2026-10-15 - Committee on Health

CHAIR HENDERSON: GOOD AFTERNOON. WE ARE IN ROOM 412 OF THE JOHN A. WILSON. I AM CHRISTINA HENDERSON. TODAY'S ROUNDTABLE WILL EXAMINE TWO RELATED CHALLENGES WITH THE DISTRICTS LONG-TERM CONTINUUM OF

CARE. THE HEALTH CARE AND BEHAVIOR HEALTH SYSTEM OFTEN OPERATE SEPARATELY. LEAVING RESIDENTS WITH OVERLAPPING WITHOUT APPROPRIATE PLACEMENT. INDIVIDUALS WITH COGNITIVE IMPAIRMENT, COMPLEX MEDICAL

CONDITIONS, AND OTHER INTENSIVE SUPPORT NEEDS MAY THE HOSPITAL R INSTITUTIONAL SETTING BUT UNABLE TO TRANSITION SAFELY TO A NURSING FACILITY OR ANOTHER COMMUNITY-BASED OR LONG-TERM CARE PLACEMENT. THE

COMMITTEE WANTS TO UNDERSTAND HOW PLACEMENT DENIALS WERE FORCED IN TRAINING LIMITATIONS AND ADEQUATE REIMBURSEMENT, SERVICE GAPS AND FRACK -- SECOND, WE WILL EXAMINE THE DISTRICTS COMMUNITY

RESIDENTIAL FACILITY SYSTEM. CRFS SERVE INDIVIDUALS WITH MENTAL HEALTH NEEDS WITH MENTAL SUPPORT BUT DON'T NEED HOSPITALIZATION AND MAY BE TOWARDS GREATER INDEPENDENCE. CONCERNS HAVE BEEN RAISED ABOUT

THE QUALITY OF SERVICES, INADEQUATE TRANSITION PLANNING, RESIDENTS REMAINING IN FACILITIES LONGER THAN NECESSARY, AND FACILITIES FAILING TO USE TREATMENT PLANS TO GUIDE RESIDENTS CARE IN PROGRESS.

RAPID FACILITY CLOSURES AND DECLINING CRF CAPACITY THREATENS TO LEAVE RESIDENTS WITH EITHER FEWER APPROPRIATE OF AUCTIONS. THE PURPOSE IS NOT JUST TO DOCUMENT THESE LONG-STANDING PROBLEMS BUT TO TRULY

GET TO IDENTIFYING SOLUTIONS FOR WE WANT TO DETERMINE HOW THE DISTRICT CAN IMPROVE COORDINATION, STRENGTH AND CARE AND TRANSITION PLANNING, STABILIZE ITS PROVIDER NETWORK, AND ENSURE RESIDENTS GET

APPROPRIATE SERVICES IN THE SETTINGS THAT SUPPORT THEIR SAFETY, RECOVERY AND INDEPENDENCE. WE PURPOSELY DID NOT INVITE ALL OF OUR AGENCY LEADERS TO TESTIFY TODAY. OUR ONE GOVERNMENT WITNESS IS SERVING

AS THE DISTRICTS FIRST D.C./LONG CARE STRATEGIC COORDINATOR. THE COMMUNITY ON HEALTH EXPENDED THIS FUNDED POSITION WITH THE EXPRESSED PURPOSE OF HAVING SOMEONE WITH A DEDICATED ROLE SITTING IN THE

HEALTH AND HUMAN SERVICES WHO WAS A PRAIRIE VIEW TO TRACK LONG-TERM CARE PURPOSES THROUGHOUT THE CLUSTER. AND TO HELP DEVELOP AND IMPROVE LONG-TERM STRATEGIES ON THIS END. I DON'T SEE ANY OF MY

COLLEAGUES THAT HAVE JOINED US, BUT I WILL CERTAINLY TURN TO THEM SOULD THEY ARRIVE. BEFORE WE GET STARTED, I WANT TO REVIEW OUR TESTIMONY GUIDELINES FOR THE PUBLIC WITNESSES. ASIDE FROM THE FIRST

PANEL, ALL OF OUR WITNESSES WILL HAVE THREE MINUTES TO SPEAK. WE HAVE CLOCKS HERE. IT IS NOT BECAUSE WE DON'T WANT TO HEAR ALL THAT YOU HAVE TO SAY. IT IS BECAUSE WE ARE TRYING TO HEAR WHAT EVERYONE

HAS TO SAY TODAY. YOU'RE WELCOME TO SUBMIT LONGER, WRITTEN TESTIMONY FOR THE RECORD THAT WE WILL REVIEW. I WANT TO UNDERSCORE MY HOPE IS TO REALLY TALK ABOUT IDENTIFYING SOLUTIONS AND USING THIS AS A

JUMPING POINT FOR THE NEXT ADMINISTRATION TO CONSIDER AND CULTIVATE NEW IDEAS ON THIS GROWING ISSUE THAT WE HAVE IN TERMS OF LONG-TERM CARE. WITH THAT, I WILL TURN TO OUR FIRST PANEL WHICH IS ALL

VIRTUAL. WE HAVE DR. MARK SALAZAR, PROFESSOR AT TEMPLE UNIVERSITY. PROFESSOR BRIAN MCGARRY, AN ASSOCIATE PROFESSOR AT THE UNIVERSITY OF ROCHESTER SCHOOL OF MEDICINE. AND MARK FREDERICK, AT ELDER SERVE

HEALTH. I THINK THEY ARE ALMOST ONLINE. I SEE DR. SALAZAR SO WE WILL START WITH HIM. THANK YOU FOR BEING WITH US TODAY. GREAT. THANK YOU FOR HAVING ME. I'M A PSYCHOLOGIST AND PROFESSOR IN THE COLLEGE

OF PUBLIC HEALTH AT TEMPLE UNIVERSITY. SINCE 2003, I HAVE SERVED AS PRINCIPAL INVESTIGATOR AND DIRECTOR OF THE TEMPLE UNIVERSITY REHABILITATION RESEARCH AND TRAINING CENTER ON COMMUNITY LIVING IN

PARTICIPATION OF, PEOPLE WITH SERIOUS MENTAL ILLNESSES WHICH IS FUNDED BY THE NATIONAL INSTITUTE ON DISABILITY, INDEPENDENT LIVING AND REHABILITATION RESEARCH. I WOULD LIKE FOR US TO THINK BACK OF THE

EARLY DAYS OF THE PANDEMIC. WORK, SCHOOL, WORSHIP, COFFEE SHOPS, GYMS, VOLUNTEERING AND EVEN TIME WITH FAMILY AND FRIENDS ALL DISAPPEARED. IT WAS HARD ON EVERYONE. NOW, IMAGINE IT WAS NOT A MOMENT IN

TIME BUT YOUR EVERYDAY LIFE. FOR MANY PEOPLE WITH SERIOUS MENTAL ILLNESSES, INCLUDING THOSE DIAGNOSED WITH SCHIZOPHRENIA, BIPOLAR DISORDER, IT IS EVERYDAY LIFE. COMMUNITY PARTICIPATION IS A MEDICAL

NECESSITY. WORK, EDUCATION, FAITH, VOLUNTEERING, AND RELATIONSHIPS SHAPE OUR PHYSICAL, COGNITIVE, AND MENTAL HEALTH AND WELLNESS. THAT IS TRUE FOR EVERYONE, INCLUDING PEOPLE WITH SERIOUS MENTAL

ILLNESSES. MENTAL HEALTH TREATMENTS INCLUDING MEDICATIONS AND THERAPY MATTER, BUT AS PROFESSOR CHARLIE RAPP PUT IT, PEOPLE DON'T NEED MORE REFERRALS TO MENTAL HEALTH SERVICES. WE ALREADY DO A PRETTY

GOOD JOB IN THAT AREA. THEY NEED REFERRALS TO LIFE IN THE COMMUNITY. PEOPLE WITH SERIOUS MENTAL ILLNESSES PARTICIPATE FAR LESS IN THE COMMUNITY THAN THE GENERAL POPULATION, AND THEY WANT TO

PARTICIPATE MORE. PARTICIPATION IS GOOD FOR PHYSICAL, COGNITIVE AND MENTAL HEALTH AND WELLNESS. PEOPLE WHO GET OUT, MOVE MORE, AND MOVEMENT LOWERS THE RISK OF HEART DISEASE, STROKE, DIABETES AND

SEVERAL CANCERS WHICH ARE HIGHLY PREVALENT IN THESE POPULATIONS. IT'S GOOD FOR THE MIND AS WELL. GETTING OUT IS LINKED TO SHARPER THINKING, LESS DEPRESSION, AND MORE HAPPINESS. AND IS A MATTER OF LIFE

AND DEATH. THE LEADING THEORY OF SUICIDES SAYS THE DEEPEST DESPAIR COMES FROM TWO FIELDS. -- FEELINGS. I DON'T BELONG AND I AM A BURDEN. PARTICIPATION IS THE ANTIDOTE TO BOTH. WHEN SOMEONE HAS A PLACE

TO GO AND PEOPLE WHO NEED THEM, THEY MATTER. THIS IS ESPECIALLY TRUE FOR PEOPLE WHO HAVE BEEN HOMELESS, WHO ARE LEAVING LONG-TERM INSTITUTIONS AND RESIDENTIAL SETTINGS. YOU CAN HAND SOMEONE A LEASE, A

KEY, AND MEDICATIONS AND THEY HAVE HOUSING BUT NO LIFE. RESEARCHER SUGGESTS A MEANINGFUL LIFE IS WHAT KEEPS PEOPLE HOUSED. SO WHAT HELPS? CONSIDER PARTICIPATION AS TREATMENT BECAUSE IT IS. ASK EVERY

PERSON WHAT THEY WANT TO DO, WHAT'S MEANINGFUL TO THEM. FIND WHAT'S AVAILABLE IN THE COMMUNITY AND HELP THEM PARTICIPATE IN THAT ACTIVITY. THEN, TACKLED THE BURDENS THAT PREVENT THEM, THE BARRIERS

THAT PREVENT THEM FROM PARTICIPATING. THERE ARE RARELY SYMPTOMS OR COGNITIVE IMPAIRMENTS. THE TYPICAL BARRIERS ARE POVERTY. NOT HAVING BUS FARE, MONEY FOR A GYM MEMBERSHIP. NO DECENT CLOTHING FOR A

JOB INTERVIEW. AND ALSO INCLUDES STIGMA. FROM PEOPLE WHO DISCOURAGE THEM OR TREAT THEM BADLY WHEN THEY TRY TO PARTICIPATE. FINALLY, KEEP CHECKING IN WITH THEM ABOUT THEIR PARTICIPATION. PROVIDE

ADDITIONAL SUPPORT AS NEEDED. AND CELEBRATE THE WINS WHEN THEY ARE ABLE TO PARTICIPATE AS MUCH AS THEY WOULD LIKE. THANK YOU VERY MUCH. CHAIR HENDERSON: THANK YOU. DR. MCGARRY? >> GREAT, THANK YOU.

CHAIRPERSON AND MEMBERS OF THE COMMITTEE, THANK YOU FOR THE OPPORTUNITY TO TESTIFY TODAY. I'M AN ASSOCIATE PROFESSOR AT THE UNIVERSITY OF ROCHESTER. I'M A HEALTH ECONOMIST AND MY RESEARCH OFTEN

FOCUSES ON NURSING HOME CARE, INCLUDING ACCESS AND QUALITY FOR INDIVIDUALS WITH SERIOUS MENTAL ILLNESS. FOR MY TESTIMONY TODAY, I WOULD LIKE TO HIGHLIGHT THREE POINTS. WHY NURSING HOMES HAVE BECOME

IMPORTANT PROVIDERS OF INSTITUTIONAL CARE FOR INDIVIDUALS WITH SERIOUS MENTAL ILLNESS. WHY THEY ARE OFTEN POORLY EQUIPPED TO MEET THESE INDIVIDUAL NEEDS. AND POTENTIAL REFORMS THAT MAY OFFER A BETTER

PATH FORWARD. TO START, NURSING HOMES HAVE BECOME A PART OF OUR DEFECTIVE PSYCHIATRIC INSTITUTIONAL SYSTEM. MOST OF YOU ALREADY KNOW, BEGINNING IN THE 1950'S, THE U.S. DRAMATICALLY REDUCE ITS RELIANCE

ON STATE PSYCHIATRIC HOSPITALS. HOWEVER, COMMUNITY-BASED MENTAL HEALTH SERVICES AND SUPPORT OF HOUSING HAVE NOT CONSISTENTLY EXPANDED TO MEET THE NEEDS OF INDIVIDUALS WITH SERIOUS MENTAL ILLNESS. AS A

RESULT, MANY INDIVIDUALS WITH CONDITIONS SUCH AS SCHIZOPHRENIA AND BIPOLAR DISORDER RESIDE IN NURSING HOMES, INCLUDING SOME WHO MAY NOT OTHER WISE REQUIRE NURSING HOME RELATED CARE. IT IS ESTIMATED

NEARLY ONE IN FIVE NURSING HOME RESIDENTS HAVE A SERIOUS MENTAL ILLNESS DIAGNOSIS. SECOND, THERE IS A FUNDAMENTAL MISMATCH BETWEEN THE SERVICES NURSING HOMES PROVIDE AND THE NEEDS OF MANY INDIVIDUALS

WITH SERIOUS MENTAL ILLNESS. THE TYPICAL NURSING HOME RESIDENT IS AN OLDER ADULT WITH SUBSTANTIAL PHYSICAL AND OR COGNITIVE LIMITATIONS REQUIRING ASSISTANCE WITH ACTIVITIES OF DAILY LIVING. BY

CONTRAST, RESIDENTS WITH MENTAL ILLNESS ARE YOUNGER AND MAY BE RELATIVELY INDEPENDENT PHYSICALLY. THEIR PRIMARY NEEDS MAY INVOLVE THINGS LIKE PSYCHIATRIC TREATMENT AND MEDICATION MANAGEMENT AND

SUPERVISION. MOT NURSING HOMES LACK PSYCHIATRIC STAFF AND BEHAVIORAL HEALTH PROGRAMMING. AND NURSING HOME FINANCING OFTEN COMPOUNDS THIS ISSUE. NURSING HOME RESIDENTS DISPROPORTIONATELY RELY ON

MEDICAID, HISTORICALLY LOW MARGIN PAYER. IN REIMBURSEMENT OFTEN DOES NOT RADICALLY RECOGNIZE THE COST OF RUNNING SPECIALIZED BEHAVIOR HEALTH CARE, CREATING LIMITED INCENTIVES. THESE STRUCTURAL

BARRIERS HAVE MEANINGFUL CONSEQUENCES FOR PATIENTS. INDIVIDUALS WITH SERIOUS MENTAL ILLNESS ARE DISPROPORTIONATELY ADMITTED TO NURSING HOMES WITH FEWER RESOURCES AND WORSE QUALITY. MY RESEARCH AND NOT

OF OTHERS HAVE SHOWN THE CLUSTERING OF PATIENTS WITH SERIOUS MENTAL ILLNESS WITHIN CERTAIN FACILITIES WORSENS THE QUALITY OF CARE PROVIDED TO ALL RESIDENTS REGARDLESS OF WHETHER OR NOT THEY HAVE A

SERIOUS MENTAL ILLNESS DIAGNOSIS. MORE RECENTLY, DECLINES IN NURSING HOME CAPACITY IN THE WAKE OF THE 2019 -- COVID-19 PANDEMIC HAS MADE IN ACCESSING ANY NURSING HOME INCREASINGLY DIFFICULT FOR

HOSPITALIZED PATIENTS WITH SERIOUS MENTAL ILLNESS. AS NURSING HOME BEDS HAVE BECOME SCARCE, DIFFICULT TO PLACE PATIENTS INCLUDING THOSE WITH BEHAVIORAL HEALTH NEEDS, HAVE FORCED THESE INDIVIDUALS TO

OFTEN WAIT WEEKS OR MONTHS IN THE HOSPITAL FOR AN AVAILABLE NURSING HOME BED, SLOWING RECOVERY AND WORSENING QUALITY OF LIFE. TO END, I WANT TO HIGHLIGHT THREE POSSIBLE APPROACHES TO ADDRESSING THESE

