Preserving Innovative Shared Living Models Under the DOL Home Care Rule

Transcription

1 Preserving Innovative Shared Living Models Under the DOL Home Care Rule Presenters: Mary Lee Fay, National Association of State Directors of Developmental Disabilities Services Robert Baker, Keystone Human Services Katherine Berland, American Network of Community Options and Resources AAIDD Annual Conference June 3, 2015

2 Mary Lee Fay Director of National Core Indicators National Association of State Directors of Developmental Disabilities Services NASDDDS Shared Living/Host Homes: Inclusiveness and Quality NASDDDS

3 Some context for creating a sustainable system 3 Demographic Climate Change Aging demographics Workforce Federal and State funding

4 The Impact of the Aging Baby Boomers % 19.3% 20% 16.1% 13%

5 Needing Care 5 SCAN Foundation Source: U.S. Census Bureau, Population Division

6 6 Source: U.S. Census Bureau, Population Division

7 Aging Baby Boomers 7 Baby Boomer Tsunami Every day 10,000 Baby Boomers qualify for Social Security

8 Aging Baby Boomers 8 Competition for Funds in the Future

9 9

10 Shortage of Care Givers 10 75,000,000 60,000,000 45,000,000 30,000,000 15,000, Source: U.S. Census Bureau, Population Division, Interim State Population Projections, 2005 Females aged Individuals 65 and older Larson, Edelstein, 2006

11 11 Walmart Raising Wage to at Least $9 McDonald s raising wages to $9.90 in 2014 and $20 in 2016

12 Confronting Reality 12 Growth in public funding will slow Workforce will not keep pace with demand 75,000,000 60,000,000 45,000,000 30,000,000 15,000, Source: U.S. Census Bureau, Population Division, Interim State Population Projections, 2005 Females aged Individuals 65 and older People Waiting For Services The Waiting List Residential Capacity Growth Needed 76, , % RISP 2011

13 The Conclusion? We are facing decades of 13 Tight Funding Workforce shortages More people who need support to live in the community We have to find a way to reach as many people as possible which means a service system that is Affordable Sustainable Supports people in community life

14 Efforts to Build a Sustainable Future Supporting Families AND Developing Innovative Supports Relationship based Building on Technology Focusing on Person Centered Planning 14 Investing in Peer Networks

15 Family Caregivers are the Backbone of the Nation's Long-Term Care System 15 39% of all adult Americans (2 of every 5) care for a loved one who is sick or disabled, an increase from 30 % in It is not just women doing the caregiving. Men are almost as likely to be caregivers as women (37% m; 40% w) 36% of Americans between ages 18 & 29 are caregivers Almost half of family caregivers perform complex medical/nursing tasks for their loved ones such as managing multiple medications, providing wound care, and operating specialized medical equipment.

16 People living with family: 89% ,000 13% 672,000 12% 4.7 Million people with I/DD Receiving Services Out of Home 13% Receiving Services Living at Home 12% 3,500,000 75% Not Receiving Services - Living at Home 75%

17 Families as Primary Caregivers 17 1,200,000 1,000,000 Place of Residence for Service Recipients with IDD % 800, , , , Arizona 86% Calif. 71% Florida 70% Idaho 75%* S.C. 72%* N.J. 71% Own Home 62,669 65,006 73,147 80,242 86,694 90, ,15 101,14 104,38 115,65 115,87 122,08 127,45 120,31 Family 325,65 355,19 391,85 451,67 482,47 500,00 503,64 533,04 569,02 576,16 588,59 599,15 592,18 610,29 Host Home 28,122 31,884 37,367 40,688 42,272 45,759 39,857 35,386 35,302 36,972 38,262 40,967 40,060 44,214 1 to 6 108,84 114,54 124,46 135,32 135,57 135,56 142,91 156,61 157,08 157,76 160,47 158,62 167,87 172,76 7 to 15 53,940 52,863 52,818 54,333 54,031 54,325 58,503 52,888 56,572 59,002 53,198 58,235 55,682 57, ,348 82,718 82,582 77,180 72,742 72,474 69,148 66,501 66,125 62,496 59,447 59,604 57,028 55,572 Nursing Home 24,144 25,533 32,195 35,155 34,820 35,005 32,899 30,027 28,206 26,013 26,080 29,608 31,832 33,661 RISP 2011 RTC on Community Living UCED U of Minnesota

