2012 Disability Services LTSS Gaps Analysis County Profile: St Louis County

2012 Disability Services LTSS Gaps Analysis County Profile: St Louis County The following is a summary of the Long-Term Services and Supports Gaps Analysis survey responses submitted by St Louis County to provide local information about the capacity and gaps in services and housing needs of persons with disabilities of all ages in Minnesota. For more information about the Gaps Analysis survey please refer to the Disability Services Division Gaps Analysis web page. Part 1: Current Capacity and Change in Services since 2011 St Louis County reported on their current capacity across a range of home and community-based long-term services and supports (LTSS). They were also asked about any changes in the availability of the service in the prior two years. Attachment 1 includes a description for any services that are reported as Available/Limited or Not Available. Coordination and Management Services Case Management Current Capacity (Dec. 2012) Change in Capacity since 2011 Age Groups Impacted 1 no change 1, 2, 3 Case Management Aide not available no change 1, 2, 3 Housing Access Coordination no change 1, 2, 3 Specialty Services no change 1, 2, 3 Caregiver Support since 2011 Impacted Caregiver Living Expenses meets demand no change Caregiver Training & Education meets demand no change Crisis Respite decreased/eliminated 2 Family Training and Counseling no change 1, 2, 3 Respite decreased/eliminated 1, 2, 3 Day Services since 2011 Impacted Adult Day Care decreased/eliminated 1, 2, 3 Adult Day Care, Bath decreased/eliminated 1, 2, 3 Consumer Training and Education no change 2 Day Training & Habilitation decreased/eliminated 2, 3 1 1=Age 65 and older; 2=Under age 65 & on a waiver; 3=Under age 65 & not on a waiver Page 1

Day Services since 2011 Impacted Prevocational Services no change 2 Structured Day Program no change 2 Supported Employment Services decreased/eliminated 2 Home / Residence Services since 2011 Impacted 24-hour Emergency Assistance no change 1, 2, 3 Adult Companion Services expanded/improved 1, 2, 3 Chore Service no change 1, 2, 3 Customized Living Services expanded/improved 1, 2, 3 Customized Living Services, 24- hour no change 1, 2 Extended Personal Care Assistance meets demand no change Home Delivered Meals expanded/improved 1, 2, 3 Homemaker no change 1, 2, 3 Night Supervision Services no change 2 Personal Support not available no change 2 Residential Care Services no change 2 Residential Habilitation no change 1, 2 Accommodations since 2011 Impacted Assistive Technology expanded/improved 1, 2 Environmental Accessibility Adaptations meets demand expanded/improved Specialized Supplies and Equipment expanded/improved 1, 2, 3 Transitional Services no change 2 Home Care Services and Supports Current Capacity Change in Capacity since 2011 Age Groups Impacted Home Health Aide (HHA) no change 1, 2, 3 Private Duty Nursing (PDN) no change 1, 2, 3 Skilled Nurse Visit (SNV) no change 1, 2, 3 Home Care Therapies (PT, OT, SLP, RT) no change 2, 3 Other Services since 2011 Impacted Behavioral Programming/Support no change 2 Consumer Directed Community Supports (CDCS) no change 1, 2 Foster Care meets demand no change ILS Therapies meets demand no change Independent Living Skills (ILS) Training no change 2 Transportation decreased/eliminated 1, 2, 3 Page 2

Part 2: Capacity to Serve Culturally Diverse Communities St Louis County was asked to provide their perspective on how prepared, in general, disability service providers are to deliver care that is culturally competent to individuals in the following communities. Cultural Community Racial/ethnic minority communities New American/ immigrant/ refugee communities Gay, lesbian, bisexual and transgender communities Other cultural community (details below) How Prepared somewhat prepared somewhat prepared somewhat prepared Description We have addressed the need for culturally competent practices and have extensive training for County staff that is also available to our community partners. Cultural competencies are always in need of improving. We have addressed the need for cultural competent practices and have extensive training for County staff that is also available to our community partners. We have addressed the need for cultural competent practices and have extensive training for County staff that is also available to our community partners. Part 3: HCBS System Improvement St Louis County was asked to rate the level of improvement within their jurisdiction for elements of the HCBS system, based on the Vision, Values and Goal of Continuing Care, with 1= no improvement, and 5=significant improvement. A score of 1 may indicate that the county s needs were already being met. HCBS System Improvement Score Choice and Independence for people with disabilities 3 Stewardship of human services resources 3 Self-determination and personal responsibility by people with disabilities 3 Integrity by Continuing Care Administration at the Minnesota Department of Human Services and 3 others Diversity because of differences make us strong 3 Partnerships and collaboration with clear roles, responsibilities and accountability for ourselves 3 and others Accountability 3 Page 3