ISSUES. FIRST, MEDICAID REIMBURSEMENT SHOULD BETTER REFLECT THE COST OF CARING FOR RESIDENTS WITH COMPLEX BEHAVIORAL HEALTH NEEDS. ENCOURAGE FACILITIES TO INVEST IN SPECIALIZED STAFFING AND

INFRASTRUCTURE. WASHINGTON, D.C. HAS BEEN AN INNOVATOR IN THIS AREA, INTRODUCING ENHANCED PAYMENTS FOR COMPLEX RESIDENCE IN 2018. CONTINUED EVALUATION IS NEEDED OF THESE TYPES OF PAYMENTS TO DETERMINE

WHETHER THEY ARE SUFFICIENTLY GENEROUS, APPROPRIATELY TARGETED, AND EFFECTIVE AND EXPANDING ACCESS AND IMPROVING QUALITY. SECOND, TELEHEALTH OFFERS OPPORTUNITIES TO EXPAND ACCESS TO SPECIALIZED

PSYCHIATRIC CARE NURSING HOMES. TELE-PSYCHIATRY CAN CONNECT RESIDENTS AND STAFF WITH BEHAVIORAL HEALTH SPECIALISTS FOR PSYCHIATRIC ASSESSMENTS, MEDICATION MANAGEMENT, AND STAFF COACHING. SUSTAINED

REIMBURSEMENT, INVESTMENT IN TECHNOLOGY AND STAFF TRAINING WILL BE IMPORTANT TO SUPPORTING THESE SERVICES. THIRD, POLICY MAKERS THAT CONTINUE TO EXPLORE ALTERNATIVES TO A CONVENTIONAL NURSING HOMES

ARE INDIVIDUALS WHOSE PRIMARY NEEDS INVOLVE PSYCHIATRIC TREATMENT AND SUPERVISION RATHER THAN PHYSICAL NURSING CARE. WE ARE OPERATES SPECIALIZED RESIDENTIAL PROGRAMS THAT COMBINE HOUSING, BEHAVIORAL

HEALTH SERVICES AND 24 HOUR STAFFING. ON THE RIGOROUS EVIDENCE COMPARING THESE MODELS OF NURSING HOME CARE REMAINS LIMITED, THEY HAVE OFFERED POTENTIALLY MORE APPROPRIATE SETTINGS FOR SOME

INDIVIDUALS. TO CLOSE, THE GOAL OF FUTURE REFORM SHOULD NOT SIMPLY BE TO MOVE PEOPLE WITH SERIOUS MENTAL ILLNESS OUT OF NURSING HOMES, BUT IT SHOULD BE TO ENSURE THAT INDIVIDUALS RECEIVE CARE TO THE

LEAST RESTRICTIVE SETTING CAPABLE OF SAFELY AND EFFECTIVELY MEETING THEIR NEEDS WHILE RESPECTING INDIVIDUAL'S DIGNITY AND QUALITY OF LIFE. THANK YOU FOR THE OPPORTUNITY TO TESTIFY. CHAIR HENDERSON:

THANK YOU. FINALLY FOR THIS PANEL, MR. FREDERICK. YOU'RE ON MUTE. >> CAN YOU HEAR ME? CHAIR HENDERSON: YES. THANK YOU FOR BEING HERE. THANK YOU FOR INVITING ME. MY NAME IS MARK FREDERICK. I'M A

LICENSED CLINICAL SOCIAL WORKER. I WORK FOR ELDER SERVE HEALTH WHICH IS A MANAGED LONG-TERM HEALTH CARE PROGRAM IN NEW YORK. WE HAVE A VARIETY OF MEMBERS WHO ARE PART OF OUR PROGRAM. SOME OF THEM ARE

SMI'S. LET ME SAY QUICKLY, MANAGING YOUR OWN PROGRAM IS A MEDICAID PROGRAM THAT HELPS PEOPLE WITH LONG-TERM HEALTH NEEDS. GET THE CARE AND SERVICES THAT THEY NEED WHILE LIVING AT HOME. MANAGED LONG-

TERM CARE PLANS HELP SERVICES SUCH AS HEALTH -- HOME CARE, MEDICAL APPOINTMENTS, TRANSPORTATION AND OTHER SUPPORTS. IN ORDER TO KEEP SAFE AND IS INDEPENDENT AS POSSIBLE WHILE THEY ARE IN THE

COMMUNITY. BASICALLY, THE GOAL IS TO KEEP PEOPLE AS HEALTHY AS POSSIBLE AND AVOID UNNECESSARY HOSPITALIZATIONS. AND BE ABLE TO HAVE AS MANY OF A LIFE IN THE COMMUNITY AS THEY CAN. WE HAVE UPWARD OF

22,000 MEMBERS ENROLLED IN OUR PROGRAM. A GOOD NUMBER OF THEM ARE MENTALLY ILL. WE DO HAVE A PORTION OF OUR PROGRAM THAT IS DEDICATED SPECIFICALLY TO THIS POPULATION. WE HAVE MANAGERS THAT ARE

SPECIFICALLY ASSIGNED TO THIS POPULATION TO HELP THEM. THERE ARE TWO AREAS OF HOUSING THAT WE UTILIZE TO HELP US MANAGE THIS POPULATION IN A MORE EFFICIENT MANNER. ONE TYPE OF HOUSING IS A HOUSE HOME.

IT IS A MEDICAID FUNDED PROGRAM. THEY DO HAVE THEIR OWN CARE MANAGERS THAT HELP COORDINATE MEDICAL, BEHAVIORAL HEALTH AND SOCIAL SERVICES WHILE CONNECTING THOSE MEMBERS TO BENEFITS AND COMMUNITY

RESOURCES. THE OTHER AREA IS WHAT IS KNOWN AS LEVEL TWO HOUSING. IT IS A BIT DIFFERENT BUT IT IS LICENSED BY THE ORGANIZATION. THE OFFICE OF MENTAL HEALTH WITH SUPPORTIVE HOUSING. THEY GET ASSISTANCE

WITH MEDICAL MANAGEMENT, INDEPENDENT LIVING SKILLS, AND TREATMENT ENGAGEMENT. WHAT WE DO AS AN ORGANIZATION IS SUPPLEMENT THEM. IF YOU HAVE A TEAM OF CLINICIANS, SOCIAL WORKERS NURSES WHO HELP SUPPORT

THESE NUMBERS WHILE THEY ARE IN THE COMMUNITY THEY CAN BE VERY CHALLENGING AT TIMES. OFTEN, THEY COME FROM A HOMELESS SITUATION INTO AN ENVIRONMENT THAT IS NOT RESTRICTIVE, BUT THAT REQUIRES THEM TO

BE ABLE TO FUNCTION, TO BUILD SOME LIFE SKILLS BASICALLY. THAT IS HOW WE TRY TO HELP SUPPLEMENT AND REINFORCE THOSE NEEDS. OUR EXPERIENCE, WE FIND THAT THROUGH PROPER COORDINATION PROPER COMMUNICATION

AND ENSURING THEY ARE COMPLIANT WITH HER MEDICATIONS, KEEPING THE MEDICAL APPOINTMENTS, ESPECIALLY PSYCHIATRIC APPOINTMENTS -- WE FIND WE ARE ABLE TO HELP THEM MANAGE VERY WELL IN THEIR COMMUNITIES.

WE DO HAVE OTHER FORMS OF HOUSING THAT ARE MORE A SYMBOL FOR THE PEOPLE WHO ARE NOT MENTALLY ILL BUT FOR THOSE PEOPLE THAT REQUIRE -- VERY HIGH LEVEL OF SUPERVISION AND ASSISTANCE THAT IS WHAT OUR

TEAM HERE DO ON A REGULAR, DAILY BASIS. OUR SOCIAL WORKERS ARE ALL LICENSED SOCIAL WORKERS. MANY OF THEM HAVE A LOT OF EXPERIENCE IN WORKING WITH FOLKS THAT HAVE MENTAL ILLNESS. WHAT WE DO IS

CONSISTENTLY TRY TO CONNECT OUR MEMBERS TO SERVICES IN THE COMMUNITY THAT CAN HELP REINFORCE THEM BEING AT HOME AND BE AS INDEPENDENT AS POSSIBLE. THAT IS ALL I HAVE. CHAIR HENDERSON: ALL RIGHT, THANK

YOU SO MUCH TO THIS PANEL. VERY INTERESTING IN THAT THIS IS THE COMMITTEE ON HEALTH. WE ARE TALKING ABOUT HEALTH AND ALL THREE OF YOU ARE LITERALLY TALKING ABOUT HOUSING AT THE SAME TIME. WHICH I

THINK SPEAKS TO THE FACT THAT THIS IS NOT JUST A ONE SIDED ISSUE, BUT IT IS COMPLEX AND YOU ARE BRINGING A VARIETY OF DIFFERENT PIECES TOGETHER. HOLD ON. ANGIE, CAN YOU PUT ME ON A 10 MINUTE TIMER? I

WILL PUT MY OWN SELF ON A CLOCK SO WE CAN KEEP MOVING. I WANTED TO ASK -- I HAVE A FEW FOLLOW-UP QUESTIONS. DR. MCGARRY, I THINK ONE OF THE ISSUES THAT WE HAVE RUN INTO AN EVEN WHEN PEOPLE CONTACT OUR

OFFICE IS THAT MANY LONG-TERM CARE RESIDENTS ARE DUALLY ELIGIBLE FOR BOTH MEDICAID AND MEDICARE. IN THESE PROGRAMS DON'T OFTEN WORK WELL IN THE SANDBOX TOGETHER. HOW DOES THE DIVISION OF

RESPONSIBILITY BETWEEN THE TWO PROGRAMS AFFECT ACCESS TO THE APPROPRIATE LEVEL OF CARE WHEN YOU HAVE SOMEONE MIGHT HAVE A SUBSTANCE USE DISORDER OR NEEDING PSYCHIATRIC CARE? HOW DO WE OVERCOME THAT?

YEAH, THAT'S A GREAT QUESTION. IT IS ONE WE STRUGGLE WITH IN THE NURSING HOME SETTING FOR ALL PATIENTS, NOT JUST PATIENTS WITH COMPLEX MEDICAL NEEDS. YOU'RE COMPLETELY RIGHT. THE INCENTIVES ARE OFTEN

NOT ALIGNED. JUST TO DRAW AN EXAMPLE OF THIS -- THE C1 COST OF SENDING SOMEONE FROM A NURSING HOME TO A HOSPITAL WHEN THEY HAVE SOME KIND OF HEALTH SHOCK, THE NURSING HOME HAS NO FINANCIAL INCENTIVE

TO KEEP THE PATIENT IN PLACE AND NOT HAVE THIS DISRUPTIVE TRANSFER. THEY OFTEN GET TO HAVE ONE LESS PATIENT FOR A TIME BEING. SOME STATES WILL CONTINUE TO RECEIVE PAYMENT FOR THAT. WE REALLY HAVE THE

WRONG SET OF INCENTIVES. IT IS A DIFFICULT ISSUE TO SOLVE. WE HAVE SEEN SOME PROGRESS. THEY ARE DESIGNED TO PROVIDE COVERAGE FOR ITS CETACEANS. THE ADVANTAGE PLANS. THE MODEL RELIES ON THAT. THEY CAN

ADDRESS CARE NEEDS FOR PATIENTS. FOR TRIAGING PATIENTS. I THINK THAT IS A MODEL THAT HAS PROVEN TO BE EFFECTIVE. HOW CAN THEY PUT ALL THE BENEFITS UNDER A SIMILAR UMBRELLA? TO OPTIMIZE CARE FOR

INDIVIDUALS. WE CAN PREVENT HOSPITALIZATIONS TO SHARE IN THESE COST SAVINGS. IN THESE EFFORTS WITH THE NURSING HOMES. >> THANK YOU FOR THAT EXAMPLE. WE DON'T DO MEDICARE. THERE ARE TOO MANY PARTS. IT

IS NOT A FUNCTION THAT COMES TO US. BUT WE OFTEN HAVE TO WORK WITH IT. TRYING TO HANDLE SOME OF THOSE PARTICULAR ISSUES. IT IS NOT A STATE-BASED TYPE OF PROGRAM. WE HAVE A VARIETY OF DIFFERENT

PROGRAMS. NOT NECESSARILY ALL OF THE LONG-TERM CARE SPACE. IN THEORY IF IT ALL GOES WELL AND YOU HAVE SOMEONE WHO IS COMBINING BOTH HEALTH CARE AND MENTAL HEALTH SERVICES SUPPORTS LIKE PERMANENT

SUPPORTIVE HOUSING, HOWEVER THERE IS ALL FIT IN A PIECE OF AROUND PERSONAL CHOICE WHEN WE GET INTO THESE CONVERSATIONS. WE HAVE PROVIDED SOME HOUSING BUT THERE IS STILL A CHOICE IF THEY WANT TO

PARTICIPATE IN THE PROGRAM TO HELP SUPPORT. HOW DO WE HANDLE THOSE PIECES PARTICULARLY FROM A LONG TERM CARE SITUATION WHERE IT IS VERY EVIDENT THAT SOMEONE NEEDS PROFESSIONAL HELP BUT THEY CAN STILL

CHOOSE I JUST WANT THE HOUSING. I DON'T WANT THE OTHER PIECE? >> I AM FAMILIAR WITH A LOT OF THE GREAT SERVICES THAT THE DISTRICT HAS AVAILABLE. THE HOUSING FIRST PROGRAM THAT YOU HAVE IN THE

DISTRICT. AND SOME OF THE EMPLOYMENT SERVICES THAT YOU HAVE. THE DISTRICT HAS SOME WONDERFUL, ROBUST SERVICES. RESEARCH SUGGESTS THAT PROMOTING SELF-DETERMINATION AND SELF DIRECTION IS CRITICAL FOR

POSITIVE HEALTH OUTCOMES. IT IS HARD TO WATCH SOMETIMES. PEOPLE MAKE DECISIONS THAT ARE NOT NECESSARILY IN THEIR BEST INTEREST. ESPECIALLY IN THE SHORT TERM. IN THE LONG TERM PROMOTING SELF-DIRECTION

AND THE OPPORTUNITY FOR PEOPLE TO HAVE CHOICE ABOUT WHAT THEY TO RELATE TO BETTER HEALTH OUTCOMES. ONE THING THAT HAPPENS IN THE HOUSING AREA IS SOMETIMES THE OPTIONS THAT ARE AVAILABLE TO PEOPLE ARE

NOT OPTIMAL FOR THEM. THEY ARE TRULY MAKING OPTIMAL DECISIONS. THEY ARE MAKING CHOICES THAT THEY BELIEVE ARE IN THEIR BEST INTEREST. WHAT THIS LEADS US TO FOCUS ON IS TRYING TO REINVIGORATE SERVICES

THAT WE ARE OFFERING. MAKING SURE THAT THEY ARE THE BEST PRACTICES. THAT THEY ARE FULLY PROMOTING CHOICE AS MUCH AS POSSIBLE. IN ENTICING PEOPLE TO UTILIZE THESE HEALTH SERVICES. RATHER THAN ASKING

THEM TO CHOOSE OPTIONS THEY MIGHT NOT NECESSARILY BE INTERESTED IN. >> I WAS TALKING TO SOME FOLKS ABOUT THIS YESTERDAY. WE HAVE A VARIETY OF MODELS. IN SOME CASES THEY ARE PEOPLE WHO ARE IN THE WRONG

TYPE OF FACILITY BUT ARE THERE BECAUSE THEY HAD A BED. AS OPPOSED TO YOU WERE PROPERLY ANALYZED AND PUT IN THE RIGHT ONE THAT GIVES YOU THE RIGHT LEVEL OF CARE. YOU TALKED ABOUT NEW YORK HAVING

SPECIALIZED HOUSING PROGRAMS THAT COMBINED NURSING AND MENTAL HEALTH. HOW DID THEY PAY FOR THAT? WHAT DOES FEE PAYMENT MODEL LOOK LIKE FOR THAT TYPE OF COMBINATION? I WILL DEFER TO OTHERS. THAT IS

