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Lesley Cottrell: Hi, Heidi! Can you hear me.

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Lesley Cottrell: Heidi? Can you hear me?

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Lesley Cottrell: Hello! Hello! Hello!

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heidi thomas: Yes! Can you hear me?

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Lesley Cottrell: Oh, I think I did say it one more time. Can you hear me? Okay.

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Hello!

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heidi thomas: I've been having problems with my camera and the sound.

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Lesley Cottrell: Oh, every time like my Zoom decided to update right before this. I said, Are you serious?

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Lesley Cottrell: Serious? Okay. So we have 46 people in the in the wait room. I'm gonna bring them in. I wanted to check in with you. It looked great. Did you have any questions? Did you want to talk about anything before we get going?

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heidi thomas: No, my, it's

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heidi thomas: I'm finding that the case. Studies II found were not waiver folks. I've just been encountering some interesting themes with my new position.

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Lesley Cottrell: Yeah with Dd folks. So I think that

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heidi thomas: I hope that doesn't become a problem. But with the budget stuff going on, too. I

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Lesley Cottrell: oh, I know right?

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heidi thomas: So I don't

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Lesley Cottrell: that up because what we're talking about today is like, how do we go through these decisions? And as one option goes away, for whatever reason.

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Lesley Cottrell: you know, finding another option. So it's the process of making decisions behind that you that you went through for both of those clients. But yeah, all of those factors I think I mentioned like funding in my slides a little bit, but elaborate on any of that that really think about and provide their experiences with too.

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heidi thomas: absolutely

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Lesley Cottrell: all right. Well, I'm gonna let em in and do this. Do this, spiel.

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Lesley Cottrell: and then we'll get started alright. Can you see where the slides. Okay.

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heidi thomas: I can

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Lesley Cottrell: alright. And it is it recording? Did it tell you it's recording?

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heidi thomas: I mean, it did kind of yell at me, and that

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heidi thomas: when it tells you it's doing something.

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Lesley Cottrell: Okay? I think you did

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Lesley Cottrell: oops.

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Lesley Cottrell: Alright. They're coming in.

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Lesley Cottrell: Good afternoon. Everyone

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Lesley Cottrell: letting people into the in from the waiting room. Give us just a second hope. Everyone's doing. Okay.

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Lesley Cottrell: Make sure that your microphones are working. Cause we're gonna have an active discussion. Want to hear from you

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Lesley Cottrell: today.

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Lesley Cottrell: Okay, a little bit of housekeeping, just as we've done in the past 2 sessions, please. If you don't mind, provide your name and affiliation. Tell us a little bit about yourself gives us a a great background and context for who's participating in the in the discussions?

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Lesley Cottrell: So put that in the chat

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Lesley Cottrell: we do have closed captioning available. Please utilize that option. If that's given you fits, do not hesitate to let me know, and we can get it

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Lesley Cottrell: figured out.

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Lesley Cottrell: Be sure to mute unless we're into a discussion and then open it wide up. Feel free to raise your hand, or just jump in at any point in time. This is meant to be a a team discussion for sure. Okay, we have

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Lesley Cottrell: quick intros being that not much of a transition you have Heidi and and myself real quickly. I'll give you a little bit about my background today. We're talking about transitional placement, decision making. So what is the dis? The process that we have in our minds when we either hit a wall and are having difficulties, placing someone with an intellectual developmental disability somewhere that fits their needs.

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Lesley Cottrell: What do we do? So Heidi, Thomas and I are going to be sharing our experiences and a little bit from the literature elsewhere. What have people been doing? What do they say about this topic? And then the rest of the time based on Heidi's examples and your experiences. We're gonna really dig into this. So

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Lesley Cottrell: the other housekeeping and and just a little bit about myself and Heidi, please please feel free to do the same. I'm a developmental psychologist by training child clinical psychologists, masters from Marshall as well, and had the opportunity, have the opportunity to be the Director of the Center for excellence and disabilities in West Virginia. Heidi. You care to

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Lesley Cottrell: introduce yourself.

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heidi thomas: Good afternoon. My name is Heidi Thomas, I hope you can hear me. Okay, I've been having some sound issues but I'm actually transitioning out of the Division Director of Ivd services at Westbrook into the director of Qa. And Compliance.

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heidi thomas:  my background is really crazy, weird. I was in the military for about 13 years. I've mostly worked in acute care. I found this this field about 4 years, 4 and a half years ago. I'm working on my aba

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heidi thomas: masters now, just so I can get my Bcba. But that's kind of my

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heidi thomas: my big thing.

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heidi thomas: probably the reason why I'm here talking is because we now sadly now have the only crisis response unit

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heidi thomas: in the State for Idd. And in reality, as most of you guys know. And we found out really quickly. It really cannot be called a crisis site, because you can't just get people in right away. Just because some of the complexity.

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heidi thomas: And so those are some of the things we'll discuss

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Lesley Cottrell: you very much.

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Lesley Cottrell: Alright. So let's go ahead and get started. I'll try to keep up with the waiting room.

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Lesley Cottrell: So again, you're here because this is the third session of a larger series. I mean, we're talking about our rising institutionalization rates for individuals with intellectual and developmental disabilities here in West Virginia. This is a series just for those of us who experience these items in West Virginia from different lenses to talk about it, problem solve and then perhaps

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Lesley Cottrell: provide recommendations to those who make those big changes that we need to happen.

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Lesley Cottrell: Okay, it today again, we're talking about decision-making and and finding options gathering information. What is it all about? So transitional living options? We're gonna summarize

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Lesley Cottrell: kind of a you might know all of this. But this is from the national literature. Again, what are they saying? Then we're gonna for the case. We're gonna get an idea of illustrating an example, analyzing the good, the bad, the ugly in those decision makings, what worked what didn't work, and then also talk about these temporary placement arrangements that

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Lesley Cottrell: we may or may not have available to us, and what other people have recommended for

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Lesley Cottrell: for increasing those options.

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Lesley Cottrell: So I've already introduced myself. And so let's in terms of the literature. A few kind of just behind the scenes. Session one and session 2 gave us a little bit of this already. So what do we talk? Who's the population we're talking about again, those with developmental and intellectual disabilities. This slide, you know, in general, you all know this

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Lesley Cottrell: age years 5 to 22 years of age. Mental physical condition is likely to occur indefinitely. Here are 3 or more categories of limitations where they're often used to diagnose or describe someone's intellectual or developmental disability.

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Lesley Cottrell: That fourth bullet, just some examples, autism, spectrum disorder, cerebral palsy seizure, disorder. And then this statistic has come as an average statistic. That's whether approximately 14% of the Us children. And we're talking across the lifespan in this case in this series. But just among children have a developmental disability. This is a broad definition.

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Lesley Cottrell: of course, but we're talking about, and I don't have to. You know. I'm preaching considerable proportion of our population.

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Lesley Cottrell: Alright. Just remember to mute yourself, if you don't mind. Alright. So, in terms of one of the challenges that have also come up in the first 2 sessions was that the behaviors, if you particularly have someone with an intellectual developmental disability who has severe behaviors, disruptive behaviors.

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Lesley Cottrell: This is where one some of the challenges finding transitional placement occurs.

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Lesley Cottrell: What do we mean by challenging behaviors so abnormally behaviors that either relate to intensity the frequency at which they're exhibited the duration of time that involve the physical safety of the individual or others around that individual. Okay.

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Lesley Cottrell:  behavior which is likely to seriously limit again, disruptive to themselves and and others around them. And then the last bullet. Some examples, the more common examples, and the ones we've been talking about the last 2 months include aggressive behaviors, self-interest, behaviors,

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Lesley Cottrell: other stereotypical or or more common disruptive behaviors. Again to that person's quality of life and daily living.

