Download
1 / 39
E N D
AN OVERVIEW OF COMMUNITY RESIDENTIAL SERVICES Supported Living & Group Home 101
History of Alpha Supported Living Services • The Alpha Home Established in 1974 • Founded by parents of individuals with a developmental disability • Merger with Spring Meadow in 1998 • First supported living home in that same year • Merger with Seattle Specialized in 2007 • Merger with Residence East in 2008 • Separate branches created • Offices merged into one location in Bothell in 2013
Current Agency Statistics Serve 113 people in the residential program 98 individuals served in supported living program 14 individuals served in the two group homes 1 person served on a private pay basis Representative payee program Serve approximately 45 people not served residentially by the agency Another 12 payee clients are pending with Social Security Alpha Bookkeeping Provide bookkeeping services for other like agencies Community Access Services Currently serve 3 people with plans to expand to 20 this year
Overview of the Waiver Services • What is a Waiver? • A waiver represents that an individual’s right to live in an institution has been “waived” and they choose to live in the community instead • There are currently four waiver programs • Basic Plus • MPC or • Adult Family Home • Core • Supported Living • Wide range of services • Community Protection • Supported Living for those with Community Protection issues • CIIBS • Children’s Intensive In-home Behavioral Support
What is Supported Living (Core Waiver) • Supported Living is one of several models of residential services provided in the community • In Supported Living, the individual owns or rents their own home, and the agency provides services in the client’s home • The individual pays for their own groceries, utilities, and other bills – just like you and me
Supported Living Services • Certifiedon a biannual basis • Full range of support services provided by agencies certified by RCS and contracted through DDA • Groups of 2- 4 people living together and sharing services in their own or rented home • Some single-person homes – typically due to challenging behaviors • Shared amongst housemates are 1 to 24 hour/day supports provided in participants’ own home according to needs of the individuals • Approximately 3,800 people are supported in all of the Supported Living programs • This includes approximately 450 served in Community Protection programs
Group HomesAssisted Living Facilities • Contracted through DDA and licensed by Aging and Disability Services. • Small 6-8 person homes in the community owned by the agency • Provide services similar to supported living • Must comply with additional boarding home requirements • 281 people reside in these programs
RHC’s & SOLA – Residential Habilitation Centers and State-Operated Living Alternatives • 4 RHC’s provide a full range of support services through state employees • Fircrest in Shoreline 206 people • Rainier in Buckley 344 people • Lakeland in Medical Lake 209 people • Yakima Valley School in Selah 84 people • 843 people reside in the RHC’s • 31 of these are respite placements • Washington used to have six RHC’s • Francis Hadden Morgan Center in Bremerton closed in 2011 • Interlake School was closed by the legislature in 1994 • SOLA’s, (small two to four person homes in the community) provide a full range of support services through state employees • 127 people receive SOLA services
How does Washington compare to other states with regard to providing community-based services? • As of this year • 12 states have no individuals with developmental disabilities in state institutions • 18 states have less than 100 individuals in state institutions • 31 states have less than 500 individuals in state institutions • Washington has 843 individuals living in four state institutions • Washington has the 14th highest number of people with developmental disabilities in state institutions per capita in the nation • Taken from The Case for Inclusion 2013 (data from the Research & Training Center on Community Living)
Almost 15 years after the Olmstead decision, many people with developmental disabilities are not afforded the right to live in the community. “Unjustified isolation, we hold, is properly regarded as discrimination based on disability.” - U.S. Supreme Court Justice Ruth Bader Ginsberg, writing in 1999 for the majority in Olmstead v. L.C. & E.W. • In Washington, 843 people with developmental disabilities continue to live in state institutions • Approximately 14,000 enrolled clients of DDA do not receive any paid services • Spending per capita for Developmental Disabilities ranks Washington 39th in the nation • Taken from The Case for Inclusion 2013 (data from the Coleman Institute) • The waiting game continues
Many of the people served in supported living have previously lived in state institutions
Supported living agencies serve people with challenging and assaultive behavior, specialized communication needs, and intensive medical needs
SERVICES IN SUPPORTED LIVING & GROUP HOME PROGRAMS • What services are provided • How services are determined
What services are provided? • Services are individualized and are based upon client need • Each client’s support needs will be outlined in the agency’s IISP • The IISP is an agreement between the agency, the client, and the client’s guardian about how the supports will be provided • It is based upon needs outlined in the DDA Assessment • The IISP is updated annually • Guardians and other interested parties are included in the meeting
What services are provided? • Supports will cover a wide-range of services, including: • Home Living • Community Living • Lifelong Learning • Employment activities • Health & Safety • Social Activities • Protection & Advocacy • Medical Supports • Behavior Supports • Individualized Goals are then developed
Goals and supports uphold the Residential Service Guidelines • Competence • Health & Safety • Integration • Relationships • Power & Choice • Status
What other services are provided? • The agency can assist the person access other services through the waiver, such as: • Therapies • Employment/Day Program Services • Skilled Nursing • Mental Health Stabilization • Environmental Accessibility Adaptations • Specialized Medical Equipment
RELATIONSHIP BETWEEN PARENT/GUARDIAN AND THE AGENCY • How services are different from his/her parents’ home • We are on the same “team” • Different levels of involvement • Establishing lines of communication • Various decision-making