REALLY NOT MY AREA OF EXPERTISE. I THINK IT IS FINANCED WITH SOME MEDICAID DOLLARS. BUT IT IS DISTINCT FROM THE LONG-TERM CARE SETTING. >> I AM IN PHILADELPHIA, A LITTLE CLOSER TO THE DISTRICT FOR NEW

YORK. PHILADELPHIA ALSO HAS SPECIALIZED RESIDENTIAL PROGRAMS FOR PEOPLE WITH SERIOUS MENTAL ILLNESSES. MY UNDERSTANDING IS THEY USE A BLENDED FUNDING MODEL. WITH SOME MEDICAID FUNDING AND COUNTY AND

STATE FUNDING AS WELL. THEY RECOGNIZE THAT TOGETHER WHEN YOU ARE PROVIDING FOR THOSE INDIVIDUALS, IT IS ACTUALLY CHEAPER TO KEEP THEM IN A RESIDENTIAL PROGRAM THAT IS SPECIALIZED RATHER THAN BEING IN

OTHER TYPES OF INSTITUTIONAL SETTINGS THAT MIGHT NOT MEET THEIR NEEDS. IT IS SIMILAR. IT IS FUNDED THROUGH MEDICAID AND THE OFFICE OF MENTAL HEALTH. AND SOME STATE FUNDING. DEPARTMENT OF BEHAVIORAL

HEALTH WANTS TO GET OUT OF MANAGING HOUSING. FOR YOU GUYS HAVE GIVEN ME THREE EXAMPLES WHERE IT IS LIKE BEHAVIORAL HEALTH FUNDING IS DEFINITELY PART OF THAT FUNDING. HOW DOES THAT WORK? WITH HOUSING

PROVIDERS TO MAKE SURE YOUR MEMBERS ARE IN THE LEAST RESTRICTIVE CARE ENVIRONMENT. THROUGH COORDINATION WITH THE OFFICE OF MENTAL HEALTH. THEY REALLY ARE IN CHARGE OF DIRECTING A LOT OF WHAT WE DO

BOTH FINANCIALLY AND CLINICAL INTERVENTIONS THAT TAKE PLACE. HOW MANY CASE MANAGERS DO YOU GUYS HAVE? ACROSS YOUR ORGANIZATION WE HAVE ABOUT 155. I BELIEVE IT IS CLOSE TO 40 NURSES WITH PSYCHIATRIC

CARE BACKGROUND. WORKING SPECIFICALLY WITH THAT POPULATION. >> THEY ARE A HOT COMMODITY. THE FACT THAT YOU HAVE 40 OF THEM, I KNOW I AM OVER MY TIME BUT I WOULD ASK THIS QUESTION. IS THE REIMBURSEMENT

REALLY THE DRIVER HERE? IN TERMS OF IMPROVEMENT? THERE ARE SOME FACILITIES THAT ARE OFTEN RELUCTANT TO ADMIT RESIDENCE THAT HAVE SIGNIFICANT MEDICAL NEEDS OR MENTAL HEALTH NEEDS AND CERTAINLY WHEN

THEY ARE ALL COMBINED IS THAT THE RATES THAT IS DRIVING THIS OR ARE THERE OTHER TYPES OF SUPPORTS THAT WE CAN HELP WITH INSTITUTIONS TO NOT TURN FOLKS AWAY? >> I WILL RESPOND. I DID NOT THINK YOU WERE

IN NEW YORK. RATES ARE A BIG ISSUE. REIMBURSEMENT IS A BIG ISSUE. ALL OVER THE PLACE. STAFFING IS ALSO AN ISSUE. THAT IS REALLY INFLUENCED BY HOW MUCH YOU CAN PAY PEOPLE. IF WE CAN PAY PEOPLE BETTER

WE CAN KEEP THEM LONGER. WE CAN HIRE MORE SKILLED FOLKS. RATES IS A BIG ISSUE. AT LEAST IN PHILADELPHIA AND PENNSYLVANIA. FOR US IN NEW YORK THE RATE IS EVERYWHERE A BIG ISSUE. IT IS THE DECREASE IN

THE FUNDING THAT SEEMS TO BE HAPPENING. IT PRESENTS A VERY BIG CHALLENGE FOR US. THAT IS ALWAYS AT THE CORE OF IT. >> I WILL REITERATE. IT IS OF MONEY IN THE RATES, OF COURSE. A LOT OF THE ISSUES WE

ARE SEEING RIGHT NOW WITH HOSPITAL BOTTLENECKS AND DIFFICULTY PLACING PEOPLE IS IN PART BECAUSE THEY ARE RELATIVELY EXPENSIVE TO CARE FOR IT. THEY ARE NOT TYPICALLY COMPENSATED FOR THAT. RATES ARE A

BIG PART OF IT. IT IS PART OF THE SOLUTION. COUPLED WITH THAT IS THE NEED FOR OVERSIGHT. WE ARE PAYING MORE TO TAKE THESE TYPES OF PATIENTS. DO WE WORRY ABOUT FACILITY PATIENTS AND BECAUSE THEY ARE

HIGH REVENUE? IT IS RATES COUPLED WITH OVERSIGHT. >> WHAT ABOUT INDIVIDUALS? WHO DO NOT QUALIFY FOR MEDICAID? BUT THEY STILL CANNOT PRIVATE PAY. AND THEY CANNOT BE DISCHARGED HOME. WE HAVE RESIDENTS

WHO HAVE BEEN LIVING IN OUR HOSPITALS. HUNDREDS OF DAYS BECAUSE THERE IS NO PLACE TO SAFELY DISCHARGE THEM TO DO. BECAUSE THERE IS NO PAYMENT OPTION. HOW DO WE HANDLE THAT? >> THAT IS A BIG ISSUE WE

HAVE BEEN DOING WITH THE STATE. WE HAVE HAD SOME SUCCESS HERE AT OUR HEALTH SYSTEM WITH THE HOSPITAL PARTNERING WITH NURSING HOMES TO PROVIDE SOME BRIDGE FUNDING OR FINANCIAL INCENTIVES. TO COVER THAT

GAP. WHILE THE MEDICARE DETERMINATION IS GOING ON. THE HOSPITALS ARE HIGHLY INCENTIVIZED. THERE IS POTENTIALLY A PARTNER THERE AND SOME OF THE LARGER HOSPITALS. TO MAKE IT WORK FOR EVERYONE. TO TRY TO

ADDRESS THE PROBLEM. HE>> THIS IS A NATIONAL PROBLEM. WHY NURSING HOMES ARE EXPENSIVE. THE SOLUTION IS TO PROVIDE MORE LOW INCOME HOUSING. AND TO INVEST IN LOW INCOME HOUSING. IN ORDER TO SAVE MONEY

ON THE BACKEND. IT IS HARD SOMETIMES FOR CITIES TO DO THIS. TO INVEST IN A LOW INCOME HOUSING. EVEN THOUGH THE SAVINGS WILL BE THERE LONG TERM, THE SHORT TERM EXPENSE REALLY KEEPS A LOT OF PLACES FROM

INVESTING. CITIES HAVE WORKED WITH REAL ESTATE DEVELOPERS TO HIRE THEM. AND SET ASIDE A CERTAIN MEMBER OF THE UNITS FOR LOW INCOME HOUSING. A LOT MORE NEEDS TO BE DONE TO MAKE LOW INCOME HOUSING

AVAILABLE. YOU CAN SAVE SOME MONEY LONG-TERM. >> IN NEW YORK WILL BE TRYING TO DO IN SITUATIONS LIKE THAT IS WORK WITH THE DEPARTMENT OF HOMELESS SERVICES. OFTEN THEY CAN TRANSITION THE PERSON FROM

THE HOSPITAL SETTING TO ONE OF THEIR OWN FACILITIES. AS LONG AS THE PERSON AGREES TO GO IN THAT SYSTEM, THE CITY WILL SUBSIDIZE HOUSING. IF WE COULD MAKE THE TRANSITION HAPPEN WE CAN ALMOST GUARANTEE

THAT PERSON WILL HAVE AN APARTMENT. IT DOES NOT ALWAYS WORK. PEOPLE HAVE CHOICE. THEY MIGHT SAY NO. IF IT IS DIFFICULT TO WORK WITH THAT SITUATION. WE ALWAYS GO TO THE DEPARTMENT OF HOMELESS SERVICES.

THANK YOU ALL SO MUCH FOR BEING HERE AND PARTICIPATING IN THIS CONVERSATION. I REALLY APPRECIATE IT. WE ARE GOING TO GO TO THE NEXT PANEL. MARK MILLER IS THE STATE OMBUDSMAN. KIMBERLY WALKER IS THE

SENIOR OMBUDSMAN SPECIALIST. SHE IS AN OMBUDSMAN SPECIALIST. AND A SENIOR STAFF ATTORNEY. THERE YOU GO. >> THANK YOU SO MUCH. GOOD AFTERNOON. I AM AN OMBUDSMAN SPECIALIST. THANK YOU SO MUCH FOR THE

OPPORTUNITY TO TESTIFY TODAY. AS WE HAVE TESTIFIED IN PREVIOUS HEARINGS, WE ARE CONCERNED ABOUT THE WIDESPREAD CLOSURES OF OUR RESIDENTIAL FACILITIES. RECENTLY THE DISTRICT HAS EXPERIENCE AND NUMBER

OF INCREASES IN OPERATORS CLOSING MULTIPLE FACILITIES AT ONCE. THE DISTRICT LOST 20 BEDS. 10 FACILITIES HAVE CLOSED. THIS REFLECTS A LOSS OF 55 BEDS FOR THOSE IN NEED OF SPECIALIZED SUPPORTIVE

HOUSING. IT CONTINUES A DOWNWARD TREND. THE NUMBER OF CLOSURES OUTPACED OPENINGS, EXACERBATING THE DEFICIT IN CARE. IN ADDITION TO AN OVERALL ALSO BEDS, THIS IS EVEN MORE SEVERE. THE NUMBER OF BEDS

DECLINED FROM 201-2138. THIS IS A DISTURBING TREND. THERE MUST BE A LONG-TERM PLAN FOR SUSTAINABLE HOUSING OPTIONS. PARTICULARLY FOR THOSE WITH THE HIGHEST LEVEL OF CARE NEEDS. THE SHRINKING HOUSING

OPTIONS AVAILABLE FOR ADULTS WITH MENTAL HEALTH CHALLENGES HAS LED TO AN INCREASING NUMBER OF RESIDENTS REQUIRING A MOVE TO A NURSING HOME. THEY DO NOT HAVE MANY VACANCIES. THEY OFTEN DO NOT ACCEPT

INDIVIDUALS WITH MENTAL HEALTH DIAGNOSES. THE LACK OF AVAILABLE NURSING HOME BEDS FORCES RESIDENTS TO LOOK FOR FACILITIES WITH A NURSING HOME LEVEL OF CARE OUT OF STATE. THESE RESIDENTS WOULD

PREFERRED TO REMAIN IN THEIR COMMUNITY. IT'S SHIFTING THESE PEOPLE HAD A LEAD TO INCREASED ISOLATION AND POTENTIAL HOMELESSNESS. WE WILL BE INCLUDING AN ADDENDUM SHOWING SUMMARY DATA FROM AN ANONYMOUS

SURVEY THAT OUR PARTNERS SENT TO ALL OPERATORS. THE FINDINGS FROM THIS SURVEY INDICATE THAT THE HIGHEST RATED CATEGORY OF DIFFICULTIES THAT OPERATORS PLACED IS RELATED TO FINANCES. THANK YOU FOR THE

OPPORTUNITY TO TESTIFY. MY COLLEAGUES WILL PROVIDE INDIVIDUAL STORIES ABOUT THESE FAILURES. THANK YOU. >> GOOD AFTERNOON. MY TESTIMONY TODAY IS ON THE CONTINUED LEVEL OF CARE ISSUES. IN RESIDENTIAL

FACILITIES. CURRENTLY THESE RESIDENTS ARE NOT RECEIVING APPROPRIATE ASSESSMENTS. THEY ARE NOT BEING PLACED IN APPROPRIATE CARE SETTINGS. THIS PUTS RESIDENTS AT RISK. A PROVIDER RECENTLY CLOSED A

FACILITY. BECAUSE THERE ARE LIMITED VACANCIES, THEY DICTATED THAT SOME RESIDENTS COULD MOVE TO A SUPPORTED RESIDENCE WHICH IS A LOWER LEVEL OF CARE. THEY DETERMINED THAT THEY COULD MOVE TO INDEPENDENT

LIVING. THIS IS A CONCERN BECAUSE WHEN A RESIDENT SHOWS INTEREST OR THE ABILITY TO BE INDEPENDENT, THEY SHOULD TRANSITION TO A LOWER LEVEL OF CARE SO THEY CAN WORK ON INDEPENDENT GOALS AND PREPARE FOR

INDEPENDENT LIVING. THIS IS NECESSARY FOR THE SAFETY OF OUR RESIDENTS. THE FAILURE TO ASSESS LEAD TO THEM DETERMINING POSSIBLY WITHOUT JUSTIFICATION THAT RESIDENTS COULD MOVE TO A LOWER LEVEL OF CARE.

THEY PLACED A RESIDENT WHO NEEDED SUPPORT TO A SUPPORTED RESIDENCE FACILITY WITH NO ADDED SUPPORT. THE LACK OF APPROPRIATE VACANCIES BECAUSE THE RESIDENT TO HAVE A MENTAL HEALTH CRISIS THAT REQUIRED A

CRISIS RESPONSE TEAM. THIS RESIDENT IS STILL IN THE SAME FACILITY WITH AN APPROPRIATE LEVEL OF CARE. YET ANOTHER RESIDENT WAS ASSESSED AS NEEDING A HIGHER LEVEL OF CARE BUT WAS FORCED TO REMAIN AT A

LOWER LEVEL OF CARE FACILITY UNTIL THE PROVIDER ISSUED NOTICE OF CLOSURE. THE RECEIVED A VISIT FROM THE CRISIS OF RESPONSE TEAM. HE WAS TOLD HE WOULD MOVE TO ANOTHER FACILITY. HE WENT TO A CRISIS BED

TWICE AND SPENT HIS OWN MONEY ON A HOTEL AND GOT ARRESTED AND ENDED UP HOMELESS BECAUSE OF THE SYSTEMS FAILURES. RESIDENTS HAVE BEEN MEDICALLY DIAGNOSED WITH SEVERE PSYCHIATRIC SITUATIONS. THEY NEED A

TREATMENT PLAN IN AN APPROPRIATE LEVEL OF CARE. CLOSURES TRIGGER OUR RESIDENTS AND CAUSE BEHAVIOR ESCALATION TO AN UNMANAGED POINT. THIS BECOMES A COSTLY CYCLE OF HOSPITALIZATION, TRANSFER,

ASSESSMENT, AND INSTABILITY THAT WE CANNOT FIX. THANK YOU. THANK YOU. >> GOOD AFTERNOON. TO THE MEMBERS OF THE COMMITTEE. I AM A SENIOR ATTORNEY. A SIGNIFICANT PART OF MY WORK IS REPRESENTING A

RESIDENCE OF MENTAL CARE FACILITIES WHEN THEY FACED AND VOLUNTARY TRANSFER. I HAVE VERY SERIOUS CONCERNS ABOUT OVERSIGHT OF FACILITY CLOSURES AND RESIDENT TRANSITIONS. OUR OFFICE CONTINUES TO SEE

SITUATIONS IN WHICH CLOSER PLANNING IS TOO LATE. AND DISCHARGE NOTICES FAILED TO SATISFY BASIC LEGAL REQUIREMENTS. MY OFFICE IS PARTICULARLY CONCERNED ABOUT THE POSITION REFLECTED IN THE MOST RECENT

MODEL DISCHARGE PLAN AT A HOMELESS SHELTER IS AN ACCEPTABLE DISCHARGE DESTINATION. IN OUR VIEW, DISCHARGE TO A HOMELESS SHELTER IS INCONSISTENT WITH THE SAFE AND APPROPRIATE TRANSITION OF CARE FROM AN