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Lesley Cottrell: measuring this before we get into the decision making. I wanted to make sure. You know, Heidi and I were wanting to make sure that we were all getting at the same page that what is a challenging or disruptive or severe behavior?

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Lesley Cottrell: And so

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Lesley Cottrell: the idea that 2 or more people can agree on that behavior on some basis. Some measurable basis is where we're wanting to get at right. So a reliable assessment.

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Lesley Cottrell: even after a couple of days. an example would be self-interest, behaviors.

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Lesley Cottrell: measurement, individual individual. Excuse me forcibly hitting one's own body with open or closed fists, or banging head against self or objects that's written in a way that it could be measurable

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Lesley Cottrell: instead of just self-induced behavior. That piece, what is it?

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Lesley Cottrell: We could add more to be more helpful. And we're going to get into that

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Lesley Cottrell: the less specific we get.

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Lesley Cottrell: the less reliability we get. Now, why are we talking about it again is because if we're talking about transitional plans and placement that fits their needs. We need to be very specific about what the what the challenges and what the behaviors are.

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Lesley Cottrell: Just a individual checklist for making sure we have it down right for others to review and concur and count, or time of the behavior. How long the the behavior takes before it occurs. So we have something that happens.

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Lesley Cottrell: And when does the behavior start?

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Lesley Cottrell: And that could be time, minutes, seconds.

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Lesley Cottrell: Did we observe? Or can we observe the behavior? Can we measure the behavior?

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Lesley Cottrell: Will a stranger know exactly what the behavior looks like

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Lesley Cottrell: after reading your definition? Do you get an idea if I read it, wrote it down. What I'm talking about and could could look out for it.

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Lesley Cottrell: Can can you explain the behavior that I've written down. or you need more information.

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Lesley Cottrell: And then, could we break the behavior into smaller, specific pieces? So it's more observable. Again, we want to reliably concur that this is happening. If we take someone out of a placement, or if a perfect placement for them based on their needs is no longer available because of a behavior.

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Lesley Cottrell: What is it? What is the challenge? What part of the behavior?

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Lesley Cottrell: And this is just visually showcasing how, what pieces of the behaviors or behavior we're talking about. So again, frequency at the top. How many times does this occur? Did it occur once

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Lesley Cottrell: or more than once? How long does it happen when it does happen?

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Lesley Cottrell: Does it vary? Okay, what does it vary on topography is, how

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Lesley Cottrell: so does something tend to occur before it happens? What happens after is the reinforcement? Does that some type of

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Lesley Cottrell: reinforcing event happen?

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Lesley Cottrell: And then permanent product is more of? I can say that they're throwing items. They're breaking furniture, but breaking pieces. You know, I need to get very specific on that instead of just aggressive behavior.

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Lesley Cottrell: Alright.

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Lesley Cottrell: So why are we talking about it? These types of behaviors

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Lesley Cottrell: tend to occur more often or more prevalent among individuals with intellectual and developmental disabilities. So there are several reviews across studies in the Us. As well as international. And about across those studies, they say about 15 to 17.5% of people

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Lesley Cottrell: with this diagnosis exhibit these challenging behaviors. Okay, the types of behaviors vary.

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Lesley Cottrell: Okay? And of course, across these studies, it depends on who tells you

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Lesley Cottrell: and how specific and reliable they are. So in one, just an example here that 19% of individuals from parent report or caregiver report

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Lesley Cottrell: engaged in self-interest behaviors that could be different if it was from other type of source. So just to give an example.

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Lesley Cottrell: Some factors associated with more prevalence or greater prevalence of these behaviors, more severe levels of intellectual developmental disability, a comorbid psychopathology. And then someone who's having communication deficiencies isn't able to express themselves, communicate.

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Lesley Cottrell: If a severe behavior again, things that we've talked about and things that this group can

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Lesley Cottrell: can give so many examples, for severe behaviors are more associated with teacher burnout, and stress for kids in classrooms.

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Lesley Cottrell: and they tend to

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Lesley Cottrell: bring about restricted restrictive processes, or occur more often in reaction to restrictive processes. So this whole escalation

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Lesley Cottrell: of events that we've heard more and more in the media and and seen more in our experiences, brings about even more of the severe behavior. So we need to talk about options that de-escalate the behavior outside of the transitional living piece.

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Lesley Cottrell: So many times people seclude the individual, restrain the individual or consider medication.

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Lesley Cottrell: I wanted to include this because it came up in session 2

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Lesley Cottrell: with Dr. Playman, and particularly noting that the and we're going to get into this with in another session. I think session 5

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Lesley Cottrell: with Dr. Swagger. I'm here to Heidi, and I are talking about a behavior and how it might relate to where we're we're placing someone today.

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Lesley Cottrell: But the etiology. The reason behind the behavior is equally perhaps, more important than the behavior itself. And so this table talks about

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Lesley Cottrell: just just puts it out there for us to consider. It's not just the behavior which you can see in the third column. but it that is the individual hungry. Are they lonely, is it? Are they engaged in a difficult situation

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Lesley Cottrell: to them low, level, high, level stimulation. We need to get to that to really affect, decrease

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Lesley Cottrell: the the behavior at hand

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Lesley Cottrell: oop.

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Lesley Cottrell: Alright.

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Lesley Cottrell: alright. Tends to want to.

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Lesley Cottrell: Okay. So housing, we're here today to talk about housing options. And how do we decide?

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Lesley Cottrell: where to put people so supportive housing. And again, this is from the literature best practice, intervention. Again, stable housing is what our goal is for any individual regardless of

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Lesley Cottrell: disability or circumstances.

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Lesley Cottrell: literature shows that if we get someone to stay in housing up to, actually, this is 6 years. But it even worked down. Some studies were saying up to 2 years, we can, you know, it's highly predictive of a stable housing over time.

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Lesley Cottrell: Some of the factors and the difficulties with types of housing again. Nothing that you all don't already know. Homelessness comes in. Rehospitalization.

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Lesley Cottrell: Funding sources come into play. And this figure. is from a couple of studies. Nationally, Hrsa did. This shows about in their sample. Where were people located who had intellectual or developmental disabilities on average.

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Lesley Cottrell: so group homes, agency operated apartments about a third independent apartments. 19% institutionalizations are rates

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Lesley Cottrell: Bob Hanson had mentioned are are even a little higher than this. And we're kind of that option's becoming more and more prevalent.

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Lesley Cottrell: So why why are we in that situation?

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Lesley Cottrell: Heidi's gonna talk a little bit about this related to the cases. But just some of these examples of funding that has changed over time, or even just recently.

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Lesley Cottrell: Sometimes funding has been there, but only in certain pockets, pays for certain things. So providers must, like a patchwork, must must get these things together for both the the

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Lesley Cottrell: care as well as the housing components as there's not one thing that does it all consistently over time, and then, of course, some funding, as many of us have been involved, is at risk and and potentially declining.

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Lesley Cottrell: Okay, just another visual the other factors. So funding options, the diversity of the placements meeting the placement, the placement. How how able the placement is to meet the individuals needs all of that, is there. But then our workforce we've also talked about in past sessions.

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Lesley Cottrell: limited. So on one end you have a limitations, and on the other end you have a very strong or resources that we can build from. So

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Lesley Cottrell: we have difficulty hiring and maintaining trained staff. On the left

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Lesley Cottrell: we have issues with referrals for needed services. The process falling in some cracks.

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Lesley Cottrell: compensation for for different levels may or may not be there, what it should be. And then

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Lesley Cottrell: even our case last month talked about this rigidity, and how it like. So in some cases flexibility and autonomy are needed to appropriately make decisions. That benefit the individual complacement

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Lesley Cottrell: on the other side again, well trained team with particular skills team approach available so that connectivity there that teams appropriately compensated and those available supports are there. We we tend to either go to the left or working in the middle here.