18 Figure 2.1 Individualized and Congregate Living Arrangements for People with IDD Receiving Medicaid or Non-Medicaid Funded Long-Term Supports and Services Under the Auspices of State IDD Programs on June 30, 2012 (Estimated Totals) Setting Individua lized Settings (3 or fewer people with IDD) Congrega te Settings (4 or more people with IDD) US Total (Est.) Own Home 118,57 6 Family Home 634,9 Host Family/Foster IDD Group 1 to 3 IDD Group 4+ (Not ICF/IID) IDD Group 4+ (ICF/IID) Not IDD (Nursing Home, Psychiatric) Perce nt 10% 56% 88 54,75 5 5% 68,78 1 6% 146, % 85,38 4 8% 29,20 3 3% Family Home [CATEGORY NAME] Congregate Own Home 1 to 3 IDD Group 1 to 3 IDD Group 4+ (Not ICF/IID) IDD Group 4+ (ICF/IID) Not IDD (Nursing Home, Psychiatric)

19 Slides by the RISP and FISP Projects at the U of MN's RTC on Community Living

20 Slides by the RISP and FISP Projects at the U of MN's RTC on Community Living

21 Supports should enhance real lives

22 Current Support System 22

23 Real People, Real Lives with Integrated Supports 23

24 The Shared Living Experience in Pennsylvania Presented by: Robert J. Baker Vice President, Keystone Human Services 124 Pine Street Harrisburg, PA

25 The Shared Living Experience Keystone Human Services : $150 million human services non-profit organization. Pennsylvania based. Services provided in PA, DE, Washington D.C. and CT. International Services and consulting in Eastern Europe and India Full range of Intellectual Disability, Mental Health and Autism services along with Early Childhood Education and Service Dogs. 25

26 Definition: The Shared Living Experience PA Terminology is Lifesharing through Family Living Lifesharing is living with and sharing life experiences with supportive persons who form a caring household. The mission of Lifesharing is to enrich the lives of people with disabilities by matching them with those who choose to open their homes and their hearts. 26

27 Shared Living is: The Shared Living Experience People live together and share life experiences. For the person it is a community life-not a service life. For the Shared Living Provider it isn't a job, or providing service. Includes the routines and rhythms that are inclusive of people living life in the community. 27

28 The Shared Living Experience Statistics: Keystone has been providing Lifesharing Services for over 25 years. Some of our Lifesharing provider families have been supporting the same individual for over 20 years. Keystone serves 154 individuals in Lifesharing. Keystone is one of the largest providers of Lifesharing services in PA. It is the lowest cost residential service and provides the highest level of satisfaction according to PA consumer satisfaction results. Target is Individuals looking for a typical family situation. 28

29 The Shared Living Experience THREE PARTNERS IN LIFESHARING: Individual in service Lifesharing Family Lifesharing Agency 29

30 The Shared Living Experience EXPECTATIONS OF THE INDIVIDUAL: Be aware of the household expectations. Respect other family members space and belongings. Participate in fire safety training. Participate in their team process at meetings and medical appointments to the extent of their ability. Pay room and board and other personal expenses to the best of their ability. 30

31 The Shared Living Experience EXPECTATIONS OF THE LIFESHARING FAMILY: Respect the Individual. Meet the Individual s basic need of health, safety and welfare. Help the Individual become connected to the family and their community. Maintain a caring, safe, nurturing family environment in which the Individual has a choice. Provide supports that respond to the Individual s needs, wants and interests. Develop a long term relationship. Meet the requirements of their contract. Meet all documentation and licensing requirements. Provide access to the home and the Individual at Agency, County or State request. 31

32 The Shared Living Experience EXPECTATIONS OF THE LIFESHARING AGENCY: Balance the logistics and the philosophy. Recruitment and screening. Support the matching process. Provide support to the family including the Lifesharing Coordinator. Provide training. Provide an on-call system with someone available 24/7. 32

33 The Shared Living Experience ROLE OF THE LIFESHARING COORDINATOR: Works toward the goal of helping people live the highest quality of life possible. Understands family dynamics and problem management strategies. Is a good communicator, organized and detail-oriented. Support families with coordination of medical concerns/appointments. Be current on all trainings. Be educated on the Individual s ISP and Assessment 33

34 The Shared Living Experience ROLE OF THE LIFESHARING COORDINATOR: Monitor the implementation of Support Plans. Act as a liaison with providers, natural families, friends, caseworkers, and others. Respond to crisis situations and emergencies. Support providers with education and training with PA regulations and licensing process. Be a resource to providers with questions and concerns. Assure that supervision requirements are understood and met by the family. Do whatever it takes to help the relationship between the family and the Individual. 34