INDIVIDUAL LEAVING A LICENSED MENTAL HEALTH FACILITY. SHORTLY AFTER THAT REVISED DISCHARGE PLAN IS ISSUED, I REPRESENTED A RESIDENT WHOSE DISCHARGE NOTICE IDENTIFIED A SHELTER AS HIS DESTINATION. THAT

CASE ILLUSTRATES SEVERAL RECURRING PROBLEMS. WE PARTICIPATED IN NUMEROUS MEETINGS CONCERNING HIS CARE FOR THE NEXT SIX MONTHS. THE RESIDENT REPORTED THAT HIS RELATIONSHIP WITH HIS TEAM HAD BROKEN DOWN

AND REPEATEDLY REQUESTED REASSIGNMENT. NO REPLACEMENT WAS ASSIGNED. NO PROGRESS WAS MADE. THE PROVIDER BECAME FED UP AND NOTIFIED DBH. SAID AND THEN. DBH FAILED TO INFORM OUR OFFICE. WELL BEFORE THE

ANTICIPATED CLOSURE DATE, THE FACILITY ANNOUNCED IT WOULD CEASE OPERATIONS WITHIN A WEEK AND RESIDENTS HAD TO LEAVE IN SEVEN DAYS. AT THAT POINT THERE WAS NO TRANSITION PLAN DESPITE THE PREVIOUS SIX

MONTHS OF MEETINGS. THE RESIDENT INTERIOR OF THE CRISIS IS 10, MOVE THROUGH MULTIPLE TEMPORARY PLACEMENTS, AND ULTIMATELY BECAME HOMELESS. ONLY AFTER A NEW TEAM WAS FINALLY ASSIGNED DID WE OBSERVE

MEANINGFUL IMPROVEMENT. HE REPORTED FEELING SUPPORTED. THIS WAS THE SAME INTERVENTION THAT HAVE BEEN REQUESTED MONTHS EARLIER. SADLY IT WAS TOO LATE. HE IS NOW HOMELESS AGAIN AND WE DO NOT KNOW WHERE

HE IS. THIS IS NOT UNIQUE. THESE CLOSURES ARE LIKELY TO CONTINUE TO OCCUR IF THEY ARE NOT ADDRESSED IT WILL JUST CONTINUE TO GET WORSE. THANK YOU. GOOD AFTERNOON. I AM THE FORMER STATE LONG-TERM CARE

OMBUDSMAN. I REALIZE YOU HAVE HEARD A LOT OF THESE ISSUES THAT WE HAVE TALKED ABOUT. IN OUR PREVIOUS TESTIMONIES AND CONVERSATIONS WE HAVE HAD. 23% OF ALL THE COMPLAINTS CAME FROM CRFS BUT THEY ONLY

REPRESENT 28% OF THE LONG-TERM CARE BEDS IN THE DISTRICT. SO CLEARLY WE HAVE PROBLEMS AND WE ARE PUTTING A LOT OF EFFORTS INTO RESOLVING THEM. CAPACITY CONTINUES TO BE A SERIOUS ISSUE. WE HAVE LOST

30% OF OUR RESIDENTS FACILITIES. SERIOUSLY LIMITING ACCESS TO THIS THERAPEUTIC HOUSING. PROTECTING RESIDENTS RIGHTS CONTINUES TO BE ANOTHER TOP CONCERN. WE HAVE SEEN RESIDENTS MOVE TO INAPPROPRIATE

SETTINGS. BECAUSE OF A LACK OF OPTIONS TO MEET THEM. OR TO MEET AN ARBITRARY CLOSURE DEADLINE. THERE IS SOME TORTURED LOGIC. THEY CONSIDER SHELTERS TO BE AN APPROPRIATE DISCHARGE IN SOME SITUATIONS.

THIS PLACES RESIDENTS AT RISK FOR ABUSE, NEGLECT, EXPLOITATION, AND HOMELESSNESS. SO WHERE ARE WE? A COMPREHENSIVE STUDY IS DESPERATELY NEEDED. THERE ARE MANY OF THE SAME ISSUES WE HAVE RAISED. THE

SYSTEM IS BROKEN. WE ALL KNOW IT. THE REAL QUESTION IS WHAT ARE WE GOING TO DO ABOUT IT? THERE IS NO SINGLE ANSWER BUT WE CAN WORK TOGETHER TO FIX IT. WE NEED TO UNDERSTAND WHERE IT IS BROKEN AND WHY

IN ORDER TO DEVELOP A STRATEGIC PLAN MOVING FORWARD. WE RECOMMEND THAT THE COUNCIL REQUIRE AN INDEPENDENT ENTITY AND FUND IT TO HAVE A COMPREHENSIVE STUDY OF THE MENTAL HEALTH SYSTEM. SIMILAR TO THE

STUDY OF LONG-TERM CARE FACILITIES. THIS PAINTED A COMPREHENSIVE LANDSCAPE. THAT DID NOT INCLUDE CRFS AT THAT TIME. IT SHOULD BRING TOGETHER RESIDENTS AND ALL OTHER RELEVANT STAKEHOLDERS. WE BELIEVE

IT SHOULD AT A MINIMUM MAKE RECOMMENDATIONS CONCERNING THE PROJECTED NEED OVER THE NEXT FIVE YEARS AT ALL LEVELS. THE AVAILABILITY AND MARKET VALUE OF HOUSING VOUCHERS AND PROBLEMS WITH ACCESSING

THEM. WHICH WE HAVE HEARD ABOUT FOUR YEARS NOW. THE ADEQUACY OF CURRENT PROVIDER REIMBURSEMENT RATES. AND CLINICAL COMPLEXITY. THE MANAGEMENT OF THE CLOSURE PROCESS. AND THE EFFECTIVENESS OF

REGULATORY OVERSIGHT. I APPRECIATE THE OPPORTUNITY TO SPEAK ABOUT THIS IMPORTANT ISSUE AND FOR YOUR CONTINUED INTEREST AND SUPPORT IN PROVIDING THE SERVICES. THANK YOU SO MUCH TO THIS PANEL OF

WITNESSES. FOR YOUR TESTIMONY AND YOUR CONTINUED ADVOCACY ON BEHALF OF RESIDENTS OF THE DISTRICT. A LOT OF THE TESTIMONY YOU HAVE PRESENTED IS VERY FRUSTRATING TO HEAR. EVEN FROM THE PERSPECTIVE THAT

A SHELTER IS AN DISCHARGE SPACE. WHICH I'M SURE IF I TALKED TO OUR SHELTER PROVIDERS THEY WOULD SAY WE DO NOT HAVE THE STAFFING CAPACITY TO MANAGE APPROPRIATELY THE CARE NEEDS OF SOMEONE WHO COMES

INTO THE SYSTEM THAT WAY. HAVING SOMEONE IN A ROOM WITH 10 OTHER PEOPLE OR FIVE OTHER PEOPLE, IT WILL NOT WORK FOR ANYBODY. EVERYONE IS FRUSTRATED GETTING THAT TYPE OF SITUATION. I'M TRYING TO THINK

OF WHERE TO GO HERE. IN TERMS OF QUESTIONS. I APPRECIATE YOU BEING HERE AND I UNDERSTAND YOUR FRUSTRATION ON THIS BECAUSE YOU HAVE TESTIFIED AT EVERY HEARING ABOUT THIS BEING A PARTICULAR ISSUE. LET'S

TALK SOLUTIONS. LET'S TALK ABOUT WHERE TO GO. YOUR SUGGESTION WAS AROUND A THIRD PARTY EVALUATION. THAT MAKES ME CRINGE A LITTLE. THEY ARE GOING TO CHARGE FOR THAT. AND WE ARE NOT IN A BUDGET CYCLE.

WHICH MEANS THE FIRST OPPORTUNITY WE WOULD HAVE TO EVEN RELEASE AN RFP FOR THAT STUDY WOULD BE OCTOBER OF 2027. THEN THEY WOULD NEED TIME TO DO THE EVALUATION. WHICH WOULD EXCEED WHATEVER THE NEXT

BUDGET CYCLE IS. WHATEVER THEY COME TO US WITH IN TERMS OF SOLUTIONS, WE WOULD NOT IT WOULD BE ABLE TO FUND IT UNTIL 2028. >> THE LONG-TERM CARE SERVICES STUDY THAT WE DID, I THINK THERE WERE

THOUSANDS CONNECTED TO THAT. THE HEALTH DEPARTMENT CONTRACTED THAT OUT TO GEORGE WASHINGTON TO DO THAT STUDY. IT DOES NOT MEAN YOU CANNOT LAY THE GROUNDWORK FOR IT. IT DOESN'T HAVE TO BE AN OUTSIDE

ENTITY. YOU COULD ASK FOR IT OFFICE OF INSPECTOR GENERAL REPORT TO INITIATE THIS. THERE MIGHT BE SOME OTHER OPTIONS. BY REALIZING THAT THE FUNDING WILL COME INTO PLAY. BUT I DON'T SEE ANOTHER WAY TO

BRING ALL THE PARTIES TOGETHER. WITH AN INDEPENDENT ENTITY. TO OFFER REAL SOLUTIONS. IT CAN BE DONE. IF IT IS IMPORTANT ENOUGH TO THE CITY. YOU FIND WAYS. THE CITY HAS FUNDED A LOT OF STUFF OVER THE

YEARS. MAYBE WE COULD FIND A LITTLE BIT OF MONEY FOR THIS. >> THERE ARE OTHER ENTITIES AT PLAY HERE. WHO HAVE A ROLE IN IT. I DID A WALKING TOUR WITH ONE OF OUR BIDS. AND THEN I GOT AN EMAIL A COUPLE

OF DAYS LATER. WE WALKED INTO SOME PARTS DOWNTOWN WHERE WE HAVE SIGNIFICANT INDIVIDUALS WHO ARE PRESENTING WITH MENTAL ILLNESS AND ALSO HOMELESS. BIDS HAVE STRETCHED OUTSIDE OF THEIR MISSION AND

COMFORT ZONE IN TERMS OF THEY HAVE CASE MANAGERS NOW AND HOMELESS FOLKS AND SOCIAL WORKERS. THERE WAS AN INCIDENT REPORTED IN THAT SPACE. THERE IS DEFINITELY DOES NEED. WE HAVE BEEN TRYING TO PUSH

THEM ON A VARIETY OF OTHER ISSUES. ESPECIALLY IN THE RESIDENTIAL SPACE. THEY ARE HAVING A SIMILAR ISSUE. IT IS PERSISTENT. WHAT IS THE MOST URGENT WAY FOR US TO DO THIS? TO ADDRESS THIS? YOU TALKED

ABOUT THE NUMBER OF CLOSURES. THAT THERE WAS A SURVEY THAT WAS DONE. CAN ANY OF YOU SAY MORE ABOUT THAT? WE PUT TOGETHER AN ANONYMOUS ONLINE SURVEY. HE WAS EMAILED TO ALL CURRENT OPERATORS. SHE HAS

FOR US TO HELP ADVOCATE BETTER AND UNDERSTAND MORE OF THE DISTURBING TRENDS. WE HAVE A 70 FACILITIES CLOSED THEIR DOORS AT ONCE. IT IS IMPOSSIBLE FOR THE SYSTEM TO KEEP UP AND DO WHAT THEY NEED TO DO.

WE HAVE COMPILED SOME RESPONSES. WE WILL BE PROVIDING THOSE. I WAS GOING TO ASK IF SOME OF THOSE COULD BE SHARED. THE NUMBER ONE REASON WAS DUE TO FUNDING. IS THAT REIMBURSEMENT? >> I BELIEVE SO. SOME

OF THE RESPONDENTS OWN HOMES. SOME OF THEM RENT HOMES. WE DID NOT GET A LARGE RESPONSE RATE. >> BY LAW HOW MUCH TIME DOES THE CRF HAVE TO PROVIDE NOTICE? >> AT LEAST 90 DAYS. THAT GIVES THE CLINICAL

TEAM 90 DAYS TO HELP THAT RESIDENT. OK. I THINK WE GET A BILL ON THIS. OR MAYBE AN AMENDMENT. IT WAS WITHIN HOUSING. NOTICE OF RENTAL INCREASES. ACKNOWLEDGING THAT IN THE PRIVATE MARKET IT TAKES

LONGER THAN 30 DAYS. TO FIND SOMEPLACE NEW TO LIVE. THREE MONTHS TO FIND A NEW PLACEMENT. THAT SEEMS SHORT. THAT WOULD BE CORRECT. >> YOU BOTH HAD STORIES OF FOLKS. THEY WILL TELL ME EVERYONE IS

GUARANTEED PLACEMENT. THE RESIDENT WAS GIVEN SEVEN DAYS NOTIFICATION. THAT THE PROVIDER WAS CLOSING. THAT IS THE RESIDENT THAT IS CURRENTLY HOMELESS. THAT IS DEFINITELY A BIG ISSUE. 90 DAYS IS NOT

LONG ENOUGH. I'M TRYING TO UNDERSTAND IT FROM THE PERSPECTIVE OF A PROVIDER. WHEN YOU THINK YOU CAN KEEP GOING. BUT YOU MIGHT NOT BE ABLE TO. WE HAVE THAT HAPPEN IN A VARIETY OF SETTINGS. LIKE WITH

CHARTER SCHOOLS WHERE WE WANT MAXIMUM NOTICE THAT YOU ARE GOING TO CLOSE SO WE CAN MOVE STUDENTS. HOW MANY INDIVIDUALS WOULD YOU SAY END UP IN OTHER JURISDICTIONS? >> I DON'T THINK WE HAVE THAT

INFORMATION. >> TYPICALLY WHAT HAPPENS IS THE RESIDENT WILL FIND ANOTHER FACILITY. IT IS NOT COMMON THAT A RESIDENT AT THAT FACILITY WILL GO TO ANOTHER STATE. IT IS IMPORTANT FOR DBH TO HAVE THE

VACANCIES AVAILABLE. TO HELP THE RESIDENT FIND ANOTHER HOME. >> IF ONE FACILITY IS CLOSING AND YOU HAVE NOTHING ELSE AVAILABLE, WHAT ARE THE OPTIONS? IF THE PIPELINE IS NOT CONTINUOUSLY ADDING BEDS.