3b. What issues/barriers are currently most critical to overcome in St Louis County to ensure that persons with disabilities have home and community-based support options? Affordable housing with services options, Dependence upon small number of providers, Distance/isolation, Lack of specialty care, Provider rates, Recruiting and maintaining staff, Transportation for non-medical needs. 3c. Highest priority for HCBS development for upcoming biennium (2014-2015): Increasing the number of providers and the capacity to provide In Home Family Supports, Respite services and transportation services. Developing a rate system and integrating developmental disabilities services into MnCHOICES. User "very friendly" technology can help keep individuals home with their families. Technology includes video contact between elders and their children, medication dispensers etc. Part 4: Housing Options St Louis County was provided a list of resources that could be used to modify current housing stock (private homes and apartments) to accommodate the needs of persons with disabilities. They were asked to assess their capacity of these resources that enhance accessibility. Resources for Accessible Housing Local builders/contractors with accessibility remodeling/new construction expertise (i.e. ramps, elevators, enlarged doorways and hallways, technology for temperature control, lighting, security, etc.) Builders/contractors willing to take on environmental accessibility modifications Adequate reimbursement under the waiver program for needed modifications Other (if indicated, see description below) Availability meets demand 4b. St Louis County was asked to indicate the variety and availability of specific subsidized and market-rate housing options. Capacity of Housing Options Subsidized rental apartments with no services Subsidized rental apartments with support services only Subsidized rental apartments with supervision/health care services Subsidized Adult Family Foster Care Corporate Adult Foster Care Other subsidized housing options (Board & Lodging, Board & Care, Residential Care) Availability exceeds demand Page 4

4c. Indicate the issues/barriers to relocation of persons into the home of their choice in St Louis County: Limited resources, Lack of housing, Caregiver issues, Access to transportation 4d. Relocation into the Community Question Are there any persons receiving disability services in St Louis County who could move to their own home from provider-controlled housing if they had adequate supports available? Systematic strategy for relocating persons from congregate settings to the community in St Louis County Systematic strategy for relocating persons receiving disability services from provider-controlled housing into the community in St Louis County Yes Details Case Management reviews least restrictive options with an annual and semiannual assessment and during OBRA Level II assessments. We have two dedicated Long Term Care Assessors, one full time and one half-time, for nursing home relocation. All case management staff review requests and assess need to move into less restrictive community settings. All case managers can provide transition services where necessary. No This is reviewed semiannually. There is unwillingness on the part of guardians to move participants into less restrictive housing. The resources needed to provide services to high needs individuals are. It is difficult to have a systematic strategy to relocate individuals from provider -controlled housing when the majority of the individuals in our corporate foster care are not from St. Louis County. Part 5: Employment 5a. Please list the barriers to increasing employment for persons receiving disability services in St Louis County: b. Job market fluctuations (large lay-offs or high unemployment in the area), c. Access to transportation, d. Lack of employment supports such as access to effective supported employment services Page 5