How supports might be different from the parents’ home Parents’ Home Supported Living Setting • Can set a bedtime • Can restrict TV viewing • Can require chores • Diet • Can have token system for completing tasks or good behavior • Encourage bedtime • Encourage certain programs on TV • Create household task list • Encourage proper nutrition • Token economy not permitted without ETP
What if family methods work but we are not allowed to use them? • Use less restrictive options • Work with family to create options • Develop a functional assessment and positive behavior support plan • Utilize Right Response for challenging behaviors • Request an Exception to Policy (ETP) or Exception to Rule (ETR) • Requires approval of DDA Regional Administrator or Director
Team Approach • All advocating for the best life of the individual being served • Some parents have been required to fight for services for most of life • Work together – gaining your trust
Levels of Involvement • Some parents/ guardians are very involved • Some are active in the person’s life, but see the individual on a monthly basis • Others see the individual around holidays and at the IISP • Many of those served have paid guardians and/or no family involvement • These levels of involvement will greatly impact the type of communication
Landlord • Alpha Supported Living Services is the service provider • Landlord is typically another entity/party • Other non-profit housing provider • Parkview – 8 homes • IERR – 5 homes • Foundation for the Challenged – 4 homes • Apartment complexes (Section 8 may be involved) – 13 units • Parent/Guardian owned homes – 2 homes • Other landlords – 2 homes • Alpha has done considerable work to obtain affordable/ subsidized housing for the individuals served • Responsibility for repairs is the client, the landlord, or DDA • Alpha can assist with negotiating responsibility • Client and/or guardian will sign the lease • ASLS is the landlord for the two group homes and Fountain
THE COST OF SERVICES & AGENCY STATISTICS • What services cost in the various sectors • How reimbursement rates are determined for community providers • What has been the impact of the recent budget cuts
Average Daily Cost of Current Residential Services • Supported Living and Group Home Services • $229 per person per day • Paid for through contract with DDA via the waiver • Note: Alpha average is $284 per person per day • SOLA • $322 per person per day • State Institutions • $573 per person per day State Institution costs include vocational, some medical services, and IMR tax. These services are purchased separately by community program participants through Medicaid or with other funding through DDA or DVR. Most medical costs are billed to Medicaid in the community.
How client rates are determined in Supported Living • Each client has an assessment, which includes the Support Intensity Scale (SIS) • From this a service level is determined that provides parameters around the level of staffing hours needed • Levels 1 through 6 • All but three current clients receive in-home overnight support • Rate setting (Economies of Scale) meeting is held to determine the number of hours needed for each person in a household, which is based upon the assessed need. • In addition, the household configuration and the total “pool” of staffing hours for the household are considered.
What comprises the daily rate for clients in supported living • ISS Hours Per Day • Includes Direct Support Professionals, Program Coordinators, Program Supervisors, Financial Services Supervisors, Healthcare Supervisors, Trainers, Client Services Manager, Clinical Manager, Branch Directors etc. • Benchmark • Professional Services (for a limited number of rates) • Transportation • Indirect Client Support/Administrative Rate
Each client has a contracted rate based upon “need” • From the Economies of Scale meeting, the number of staffing hours is determined (ISS Hours) • This is multiplied by current benchmark rate • The Indirect Client Support/Administrative rate is taken from a standardized table based upon daily hours and service area (Rural, MSA, and King County) • Transportation rate is determined based upon estimated miles driven for the client. • Other professional service rates can be added into the rate when determined necessary • Examples include skilled nursing and interpreters • All these rate components are added together to provide the total client rate
How did the budget cuts impact supported living and group home providers? • Cuts were applied to the benchmark • 3% in 2009 • 1% in 2010 • Average of 3.4% cut was applied to the ICS/ Admin Rates The benchmark had never been decreased before by the legislature
What will it cost to “fix” the ICS/Administrative Rates? • Came about as response to JLARC report • With recent budget cuts, 95% of all agencies are now funded below the rate standard • To bring all agencies to the standard while holding harmless those above the standard • $2.08M GF-S for the next biennium
How do Alpha ICS/Administrative Rates compare to the standard? • As an agency, we are currently funded 5.76% below the standard • Supported Living = 4.18% below the standard • Group Homes = 13.76% below the standard • As an agency, we are “underfunded” by approximately $100,000 annually • Supported Living: clients underfunded by average of $617 per client per year • Group Homes: clients underfunded by average of $2,819 per client per year • The two group homes account for 39.5% of the “underfunding”
Turnover & Wage Data How do low wages impact staff turnover? Note: Turnover for West Branch = 10.2%, East Branch = 27.3% Starting wage for Direct Support Professionals raised to $11.40 January 2014
How direct support expenses are funded • The contract with DSHS is supposed to pay for all direct support wages and benefits • Funding supplemented • Shift Administrative Funding • Fundraising & Development • Benefits • Lowers turnover • Greater Continuity of Care • Average annual cost per client • $103,873 per client per year • Contract pays for $99,748 per client • Must raise additional $4,125per client
What makes alpha different? Structure of the organization History Non-profit started by family members Three successful mergers Strategic Plan guides the agency Financial stability Agency vehicles Statewide advocacy Need to raise additional revenue
How can family members be involved? Attend parent/guardian meetings Attend annual meeting Corporate membership Fundraising Giving through Song Benefit Dinner Seattle Foundation’s Give Big Bike Bash Annual Giving Drive Volunteer at events Advocacy
providing support, empowering choices, and encouraging individuality since 1974