OBVIOUSLY THERE WILL BE NATURAL CONTRACTION IN THE SYSTEM. PEOPLE SAY THIS IS NOT WORKING FOR ME. SOMEONE SAID THEY ARE NOT ADDING THAT HAS THEIR CLOSING. ABSOLUTELY. THAT IS A BIG ISSUE. WE HAD A

PROVIDER THAT CLOSED SIX FACILITIES. THEY HAD TO EXTEND THEIR CLOSURE DATE. THEY ARE JUST OUT OF BEDS. WE HAVE TALKED TO THE OFFICE. BY THEIR OWN DATA, THERE IS NO BEDS. THAT IS WHY PEOPLE END UP IN

LOCATIONS THAT ARE NOT ALIGNED WITH THEIR NEEDS. AND THEN ANOTHER COMPLAINT ARISES. >> YOU TALKED ABOUT A PERSON WHO ENDED UP IN INDEPENDENT LIVING? >> I TALKED ABOUT A COUPLE OF INDIVIDUALS FROM THE

PROVIDER WHO CLOSED SIX OF THE FACILITIES. IT WAS SURPRISING BECAUSE THEY WERE IN A SUPPORTIVE RESIDENCE. THAT REQUIRES MORE SUPPORT. TO BE THAT TYPE OF SETTING. THAT IS OUR CONCERN. HOW ARE THESE

LEVEL OF CARE ASSESSMENTS BEING DETERMINED? A RESIDENT SHOULD STEP DOWN TO A SUPPORTIVE RESIDENCE WHEN THEY SHOW SIGNS THAT THEY ARE ABLE TO. THAT IS A JUMP. PROGRESS CAN HAPPEN. [LAUGHTER] >> THAT IS

A CHUMP. IT IS ALMOST A SET UP FOR THE RESIDENT. FOR FAILURE. IT QUESTIONS HOW ARE THESE ASSESSMENTS MAY DETERMINE THAT HE WAS MAKING THESE DETERMINATIONS? >> WHO DOES THE ASSESSMENTS? I WOULD SAY DBH

MAKES THE FINAL ASSESSMENT. I AM SERIOUS, WHO IS REVIEWING THE CASE FILE DOCUMENTATION TO DETERMINE? ON OTHER THINGS WE HAVE IS OUTSIDE ENTITY THAT HELPS IN TERMS OF DETERMINATIONS AND PRIOR

AUTHORIZATIONS AND REVIEWS AND ALL OF THESE DIFFERENT THINGS. WHO DOES THIS? WHAT I WOULD SAY TO THAT IS THE RESIDENT'S CLINICAL TEAM IS RESPONSIBLE FOR GATHERING ALL THE CLINICAL DOCUMENTS. THEY HAVE

A DOCTOR WHO MAKES A RECOMMENDATION FOR A LEVEL OF CARE. THAT PACKET IS SUBMITTED TO DBH FOR FINAL REVIEW. ON WHAT THE LEVEL OF CARE WILL BE. THAT IS WHAT WE WOULD LIKE TO KNOW ALSO. WE DO NOT KNOW

WHO IS MAKING THOSE DETERMINATIONS. >> IS THERE A PROCESS OF APPEAL? IF THERE IS WE HAVE NO KNOWLEDGE OF IT. AND NEITHER DOES THE RESIDENT. >> WE WILL FOLLOW UP ON THIS. I THINK WE WILL GET TESTIMONY

FROM LEGAL SERVICES. I HAVE THAT QUESTION AROUND, THE RISK MANAGEMENT IN ME IS SUGGESTING THAT SOMETHING CAN BE FULLY OFF HERE. WHAT IF YOU HAVE THE CLINICAL TEAM THAT SAID NO. THIS PERSON STILL NEEDS

TO BE A HIGH LEVEL OF CARE. BUT I DON'T HAVE A BED SO I WILL PUT YOU HERE. AND THEN SOMETHING GOES AWRY. >> THAT HAS HAPPENED. I THINK I ALSO TOUCHED ON IT. I DID NOT GO INTO DETAIL FOR

CONFIDENTIALITY PURPOSES. THERE WAS A SITUATION LIKE THAT WHERE THEY INDICATED NO. THEY ONLY HAVE VACANCIES AVAILABLE. TO THIS PERSON HAS TO GO INTO A SUPPORTED RESIDENCE VACANCY. THE CASE MANAGER

SAYS WE DO NOT AGREE WITH THAT AT ALL. THAT IS ONE OF THE SCENARIOS I HAD IN MY TESTIMONY WHERE THE RESIDENT IS STILL IN THE INAPPROPRIATE LEVEL OF CARE WHERE HE NEEDED A HIGHER LEVEL OF CARE. HE HAS

BEEN IN DEBT SINCE MARCH. HE HAS BEEN IN THE HOSPITAL A FEW TIMES. THERE HAS BEEN SOME ISSUES. THE PROVIDER HAS EXPRESSED SEVERAL TIMES THAT THEY HAVE BEEN STRUGGLING TO MEET THE NEEDS OF THE

RESIDENT. >> THANK YOU SO MUCH. IF YOU HAVE NOT PROVIDED WRITTEN TESTIMONY FOR THE RECORD PLEASE DO SO. WE WILL GO TO OUR NEXT PANEL. ELIZABETH DAVIS. OK. THESE ARE VIRTUAL FOLKS. HE WILL JOIN US

VIRTUALLY. THEY ARE BOTH VIRTUAL. >> GOOD AFTERNOON. I AM AN ATTORNEY AT DISABILITY RIGHTS D.C.. DISTRICT RESIDENTS WITH DISABILITIES RECEIVE SERVICES IN THE MOST INTEGRATED FACILITY TO THEIR NEEDS.

WE THANK THE COMMITTEE FOR YOUR FURTHER ATTENTION ON ONGOING CONCERNS WITH OUR BEHAVIORAL HEALTH AND LONG-TERM CARE SYSTEMS. THE DISTRICT IS CONTINUING TO MAKE CHOICES THAT RESULTS IN THE UNNECESSARY

AND ILLEGAL INSTITUTION THAT IS PUTTING THEM AT RISK. CALLS FOR AN INCREASE IN INSTITUTIONAL PLACEMENTS WHERE MORE FACILITIES TURN IN THE WRONG DIRECTION ARE OFTEN A REACTION TO AND ARE PART OF THIS

PROGRAM. TODAY I WILL ONLY SUMMARIZE SOME OF OUR CURRENT CONCERNS WITH THE COMMUNITIES DISTRICT BASED SERVICES. MY WRITTEN TESTIMONY WILL GO ON A MUCH MORE DETAIL. AS THIS COMMITTEE KNOWS AND AS WE

JUST TALKED ABOUT IN THE PREVIOUS PANEL, WE CONTINUE TO BE DEEPLY CONCERNED. THERE CONTINUES TO BE A TREND OF RAPIDLY CLOSING FACILITIES IN THE DISTRICT. THEY REMAIN CONCERNED ABOUT THE LACK OF

PHYSICALLY AVAILABLE CRS. THEY HAVE A NUMBER OF BEDS THAT ARE ACCESSIBLE FOR WHEELCHAIR USERS AND OTHERS WITH PHYSICAL DISABILITIES AS IT REQUIRED BY THE ADA. THEY CONTINUE TO NOT BE THAT OBLIGATION.

AS WE HAVE HIGHLIGHTED BEFORE, THERE IS A WOEFULLY INADEQUATE NUMBER OF HOUSING VOUCHERS FOR PEOPLE WHO ARE INSTITUTIONALIZED. THE RENTAL CAP IS VOUCHERS THAT ARE SUBSIDIZED THROUGH THE FUND OF THE

PROGRAM. WE HAVE URGED FURTHER ATTENTION TO THESE ISSUES. THERE WAS A CLASS-ACTION ON BEHALF OF RESIDENCE. THEY ARE MOVING BACK TO THE COMMUNITY. THE ISSUE CONTINUES TO BE UNDER AN INJUNCTIVE ORDER.

REQUIRING THE DISTRICT TO BE AT THE RESIDENCE. THE DISTRICT HAS MADE LITTLE PROGRESS IN IMPLEMENTING THE SYSTEM. AT THE SAME TIME, THE DISTRICT IS FAILING TO MEET ITS INJUNCTION. THIS IS FOR MEDICAID

BENEFICIARIES. DESPITE DEMONSTRATED NEED. THESE ARE BENEFICIARIES OF THESE PROVIDERS. THIS WILL RESULT IN GREATER POPULATION OF INDIVIDUALS WITH DISABILITIES AND WILL FRUSTRATE NURSING HOME FACILITIES

IN THE COMMUNITY. IN VIOLATION OF THE MANDATE AND THE INJUNCTION. THANK YOU AGAIN FOR THIS OPPORTUNITY TO TESTIFY. I WELCOME ANY QUESTIONS. THANK YOU. >> GOOD AFTERNOON. I AM THE SENIOR DIRECTOR.

THANK YOU FOR THE OPPORTUNITY TO PROVIDE TODAY'S TESTIMONY AT THIS ROUNDTABLE. OVER THE PAST SEVERAL YEARS WE HAVE RECOGNIZED A GROWING CHALLENGE ASSOCIATED WITH ENSURING PATIENTS WHO REQUIRE LONG-

TERM CARE AND SUPPORT TRANSITION TO THE APPROPRIATE SETTING. WE HAVE TAKEN STEPS TO BETTER UNDERSTAND THE DELAYS IN CARE TRANSITIONS. OUR ONGOING MONTHLY DATA HAS IDENTIFIED FOUR MAIN BARRIERS TO

DISCHARGE. ONE IS LACK OF ACCESS TO COMMUNITY HEALTH SYSTEMS. THERE ARE CHALLENGES WITH LOCATING APPROPRIATE PLACEMENT FOR UNDOCUMENTED PATIENTS. WE HAVE HEARD FROM SEVERAL OF OUR HOSPITALS THAT

DELAYS IN SECURING GUARDIANSHIP FOR LONG-TERM CARE PATIENTS IS A PROBLEM. WE IDENTIFIED 29 PATIENTS THAT REMAIN HOSPITALIZED BEYOND MEDICAL CLEARANCE. 32 HAD A DISCHARGE DISPOSITION FOR LONG-TERM

CARE. THEY SPENT MORE THAN A HUNDRED DAYS IN THE HOSPITAL. THESE FINDINGS PROVIDE A BRIEF SNAPSHOT OF THE CHALLENGES THAT HOSPITALS FACE IN SECURING PLACEMENTS. WE ARE ALSO WORKING TO STRENGTHEN

COMMUNITY-BASED RESOURCES. AND SAFE TRANSITIONS FOR LONG-TERM CARE RESIDENTS. THROUGH OUR COMMUNITY CARE INVESTMENT WE ARE EXPANDING PATHWAYS INTO HEALTH CARE CAREERS. WE ARE ALSO PROVIDING SUPPORT TO

A MEDICAL RESPITE PROGRAM. FOLLOWING A HOSPITAL STAY. TRYING TO BRIDGE THE GAP BETWEEN LONG-TERM ARRANGEMENTS. THEY REQUIRE SOLUTIONS. THEY REMAIN COMMITTED TO THE DISTRICT. THEY NEED THAT AT THE

RIGHT PLACE IN THE RIGHT TIME. THANK YOU FOR THE OPPORTUNITY TO TESTIFY. >> GREAT NAME. THANK YOU. I AM A CLINICAL PSYCHOLOGIST AND COFOUNDER AND CHIEF CLINICAL OFFICER. WE WORK ACROSS MULTIPLE

STATES. DEVELOPING MENTAL HEALTH PROGRAMS. THIS IS A POPULATION THAT IS GROWING EXPONENTIALLY. THERE IS A LONG-TERM CAPACITY PROGRAM. PATIENT TO A MEDICALLY READY FOR DISCHARGE REMAINING COSTLY ACUTE

CARE SETTINGS SOMETIMES FOR HUNDREDS OF ADDITIONAL DAYS BECAUSE NURSING FACILITIES LACK THE RESOURCES TO SAFELY MANAGE THEIR NEEDS. THIS RESULTS IN UNNECESSARY HEALTH CARE SPENDING. AND POOR PATIENT

OUTCOMES. RESIDENTS ALREADY LIVING IN NURSING FACILITIES MIGHT SEE ESCALATING BEHAVIOR. WITH THAT APPROPRIATE SUPPORT INDIVIDUALS CAN END UP IN CRISIS, HOSPITALIZED, AND ULTIMATELY BECOME HARD TO

PLACE. THE DISTRICT HAS RECOGNIZED THIS NEED. THIS LIMITS ITS EFFECTIVENESS. THIS DIMMICK CRATE -- DIFFERENT STRAITS THAT THIS CAN CHANGE NURSING CAPACITY. THIS PROGRAM ALLOWS STAFF TRAINING. AND

CLINICAL OVERSIGHT AND ONGOING SUPPORT. WE HAVE EVIDENCE THIS APPROACH WORKS. INVOLVING 60,000 RESIDENTS. WE SHOW THAT PATIENTS INVOLVED IN THESE PROGRAMS HAD GREATER QUALITY OF LIFE OUTCOMES. THEY

HAD LESS HOSPITALIZATION. THERE SHOULD BE THREE PRIORITIES. TO MAKE THIS PROGRAM MORE EXPENSIVE AND ACCESSIBLE. TO MAKE IT LAST OF MORE THAN 90 DAYS SO PATIENTS DO NOT LOSE THE SUPPORT AS IT AS THEY

START RECOVERING. AND TITUS OUTCOMES LIKE HOSPITAL UTILIZATION AND BOARDING DAYS THAT PATIENTS SPEND IN THE HOSPITAL. I THINK THIS IS A GREAT SOLUTION FOR THE DISTRICT. THANK YOU. THANK YOU. >> GOOD

AFTERNOON. I AM A SENIOR COUNSEL AT LEGAL AID D.C. WE THANK YOU FOR HOLDING THIS ROUNDTABLE. MY TESTIMONY WILL FOCUS ON PERSONAL CARE SERVICES. TO TRANSITION TO HER REMAIN IN THEIR COMMUNITY. WE ARE

GLAD THE COUNCIL PASSED THE DIRECT CARE WORKER AMENDMENT ACT. WE HOPE THAT LEGISLATION WILL CONTINUE TO ADDRESS THESE PROBLEMS. LEGAL AID CONTINUES TO ENCOUNTER CLIENTS THAT ARE NOT RECEIVING THE FULL

AMOUNT OF HOURS THEY ARE AUTHORIZED TO RECEIVE. TO PROVIDE PERSONNEL TO FULLY STAFF THESE HOURS. THIS PROBLEM IS PARTICULARLY ACUTE IN THESE SITUATIONS. FOR EXAMPLE, IF SOMEONE IN A STATE PLAN IS

APPROVED FOR A FEW HOURS A DAY, ANOTHER BENEFICIARY IS APPROVED FOR 12 HOURS. HOME HEALTH AIDES WANT TO BE WITH PAID FOR LONGER SHIFTS. THERE IS SIMPLY MORE DEMAND FOR HOME HEALTH AIDES. INDIVIDUALS

IN THIS PROGRAM HAVE THE OPTION OF USING SERVICES TO RECEIVE ASSISTANCE FROM FAMILY MEMBERS OR FRIENDS. PEOPLE HAVE MORE FLEXIBILITY TO PROVIDE CARE. SERVICE IS MY WAY IS OFTEN THE BEST CHOICE. THAT

OPTION DOES NOT EXIST FOR ESTATE PLANNING BENEFICIARIES. WE URGE YOU TO IMPLEMENT A STATE PLAN AMENDMENT TO HELP STATE PLAN FOR SHERRY'S PROVIDE ACCESS FOR THE SERVICES. STATE PLAN BENEFICIARIES DO

NOT MEET THE SAME INTENSIVE ASSISTANCE AS THOSE IN THE WAIVER. THEY CAN BENEFIT THE MOST FROM AN AIDE FOR A FEW HOURS A DAY. WHEN THE BENEFICIARIES DO NOT RECEIVE THE ASSISTANCE THEY NEED WITH THESE

ACTIVITIES, THEY RISK INJURING THEMSELVES AND LOSING THEIR ABILITY TO REMAIN AT HOME. THEY MIGHT NEED AN INCREASE IN HOURS TO REMAIN AT HOME. IT IS THE SHORTER SHIFTS THAT ARE CONSISTENTLY THE MOST

DIFFICULT FOR HOME AGENCIES TO FAIL. IMPLEMENTING THIS CAN ALSO BENEFIT INDIVIDUALS WITH BEHAVIORAL OR MENTAL HEALTH NEEDS THAT MAY FIND IT MORE CHALLENGING TO WORK WITH A OR WHO MAY NOT BE ABLE TO

TRANSITION TO AN INPATIENT FACILITY AS OPPOSED TO A FAMILY MEMBER OR ACQUITTANCE. IN ADDITION TO A 1915, THERE COULD BE OTHER POLICIES TO IMPLEMENT HEALTH AIDS TO TAKE SHORTER SHIPS LIKE REIMBURSING

AIDS FOR TRAVEL TIME. POLICIES JUST AS THESE SHOULD GO FURTHER TO FILLING A CRITICAL GAP IN THE DISTRICTS PROGRAMS WITH ALLOW PEOPLE TO REMAIN IN THEIR HOMES AND COMMUNITIES. MY WRITTEN TESTIMONY GOES

INTO SOME CONCERNS WE HAVE ABOUT RECERTIFICATION'S BUT I SEE I AM OUT OF TIME SO I WILL SUBMIT THAT FOR THE RECORD. THANK YOU. CHAIR HENDERSON: THANK YOU. GOOD AFTERNOON. I'M THE SENIOR POLICY

COUNSELOR AT D.C. APPLESEED AND CHAIR OF THE WORKFORCE COMMITTEE OF THE D.C. COALITION ON LONG-TERM CARE. THANK YOU FOR THE OPPORTUNITY TO TESTIFY. THIS ISSUE INVOLVES FUNDING, HEALTH CARE COVERAGE,