5b. Is there a systematic strategy to increase competitive employment and earnings for persons receiving disability services in St Louis County? Case managers review their client's needs on an individual basis. St. Louis County will have increased training directed at assuring that all waiver participants are made aware of the vocational services provided by the waiver and other employment resources and incentives. In addition, all working age participants will have vocational needs addressed in their care plans. 5c. Is there a strategy to incorporate benefits planning in your work with persons receiving disability services in St Louis County? We use MN Work Incentives to assist with benefit assessment. 5d. Does your agency have the capacity to incorporate the use of DB101 into a service for people? If so, are people who are receiving disability services also receiving referral to or access to DB101 or other benefits planning tools? Yes. Individuals are referred to this service by County staff and other service providers. Our agency has the capacity. Part 6: Consumer Directed Community Supports (CDCS) 6a. Is there a systematic strategy to offer the CDCS option to persons receiving disability services in St Louis County? CDCS is offered to participants through the assessment process. The choice of CDCS is often explored at team meetings. We are refining our policies and implementing training on consumer directed services. We believe that if we increase case manager knowledge of the CDCS program, more participants will elect CDCS services. 6b. Indicate any barriers to transitioning persons receiving disability services in your jurisdictions to CDCS: a. Lack of incentives, b. Lack of knowledge/education about CDCS, d. Other, Inconsistant knowledge of the CDCS program across all case managers and disability units. Inconsistant knowledge of the CDCS program across all case managers and disability units. Page 6

Part 7: Final Comments: Accomplishments and Challenges within HCBS LTSS Accomplishments, Achievements and Best Practices Major/Priority Issues or Challenges HCBS LTSS: Summary of Accomplishments and Challenges Annual full team screenings of developmental disabilities waiver recipients. Extensive review of adult foster care placement that takes into account resident mix and providers' skills through the use of case management best practices. We have implemented a 4 level review system for all new developmental disabilities, CADI, BI, and CAC waivers. Transportation difficulties and the choice of providers in some service areas. We are currently working with a transportation provider, to be funded by waiver services, in our rural communities. The implementation of MN Choices. 7b. Indicate how St Louis County is striving to improve on the following priorities of the Disability Services Division focus on the CHOICE domains of a meaningful life: Priorities Community membership Health, wellness and safety Own place to live Important longterm relationships Control over supports Employment earnings and stable income Methods of improvement We ensure that participants are aware that they can choose amongst available service providers. We have goals and outcomes focused on ensuring that services are provided in integrated settings. The goals and outcomes are directed by the participant. We use integrated community settings/services wherever possible. We would like to increase health care monitoring in the home through the use of technology. We would like to develop services that allow participants to elect less restrictive settings wherever possible. We would like to increase services such as 24 hr. crisis services and night supervision and technology services. Include family, friends and neighbors, whenever possible, into service planning. Systematically provide participants with information regarding choice of services and providers. We make individuals aware of their rights to have control over their supports. We are focusing on this challenge this year. We need to increase the employment and earnings of the working age disabled in our County. We will address this by restructuring our care plans and providing training to case managers, agency wide, on employment programs and incentives. Training will focus on waiver programs and other employment services. Page 7

Attachment 1: Description for Services Reported as Not Available or Available but Limited Case Management: Case Management services are provided by the County agency. There are no other providers of Waiver case management. High caseloads reduce contact time with clients. It affects the process time for service application and in depth case planning. Case Management Aide Services: St. Louis County does not utilize case aides. Housing Access Coordination: This service is available and meeting needs. Demand is high. Housing is less available in some areas in our county. More outreach is needed to ensure that individuals are aware of the service. Specialist Services: There are specialist services. It would benefit consumers to have more specialist services. They are not as readily available in all locations. Crisis Respite: Due to the loss of one provider, we were impacted by less availability of this resource. Family Training and Counseling: Few providers have indicated an interest in providing this service. Respite: Rate structure problems for out-of-home respite providers. Reimbursement rates are perceived to be too low. Providers to high needs individuals find it more viable to serve permanent residents in licensed settings. Adult Day Care: Available in South St. Louis County, less available in Northern St. Louis County due to the loss of a provider. The provider did not feel it had enough participants to make the day care sustainable. Adult Day Care, Bath: Available in South St. Louis County, less available in Northern St. Louis County. Lack of payment for transportation costs or availability of transportation to and from the home and the adult day care makes access difficulty, especially in rural areas. Loss of one provider. Consumer Training and Education: There has not been a great deal of interest on the part of providers to provide this service. Demand from consumers varies or is not easy to determine. Education and training may be available through other non-waiver funded programs. Day Training & Habilitation: There has been an expansion of this service in Duluth. There has been a decrease in the availability of this service in the North. There are waiting lists for some desirable providers. Page 8