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Lesley Cottrell: And this discussion today is, how do we work effectively in the middle, sometimes with limited or often with limited resources?

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Lesley Cottrell: How do we work within that middle.

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Lesley Cottrell: Okay.

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Lesley Cottrell: so person must be assessed and placed in a setting based on that assessment. So that must be part of the process.

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Lesley Cottrell:  The ideal would be that we have options right, and that person could be moved based on changes in their needs.

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Lesley Cottrell: So, as the third bullet said, if destabilized, may need to move into a higher level of care, and then come back, that there's that flexibility that may or may not be there for some for our our transition care in West Virginia.

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Lesley Cottrell: Services that are high quality. We need more outpatient services with linkages. You guys mentioned that last time. And then, yeah, we have outdated laws that also prevent us from providing

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Lesley Cottrell: here.

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Lesley Cottrell: Keep that in mind for the recommendations that we

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Lesley Cottrell: produce from this group. And this effort. Okay?

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Lesley Cottrell: So without going too much into it, you're going to get the slides. You're going to get these resources, many of these collaborative and initiatives elsewhere. These are in different states.

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Lesley Cottrell: Have really helpful materials and guidelines and flow sheets that are really helpful. Those will all be in that email that follows up and you can click, and you can go to it. And hopefully, if you feel like using it, it's ready to go. These are just examples of that, how people have incorporated that flexibility, working with that person's needs as they change, providing more care or less care

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Lesley Cottrell: over time.

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Lesley Cottrell: And then how the funding comes into play. Many of these have also found funding for that purpose.

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Lesley Cottrell: And here's just again other examples where community like they have incorporated that community living, that inclusivity, while also providing that high level of care for the severe behaviors, the disruptive behaviors during that time, where they tend to be

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Lesley Cottrell: significant. significantly disruptive. And then they come back. Okay?

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Lesley Cottrell: And then again, more lessons learned. I don't want to take away. I want more of the discussion from us. But you'll get these illinois, Connecticut, and California tend to be the States that have dabbled in this and have some prominent models.

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Lesley Cottrell: Okay, Heidi, I'm going to turn it over to you, but I'll work the slides if that's okay.

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heidi thomas: that'd be great. Again. My name's Heidi

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heidi thomas: and of course I would be remiss without saying that. I know a lot of us are a little nervous because

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heidi thomas: potential funding slash that they're discussing right now. And and that's definitely something that is on everyone's mind.

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heidi thomas: Interestingly.

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heidi thomas: I, as a transition from the other, from my Idd role into the quality role I encountered a

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heidi thomas: individual last week not waiver. And this is. And so this is why it's why is this important that

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heidi thomas: I have someone, the cru who's not waiver, who's been there for 4 months. I'm sure we can also all agree that we don't have the right continuum of care and the State of West Virginia for our individuals.

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heidi thomas: whether they're waiver or not. And sometimes.

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heidi thomas: as I'm seeing the other side of our mental health business the id folks are here all the time.

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heidi thomas: and and they're not waiver, and it's

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heidi thomas: it's very interesting. I went from a very sheltered world with caring for the population. So now I'm seeing some things that was really difficult. And the reason why I wanted to share this one was because I actually probably learned a little bit about myself and my boundaries.

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heidi thomas: Last week. because I got very kind of emotionally into the situation. We had an individual show up

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heidi thomas: 32 years old has

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heidi thomas: did in and out of services for us, for since 2,014 did our Cft program, that's more of a community focused training, more of the mental health.

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heidi thomas: Folks, but also probably some folks who didn't get idd diagnosis prior to 22

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heidi thomas:  This individual had the mild idd and also schizoaffective disorder bipolar without a good prognostic features.

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heidi thomas: very high functioning, though.

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heidi thomas: and I think this is this so? Both my cases are the people, I think, who fall through the cracks

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heidi thomas: this person showed up to our Csu our crisis stabilization unit. I mentioned earlier that we have our crisis response unit.

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heidi thomas: And definitely, since we've been involved with Bob, we've we've definitely learned, we we are not really crisis.

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heidi thomas: Because you have to be careful who you put in a unit with Idd

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heidi thomas: it's not as simple as people were, just am a or different themes of that nature. So it gets a little bit more complicated. But this individual is evicted from their home.

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heidi thomas: When the crisis staff came, got me, they say, like, Look, we have an individual whose ied has 2 black eyes.

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Mary Wilson: and the significant other just got a medical and financial power attorney yesterday.

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Let's see.

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Mary Wilson: I know this for an immediate part.

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heidi thomas: Somebody's mute calendar. Oh, there we go!

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heidi thomas: And so

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heidi thomas: power attorneys definitely wear red flags.

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heidi thomas: I'm not sure if anybody else is like Oh, crap! But from my protective worldview, why is this person getting these power of attorneys.

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heidi thomas: So I went in and talked to the individual. and

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heidi thomas: it again

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heidi thomas: very high functioning.

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heidi thomas: I asked about waiver had them call waiver to see if they had waiver because she they weren't really they weren't really sure.

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heidi thomas: They came off voluntarily in 2020, which is either because of Covid, or because, as I learned speaking with her longer and longer

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heidi thomas: they really wanted their independence.

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heidi thomas: and they liked having a worker. But they didn't want someone telling them what to do all the time.

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heidi thomas: And so we just talked, and I reassured them that you're a very important member of society. You still need supports. We want to make sure we help you.

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heidi thomas: can we get you into this program just for a few days? So we can try to help you out because you were evicted. You don't have a place to go. We had separated from the significant other.

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heidi thomas: and

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heidi thomas: she they started crying, and they said, I wish you were my my mom or my sister.

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heidi thomas: Will you be my worker? And I had to say, Look, I need to put some boundaries up with you. I can be your coach, and I can be your mentor, but I cannot be your family or friend.

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heidi thomas:  And I said, Look, if you can get you into the Csu.

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heidi thomas: I'll come visit you Monday. We can talk about getting into other programs.

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heidi thomas: and we'll get you into programs to try to get you sign up for some training for a job. We have a we actually have an open bed

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heidi thomas: in our mental health support of living.

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heidi thomas: but they indicated they did not want to be a group home setting again. and I came back the power of attorney situation. So I will tell you that the power attorney for medical was limited. So I explained to the certificate other. You could only use this.

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heidi thomas: Yes. the person's incapacitated.

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heidi thomas: They have a State appointed payee. So I let them know that they'd have to go to court to get that.

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heidi thomas: It was basically not good paperwork but when I came back to be unit the next day.

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heidi thomas: They had Ama. 4 h after going in on Friday. My first response was, I wanted to go out and look around town. And then that's when I started realizing my boundaries are not good.

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heidi thomas: They also revealed to me that they had been using meth

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heidi thomas: a couple days prior. So these these are all the things that like I'm all

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heidi thomas: I just want to take you and hold you and take care of you, because that's not. I'm in a very protective world recently, with all my folks might have behaviors, but at least at nighttime they go to bed, and they're safe.

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heidi thomas: And so I was introduced to a very different side of this. II did not know.

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heidi thomas: I don't know how to help them now that they're gone, and I hope that they pop up again and because they're out there and they're being taken advantage of. They're homeless.

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heidi thomas: and I'll go. Be honest with you. That's very scary.

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And so sometimes there's the limitations with waiver

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heidi thomas: is not knowing

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heidi thomas: that not everybody can can get those support. So this was very hard because this person I couldn't have put in the cru, even if I, even if it was something I could do quickly because of the fact that

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heidi thomas: their and the independent side of it was so important to them, and why our cru is not locked. We are going to follow you. You're not. You can't just am A and roll out. I have to keep you safe.

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heidi thomas: And I and that probably wouldn't have been a good solution for her. So it definitely came down. To what resources do we have that that can help? Unfortunately, unless you're waiver, it's very hard to get those services to help id folks

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heidi thomas: through mental health.