REIMBURSEMENT AND HOUSING AMONG OTHER AREAS. I'LL FOCUS ON THE WORKFORCE BECAUSE WITHOUT STAFF, POLICY CHANGES WILL NOT DELIVER THE RIGHT CARE. OUR POPULATION IS AGING, RESIDENTS ARE LIVING LONGER

WITH COMPLEX CONDITIONS. RISING COSTS AND HEALTH CARE COVERAGE LOSSES PUT MORE PEOPLE AT RISK OF HOMELESSNESS. ALL OF THIS STRIKES THE MEN FOR HIGHER LEVELS OF CARE. SERVING THESE RESIDENTS REQUIRE

SPECIALIZED SKILLS AND A BROADER TEAM OF PSYCHIATRIC CARE PROVIDERS, SOCIAL WORKERS, AND PEER SUPPORT SPECIALISTS. IN AN ADDITION TO THE WORKERS. WITHOUT THIS WORKFORCE, RESIDENTS WILL KEEP BEING

DENIED PLACEMENT WERE WAITING IN HOSPITALS. A CENTRAL PROBLEM IS WE DO NOT HAVE THE DATA. WE DON'T KNOW HOW MANY RESIDENTS NEED THE LEVEL OF CARE, WHETHER WE HAVE AN OF HOUSING OR FACILITIES WITH THE

CAPACITY TO PROVIDE IT. WHAT COMMUNITY CARE REQUIRES. HOW MANY PEOPLE HOLD THOSE CREDENTIALS OR IF WE CAN TRAIN MORE IF NEEDED. THE WORKFORCE FOUNDATION STILL NEEDS WORK. IT IS A CLEAR EXAMPLE. MORE

THAN FIVE YEARS AFTER THE REGULATIONS FOR THE CERTIFICATION, NO TRAINING SCHOOL HAS BEEN APPROVED AND A PATHWAY TO CERTIFICATION EXISTS. THIS EXASPERATES THE NURSING SHORTAGE AS NURSES PROVIDING

MEDICAL CARE THAT CNA'S COULD PROVIDE. ALSO AT A RECENT ROUNDTABLE, WE HEARD THAT THE DISTRICT HAS NOT DATA TO UNDERSTAND TRAIN CAPACITY AND BARRIERS AND HAS BEEN SLOW TO IMPLEMENT CHANGES THAT WOULD

INCREASE THE WORKFORCE. WE HAVE SIX ASKS TO CAP ENSURE WE HAVE THE DATA, WORKFORCE NEEDED. FIRST, IDENTIFY THE SIZE AND SPECIFIC NEEDS FOR THE POPULATIONS REQUIRING CARE AND THEN CONDUCT A GAP

ANALYSIS OF CAPACITY WORKFORCE NEEDS AND TRAINING CAPACITY. SECOND, PAIR EVERY REGULATORY CHANGE WITH THE FUNDED TRAINING PLAN. THIRD, SOLIDIFY TRAINING PATHWAYS. COMPLETE AND SUCCESSFULLY IMPLEMENT

THE UNIFIED PROVINCIAL. ESTABLISH THE PATHWAY AND OTHER TRAINING IDENTIFIED IN THE GAP ANALYSIS. AND CONNECT CURRENT WORKERS TO THE TRAINING. FOURTH, MAKE EVERY AGENCY ACCOUNTABLE FOR ITS TRAINING AND

WORKFORCE DATA. AND MAKE THAT DATA PUBLIC WITH ANNUAL REPORTING. THIS ALONG WITH DEVELOPING HIS LONG-TERM STRATEGIC PLAN, INCLUDING HOW THE DISTRICT PLANS ON SERVING MEDICALLY COMPLEX POPULATIONS.

SIX, PROVIDE THE D.C. PROGRAM OFFICER WHO COORDINATES THE LONG-TERM CARE STRATEGY WITH THE STAFF NEEDED TO COORDINATE AND IMPLEMENT THE STRATEGIC PLAN. EITHER BY ADDING A STAFF POSITION OR CREATING A

DEDICATED LONG-TERM CARE STRATEGIC COORDINATOR. WORKFORCE PLANNING IS WHAT TURNS IT INTO WHAT D.C. RESIDENTS DESERVE. THANK YOU. CHAIR HENDERSON: THANK YOU. WOW. THERE WAS A LOT. I SHOULD NOT HAVE

DONE A PANEL OF FIVE. YOU ALL HAD SO MUCH STUFF. I WILL DO MY BEST. I WILL START WITH KRISTEN. YOU HAD SIX REALLY GOOD RECOMMENDATIONS THERE. I THINK YOUR POINT AROUND WE DON'T REALLY HAVE THE DATA IS

INTERESTING. I WAS TELLING REBECCA -- I WOULD SAY OF YEAR AGO, TWO YEARS AGO MAYBE, THERE WAS AN AGE FRIENDLY D.C. SURVEY. BUT YOU WOULDN'T NECESSARILY KNOW WHAT FOLKS WHO ARE NEARING SENIOR SHIP

WOULD THINK BECAUSE THE VAST MAJORITY OF PEOPLE WHO FILLED OUT THE SURVEY WERE IN THEIR 20'S. IT WAS LIKE, HOW ARE WE USING THIS DATA TO FORM? I REMEMBER AT THE TIME, OH, WELL, THIS TELLS US WHAT WE

NEED TO DO TO SET UP FOR. I'M LIKE YEAH, WE CAN ALSO TALK TO PEOPLE IN THEIR 50'S OR 60'S, WHO ARE MORE IMMEDIATELY GOING TO BE NEEDING THE SERVICES, WHETHER IT BE OF DACAL OR ONE OF THE FACILITIES,

ETC. SO, YEAH, YOU ARE RIGHT. WE HAVE NO IDEA. WE HAVE AN IDEA, BUT I THINK IN PART, IT'S CERTAINLY MISSING BECAUSE IT IS EITHER THROUGH THE VILLAGES, INDIVIDUALS WHO MAY ENGAGE WITH DACAL, WHICH IS

NOT A LOT. THEN, I THINK INTERESTINGLY ENOUGH, OTR. BECAUSE THEY WOULD HAVE PEOPLE WHO ARE RECEIVING CERTAIN TAX EXEMPTIONS BASED ON AGE STATUS. AGAIN, THAT IS ONLY IF YOU OWN A HOME. YEAH. HOW SHOULD

WE DO BETTER? I MEAN, I THINK HANNAH IS A BIG PART OF THIS AND WILL BE TESTIFYING LATER. I THINK THAT IS THE STARTING POINT. AND MAKING SURE SHE IS SUPPORTED IN THAT ROLE AND THAT THERE IS BUY-IN FROM

ALL OF THESE AGENCIES SO THAT EVERYONE CAN GET INTO A ROOM AND SEE HERE'S -- AND SAY HERE'S THE DATA I HAVE. PULL IT ALL TOGETHER AND MEET WITH COMMUNITY STAKEHOLDERS TO FIGURE OUT WHAT THEY HAVE, AND

GET IT ALL TOGETHER. THAT IS WHAT YOU BASE YOUR STRATEGIC PLAN ON. WHAT IS THE ACTUAL NEED RIGHT NOW? OF COURSE, YOU PLAN FOR YEARS OUT BECAUSE WE NEED TO BE DOING THAT. BUT WE ARE NOT NAILING IT

RIGHT NOW. WE HAVE TO FIGURE OUT WHAT'S MISSING RIGHT NOW. CHAIR HENDERSON: THIS IS A QUESTION FOR EVERYONE. I'M JUST SORT OF THINKING IT OFF THE TOP OF MY HEAD. THERE IS GOING TO BE A MAJOR SHIFT AT

THE COUNCIL IN TERMS OF WHO HAS WHAT TYPE OF OVERSIGHT. SHOULD IT BE WITH THE HEALTH CLUSTER? I DON'T KNOW IF ANYBODY HAS ANY THOUGHTS ON THAT. NOW THAT I AM ASKING FOR MORE RESPONSIBILITY -- I AM

THINKING IN TERMS OF ALIGNMENT. >> I WOULD SAY THERE'S A LOT OF OVERLAP AND I THINK THERE COULD BE BENEFIT TO A FALLING IN THE PURVIEW. CHAIR HENDERSON: OK. I WILL GENERALLYBECAUSE THEYO MUCH TOGETHER

ON THAT. I THINK THEM ALL BEING UNDER THE SAME OVERSIGHT AUTHORITY WOULD BE HELPFUL. CHAIR HENDERSON: LET ME ASK -- I WILL PROBABLY GET A TEXT ABOUT THAT LATER. I'M JUST THINKING IN TERMS OF WE ARE

ASKING FOR STREAMLINING AND ALIGNMENT. FROM AN OVERSIGHT STANDPOINT, I DON'T THINK WE HAVE THAT. A NEARING A LONG-TERM CARE. I GUESS IF I WERE INVITING ALL THE AGENCIES THAT ARE AVAILABLE, I'VE GOT

TWO OFF THE TOP OF MY HEAD WHO ARE NOT IN MY COMMITTEE. DISABILITY SERVICES AND DACAL. THEY ARE VERY MUCH CRUCIAL TO THE CONVERSATION. LET ME GO BACK. MISS DAVIS, YOU PROVIDE A LOT OF DATA. WE DON'T

HAVE YOUR TESTIMONY. I SUBMITTED IT BEFORE I GOT HERE. IT MAY NOT HAVE BEEN APPROVED. CHAIR HENDERSON: CAN YOU TALK THROUGH SOME OF THE NUMBERS THAT YOU SAID? I THINK YOU SAID 89 PATIENTS WHO ARE

STILL AT THE HOSPITAL WHO DON'T NEED THE ACUTE LEVEL OF CARE. YES, AND THAT IS OVERALL. FOR THE LONG-TERM CARE, IT WAS 32 PATIENTS. THIS BEEN ON AVERAGE 103 ADDITIONAL DAYS IN THE HOSPITAL. CHAIR

HENDERSON: 103 ADDITIONAL DAYS. >> THAT IS THE AVERAGE, YES. CHAIR HENDERSON: OK. WHO PAYS FOR THE ADDITIONAL DAYS? >> I DON'T WANT TO MISSPEAK. CHAIR HENDERSON: DOCTOR, DO YOU HAVE -- I CANNOT SPEAK

TO THE DISTRICT SPECIFICALLY BUT WHAT WE SEE NATIONALLY IS THE HOSPITALS IN A LOT OF CASES FOOT THE BILL FOR THAT BECAUSE THERE'S ONLY A PAYMENT SOURCE FOR A CERTAIN NUMBER. WHEN WE SEE PATIENTS IN

EXCESS OF 300 DAYS OR MORE THAT HAVE BEEN APPROPRIATE CLINICALLY FOR DISCHARGED LONG AGO, AND OF COURSE, MEDICAID AND MEDICARE WILL FIT SOME OF THAT BILL BUT A LOT OF THAT FALLS ON THE HOSPITALS. WHEN

WE ARE DEALING WITH HOSPITALS THAT MAY HAVE THOSE FINANCIAL CHALLENGES, IT COULD LEAD TO SERIOUS FINANCIAL ISSUES. IT ALSO LETS THOSE BEDS BE OCCUPIED FOR PATIENTS THAT NEED THEM. CHAIR HENDERSON: I

KNOW. CAPACITY. AND I HAVE BEEN IN THE HOSPITAL -- WE HAVE GREAT HOSPITALS IN THE DISTRICT OF COLUMBIA. WE HAVE AMAZING HOSPITALS WITH GREAT NURSING STAFF, THE WHOLE NINE. AND ALSO, THOSE BEDS ARE NOT

DESIGNED FOR 103-DAY STAY. YEAH. YOU SAID SOMETHING ELSE FOR YOU GUYS DID A SURVEY? THIS IS A PART OF OUR ONGOING EFFORT, PART OF THE CARE COORDINATION COMMITTEE, WHERE WE DO WE DO THIS MONTHLY

COLLECTION OF BARRIERS TO DISCHARGE DATA FROM ALL OF THE HOSPITALS. THIS WAS A PART OF THAT SURVEY OF SEEING WHAT OUR HOSPITALS ARE SEEING IN TERMS OF HOW MANY PATIENTS ARE STAYING IN THE HOSPITAL

BEYOND MEDICAL CLEARANCE. IN TERMS OF NOT ONLY WOULD LONG-TERM CARE BUT THE OVERALL POPULATION. CHAIR HENDERSON: YOU MENTIONED -- I WANT TO SAY THIS PUBLICLY, TO APPRECIATE THE HOSPITAL ASSOCIATION

STEPPING UP IN TERMS OF HELPING. WHICH I THINK -- IT'S NOT A PANACEA BUT IT CAN CERTAINLY PROVIDE SUPPORT. BECAUSE I STILL FEEL LIKE EVEN -- IT IS A MEDICAL RESPITE PROGRAM INSIDE A SHELTER. AND A

SHELTER IS NOT AN APPROPRIATE PLACEMENT FOR FOLKS BUT IT IS AN OPTION THAT IS AVAILABLE. THE FRUSTRATING THING OF WHAT WE ARE FACING RIGHT NOW IN TERMS OF THE PROGRAM I AM SPEAKING ABOUT IS THAT IT IS

A MEDICAL RESPITE PROGRAM INSIDE OF THE BUILDING THAT IS SUFFERING FROM ELEVATOR CHALLENGES THAT ARE NOT BEING MET BY THE DEPARTMENT OF GENERAL SERVICES. HOW DO I OPEN UP A MEDICAL RESPITE PROGRAM IN

THE BUILDING WHERE NOBODY CAN GET UPSTAIRS? FOR LONG-TERM CARE OR ELDERLY. THE ROADBLOCKS ARE MANY. AND, I THINK, THAT IS A VERY FRUSTRATING ONE. CHAIRMAN MENDELSON ALREADY HAD A HEARING ON ELEVATORS,

SO I AM NOT GOING TO NECESSARILY PILE ON BUT THIS IS A DUM PROBLEMB TO HAVE. WE HAVE AN ORGANIZATION THAT WANTS TO DO THE PROGRAM, WE HAVE THE FUNDING. WE ACTUALLY HAVE A SPACE AND YET WE CANNOT

REASONABLY GET PEOPLE IN AND OUT OF THE FACILITY BECAUSE THE ELEVATORS ARE BROKEN TOO OFTEN. WHAT A WOW. OK. CAN YOU SAY MORE, MISS DAVIS COME ABOUT THE GUARDIANSHIP ISSUES? I THINK YOU WERE THE FIRST

ONE TO RAISE THAT. SO, IN PREVIOUS CONVERSATIONS WE'VE HAD WITH THE HOSPITALS, WE HAVE FOUND THAT SOME PATIENTS ARE UNABLE TO BE ABLE TO BE DISCHARGED BECAUSE THEY DON'T HAVE A GUARDIAN OR A

CONSERVATIVE SUIT -- CONSERVATORSHIP. I CAN FOLLOW UP WITH THE COMMITTEE TO SEE IF THEY HAVE SOME ADDITIONAL INSIGHT. BUT THAT IS WHAT WE'VE HEARD. CHAIR HENDERSON: OK. THAT BRINGS IN THE LEGAL PIECES

TO IT. OK. I KNOW THAT SOME OF THE HOSPITALS HAVE LEGAL CLINICS IN PARTNERSHIP WITH THE UNIVERSITIES BUT THAT MIGHT NOT BE EVERYBODY TO ADDRESS THESE PARTICULAR ISSUES AND CHALLENGES. >> I WILL

DEFINITELY FOLLOW UP AND SEE WHAT WE CAN FIND. CHAIR HENDERSON: YOU TALKED -- THE HIGHLIGHT OF YOUR TESTIMONY WAS THAT THIS IS A CAPACITY PROBLEM. WHAT IS THE TRIGGER TO GET MORE PROVIDERS TO DECIDE