35 The Shared Living Experience THE LIFESHARING ARRANGEMENT: The Lifesharing Agency: Is paid to support Lifesharing arrangements Recruits Lifesharing families Receives referrals from Individuals interested in Lifesharing Matches Individuals with families Trains Lifesharing families Pays Lifesharing families (monthly stipends) Supports the relationship 35

36 The Shared Living Experience THE IMPORTANCE OF THE MATCH : Matching is the key to success. Matching is an intensive investment of time and energy. Involves everyone. Requires openness and honesty. Cant skip touchy subjects. Ideal process is 3-6 months. 36

37 The Shared Living Experience THE MATCHING PROCESS: STEP 1. Document the needs and desires of the Individual. THE MATCHING PROCESS: STEP 2. Potential Families Complete: An extensive application, An extensive home study, Criminal background checks, Physical examinations. 37

38 The Shared Living Experience THE MATCHING PROCESS: STEP 3. TRIAL VISITS 5-10 minute visits. Lunch at the Provider s home. Overnight visits. Weekend visits. Full Week visits. Meetings with both parties after each visit. Document the findings. Mutual agreement to continue after each meeting. 38

39 The Shared Living Experience CHALLENGES FOR LIFESHARING IN PA: Low fees to agencies leading to low stipends for families. There is a risk for Individuals who are leaving a residential placement. PA does not allow guardians or siblings to serve as Lifesharing families. Lifesharing families are very satisfied but identify theses challenges: - low stipends - the amount of paperwork - substitute care practices - annual training - birth family relationships - opportunities for employment/volunteering for the Individual 39

40 The Shared Living Experience Lifesharing is a wonderful option for many Individuals Expansion should be supported through incentives It is an important option, but not for everyone 40

41 Shared Living/Host Homes: Contracting, Employment, Wage and Hour, and Tax Compliance Katherine Berland, Director of Public Policy American Network of Community Options and Resources

42 DOL Home Care Rule Final Rule Issued September 2013 updating regulations concerning the Fair Labor Standards Act Excluded use of companionship and live-in domestic service exemptions by third-party employers Narrowed definition of companionship services Imposed new recordkeeping requirements Effective date of January 1, 2015 DOL announced a limited non-enforcement policy in October 2014 January 1 June 30, 2015: No DOL enforcement July 1 December 31, 2015: Limited DOL enforcement Key portions of the rule were vacated by Federal district court in late 2014/early 2015; the ruling is currently under appeal 42

43 Implementing the Rule for Shared Living DOL developed Shared Living guidance after working closely with several stakeholder organizations. The guidance describes three types of shared living arrangements: Where the individual served joins an existing household controlled by the caregiver; Where the caregiver joins a household controlled by the individual served; and Where the individual served and the caregiver create a new, joint household. 43

44 Compliance Considerations Two major questions to be asked about any shared living support arrangement: Does the arrangement qualify for independent contractor (rather than employee) status? If the caregiver is an employee, are exemptions available to the normal FLSA requirements for minimum wage and overtime? 44

45 Compliance Considerations Independent contractor vs. employee status: The law favors employee status over independent contractor status. Substance trumps form: labeling the caregiver as an independent contractor is necessary, but not sufficient. The FLSA standard is the economic realities test, which is NOT the same standard as the Internal Revenue Code or many state laws for independent contractors 45

46 Compliance Considerations Shared Living/Host Home Sample Contract In 2014, ANCOR, NASDDDS, and NASUAD collaborated to create a model contract and supporting memorandum to educate agencies in best practices for the legal structure of host home arrangements. The sample contract may be used as a guide to create an appropriate contract between parties. Qualified legal counsel should be sought to ensure that all state and local laws are complied with. 46

47 Compliance Considerations Shared Living Compliance Best Practices: Ensure the lease or residency agreement is consistent with the party that controls the residence. Ensure work is controlled by the independent contractor; focus on outcomes rather than manner of work. Ensure that financial risks and rewards associated with the program rest with the caregiver. Ensure there is a clear organizational separation between contractors and employees. Maintain proper documentation. 47

48 Contact Information Mary Lee Fay, Director of National Core Indicators National Association of State Directors of Developmental Disabilities Services (NASDDDS) (703) Robert Baker, Vice President Keystone Human Services (717) Katherine Berland, Director of Public Policy American Network of Community Options and Resources (703) ext. 104