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heidi thomas: So that was the first case.

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heidi thomas: Yeah, our goals were housing program, meaning and work. And of course the barrier was all along.

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heidi thomas: You're muted. Alright.

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gillian has a question.

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Lesley Cottrell: Hi, Julia!

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gillian mccarty: Hi! X,

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gillian mccarty: truly not just waiver that has, or or members who don't have waiver that have an issue. I have a member who cannot get ambulance to pick him up.

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gillian mccarty: or hospital services where we are. That will do what he needs to do mental healthwise because of his Idd diagnosis.

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heidi thomas: I don't disagree at all with that. II just meant that like there's no like. There's fewer resources that fills

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heidi thomas: if they don't have waiver. And I agree, because we have a lot of doctors to discount our individuals, too. I think, in one of our counties. If you go in, if you, we take one of our id folks in, it's always the uti.

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heidi thomas: even if it's not.

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gillian mccarty: Yeah. I mean, this is

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gillian mccarty: the ambulances are like, well, we can't pick them up. Your whole job is to pick up people who are having a medical crisis, and you're refusing to pick him up.

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gillian mccarty: you know, and then you get to the hospital, and the hospitals are like. he's too hard for us to to be able to to do anything with. You're gonna have to go home and figure it out on your own.

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gillian mccarty: Well, if we could figure it out on our own, why would we be at a hospital?

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Tiffany Wilson: They won't take you if you're incontinent to. I've have a client right now that we've called everywhere in the State, and if they're non verbal and incontinent, they do not take them, they said. They do not have the staff

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Tiffany Wilson: to provide that type of care.

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gillian mccarty: and either do their homes. I mean, it's it's these members

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gillian mccarty: really pose a risk of having no services anywhere.

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gillian mccarty: And II can't even we can't even get him admitted to the State Hospital.

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gillian mccarty: Yeah, they're also continuous care. right? Because the process, the process to even get them into, to to be admitted into the State Hospital under a psychiatric.

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gillian mccarty: Whatever

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gillian mccarty: requires your local people to do what what they are refusing to help you do

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Lesley Cottrell: is the non verbal piece. I guess I'm locking into that, because it might be a potential solution there. Because they don't have communication boards or no, it's because refusal to to attempt to use any of them

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Tiffany Wilson: was able to. They can't ask them, they said. They can't ask questions to see how they're feeling. They don't know how to gauge it. That type situation, and if they're incontinent they can't.

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Lesley Cottrell: Oh, Tiffany, you broke up.

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Tiffany Wilson: Oh, I'm sorry, they said. They don't have the staff to provide that much care to be there and change the diapers and that kind of situation.

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heidi thomas: Are you role? I kind of feel like we get the same thing out of our rural counties with our folks like we get better service when

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heidi thomas: Harpersburg.

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gillian mccarty: yeah, we are in Eastern Panhandle, and

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gillian mccarty: we feel like city

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gillian mccarty: that everybody just thinks we have services available, and we don't.

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Tiffany Wilson: Yeah, I'm in Huntington ground right where Marshall is, and Saint Mary's. None of the hospitals take em if they're incontinent or non verbal.

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We've called Arh and Beckley. They won't take them non verbal incontinence. I mean, we've called everywhere in the State.

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Tiffany Wilson: and if they're nonverbal incontinent, they said they can't do anything.

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Tiffany Wilson: and my client's been on the same meds since he was 9. He's an adult now, and we can't get anybody to do a med review or anything, cause he's non verbal.

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Lesley Cottrell: So does anyone on here? I guess 2 questions. One figured out a solution or run into something different that could kind of help us

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Lesley Cottrell: with these issues and kind of share your experiences or 2 advice on how to push it for care.

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Lesley Cottrell: Any thoughts on that. Let me look at the chat.

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heidi thomas: I think what I would probably do this is discussion is if I would actually go to a provider like an Ed or anything like that, and they refuse care. At that point I probably do an Aps for neglect.

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heidi thomas: I know it doesn't always stop, and they're so far behind.

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gillian mccarty: I've done that. They won't touch it. I can't get patient advocate at the hospital

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to do anything.

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gillian mccarty: and it's more than one hospital.

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Tiffany Wilson: Yeah. We even had our one mine taken by ambulance to Saint Mary's, thinking that if he was there no, they put Mom right back out the door with him.

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Lesley Cottrell: Tamara, your your hand is up.

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Lesley Cottrell: You want to go ahead.

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Tamara Hall: hey, ladies?

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Tamara Hall: no. I work for Cps and Fayette County, but I have a child who's 22 years old. Severe autism that's in a group home and Huntington. It's called Autism Services Center, and

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Tamara Hall: it took forever and a day to get him in there. He was abandoned at Bar H. Beck Blotton Regional Hospital by the facility that he was with, because they couldn't handle him, and he was on A. The waiting list to go to Autism Services Center for 8 months was left at Bar H,

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Tamara Hall: but for 8 months before I could get him in autism Services Center, and they deal more from all his autistic population. And he is non verbal and incontinent. And it and it was. It's just such a struggle. It's so hard trying to find placement. You know, and I've set here and called for, you know, placement for people, you know, trying to, you know, PE, you know, kids that need to be placed, that have disabilities, and there's just nowhere to put them. There's just nowhere to put them, and it's so so discouraging.

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Tamara Hall: But that's my take on it.

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Lesley Cottrell: So some people have said that there's

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Lesley Cottrell: one solution is to make more beds. I wanna hear thoughts about that, because the kind of this this discussion is it? Is it not about beds, but

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Brandon Kijewski: making those beds accessible? II wanna I don't. Wanna can I? Can I? As far as the beds thing II am married to a healthcare provider who works in hospitals

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Brandon Kijewski: and particularly like when Covid came out like one of the phrases that people used a lot of times was beds being available. It's not that there are not physical beds. It's that there are not enough people to service those beds like you cannot have r ends on some of these units, having 24 patients to be, you know responsible for.

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Brandon Kijewski: And this is all over our state. This is all over our, you know. Like our healthcare system.

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Brandon Kijewski: We do not have enough staff, and that is staff from the lowest of dsps or isps, or whatever you know what whatever any particular agency calls them. At this point. Qs. You know, whatever the phrases nowadays, all the way up to people who are nurses, doctors, providers like we do not have enough.

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Brandon Kijewski: And you know I'm I'm I'm speaking specifically from something that was brought up where there were physical beds. There were no nurses like there. There were no nurses working at a particular major hospital that I'm not gonna name, just because I'd I'd like to keep a little bit of a boundary there. But they they didn't have. They didn't have a nurse, a single Rn. On an entire floor of a major hospital in our State

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Brandon Kijewski: during the Covid pandemic, and

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Brandon Kijewski: like it wasn't, it wasn't a matter of not having a physical bed for somebody to lay their head. It was a matter of staffing, and our staffing still continues to be at a critical, at least, I think a critical point. Whether that is

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Brandon Kijewski: in the population centers like Charleston and Huntington, or, you know Parkersburg or in the rural counties. Like II still firmly believe that staffing is at a critical thing. Is that a critical level? And it's really going to impact everywhere that we could possibly think of.

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Lesley Cottrell: No, I appreciate you saying that. And I think that's an important distinction to make, because people go to the physical space and and

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Lesley Cottrell: the people the workforce. It's an important distinction to make. So, Lauren, I'll go to you. And then, Tina, if you don't mind to go after Lauren.