TO ENTER INTO THIS SPACE? WHAT SHOULD WE BE DOING? IS IT YOU NEED A FACILITY, WE, THE DISTRICT, WE SHOULD NOT BE RUNNING ANYTHING ELSE ANYMORE. WE HAVE NOT SHOWN OURSELVES GREAT TO DO SOME OF THOSE

THINGS. WHAT IS IT? IS IT ADMINISTRATIVE OPERATIONS, REIMBURSEMENT? WHAT A SIGHT FOR FOLKS TO SAY I WANT TO BRING MY SERVICES TO THE DISTRICT OF COLUMBIA AND OPERATE HERE? I THINK THE CAPACITY IS

BUILDING CAPACITY WITHIN THOSE THAT ARE CURRENTLY OPERATING TO BE ABLE TO CARE FOR THOSE WITH BEHAVIORAL HEALTH COMPLEXITIES. EVEN OUTSIDE OF THAT, IT IS REIMBURSEMENT. IT IS THE ABILITY TO HAVE THE

RESOURCES TO TRAIN YOUR STAFF SPECIALLY BECAUSE STAFF TRAINING IN A TYPICAL LONG-TERM CARE FACILITY DOES NOT HAVE ANY EXPERIENCE OR TRAINING WITH HANDLING BEHAVIORAL COMPLEXITIES WHICH LEADS TO EVEN

MORE STAFFING CRISIS AND AN EXODUS OF THOSE CAREGIVERS BECAUSE IF THEY ARE NOT EQUIPPED WITH THE SKILLS AND THE CONFIDENCE TO CARE FOR SOME OF THESE BEHAVIORALLY COMPLEX, THEY WILL LEAVE AND THERE'S

GOING TO BE A BIGGER STAFFING CRISIS WE ARE SEEING EVEN AS WE ARE SEEING POPULATION AGING AND SEEING SOME OF THE CAREGIVERS AGING OUT. IT IS NOT THOSE TO REPLACE THEM. MAKING SURE WE CAN PAY THEM

ADEQUATELY AND PROVIDE SPECIALIZED STAFF TRAINING AND HAVE ALL THE RESOURCES, WRAPAROUND SERVICES AVAILABLE FOR THEM. CHAIR HENDERSON: IS THE SPECIALIZED STAFF TRAINING SEPARATE FROM SOMETHING SOMEONE

MIGHT MISS EVE IN THE NURSING CARE TRAINING? YES. MOST DEFINITELY. USUALLY BEHAVIORALLY COMPLEX IS NOT A BIG PART OF THAT TRAINING. BEHAVIORAL INTERVENTIONS, HOW TO MANAGE DE-ESCALATION AND CRISIS AND

BUILD BEHAVIORAL MODELS IS NOT PART OF STANDARD NURSING TRAINING, CAREGIVER TRAINING, AIDE, CNA TRAINING. CHAIR HENDERSON: THAT IS A LITTLE WILD. OK, SO I'M SAYING THAT FROM THE PERSPECTIVE OF DE-

ESCALATION. I FEEL LIKE EVERYBODY SHOULD GET IT. ABSOLUTELY. CHAIR HENDERSON: WE GET IT. I AM NOT IN HEALTH CARE BUT WE HAVE THESE CONVERSATIONS AND TRAININGS EVEN AROUND STAFF WHO WORK IN PUBLIC

SPACES. IS THAT -- IS THAT A TYPE OF SITUATION WHERE YOU GET THAT TRAINING ONCE YOU ARE HIRED WITH A FACILITY? I THINK THAT FACILITIES ARE STILL USING MODELS THAT WERE BUILT AROUND LONG-TERM CARE AND

REHABILITATION OF YOUR NICE GRANDMOTHER WHO IS REHABILITATING FROM A HIP REPLACEMENT AND NOT WHAT WE ARE SEEING NOW, WHICH IS A YOUNGER DEMOGRAPHIC WITH A LOT OF SERIOUS MENTAL ILLNESS. WE ARE SEEING

OLDER AND MORE COMPLEX AND FRAIL WITH COGNITIVE DISORDERS, BEHAVIORS. THEY GET TRAINING ON HOW TO HANDLE MEDICAL ISSUES BASICALLY, BUT NOT WHAT TO DO IF SOMEBODY IS SCREAMING IN YOUR FACE OR BEING

COMBATIVE OOR REFUSING CARE. THOSE ARE A LOT OF THE BEHAVIORS WE ARE SEEING AND THEY ARE NOT EQUIPPED TO MANAGE THEM WHICH IS WHY THEY ARE SO RELUCTANT TO ADMIT THAT AND WHY THERE IS A PLACEMENT

ISSUE. CHAIR HENDERSON: I WAS AT SAINT ELIZABETH'S HOSPITAL A COUPLE MONTHS AGO AND THEY HAVE WHAT IS KNOWN AS A DEER -- GERIATRIC UNIT. THESE ARE INDIVIDUALS WHO MIGHT HAVE BEEN THERE FOR YEARS.

WE'VE HAD SOME OF THOSE PATIENTS WHO HAVE BEEN THERE FOR A LONG TIME. ONCE YOU REACH A CERTAIN AGE FROM A CLINICAL PERSPECTIVE, IT IS LIKE THIS IS NOT REALLY THE SETTING YOU NEED TO BE IN. BUT THERE

IS NUMBER APPROPRIATE STEP DOWN BECAUSE EITHER THE NURSING HOME FACILITIES AND OTHER MEMORY CARE FACILITIES ARE FEARFUL OF BEING ABLE TO TAKE ON THOSE TYPES OF PATIENTS WITH THAT TYPE OF COMPLEX

MEDICAL NEED. WE HAVE A WHOLE UNIT THAT IS LIKE YEAH, WE DO MEMORY CARE HERE. OK. THAT IS INTERESTING. OK. I DON'T HAVE ANY FURTHER QUESTIONS FOR THIS PANEL. IF WE DON'T HAVE YOUR WRITTEN TESTIMONY,

CAN YOU PLEASE PROVIDE IT? I KNOW YOU HAD MORE THERE. MR. PATTERSON, THANK YOU FOR BEING HERE. TALKING ABOUT THE PCA -- THESE ARE ALL TOPICS AND THINGS WE TALKED ABOUT BEFORE. NOW IT IS A QUESTION OF

HOW WE PUT ALL THESE PIECES TOGETHER. THANK YOU SO MUCH. WE WILL GO TO OUR NEXT PANEL WHICH IS ALSO A HYBRID PANEL. LAURA LINE GREGORY. CATHERINE BUHL. OK. TIMOTHY MCNEIL. BENJAMIN ADERUI. AND

VERONICA SHARP. IT SAYS VIRTUAL BUT SHE IS HERE. OK. MS. GREGORY, WHEN YOU ARE READY. GOOD AFTERNOON AND THANK YOU FOR THE OPPORTUNITY, COUNCILPERSON HENDERSON AND YOUR COUNCIL. I JUST WANT TO HAVE --

TAKE A COUPLE OF MINUTES TO SHARE WITH YOU EXPERIENCE FROM BOTH PLACES. WHEN I SAY BOTH PLACES, MY MOM IS A PARTICIPANT IN THE SERVICE MY WAY PROGRAM. I AM HER GUARDIAN. I ALSO HAVE A SISTER FACILITY.

I AM GOING TO FOCUS MY THREE MINUTES, AT LEAST TWO AND A HALF ON THE SERVICE MY WAY PROGRAM AND -- HAVE THE DOCUMENT UPLOADED WITH THE FULL TESTIMONY. WHAT I AM HERE TODAY TO DO IS TO JUST BRING SOME

INSIGHT INTO SERVICE MY WAY. WONDERFUL PROGRAM. I THINK IT COULD BE A FLAGSHIP PROGRAM FOR D.C. IN THAT IT GIVES AN OPPORTUNITY FOR FAMILIES TO CARE FOR THEIR LOVED ONES IN THE HOME. AND PROVIDING

RESOURCES FROM DIFFERENT AREAS, BOTH FROM A HEALTH CARE PROVIDER AS WELL AS FAMILY OR FRIENDS WHO KNOW THE PARTICIPANT VERY WELL. HOWEVER, I SEE OPPORTUNITIES FOR THE PROGRAM TO BE -- REACH APEX

LEVEL. WE ARE REMINDED IT IS A SELF-DIRECTED PROGRAM, MEANING WE HAVE OPPORTUNITIES TO MAKE DECISIONS BASED ON THE SPECIFIC NEEDS OF THE PARTICIPANT WE ARE CARING FOR. ADND THAT IS VERY ATTRACTIVE FOR

THIS PROGRAM. AND TO THE GENERAL PUBLIC -- I HEARD SOMEONE COMMENT ABOUT IT EARLIER IN THEIR TESTIMONY. AND WOULD SUPPORT THE COMMENTS THEY MADE. BUT IITH THINK WHAT IS MISSING S RECOGNIZING WHILE IT

IS SELF-DIRECTED, IT IS A PARTNERSHIP. WITHOUT THE AGENCY, THE COMPANY THAT IS WORKING ON BEHALF OF D.C. WITHOUT THAT PARTNERSHIP, IT REALLY MARGINALIZED THE SERVICES THAT CLIENTS GET. THERE HAVE BEEN

SPECIFIC ISSUES AROUND COMMUNICATION AND CONVEYING POLICIES AND PROCEDURES IN A TIMELY AND ACCURATE MANNER. YOU DON'T LEARN ABOUT THEM UNTIL YOU HAVE STEPPED ON THE LANDLINE AND YOU GET YOUR WRISTS

SLAPPED. THE COMMUNICATION IS ALSO LACKING AN OPPORTUNITY FOR THE CLIENTS OR REPRESENTATIVES TO GIVE FEEDBACK, INPUT TO WHAT THE EXPERIENCES ARE AS AN OPPORTUNITY TO TRY TO IMPROVE ON WHAT WE ARE

DOING. THE STAKEHOLDER RELATIONSHIP IS PRETTY LOW AND NOT USED TO THE GREATEST EXTENT. I HAVE BEEN A PART OF OTHER STAKEHOLDER GROUPS WHERE WE HAVE DONE SOME OUTSTANDING WORK. UNFORTUNATELY, DOES NOT

EXIST IN THE SERVICE MY WAY PROGRAM. IN PARTICULAR, UNDERSTANDING THE POLICIES AND THE PROCEDURES THAT WE LIVE UNDER REQUIRES THE SUPPORT PROGRAMS THAT ARE KEY TO THIS PROCESS. THEIR ROLE AND

RESPONSIBILITIES. SADLY, I HAVE BEEN IN THE PROGRAM SINCE 2000. WE STARTED UNDER CONSUMER DIRECT AND SADLY, WE HAVE -- THAT ROLE HAS NOT BEEN PRESENT EVIDENT. IT CLEARLY LOOKS LIKE WE ARE GROSSLY

UNDER RESOURCED AND THAT IS LEADING TO ISSUES AND PROBLEMS THAT THEN GET IN BETWEEN THE PARTNERSHIP RELATIONSHIP. THE OTHER THING TO THIS -- JUST ONE EXAMPLE. THE LAST TWO HIRES THAT I'VE DONE IT

LITERALLY TOOK SIX MONTHS FROM THE TIME I PROVIDED THE INFORMATION ON A NEW HIRE. EXPERIENCING THESE KINDS OF DELAYS AND THE ABSENCE OF YOUR BROKER AND CONSTANT ISSUES WITH PAYROLL AND TIME -- IT

REALLY DOES MARGINALIZE. I AM HERE TODAY TO SHARE AND HOPEFULLY PUT THAT ON YOUR RADAR SCREEN AS SOMETHING THAT WE CAN LOOK AT AND SEE HOW TO TAKE IT TO THE NEXT LEVEL. AND BRING IN -- YES? MY THREE

MINUTES ARE UP. CHAIR HENDERSON: IT IS. YOU ARE ALSO GOING IN AND OUT. I HAVE SOME FOLLOW-UP QUESTIONS FOR YOU. WE WILL GO TO THE NEXT PERSON. >> GOOD MORNING. THANK YOU CHAIRPERSON HENDERSON AND

MEMBERS OF THE COMMITTEE FOR COMING. THIS IS MY FIRST TIME TESTIFYING AS A PRIVATE CITIZEN. I AM THE MANAGING PRINCIPAL OF A COMMUNITY DEVELOPMENT FIRM CALLED WELLNESS REAL ESTATE INNOVATIONS. I'M A

LEADER IN THE HOUSING FIELD. I PREVIOUSLY RAN THE SAINT ELIZABETH'S REDEVELOPMENT. I ALSO CREATED AND LAUNCHED THE AMAZON HOUSING EQUITY FUND IN 2021 WHICH HAS INVESTED OVER $1 BILLION IN THE REGION.

I AM ALSO THE DAUGHTER OF A MOTHER WHO HAS DEMENTIA. SHE HAS BEEN LIVING WITH DEMENTIA OVER 15 YEARS. MY FAMILY SPENDS OVER $120,000 A YEAR ON HOUSING AND HER CARE. EVEN WITH DECADES OF HOUSING

EXPERIENCE, I WAS NOT PREPARED FOR THE COST. THE LIMITED CHOICES IN THE DAILY REALITIES OF THE DISEASE. THIS CHALLENGE IS GROWING. BY 2030, 1 IN FIVE AMERICANS WILL BE OVER THE AGE OF 65. THE SENIOR

POPULATION IS ALSO GROWING AND EXPANDED 10% OVER THE LAST DECADE. BRING INCREASINGLY COMPLEX HEALTH NEEDS. AN ESTIMATED 15,100 RESIDENTS OVER THE AGE OF 65 ARE LIVING WITH ALZHEIMER'S AND DEMENTIA AND

D.C., REPRESENTING 16.8% OF OUR OLDER ADULT POPULATION. THIS MEANS ONE IN EVERY 5.5 SENIORS IN OUR CITY HAS SOME FORM OF DEMENTIA OR MEMORY LOSS. BEHIND EACH OF THE NUMBERS IS A FAMILY MAKING HARD

DECISIONS ABOUT CARE, HOUSING, WORK AND MONEY. MORE THAN 50,000 CAREGIVERS, MANY OF THEM ARE MEMBERS OF THE SANDWICH GENERATION TO OUR STRETCH BETWEEN CARING FOR CHILDREN AND AGING LOVED ONES. FOR

THOUSANDS OF DISTRICT RESIDENTS, WHILE SOME PEOPLE CALL IT THE GOLDEN WAY, THEY ARE LIVING IN A SILVER TSUNAMI. THIS IS WHY MY FIRM HELPED TO CREATE AN ART EXHIBIT CALLED DEMENTIA STORIES D.C. AND WE

WORK WITH A PROJECT WITH A CULTURAL STORYTELLER. WE PUT VOICES ALONGSIDE THE STATISTICS. WHEN ONE OF THE STORIES TO COME OUT TO MAKE THE POINT THAT WHILE DEMENTIA ENTERS ONE HOUSEHOLD AT A TIME, IT IS

A OUI PROBLEM. WE WANTED TO PUT A FACE TO THE NAMES INCLUDING PEOPLE LIKE DAN REEDER, WHO SISTER IS 59 AND LIVES WITH DEMENTIA. FROM ATTORNEY TO MOTHERS TO COUNSELORS TO TEACHERS, WE ARE ALL IMPACTED.

