South Car olina De par tme nt of Disabilitie s and Spe c ial Ne e ds Ways & Me ans He althc ar e Budge t Subc ommitte e Pa t Ma le y, Inte rim Sta te Dire c tor F e brua ry 6, 2018
Summar y of Age nc y Se r vic e s Se rving pe o ple with se ve re life lo ng disa b ilitie s in the ir ho me s with fa mily is b e st fo r the pe rso n, pre fe rre d b y fa milie s a nd is the mo st c o st-e ffic ie nt se rvic e a lte rna tive fo r ta xpa ye rs. Of the a ppro xima te ly 41,000 individua ls e lig ib le o r re c e iving DDSN se rvic e s, 87% live a t ho me with the ir fa milie s o r in the ir o wn ho me . I ndividua ls a re se rve d thro ug h a ne two rk o f Co unty Disa b ility a nd Spe c ia l Ne e ds Bo a rds, q ua lifie d priva te pro vide rs a nd Re g io na l Ce nte rs dire c tly o pe ra te d b y DDSN I n the te n-ye a r pe rio d sho wn, the re ha s b e e n a 45% g ro wth in the use o f c o st-e ffic ie nt fa mily suppo rt se rvic e s c o mpa re d to o nly 6% g ro wth in re side ntia l se rvic e s, whic h a re mo re e xpe nsive . DDSN po lic ie s re fle c t fe de ra l a nd sta te la ws b y suppo rting pe o ple in the le a st re stric tive se tting po ssib le .
Waiting L ist Re duc tion Initiative s A ma jo r e mpha sis o f the a g e nc y is to re duc e the numb e r o f pe o ple wa iting fo r se rvic e s. T he g e ne ro us funding fro m the Go ve rno r a nd Ge ne ra l Asse mb ly in re c e nt ye a rs ha s e na b le d the a g e nc y to ma ke sub sta ntia l pro g re ss a nd pro vide e sse ntia l se rvic e s to individua ls a nd fa milie s. Wa iting list re duc tio n e ffo rts a re o ng o ing a nd re q uire e xte nsive c o o rdina tio n a nd re so urc e s within DDSN’ s sta te wide pro vide r ne two rk.
SC Department of Disabilities and Special Needs Length of Time on the Waiting List ID/RD* July 2014 6.8 July 2015 4.6 July 2016 3.5 July 2017 4.0 3.4 Jan 2018 CS July 2014 4.5 July 2015 2.3 July 2016 1.5 July 2017 0.8 1.2 Jan 2018 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 Years Waited until Slot Awarded *In May 2016, movement of the ID/RD Waiting List was limited to only individuals meeting Critical Needs Criteria. On December 5, 2016 attrition slots only were restarted. In June through September of 2017 a total of 600 slots moved from the CS Waiver to the ID Waiver. ID/RD – Intellectual Disability/Related Disabilities Waiver CS – Community Supports Waiver As of January 2, 2018
DDSN Cu Curr rrent Ch t Challenges • Shortage & Turnover of Direct Care Workers • Serving High Behavioral Need Consumers • CMS "Final Rule" Planning & Impact -- Increased Federal Requirements • DDSN Payment System Review - Issues with Band Payments • Shift to Measuring Performance Outcomes • Implementing an Enterprise-wide Data System HIGH CHANGE ENVIRONMENT
DDSN Budge t Re que st F isc al Ye ar 2018- 2019 I n Prio rity Orde r
1. Safe ty and Quality of Car e / Wor k F or c e Ne e ds - $11.3 M Re q ue sting $10 millio n to b ring the dire c t c a re hiring wa g e to $12/ ho ur; 2nd ye a r o f a 3 ye a r pla n to ra ise dire c t c a re wa g e s to $13/ ho ur. Re q ue sting $1.3 millio n to a ddre ss c o mpre ssio n a nd re te ntio n o f e xisting dire c t c a re pro fe ssio na ls. GOAL : T o a ttra c t a nd ma inta in a sta b le wo rkfo rc e fo r the dire c t c a re wo rke r's diffic ult job , 24/ 7 o pe ra tio ns, a nd re q uire d o ve rtime . T he dire c t c a re wo rke r's wa g e ha s to ha ve y le ve l jobs , suc h a s Wa lma rt, se par ation fr om c ompe ting e ntr L o we 's, o r fa st fo o d.
1. Safe ty and Quality of Car e / Wor k F or c e Ne e ds - $11.3 M (Continue d) L a st ye a r's $1/ ho ur inc re a se wa s po sitive o n mo ra le b ut I c a n't find da ta it mo ve d the ne e dle ; we ma y e ve n b e re g re ssing . T his is o nly "ye a r 1" o f a "3 ye a r pla n" so we sho uld no t b e surprise d. T o da y's ne w wo rke r c ho ic e : Wa lma rt $11/ ho ur jo b sto c king she lve s o r pushing c a rts VS. the dire c t c a re wo rke r's $11/ ho ur diffic ult job dutie s with the $1/ ho ur c o st o f c o ntrib uting to sta te re tire me nt a s o nly ne g a tive ly re duc ing jo b to $10/ ho ur.
1. Safe ty and Quality of Car e / Wor k F or c e Ne e ds - $11.3 M (Continue d) 2016 Surve y o f I D Dire c t Ca re Wo rke rs: SC pro vide rs re po rte d a 37% turno ve r ra te ; na tio na l ra te is 45%. So uth Ca ro lina is fo rtuna te 75% o f dire c t c a re wo rke rs ha ve g re a te r tha n o ne ye a r e xpe rie nc e ; 65% na tio na lly. L o ng -se rving sta ff ne a ring re tire me nt e lig ib ility a re susta ining the syste m. Ge o g ra phic lo c a tio n ma tte rs--so me SC pro vide rs re po rt lo we r turno ve r ra te s, while o the rs ha ve g ive n up ho pe o f e ve r g e tting o ut o f using ma ssive o ve rtime to me e t sta ffing ne e ds.