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Lauren Swager: Yeah, thank you. No, I couldn't agree more with the workforce issue. But I also think it's important when you talk about needing more buds, you talk about

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Lauren Swager: the right beds. If we really talk about the right level of care, cause a lot of times. People are being sent to acute care hospitals for things that are really chronic that that need kind of long term behavioral management. And so you get denied

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Lauren Swager: feeling like the the needs aren't being met. But but really it's not the right level of care at the right time for the right need. So as as we talk about beds and workforce, it's also important. We match the right level of care in those beds. And and our our system is just really challenge with what I call the the middle line services. You know, we have outpatient services, we have acute services.

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Lauren Swager: We we really need kind of more of these

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Lauren Swager:  sort of long term chronic services definitely, a long dual diagnosis, but also recognizing that some of these needs are chronic and and and aren't going to get better in hospital either. So, continuing to build out the middle with services to keep people in the community with both housing needs and medical and non health needs met is an ongoing challenge, but often need all, but II think we lose

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Lauren Swager: lose our soul, and we do people a disservice. If we only talk about beds. III think that, or placement. Those those are. Those are words that I know are important. We all know that you need a placement and safe spot, but I mean, it's really the right bit at the right time for the right level of need in the right location, because many times we know how to what what we need to get. Success is not available, but it could be

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Lauren Swager: for many different reasons. It's it's not just, not that simple. II guess. I know we know it's not simple, but it's important that that we can't forget that that putting people in too high level of care also comes with its own risk to to deterioration, too. Legislative season.

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Tina Wiseman: Yeah. And and really, I don't see it as an issue of

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Tina Wiseman: number of beds. I think some others have spoken about the the right type of services and the staffing issues. But I think I can address some of the hospitalization problems. It's II was at O Flacc prior to this job for 13 years, and

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Tina Wiseman: when I was there the last few years, particularly the Hospital Association. kept coming to us, saying, If we cannot get nursing homes and behavioral health providers to take back people

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Tina Wiseman: once they are admitted and ready for discharge, that they were just going to stop taking them.

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Tina Wiseman: and they said that they didn't feel that they felt that they could do that because the majority of people that they saw we're not having a medical crisis.

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Tina Wiseman: but a behavioral one. and that pro in that providers they felt this is not me speaking, but just that. They felt that that

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Tina Wiseman: that those those needs could be met in the community, and due to fear of

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Tina Wiseman: just providers. you know, dropping off the person and not coming back to get them.

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Tina Wiseman: that they were having a a real crisis of people being there well over a year, just because they couldn't get another provider to  to to bring them back. So I think

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Tina Wiseman: part of it is that they have a very low expectation of what's going to happen when the person gets dropped off. and they? They feel that that there's a very likelihood very high probability

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Tina Wiseman: that when that person's ready for for discharge from the hospital, or if they're not even ready to be admitted that they're not gonna be able to get hold of anyone to come back and pick up that person. And that's just I, 2 cents from from those years working at Overflack.

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Lesley Cottrell: Thank you, Tina.

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heidi thomas: And I would say that that's probably because there's not that in between or continuing of care. That's it's you get to the situations where

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heidi thomas: you can't provide the care.

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heidi thomas: And yeah, the hospital's not the right place for them. But if you can't provide the care, because there's no other supports for those providers. And you're in those situations where you're trying to balance the safety of everybody, including the person that you're having. Maybe those issues with at that time.

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heidi thomas: How do you keep everyone safe? Because this, unfortunately, in the State, they don't have an those intermediate level, a care to help stabilize that person, or to be able to really focus on how to help them.

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heidi thomas: And unfortunately, I think that's what's created. It is the States kind of filled

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heidi thomas: to keep following through with what they promised to do

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heidi thomas: for the population.

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Lesley Cottrell: Real quick, Heidi, and I'll turn it back to you, Gillian, you had your hand up.

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gillian mccarty: II think there is a real

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gillian mccarty: place for

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gillian mccarty: institutionalization. because I don't know a better word.

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gillian mccarty: So like a step down from institutionalization, but a step up from hospital. I guess

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gillian mccarty: that can be created

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gillian mccarty: where wards can be created to meet these members where their current needs are and work them up through that system to be out in the community

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gillian mccarty: fully adapted, but also that institution

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gillian mccarty: function within the community.

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gillian mccarty: and so part of the regulation for having it, you know, is that they have to go out

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gillian mccarty: to into the community. So you know.

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gillian mccarty: ever so often. But I mean, I like I have a member now who's running away just just for the thought of it.

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gillian mccarty: literally, just for the fun of it. And he's gonna get end up getting run over.

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gillian mccarty: and I can't get it moved fast enough. I have another member who's on fire, causing all of this direct care staff to quit

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gillian mccarty: in a system where people already aren't paid enough, and and

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gillian mccarty: you know, but but I do think those systems could be created, and it would be a very happy medium

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gillian mccarty: that we have a lot of members

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gillian mccarty: who don't feel comfortable in the community at large, but would feel comfortable in in a community of their own members. and and meeting people where they are intellectually

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gillian mccarty: unlike what

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gillian mccarty: some of the people who come and review everybody wants them to have.

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gillian mccarty: and and I don't know how anybody would go about creating such a facility.

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gillian mccarty: but

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I know from growing up in this system.

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gillian mccarty: My siblings are in the system. I work the system. I know it is. It is something that could be done

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gillian mccarty: if the right people would head it up, and who knew what they were doing right like an Idd campus. Whoever said that, Jason? Yes, an Idd campus

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gillian mccarty: where we're teaching them functional life skills

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gillian mccarty: in a setting that is comfortable for them where we could truly

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gillian mccarty: integrate them into their community because we've taught them the things, and

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then they're in their community if they never get past that point.

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gillian mccarty: But all these systems, they're too hard to work. Nobody can get in, because there there are agencies who aren't the most amazing, who drop their people off and don't come back and get them. And then you have people who really need that service who can't access it because of those agencies that have done that

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Lesley Cottrell: there's there's some of those examples that we didn't get into too much. So we could have this conversation. But there's the Illinois, and we're actually gonna hear from them a couple of months from now. They've done something like this, but it's not a campus, because they've really tried to not segregate and just call it something different.

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Lesley Cottrell: they they've they've scaffolded care like you're talking about doing, but done it in a way

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Lesley Cottrell: that. So if they can't get past that. It's not.

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Lesley Cottrell: They're still in the in the community. They're still included within the community. So we'll be. You can put campuses anywhere.

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gillian mccarty: I mean. Look at. Look at all of the state projects.

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gillian mccarty: you know, and housing and apartments and things like that, you could easily turn that into a campus in the middle of town

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gillian mccarty: wink. There are ways to do it, and nobody's saying that this campus has to be on the outskirts in the middle of nowhere because these people need to not be seen.

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gillian mccarty: And I think that's that's where everybody wants to get away from the institutions, because these members do do have the right to access their community and not be locked away.

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gillian mccarty: But some of them do need to be locked away. not forever.

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gillian mccarty: but they do need a level of care that those units bring to keep them safe until they understand how to be in their community and not get run over by cars just because they're bored today.

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Lesley Cottrell: Right? Yeah. The additional care, Tina.

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I guess I just wouldn't.

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Tina Wiseman: you know, for the person that's like running out in the street because they're bored. I I'd be interested. What are they doing all day long? What's their schedule like? What are? What's their level?

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gillian mccarty: So so, agency, th this specific member

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gillian mccarty: is is that an agency where they are struggling to to be able to staff?

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gillian mccarty: He's running out into the street mainly because he's bored and he doesn't have.

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gillian mccarty: Well, he is not like right on the street. He's just really fast on everybody else. He got really long legs. He is super duper fast, and he is just faster than everybody.

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gillian mccarty: And once he learned that

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gillian mccarty: he's just gone.

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Tina Wiseman: you know.

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states are are.

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Tina Wiseman: I mean.

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Tina Wiseman: I don't know if you've ever heard of the Olmsted decision. But you know, States are not to be providing services in institutional settings, and that was upheld by the Supreme Court.