Prevocational Services: There has been no change in the provision of prevocational services. There is some lack of choice of providers in some communities in St. Louis County. Structured Day Program: This has increased in the Duluth area. However, this has been increased to serve the needs of residents placed in Duluth from other counties. There is a lack of choice of structured day programs that serve individuals that require personal cares. This service is not available in the northern communities of St. Louis County. Supported Employment Services: This service has been expanded in South St. Louis County. It has not been expanded in all communities in Northern St. Louis County. 24-Hour Emergency Assistance: Wide spread service area affects the availability and feasibility of providing this service in some areas of St. Louis County. We are interested in increasing this service in our County. Adult Companion Services: Availability of this service varies throughout the County and throughout disability populations. Recruitment of companions is key. Chore Service: Chore services are to a lesser extent in rural St. Louis County. County paid chore services, especially snow removal, have been reduced. Customized Living Services: Locating a customized service provider near your natural supports can be difficult in a geographically large county. This is available in the larger communities within St. Louis County. Customized Living Services, 24 Hour: Locating a customized service provider near your natural supports can be difficult in a geographically large county. This is available in the larger communities within St. Louis County. Home Delivered Meals: Services are available through Mom's meals, a service that delivers frozen food. For those who benefit from Monday through Friday daily delivery, and the personal contacts that result, there is availability of this service in rural areas. Volunteers in the summer are. Homemaker: Homemaker service is widely available in most areas of St. Louis County, less so in rural areas. Payment for mileage is not generally available from employers. There is less incentive to provide services to individuals in geographically remote areas. Night Supervision Services: There is only one provider of this service in St. Louis County. We are in discussions with an additional provider. This service has financial incentives for the contracted provider. Personal Support: Since this is not considered a habilitative service, there is little need for this service. Other services have been found to meet participant needs. Page 9

Residential Care Services: These services are more available in South St. Louis County. They are less available in Northern communities. Residential Habilitation: In South St. Louis County, the demand for in home family support is met. There is a desire for more choice in providers in our northern communities. Assistive Technology: Licensing rules can affect the use of technology in foster care homes. Providers indicate that there is a lack of reimbursement for adding technology. This demand is met in S. St. Louis County Specialized Supplies and Equipment: Although there are providers of specialized supplies and equipment, there is less availability of rehab specialists that can evaluate an individual's need for supplies and equipment and make recommendations. The demand for this service is met in South St. Louis County. Transitional Services: Given the numbers of individuals needing the service and the intensity that comes with transitioning highly complex individuals back to the community, it is difficult to adequately meet the needs of all individuals on a timely basis. The current financial reimbursement for the service does not serve as an inducement to those considering providing this service. Home Health Aide (HHA): There is less availability of this service. It is unclear why Home Health Agencies are employing fewer HHA or if there is an increase in demand for this service. There is no change in the availability of this service in the southern portion of St. Louis County. Private Duty Nursing (PDN): There is a lack of nurses interested in providing this service. The availability of nursing has not changed in southern St. Louis County. There is some difficulty with access to PDN services in geographically remote areas. Skilled Nurse Visit (SNV): This demand is met in south St. Louis County, less so in northern St. Louis County, possibly due to the widespread nursing shortages Home Care Therapies (PT, OT, SLP, RT): This demand for home care therapists is met in south St. Louis County, less so in northern St. Louis County. Behavioral Programming / Support: Not provided under the developmental disabilities waiver but is a requested service. Available in South St. Louis County. There is little real choice of providers. Consumer Directed Community Supports (CDCS): We believe more participants would benefit from CDCS services. It is unclear why more participants do not select this service. We continue to offer this as an alternative to traditional waiver services and review policies and procedures in this area. Page 10

Independent Living Skills (ILS) Training: There are adequate resources in the south and in some of the northern communities, but less available in other northern communities. Transportation: St. Louis County would benefit from more non-medical transportation service providers, especially w/c accessible transportation. There is access to transportation in the more rural areas. There is a heavy use of volunteer drivers. Page 11