Re g iona l Ce nte r HSA Sta ff Va c a nc ie s 220 200 180 # Va c a nt HSAs 160 140 120 100 Ja n-15 Jul-15 Ja n-16 Jul-16 Ja n-17 Jul-17 Ja n-18
Regional Center HSA Staff Turnover 60.0% 58.2% 50.0% % of HSAs Separating Employment 49.1% 40.0% 37.2% 33.4% 30.0% 30.1% 25.2% 20.0% 10.0% 0.0% FY12/13 FY13/14 FY14/15 FY15/16 FY16/17 PRJT FY17/18
1. Safe ty and Quality of Car e / Wor k F or c e Ne e ds - $11.3 M (Continue d) T he syste m ha s a ho le in the b o tto m o f the b uc ke t a nd is o nly a ddre sse d with sub sta ntia l o ve rtime slo wly e ro ding e xisting sta ffing , driving turno ve r, a nd le sse ning a c tua l sta ff o n the flo o r due to o ve rtime c o sts. Pre dic te d future c ha lle ng e s will o nly inc re a se in o b ta ining dire c t c a re wo rke rs o ve r the ne xt de c a de a s b a b y b o o me rs will drive up de ma nd o n re side ntia l c a re in a ll he a lthc a re se c to rs & the a va ila b le dire c t c a re wo rkfo rc e will shrink. T he Sta te is b a la nc ing the dire c t c a re wo rke rs sho rta g e issue o n the b a c ks o f the e xisting wo rkfo rc e with o ve rtime . Our wo rkfo rc e stre ng th is the "he a rt" o f the e xisting wo rkfo rc e whic h ha s a tipping po int se e n a t a re g io na l c e nte r.
2. Inc r e ase and Impr ove Ac c e ss to In- Home Individual and F amily Suppor ts and Re side ntial Suppor ts by Moving the Waiting L ists - $9.5 M K e e ping fa milie s to g e the r is b e st fo r the individua ls, the ir fa milie s a nd is the mo st c o st e ffe c tive o ptio n. $300,000 inc re a se d c o st due to re q uire d pe st c o ntro l se rvic e in HASCI wa ive r to ma tc h sa me b e ne fit in o the r wa ive rs; $400,000 in e nviro nme nta l mo dific a tio ns to a ddre ss c urre nt lo w life time $7500 b e ne fit whic h is b e ing re q ue ste d to b e ra ise d to $15,000 ina smuc h a s $7500 is fa r sho rt o f mo st mo dific a tio n ne e ds $2M Re side ntia l Hig h Ma na g e me nt fo r 50 b e ds; $2.3M re side ntia l e xpa nsio n fo r 100 b e ds to a ddre ss a g ing c a re g ive rs; 1400 a t-ho me c o nsume rs' c a re g ive rs o lde r tha n 72 & 570 c a re g ive rs o lde r tha n 80 $4.5M in-ho me suppo rts fo r 1000 c o nsume rs
3. Psyc hiatr ic Inte r ve ntion and Stabilization for Individuals - $1.8 M Critic a l ne e d a nd c o st sa ving s to o l. Pro b le m: T he se rvic e de live ry syste m ha s no re side ntia l re se rve c a pa c ity fo r c o nsume rs fa iling in the c o mmunity; 670 re g io na l c e nte r b e ds c o nstra ine d b y sta ffing le ve ls/ spa c e . Curre ntly: Pro vide rs a nd fa milie s run o ut o f o ptio ns a ddre ssing c o nsume rs fa iling in c o mmunity re sulting in ne e d fo r a c risis pla c e me nt ye t the syste m ha ving no re se rve c a pa c ity; this le a ds to ho spita liza tio n, inc a rc e ra tio ns, o r le ft stra nde d in-pla c e . T his dile mma ha s a c hilling e ffe c t o n pro vide rs a c c e pting future c o nsume rs with hig he r ne e ds.
3. Psyc hiatr ic Inte r ve ntion and Stabilization for Individuals - $1.8 M (Continue d) So lutio n is two -fo ld: 1) F o rwa rd de plo y skille d b e ha vio ra l/ me dic a l pe rso nne l to Distric t Offic e s to pro a c tive ly tre a t, to inc lude psyc hia tric inte rve ntio n/ te le he a lth, c o nsume rs with e me rg ing ne e ds c re a ting the risk o f fa iling in the ir c urre nt c o mmunity se tting (re side ntia l o r a t-ho me ); this pre ve nts a c risis o r ide ntifie s c o nsume rs e a rly re q uiring re lo c a tio n to me e t hig he r ne e ds b e fo re a c risis; 2) b uild re se rve b e d c a pa c ity fo r imme dia te a c c e pta nc e a nd tre a tme nt/ sta b iliza tio n o f c o nsume r & c re a te time to pla n fo r a ppro pria te lo ng -te rm pla c e me nt.
3. Psyc hiatr ic Inte r ve ntion and Stabilization for Individuals - $1.8 M (Continue d) $900,000 fo r Be ha vio ra l & Psyc hia tric Pe rso nne l/ Suppo rts $400,000 T e mpo ra ry Sta b iliza tio n Re side nc e $500,000 T ime limite d inpa tie nt spe c ia lize d ne uro - b e ha vio ra l tre a tme nt fo r 3-4 individua ls with a tra uma tic b ra in injury.
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