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Tina Wiseman: We have, Hartley, even though Hartley's been closed, there are still numerous court orders in place.

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Tina Wiseman:  Just

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Tina Wiseman: to me that to me the answer is, never

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Tina Wiseman: institutionalize someone. III don't know of anyone that's ever benefited from being institutionalized. You. You look at the folks that go to sharp hospital because they have just chronic mental illness. They don't have Idd, but they just have mental illness. They get their little tune up.

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Tina Wiseman: they get out, and they stop taking their meds. I mean, the cycle just goes on and on. I mean, there's there's

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Tina Wiseman: there's there's reasons why we don't have institutions today. But

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gillian mccarty: I guess that's pro. That's probably Leslie. That's probably a way broader question, just a matter of using the right words. So so there are members who, when they're on fire.

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gillian mccarty: need a unit of being able to be protected so that they can't do those things until they understand

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gillian mccarty: 4 wheel.

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gillian mccarty: but that doing that could get you killed.

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Tina Wiseman: Well, are not gonna keep people safe, Julie. I mean, you look at my hospital. They just burned the skin off. Someone's skin just melted off their entire body because they left him in a whirlpool that was too hot.

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Tina Wiseman: It's not gonna keep. Just cause you label it. Something like does not mean it's necessarily gonna keep them safe.

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gillian mccarty: Well, some of some of that comes from from being able to hire a more quality of people because you are able to pay them a different wage, too. I mean, there's bad people everywhere, though. So like that's also not gonna fix everything.

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Lesley Cottrell: And you guys are bringing up all the factors that are making this really difficult. I think the campus idea where they would prefer to live, having those opportunities, that training opportunity where they wanna live

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Lesley Cottrell: rather. So off camp off a campus or anywhere it might be located

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Lesley Cottrell: getting that accessible service is key. So I think that's a valuable piece. I think.

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Lesley Cottrell: you know, everyone's talking about it. In many instances, our lack of resources, our lack of ability. Collectively, the royal, we

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Lesley Cottrell: to get resources that we need to provide services are impacting individuals options. And I would be mad if my options were limited, because somebody couldn't get their act together and get more people to provide those services. So I think that's that line of you're absolutely right. And Tina's absolutely right of

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Lesley Cottrell: yeah it it it just

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Lesley Cottrell: trying to keep it where they'd like to be.

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Lesley Cottrell: But they need those scaffolded services. Absolutely. They need those skills taught to them at certain points, just like we all do so

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Lesley Cottrell: absolutely, absolutely

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Lesley Cottrell: real. Quick, Gillian. I could turn it back to Heidi. We've got one more client cause I want your thoughts on this plant, too. So Heidi, can you?

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heidi thomas: Yes, and I'll I'll move the slide if you're ready. Yeah, absolutely

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heidi thomas: so another client that we've encountered 19 years old

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heidi thomas: has autism, schizoaffective disorder. So again, it's that co-occurring with some generalized anxiety. Adhd depression.

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heidi thomas: and due to their their childhood, some ptsd criteria they went to a hospital we took them into our cru

383
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heidi thomas: but from the hospital they actually got them from an assisted living facility. At 19 years old.

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heidi thomas: 18 years old. They're living in this as a living facility.

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heidi thomas:  safe? Yes. But is that appropriate for someone that age? No, absolutely not.

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heidi thomas: What led to them. Going to the hospital, they blacked out and punched the staff, who took off their headphones

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heidi thomas: because they actually touch their cocular implant, which is a trigger for this individual. A, we've actually tried to find

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heidi thomas:  Long-term placement has been in the cru for 4 months, which is definitely not ideal.

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heidi thomas: With a 30 day stay unit. And

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heidi thomas: honestly, this person so delightful. I it's we got some issues with hygiene. But

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heidi thomas: honestly, very delightful. Has some.

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heidi thomas: We allowed some Internet capabilities after a little while. and creates kind of this fictional world.

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heidi thomas: And it was pretty sad. Some of the things that happened in the fictional world, which is we end up taking. When we found out some of the stuff that was going on, we ended up taking away that Internet

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heidi thomas: just simply because it was not safe, but it was making things for the person a little bit more difficult. They're not eligible for waiver services because they had a major mental health diagnosis prior to the Id diagnosis. I still don't understand how that works. I still understand why that's that way.

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heidi thomas:  and it's been a barrier to them, getting waiver and potential placement.  on a paper. This gentleman

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heidi thomas: is a mess when we got the referral they would refer to the incident where they punched this other. So the staff in the home is they blacked out.

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heidi thomas: Basically, they did everything they said a lot without saying disassociated. So we're like, okay, what's going on?

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heidi thomas: But honestly. this person wants to be

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heidi thomas: helpful, you know, which I think a lot like even your even our kids right? We usually

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heidi thomas: bring the help out of them, because, like, Oh, no, I got this. Don't don't do it because it takes time, and it's inconvenient with your kids help.

401
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heidi thomas: but he wants to be so helpful. We have the other individual kind of role modeling. And this person's younger than the other person. They're role modeling to.

402
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heidi thomas:  we did Fba. And a lot of the problems we're having is the issues with hygiene are based on safety.

403
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heidi thomas: The traumatic miss of the childhood. We feel like cleanliness

404
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heidi thomas: and and hygiene is why

405
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heidi thomas: they're avoiding

406
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heidi thomas: taking showers. They're avoiding cleaning. Well, they're avoiding brushing teeth.

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heidi thomas: washing hands. and we feel like that was probably something they did as protection.

408
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heidi thomas: so they wouldn't be

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heidi thomas: sexually assaulted

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heidi thomas: when they were younger they were. So there's

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heidi thomas: there's some challenges there to get some to get some ferbs in place to help the individual.

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heidi thomas:  but delightful. And if it wasn't for the political climate.

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heidi thomas: we would love to have this person in our homes. But you know the scariness is with

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heidi thomas: at this point, and as I'm sure this is also a big part of this conversation. How many of our agencies are going to be able to stay open? I lose a million dollars a year

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heidi thomas: providing residential services.

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gillian mccarty: I have 2 big agencies in my area that I bet will not make it through 2024

417
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gillian mccarty: that in the last week they have both closed 4 bed homes.

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gillian mccarty: Yeah. And and and it's

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gillian mccarty: the one agency is down to 2 apartments and 2 eight-bed homes. And they were a huge provider in our area

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gillian mccarty: that I think they had. I think they had 14 Al U's. And then they're 2 big group homes. And they're down to 4.

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heidi thomas: Yeah, close to about 4 homes during Covid.

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gillian mccarty: Yeah?

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gillian mccarty: And and somehow they all made the majority through the the bulk of the problem with Covid.

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gillian mccarty: But then, in 20 late 2022, they couldn't hold anymore. and they've been closing houses ever since.

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gillian mccarty: I have one member at another at another residential provider, because they don't have staffing goes and sleeps at another one of the consumer's houses every night, because they don't have night shift for him

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gillian mccarty: every night. He doesn't get to sleep in his own bed in his own house every single night.

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heidi thomas: Yeah, that's very scary.

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Lesley Cottrell: Okay, so

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Lesley Cottrell: we've had a really good discussion. These were questions that we wanted to ask it in case you we needed to prompt. But I love this group because

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Lesley Cottrell: you provide great resources and your thoughts. So I think I think we've identified the factors that are in our minds that challenge us for finding placement, for keeping people in places where where they want to be, where they need to be.

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Lesley Cottrell: I think our limited resources have been clearly defined. On this call as well as our previous sessions.

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Lesley Cottrell:  Does anyone have any?

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Lesley Cottrell:  positive kind of next steps

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Lesley Cottrell: things that they've seen to leave us on a positive footing with regards to decision making.

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Lesley Cottrell: Theresa.

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Lesley Cottrell: or you're on mute. You raise your hand feel free to go ahead.

