SCHA-LA

Residential Services: Future Direction (Mario Perez)

Posted in Uncategorized by SCHA-LA on January 14, 2010

notes to accompany the powerpoint (which I will try to get and post) Mario J Perez, Director Office of AIDS Programs & Policies, and Carlos A Vega-Matos, Clinical Enhancement Services Division

LA County Residential/Housing Investment

  • OAPP $7,051,034
  • HOPWA $14,788,755
  • TOTAL: $21,839,789

These are 2 very distinct service categories. Discreet, separate portfolios.

OAPP RCS Portfolio:

  • emergency housing $271,711
  • transitional housing $210,347
  • RCFCI $4,868,185 [residential facilities for the chronically ill] spread out geographically, distribution based on where they were able to obtain and license services, not on the geographic distribution of need.
  • ARF $1,047,049 [adult residential facilities]
  • Skilled Nursing $583,542 [1 provider]
  • Hospice $70,200 [1 provider]
  • TOTAL: $7,051,034

Looks like this:

  • 4 agencies provide EMERGENCY HOUSING – 18 beds for 216 clients
  • 3 agencies provide TRANSITIONAL HOUSING – 20 beds for 135 clients
  • 4 agencies provide RCFCI – 99 beds for 231 clients
  • 2 agencies provide ARF – 1,621 days of service for 4 clients
  • 1 agency provides HOSPICE – 234 days for 2 clients

Issues/Challenges:

  • OAPP/HOPWA overlap [emergency/transitional]
  • regulations, standards, services out of sync with changes in disease progression
  • matching actual need with level of services provided
  • inadequate incentives for self-sufficiency

Proposed Changes:

  • reduce overall OAPP investment to $5,420,660 [$1.6m savings]
  • sunset OAPP investment to emergency & transitional housing
  • reconfigure ARF in to a transitional group home
  • tighten eligibility requirements (Karnofsky used now, Global Assessment of Functioning (GAF) added to assessment)
  • set time-limits: RCFCI 24 mo, TARF 12 mo [some of this is to get “in step” with federal requirements, ie: time limits]
  • reduce # of RCFCI beds from 99 to 80

we have created an environment in which folks who don’t have critical need are receiving a level of service which is unnecessary. to the extent that  we can get folks healthier, stabler, employed, moving along the self-sufficiency continuum, but the incentives aren’t’ there to make that happen.

will lean on HOPWA partners to ensure that the shift is as seamless as possible.

these changes will result in a decreased investment of $1.6million. held off on doing this sooner to ensure that this can be done in a way that doesn’t unduly impact housing of clients.

there will be exception clauses built in to all of this. “Doctor’s note” requesting an exception if client doesn’t move along continuum.

will sunset emergency/transitional in the next month. ask the Board Of Supervisors (BOS) for extension until the RFP is released with new modifications. Need to make sure that Title II is adjusted (federal guidelines will trump the state guidelines), standards of care are approved and in place etc.

Q & A:

$14.8 HOPWA  that $ also includes some rollover money and money that came from LAHD. Actually, that money includes housing, beds, permanent, supportive services incl food, legal, CHIRP, development etc. That year approx $1.8m spent on development. With the new funding year, looking at re-examining programs in order to accommodate OAPP’s needs. [HOPWA FY is 4/1 – 3/31]

Q: how was information gathered re SNF? We get many calls per month, so confused that the number of SNF/hospice clients is 4.There is a lot of discrimination at facilities not funded by us.

A: worked with current provider who delivers SNF & hospice. staff pulled charts. there was no change in SNF/hospice. We are not the only funder. Some get hospice care at home. the rfp will look at whether services can be provided in a more cost-effective way (at home) or does it have to be funded only in an agency setting. They are $300/day – 2 most expensive services. May be able to reduce costs if people have homes.

Q. incentives/motivation for changes – questions about. also, measuring acuity with K & GAF. concerned that our doctors might move us on karnofsky and take us off the next month. will the GAF catch moderation if it is being monitored quarterly?

A. GAF will also be done quarterly. we understand that there might be difficult months and the karnofsky score might be lower, and then a month later it may go up. Do understand that it fluctuates. fairly trustworthy gauge to determine numberof hours of support needed. Karnofsky good to measure daily living function. If client has mental health or other issues the GAF can catch non-HIV-specific issues. HIV may not be the debilitating factor – it may be depression – but we will be able to see that with the GAF.

Q. Might there be higher utilization of service?

A. there might be fewer people eligible, but more people served.

Q. Is this for undocumented people as well?

A. yes. Anyone in LA County who meets eligibility requirements, regardless of documentation status. Individual providers assess eligibility. OAPP doesn’t do that. It is the providers who manage the services who do all of the eligibility-related expectations. Physician determines whether person is eligible for either skilled nursing or hospice.

Q. Is this for undocumented people as well?

A. yes

“The truth of the matter is that RCFCI has become a very, very expensive permanent housing program. Whatever needs to happen in order for that to be fixed needs to happen. We need to be real about what’s going on in this housing”.

“we need to massage some of [the] expectations between now and the release of the rfp …  staffing patterns, assessment requirements”. There are professionals besides a physician who can do the Karnofsky scoring.

Q: “without talking about what’s going into the rfp… are you looking to have a system that serves about the same number of people? in terms of numbers themselves.

A: The goal is to serve a greater number of unduplicated people living with hiv who are sick and in need of assisted living.

Richard Kearns: “I live in assisted living. Those institutions are rife with mismanagement and abuse. All they’re interested in is billing. They resist letting us in there. I had to call a lot of places to find an assisted care. Because they do stuff for me, I am able to be an advocate. … Activism is healthcare. … HIV is not a steady state.  … They don’t want clients who are “too alert” to let them not provide the services they are supposed to provide.”

Sharon White: “As chair of SPN in SPA 6, I want to talk about the incarceration issue. Please form some small commission where we can do due diligence before the inmates come out. … in SPA 6 we know there are a lot of african-americans and latinos who are incarcerated. we have 1 case manager and over 100 people on our case management roster. we need to be in front of this not behind it.”

Kathy Watt: “many times, they have managed to not do drugs & alcohol while they are incarcerated. they come out with 2/4/6 years of being clean. so when they try to access CD treatment they are denied. they don’t have a support network. we must work with ADPA on this, to help providers know that having X amount of clean time should not preclude them from treatment.”

HIV Commission will look at forming a group and will get Sharon to sit on it.

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