeling safe is reflected in the 35 percent of the clients surveyed felt worried that something may happen to them.

Rights: This section had an overall average of 79% or a “C+” grade. Of those surveyed, 75% of individuals positively rated their knowledge of who to contact to change their services. Additionally, 90% indicated they had knowledge as to how to make a complaint to if needed. This section improved significantly in 2008. Finally, 72 percent of clients report that they received a copy of their rights during 2007-08.

Communication: The majority of valid responses, 99%, indicate that individuals feel that they can communicate well with staff. Staff is available when an individual feels they need to speak with them.

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Additionally, individuals feel they are getting the help they need from their staff.

Relationships: Of the participants surveyed, 95% of individuals feel they have someone they can talk to and get advice from if needed. Ninetythree (93) percent of individuals feel they are able to be with their friends when they want. Of those surveyed, 41% indicated they would like help making new friends. In 2007, 82% of responding individuals felt they saw their family as often as they would like. The number of positive responses for 2008 was also 82%.

Quality of Life: An average of 93% responses indicates that individuals liked where they were living. All (100%) of clients were satisfied with their day program, and the amount of time they spent at the day program. Additionally 99% of individuals indicated they are happy on most days. All the individuals responded their staff is nice to them (Case Managers, Team Leaders, SLCs and Activities/Work Staff).

Transportation: Transportation needs of the individuals in SLS are well met: the average of positive responses is 93%.

Service Coordination/Case Manager at Foothills Gateway, Inc. : The average percentage of positive responses is very high: 99%.

Supported Living Consultation: All (100%) of clients were satisfied with their supported living consultant. One hundred (100) percent of the clients responded that their SLC is nice to them.

The following table summarizes all results: Section of Questions Respect/rights Health and safety Service coordination Transportation Communication Choice/self-determination

Average Percentage of Positive Responses 79% 92% 99% 93% 99% 89%

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Community inclusion Quality of life Relationships

82% 99% 87% 90%

Total



The following table summarizes the main data for seven years.

Section of Questions

Average Percentage of Positive Responses FY 01-02

FY 02-03

FY 03-04

FY 04-05

FY 05-06

FY 06-07

FY 07-08

Community inclusion Choice/self-determination Health and safety Respect/rights Communication Relationships Quality of life Service coordination

92% 97% 98% 98% 99% 94% 95% 97%

96% 96% 99% 99% 96% 92% 94% 97%

83% 92% 93% 81% 97% 88% 86% 95%

86% 87% 91% 81% 95% 79% 91% 98%

87% 86% 92% 85% 98% 85% 91% 99%

79% 90% 91% 81% 98% 79% 98% 97%

82% 89% 92% 79% 99% 87% 99% 99%

Annual average percentage

96%

96%

91%

90%

91%

89%

90%

Percent Satisfied

Overall Satisfaction (7 Year Comparison) 98 96 94 92 90 88 86 84

96

96 91

90

91 89

90 Series2

FY 01- FY 02- FY 03- FY 04- FY 05- FY 06- FY 0702 03 04 05 06 07 08 Year

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Acknowledgments: Thank you to:  Debbie Lapp, Director of Resource Coordination and Development  April Rikhoff, Community Outreach Coordinator  Ed Bowers, Database Administrator for their assistance in preparing this report.

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SLS 2007-08 Annual Report  

SLS 2007-08 Annual Report