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Teresa Bhaile: Oh, yeah, sorry about that. I had some pump pop pop up, and I couldn't

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Teresa Bhaile: get the unmute button. But I'm in social work, masters of social work program.

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Teresa Bhaile: And in the chapter that I just read on my policy in my policy class right now, they talked about community mental health. the Community Mental Health Center movement that started in

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Teresa Bhaile: the late sixties and was going pretty well up until

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Teresa Bhaile: Federal funding changed under the Reagan administration. And so I was wondering how things might do better if we went back to that kind of method. Probably you have to like, figure out how to change funding

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Teresa Bhaile: or something, but that that might be

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Teresa Bhaile: that the community health community, Mental Health Center movement from the sixties to the eighties.

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Lesley Cottrell: Thank you, Teresa Gillian, you have thoughts on that.

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gillian mccarty: Now. I'm the one that can't find my unmute button.

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gillian mccarty:  I have been told that there are other States that have great

447
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gillian mccarty: programs that I know. Some of them aren't like waiver like our waiver where they pay guardians or whatnot. But

448
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gillian mccarty: I really think that we need to

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gillian mccarty: concentrate the waiver

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gillian mccarty: on the 24 7 settings before we concentrate it at home, and I know that's awful. But

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gillian mccarty: I feel like they're on fire first. But there are other states like North Carolina that's supposed to have great services, that that if the State of West Virginia could blueprint the good things from all of these.

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gillian mccarty: from the States that have good parts.

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01:01:56.970 --> 01:01:58.709
gillian mccarty: and we can mimic it.

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gillian mccarty: Then we could take waiver, and make it a great system. If we did that, and and convince the Governor to give us money.

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Julianna Hayden: I have a question, and I'm not sure how to raise my hand, but primarily to

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Julianna Hayden: to Jillian, because you said you were in the Eastern Panhandle, and I am as well. So I I think I know the companies that you're referring to.

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Julianna Hayden: Is it possible? Not just in the Eastern Pando, but through the State.

458
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Julianna Hayden: to

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Julianna Hayden: have a campus-like setting

460
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Julianna Hayden: that is staffed by

461
01:02:44.730 --> 01:02:50.539
Julianna Hayden: different agencies there to kind of pull the workforce

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Julianna Hayden: to provide services for more people at once without having to go to

463
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Julianna Hayden:  kind of individual apartments. If you had, say 4 apartments with a common room.

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gillian mccarty: They don't. They don't look at that. No, no. So because waiver currently has done away with iss times one

465
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gillian mccarty: that essentially would be a group home because you were. You would be looking at 4 apartments and one living room.

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gillian mccarty: or 1 4 bedroom.

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01:03:29.320 --> 01:03:44.650
Julianna Hayden:  well, no, see, I'm thinking, like a bedroom with a sitting area, and maybe a kitchen at and then like a gathering room, almost like a college dorm a quad.

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Julianna Hayden:  where each resident has their own individual space. And of course I'm not talking somebody who needs one on one

469
01:03:55.910 --> 01:03:57.350
Julianna Hayden: when they're constant

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01:03:57.380 --> 01:04:03.759
Julianna Hayden: visual contact. but where you could. I think there is a place where that

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gillian mccarty: good work for people who are really borderline and maybe don't need traditional

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gillian mccarty: up. Your dairy air waiver services cause. We do have some of those. We do have some people that just have somebody, you know. They just need somebody to come in an hour or 2 a day to make sure that they remember to take their meds, and that they remember to turn off their stove and stuff before they go to bed, and I and I think

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gillian mccarty: I think you could create that, and possibly bill it as a respite or something for the person who comes in and does that.

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gillian mccarty: I'm just thinking. If you had, you know.

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Julianna Hayden: say, 3 or 4 people, even 6 people who needed one to 3 care.

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Julianna Hayden: And it's not a 3 bedroom apartment, but each apartment opens on to that common quad area where you could have a series of

477
01:05:05.660 --> 01:05:10.979
Julianna Hayden: direct care providers in the common area, but who have direct access

478
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Julianna Hayden: to the personal area to do the checks throughout

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gillian mccarty: that 8 h shift. II don't think you would be able to get enough staff to do it that way. I

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01:05:22.480 --> 01:05:23.720
gillian mccarty: the

481
01:05:23.750 --> 01:05:26.380
gillian mccarty: the house is one thing you know. Yeah.

482
01:05:27.190 --> 01:05:29.019
Julianna Hayden: I'm I'm just saying like, if

483
01:05:29.100 --> 01:05:37.429
Julianna Hayden: if one client is from company, a one client is from Company B, one clients, you know, and so forth.

484
01:05:37.610 --> 01:05:44.520
Julianna Hayden: Then the direct staff could be provided by each of those companies. and instead of having to.

485
01:05:45.180 --> 01:05:50.190
gillian mccarty: I don't think to be on the same page to do that.

486
01:05:50.320 --> 01:05:53.739
gillian mccarty: I do think that could technically be done.

487
01:05:54.290 --> 01:05:55.350
gillian mccarty: Technically.

488
01:05:56.770 --> 01:06:01.200
gillian mccarty: I don't think you'd get the provider agency to play nice with each other to do it.

489
01:06:01.410 --> 01:06:04.329
Julianna Hayden: II agree with that. A 100%.

490
01:06:05.210 --> 01:06:08.920
Julianna Hayden: But in the perfect world that would be one way to do it.

491
01:06:09.610 --> 01:06:16.459
gillian mccarty: It could be. Yes, I like how you're thinking, Juliana. Creative thinking is where you know it's going to get us to the end here.

492
01:06:16.490 --> 01:06:22.239
Lesley Cottrell: but but have to. Bonus is on us to play in the sandbox.

493
01:06:22.680 --> 01:06:23.500
gillian mccarty: Yeah.

494
01:06:23.900 --> 01:06:27.349
Marc Wilson: my, I'm sorry. Go ahead.

495
01:06:29.420 --> 01:06:32.060
Marc Wilson: There's also the rest assured program.

496
01:06:32.470 --> 01:06:34.440
Marc Wilson: Camera monitoring so scap.

497
01:06:34.800 --> 01:06:37.239
Marc Wilson: I think that's widely underutilized.

498
01:06:37.640 --> 01:06:39.130
gillian mccarty: More programming group.

499
01:06:39.730 --> 01:06:41.599
Marc Wilson: rest assured, is that

500
01:06:41.760 --> 01:06:47.359
Marc Wilson: it's a sister company of rest here, but any company can use it where you can have cameras monitoring

501
01:06:47.520 --> 01:06:50.330
Marc Wilson: from a remote location, actually in another state.

502
01:06:50.690 --> 01:06:53.829
Marc Wilson: And they monitor the client overnight. There's a call, but

503
01:06:54.540 --> 01:06:55.230
something.

504
01:06:55.570 --> 01:06:59.119
gillian mccarty: Oh, you really need mild clients for that.

505
01:07:00.940 --> 01:07:06.089
Marc Wilson: Yeah. And there are some clients who don't need 24 HA week.

506
01:07:07.950 --> 01:07:12.580
Julianna Hayden: and I mean Gillian. That's where I come at. My son is 26,

507
01:07:12.640 --> 01:07:14.419
Julianna Hayden: and he's autistic.

508
01:07:14.490 --> 01:07:18.179
Julianna Hayden: and he's fairly high functioning. So I mean.

509
01:07:19.430 --> 01:07:25.680
Julianna Hayden: I know, like he has a group of friends, and they're all autistic. They all went to high school together.

510
01:07:26.230 --> 01:07:33.310
Julianna Hayden: and that's where I come with that idea of almost like a group home or a college quad

511
01:07:34.340 --> 01:07:36.979
Julianna Hayden: where you just have that one person who's

512
01:07:37.390 --> 01:07:46.719
Julianna Hayden: going to check on them routinely, you know, but is somebody's there all the time?  And I've had a lot of clients

513
01:07:47.050 --> 01:07:57.379
Julianna Hayden: that would fit that situation, and by doing something like that you would take some of the pressure off to provide staff

514
01:07:57.490 --> 01:08:00.979
Julianna Hayden: for clients who need more intensive help.

515
01:08:01.310 --> 01:08:12.000
gillian mccarty: I think there's also so here I'm sure they have them in other areas, too. But we have like affording affordable seniors.

516
01:08:12.660 --> 01:08:15.549
gillian mccarty: senior towers, or like senior apartments

517
01:08:16.220 --> 01:08:27.850
gillian mccarty: that could be great for a certain part of our population where they don't need somebody with them all the time. And there are a couple of people throughout the building or on each floor.

518
01:08:28.220 --> 01:08:31.159
gillian mccarty: that if they needed services

519
01:08:31.920 --> 01:08:35.640
gillian mccarty: the the people would be there, but they would also be mostly independent.

520
01:08:35.710 --> 01:08:42.929
gillian mccarty: I think I think there is a level, especially with the huge high rate of autism that there is now.

521
01:08:43.010 --> 01:08:52.210
gillian mccarty: and the borderline autism that we are seeing where the where they're not so severe, and they probably could be mostly independent

522
01:08:52.240 --> 01:09:05.020
gillian mccarty: where that would be a great service to be able to open up and provide to them. I don't know that it could be a waable service with the way the waiver in and of itself works, but I think that there is a real

523
01:09:05.149 --> 01:09:06.430
gillian mccarty: model

524
01:09:06.779 --> 01:09:09.510
gillian mccarty: for for availability, for that

525
01:09:10.330 --> 01:09:13.669
Julianna Hayden: right, and I cause I go back to my son.

526
01:09:13.930 --> 01:09:20.010
Julianna Hayden: He's 26. He lives at home. but you know I can be gone

527
01:09:21.630 --> 01:09:26.999
Julianna Hayden: for even 6 h as long as he has a way to reach me by phone. He's good.

528
01:09:27.479 --> 01:09:40.169
Julianna Hayden: No, he doesn't use the stove or anything like that when I'm gone. But like I said that, that's where I come at this idea. There are a lot of.

529
01:09:41.180 --> 01:09:45.870
Julianna Hayden: and it's not just autistic. I had a client that was down syndrome.

530
01:09:46.120 --> 01:09:48.990
Julianna Hayden: who could stay by herself for

531
01:09:49.120 --> 01:09:53.749
Julianna Hayden: a given period of time and was fairly independent.

532
01:09:54.120 --> 01:10:00.109
Julianna Hayden: But she just needed that supervisor to make sure. She ate to make sure she took her meds

533
01:10:00.300 --> 01:10:02.690
Julianna Hayden: to supervise cooking.

534
01:10:03.280 --> 01:10:05.000
Julianna Hayden: You know that that

535
01:10:06.290 --> 01:10:09.559
Julianna Hayden: light supervision, and if they could contribute.

536
01:10:09.630 --> 01:10:15.170
Julianna Hayden: Say, you have 4 people. Each of them contributes a fourth of

537
01:10:16.760 --> 01:10:21.149
Julianna Hayden: the cost of the direct staff. It eases their budget.

538
01:10:22.760 --> 01:10:29.570
Julianna Hayden: It eases the need for more staffing right, and then opens up for

539
01:10:30.860 --> 01:10:32.560
Julianna Hayden: people who need more.

540
01:10:33.550 --> 01:10:34.410
gillian mccarty: Right?

541
01:10:36.230 --> 01:10:48.069
gillian mccarty: I think there's a real availability possibly, for that. I don't think. Don't think it would work with the more severe consumers.

542
01:10:48.160 --> 01:10:53.299
gillian mccarty: We'd have to get everybody on the same playing field. But I

543
01:10:53.600 --> 01:11:11.249
gillian mccarty: I think there's a real potentiality for conversations to be had for the, for the people that they do have that are mild like that, that maybe that is a solution to some of these agency staffing issues, where they have one staff here on one staff here and one staff here.

544
01:11:11.620 --> 01:11:12.740
Julianna Hayden: right?

545
01:11:13.060 --> 01:11:16.090
gillian mccarty: And it and it could be it could be

546
01:11:16.400 --> 01:11:28.230
gillian mccarty: at least a temporary solution, because because smaller placement. So anything that's less than that's unlicensed. Home doesn't have to go through the licensing process.

547
01:11:30.840 --> 01:11:32.500
gillian mccarty: which is difficult.

548
01:11:32.810 --> 01:11:33.760
Julianna Hayden: Yes.

549
01:11:35.280 --> 01:11:45.279
Lesley Cottrell: so I'm gonna I'm gonna stop your your creative thinking there, cause we're over and people are hanging on. II do want to tease you a little bit. Because

550
01:11:45.340 --> 01:11:48.420
Lesley Cottrell: again, some people have tried this.

551
01:11:48.790 --> 01:11:59.799
Lesley Cottrell: that that's just you guys are talking about slightly different way. But we're gonna hear them  in May during their session.

552
01:11:59.880 --> 01:12:02.800
Lesley Cottrell: And then again, just to kind of wrap this up.

553
01:12:02.980 --> 01:12:17.069
Lesley Cottrell:  some resources. And I was typing in some things based on the discussion of additional resources, we should add, so thank you for that. So be on the lookout for an email. We always have a summary email with, take home points

554
01:12:17.180 --> 01:12:18.619
Lesley Cottrell: and resources.

555
01:12:18.880 --> 01:12:30.430
Lesley Cottrell:  finish out housekeeping. If you need a certificate of attendance, shoot me an email, let me know. Put it in the chat. I'll give you some time to do that before I shut it down.

556
01:12:30.610 --> 01:12:35.419
Lesley Cottrell: and and we'll get those out and then join us this time

557
01:12:35.560 --> 01:12:38.829
Lesley Cottrell: next month, and and we'll

558
01:12:39.150 --> 01:12:43.869
Lesley Cottrell: with the recording of this and more information about who that is, and what we're talking about.

559
01:12:44.540 --> 01:12:50.900
Lesley Cottrell: So thank you all for joining us, spending your lunch. Break with us. Great discussion. Appreciate it, and more soon.

560
01:12:51.510 --> 01:12:52.690
Tiffany Wilson: Thank you.

561
01:12:53.080 --> 01:12:54.359
Julianna Hayden: Thank you.

562
01:12:54.730 --> 01:12:55.900
heidi thomas: Thank you.

563
01:13:14.650 --> 01:13:20.630
Regina Desmond: Dr. Cotral. This is Gina. Next next month's is on a Tuesday, right? I was like.

564
01:13:20.840 --> 01:13:25.499
Regina Desmond: it's in my calendar as a Tuesday, but that felt wrong. So I thought, well, since you're stolen here, I'd check.

565
01:13:25.590 --> 01:13:29.170
Lesley Cottrell: Yes, let's do this. Hold on. It's my phone here

566
01:13:29.620 --> 01:13:32.299
Lesley Cottrell: said this time next month, and I might have been wrong.

567
01:13:32.910 --> 01:13:43.280
Lesley Cottrell:  I also could have put it on my calendar wrong? So I doubt that

568
01:13:43.290 --> 01:13:46.260
Lesley Cottrell: and doubt it. Let me. Where is it?

569
01:13:46.410 --> 01:14:02.879
Regina Desmond: Tuesday, the April sixteenth. Is that right? April sixteenth. You're right. Okay, alright, just just checking. That's close enough. I just I just. I noticed that this morning, and I was like so alright. Thank you very much. You, too, bye.