BUT, D.C. HAS A TIMELY OPPORTUNITY TO CONNECT THE URGENT NEEDS OF RAGING RESIDENTS WITH PUBLICLY OWNED LAND FOR REDEVELOPMENT, HEALTH CARE INVESTMENTS, AND PLANNING TOOL SUCH AS THE D.C. COMPREHENSIVE

PLAN. WE CANNOT KEEP ADDRESSING HOUSING OVER HERE AND HEALTH CARE OVER THERE. AND WE NOW HAVE AN OPPORTUNITY TO INVEST IN PLACES THAT MEET BOTH OF THESE NEEDS SO THAT WE CAN SAVE LATER DOLLARS, CRISIS

AND HUMAN HARDSHIP. THERE ARE PLACES LIKE FLETCHER JOHNSON AND WARD 7 -- IN WARD 7 WHERE WE DISCUSSED HOLDING D.C.'S FIRST DEMENTIA VILLAGE. IT WOULD BE HOUSING, A DAY CENTER, SAFE OUTDOOR SPACE,

ALLOWING RESIDENTS TO LIVE WITH DIGNITY, FAMILIARITY AND CONNECTION. AN EMERGENCY RISK -- EMERGENCY ROOM RESPONSE TO A CRISIS WHEN IT HAPPENS BUT IT DEMENTIA VILLAGE IS INTENDED TO AVOID THOSE CRISES

ALTOGETHER. IN 2025, WE LAUNCHED MY FIRM -- MY FIRM HELPED LAUNCH AN INITIATIVE CALLED THE WE ALL WELL COMMUNITIES INITIATIVE. WE ARE PROUD TO PARTNER WITH GW, THE CENTER FOR NONPROFIT ADVANCEMENT,

THE COALITION AMONGST OTHER PARTNERS. WE ARE ADVANCING MODELS THAT ADVANCE HOUSING, CAREGIVING, PORTABILITY, SOCIAL CONNECTION AND RESOURCE AND DATA. WE HAVE LAUNCHED THE INITIATIVE, AGING WELL, WHICH

FEATURES CREATORS. WE BROUGHT THEM OUT FROM THE NETHERLANDS. WE HAVE INSPIRED WASHINGTON POST ARTICLE WHY DEMENTIA VILLAGE AND NETHERLANDS IS INSPIRING HOPE IN D.C. I RECOGNIZE I'M GETTING OVER MY

TIME SO I WILL GET TO THE I RECOGNIZE I AM OVER MY TIME SO I WILL GET TO THE POINT. . I AM HERE TO EXPLORE DIFFERENT OUTCOMES. THE COMPREHENSIVE PLAN IS A REAL OPPORTUNITY THROUGH THINGS LIKE HEALTH

INVESTMENT ZONES AND OTHER THINGS. CREATING MEMORY CARE HOUSING REGULATIONS, WHICH CRAZY ENOUGH D.C. DOES NOT HAVE. WHILE WE CALL THE SEE THE DEMENTIA CAPITAL, WE DO NOT HAVE MEMORY CARE REGULATIONS.

BRINGING ENSURE INVESTMENTS INTO -- INSURER INVESTMENTS INTO HOUSING. THERE ARE HEALTH INSURERS CAN SHIPPING MAJOR DOLLARS. UNITED CONTRIBUTE OVER $1.2 BILLION TO AFFORDABLE HOUSING. WE CAN HARNESS

THOSE INVESTMENTS IN D.C. AND SUPPORT DEMONSTRATOR PROJECTS IN D.C. BEING TALKED ABOUT -- DEMONSTRATED PROJECTS IN D.C. BEING TALKED ABOUT. A DEVELOPMENT PERSON CAN MAKE A HUGE DIFFERENCE WHEN PAIRED

WITH DATA. THANK YOU FOR LETTING ME TESTIFY. HEALTH THANK YOU -- CHAIR HENDERSON: THANK YOU. I DON'T SEE TIMOTHY BUT I DO SEE BENJAMIN. GOOD AFTERNOON, CHAIRWOMAN HENDERSON. MY NAME IS BENJAMIN

ADDURU, I AM VICE PRESIDENT OF COMPLIANCE AND STRATEGY OF HELP CONSTANT -- HEALTH CONSULTING SERVICES. IT WAS CREATED IN 2018 FOR A VERY GOOD REASON. D.C. RESIDENTS WITH SERIOUS NEEDS CLOSE TO THE

FAMILY. THE CRITERIA AS WRITTEN WERE AGAINST THAT PURPOSE. WE OFFER SUGGESTED CHANGES TO IMPROVE OUTCOMES FOR PATIENTS. A RESIDENT QUALIFIES ONLY IF THEY SHOW TWO OR MORE CATEGORIES OF BEHAVIOR EVERY

WEEK WITH AT LEAST ONE HAPPENING FOUR OR MORE DAYS A WEEK. WE MUST DOCUMENT DISRUPTIVE BEHAVIOR WITHIN THE LAST 30 DAYS AND AUTHORIZATION ENDS AFTER 90 DAYS AND MUST BE EARNED AGAIN WITH NEW

BEHAVIORS. WHEN WE ADMIT A RESIDENT WITH AGGRESSION OR SELF INJURY, WE ADD STAFF, WE TRAIN THEM. WE ADJUST THE ENVIRONMENT AND BUILD AN INDIVIDUALIZED PLAN. IF THAT PLAN WORKS AND THE BEHAVIOR DROPS

TO THREE DAYS A WEEK, THE RESIDENT NO LONGER QUALIFIES FOR THE BEHAVIOR OUT ADD ON. THE STAFF AND SUPERVISION STAY BUT THE PAYMENTS STOP. THE PROGRAM WITHDRAWS SUPPORT THE MOMENT CARE SUCCEEDS. THAT

IS NOT SUSTAINABLE FOR ANY FACILITY AND DOES NOT ALIGN WITH INDUSTRY. D.C. MEASURES THEM ON REDUCING ANTIPSYCHOTIC USE. ALL OF THAT IS DESIGNED TO PREVENT BEHAVIOR. THE ADD-ON ONLY PAYS WHEN THE

BEHAVIORS HAPPEN. WE ARE REGULATED BY ONE AND PAID BY THE OTHER. EVERY AUTHORIZATION REQUIRES RECORDS, PROGRESS NOTES, REPORTS, AND RECORDS FROM ANY PRIOR FACILITY. EVERY 90 DAYS, WE MUST PROVE THE

RESIDENT IS STILL IN CRISIS AND HAS THE BEHAVIOR. THE STAFF TIME GOES TO BUILDING A CASE FOR DISRUPTION INSTEAD OF PREVENTING IT. THE CONSEQUENCES FALL ON THE RESIDENTS. WHEN SUPPORT IS NOT RELIABLE,

FACILITIES ARE MORE HESITANT TO TAKE PEOPLE WITH SIGNIFICANT NEEDS. SOME OF THOSE END UP IN FACILITIES OUTSIDE THE DISTRICT AWAY FROM FAMILIES AND COMMUNITY. THIS PROGRAM SHOULD BE MEASURED BY HOW

MANY OF THESE PRESIDENT'' DAY NBC AND STABILIZE. TODAY, IT IS -- WE ASK THE COUNCIL TO CONSIDER CHANGES SO THE PROGRAM PAYS FOR THE WORK OF MANAGING BEHAVIOR AND NOT THE BEHAVIOR ITSELF. CHAIR

HENDERSON: THANK YOU. VERONICA? TURN YOUR MICROPHONE ON. >> GOOD AFTERNOON. MY NAME IS VERONICA SHARP. WE REPRESENT ALL OF THE LICENSED NURSING FACILITIES AND SEVERAL ASSISTED-LIVING COMMUNITIES IN

THE DISTRICT. MENTAL HEALTH END NURSING HOMES IS CRITICAL AND YET OFTEN OVERLOOKED ASPECT OF THE CARE PROVIDED. THE HIGH PREVALENCE COMBINED WITH UNDER DIAGNOSIS AND INSUFFICIENT TREATMENT UNDERSCORES

THE NEED FOR A COMPREHENSIVE PERSON-CENTERED APPROACH THAT INTEGRATES PSYCHOSOCIAL SUPPORT AND PROFESSIONAL MENTAL HEALTH SERVICES. D.C. HAS HAD POPULATION CHANGES OVER THE LAST 30 YEARS. THE

POPULATION NOW INCLUDES MORE RESIDENTS WITH COGNITIVE IMPAIRMENT, MENTAL HEALTH CONDITIONS, AND YOUNGER INDIVIDUALS WITH SERIOUS MENTAL ILLNESS AND SUBSTANCE USE DISORDERS. SKILLED NURSING FACILITIES

AND ASSISTED-LIVING PROVIDERS ARE C1 ARE VERY GOOD REASONS. ACCORDING TO A 2024 MEDICAL RESEARCH ARCHIVE SERIES, OVER 25% OF THE FACILITIES PROVIDING THAT TYPE OF CARE WERE CITED IN THE FIRST HALF OF

24 FOR DEFICIENCIES IN PROTECTING RESIDENTS FROM ABUSE OR NEGLECT. THE AUTHORS OF THE RESEARCH HIGHLIGHT A GROWING NUMBER OF RESIDENTS WITH SERIOUS MENTAL HEALTH ILLNESSES AND OR ABUSE DISORDERS,

LEADING TO BEHAVIORS SUCH AS WITHDRAWAL, SELF-HARM, ATTEMPTS, AGGRESSION AND SEXUALIZING APPROACHES TO OTHERS. DIRECT CARE WORKFORCE THAT ARE CURRENTLY EMPLOYED EMPLOYED. THEY LACK THE TRAINING TO

RESPOND EFFECTIVELY TO THESE BEHAVIORS. THE SOLUTION IS NOT AS SIMPLE AS JUST ADDITIONAL STAFF TRAINING. THE DISTRICT NEEDS AN INTEGRATED BEHAVIORAL HEALTH SYSTEM WITH STEPPED LEVELS OF CARE. THE

FIRST STEP TO REMOVE A BARRIER FOR SKILLED NURSING FACILITIES THAT WANT TO CARE FOR THIS TYPE OF RESIDENT IS TO REDRAFT THE LANGUAGE OF THE PRIOR AUTHORIZATION NEEDED TO RECEIVE PAYMENT. THE LANGUAGE

IS OVERLY PRESCRIPTIVE AND ONLY SERVES TO KEEP MANY RESIDENTS THAT NEED THIS LEVEL OF CARE FROM RECEIVING IT. THE. AGAIN, THE PRIOR AUTHORIZATION IS ONLY FOR 90 DAYS. AFTER 90 DAYS, THE PROVIDER NEEDS

TO APPLY AGAIN. IF THE PROGRAM THAT HAS BEEN PUT INTO PLACE TO CARE FOR THE RESIDENTS IS WORKING, THEN YOU WON'T HAVE THE. THE DOCUMENTATION OF THE DISRUPTIVE BEHAVIORS. IT WOULD MAKE MORE SENSE TO

PROVIDE DOCUMENTATION OF THE CARE BEING RECEIVED OR OUTCOMES SUCH AS DOCTOR KOVACS TESTIFIED ABOUT. NURSING FACILITIES ARE NOT THE ONLY PROVIDERS WHERE RESIDENTS WITH THESE HEALTH CONCERNS EXIST. WE

HAVE SEVERAL NEW DEVELOPMENT, DEVELOPMENT LED ASSISTED LIVING FACILITIES. THERE'S NO ADDITIONAL ADD ON FOR THEIR FOR THEIR BEING ABLE TO CARE FOR CARE FOR COMPLEX PAGES. AND WE WOULD EXPECT THAT THIS

THAT WE WOULD BE ABLE TO ADD ADD ONS FOR THEM AS WELL. ADDITIONAL FUNDING IS NEEDED TO PROVIDE THE LEVEL OF CARE NEEDED. THE CURRENT RATE FOR THE ADD ON IS $82 A DAY. IF A RESIDENT REQUIRES 24 HOUR,

ONE ON ONE CARE BY THE LOWEST LEVEL EMPLOYEE, A CNA WITH A. WITH THE CURRENT DC MINIMUM WAGE COSTS $441.60. THAT'S ON AN $82 A DAY PREMIUM. I APPLAUD THE DC FOR THE CONSIDERATION OF BEHAVIORAL COMPLEX

NEEDS. SINCE 2018, BUT ANALYSIS OF THIS LEVEL OF CARE TRULY WAS NEVER DONE, AND NOW WOULD BE A GREAT TIME TO DO IT. HOWEVER, THAT SHOULD NOT DELAY THE REDRAFTING OF THE PRIOR AUTHORIZATION LANGUAGE.

WE STAND READY TO HELP. DHCF WORK ON GETTING THAT CHANGE IMMEDIATELY. THANK YOU FOR THE OPPORTUNITY TO TESTIFY. THANK YOU. THANK YOU FOR THIS PANEL OF WITNESSES, AND I THINK SOME OF YOU BROUGHT UP

SOME. OF THE SAME SITUATIONS HERE. BENJAMIN, I THINK YOUR TESTIMONY AROUND THE BEHAVIORAL HEALTH ADD ON IS, IS, IS GOOD IN THEORY. HOWEVER. IN SOME WAYS IT'S DESIGNED, IT FEELS LIKE IT'S PENALIZING A

FACILITY WHEN THEY START TO DO WELL IN TERMS OF MANAGING A PATIENT THAT HAS COMPLEX NEEDS. BECAUSE IF THE BEHAVIORS ARE STILL IF THE BEHAVIORS. BECOME IF THE BEHAVIORS BECOME MORE LIMITED, YOU LOSE

THE ADDITIONAL FUNDING. IT IS THE CARE THAT HELPED LIMIT THE BEHAVIORS IN SOME WAYS, RIGHT? AM I UNDERSTANDING THAT CORRECTLY? >> THAT IS VERY ACCURATE, CHAIR HENDERSON. IT IS DESIGNED FOR US TO GET

FUNDED IF RESIDENTS CONTINUE TO HAVE BEHAVED -- WITHIN THE WEEK, THAT IS THE ONLY WEEK WE WILL GET FUNDING SAY IF THEY WERE VIOLENT OR SCREAMING, AND WE HAD TO DOCUMENT EVERY SINGLE WEEK THEY DID HAVE

THOSE TO BE PAID. CHAIR LEWIS GEORGE: -- CHAIR HENDERSON: I FEEL LIKE $82 A DAY SEEMS LOW. HE SAID WE DID IT -- YOU SAID WE DID IT, VERONICA. IT IS NOT ADEQUATE. CHAIR HENDERSON: OK. WHEN IS THE LAST

TIME -- >> 2018. CHAIR HENDERSON: OK. IT HAS NOT BEEN CHANGED SINCE THEN? >> NO, IT HAS NOT. CHAIR HENDERSON: OK. CAN I ASK THE QUESTION? THE 90-DAY EVALUATION IS THERE AND EXISTS. SHOULD IT BE

LONGER? I CAN UNDERSTAND MAYBE THE ARGUMENT THAT WE DO NOT NECESSARILY WANT TO DO THE ADD-ON IF SOMEONE DOES NOT NEED IT. HOWEVER, FROM A STAFFING PERSPECTIVE, I IMAGINE IT IS VERY UNSTABLE IN TERMS

OF YOU BRING SOMEBODY AN EXTRA TO HELP PROVIDE THE ADDITIONAL 24 HOUR LEVEL OF CARE AND AFTER 90 DAYS THAT PERSON IS GONE, OR NOT. WHAT IS A BETTER WAY TO DO IT OTHER THAN EVERY 90 DAYS? >> I THINK

EXTENDING THE 90 DAYS BUT ALSO REDRAFTING THE LANGUAGE. IT IS SO PRESCRIPTIVE. YOU ARE DOCUMENTING BAD BEHAVIORS. IF YOUR PROGRAM IS WORKING, YOU ARE NOT GOING TO HAVE THOSE BAD BEHAVIORS ARE

FREQUENTLY AS BEFORE. YOU WOULD BE BETTER OFF HAVING TO PROVIDE DOCUMENTATION OF THE CARE BEING PROVIDED DURING THAT PERIOD OR LOOKING AT OUTCOMES LIKE HOSPITALIZATIONS OR SELF INJURY. I THINK THERE

ARE BETTER WAYS TO DO IT. CHAIR HENDERSON: OK. DO YOU HAVE A THOUGHT ON THIS BEFORE WE MOVE ON? QUICK SAME THING. THE DIAGNOSIS DOES NOT GO AWAY. THE DIAGNOSES ARE USUALLY ASSOCIATED WITH THE

BEHAVIOR. IT WOULD BE GREAT IF BASED ON THE CARE, OUTCOMES SHOULD BE REWARDED RATHER THAN JUST DEMONSTRATING A BEHAVIOR WHERE THEY LOOK AT EVERYTHING WILL DOCUMENTATION WEEK BY WEEK TO SEE IF WE

QUALIFY FOR THE PAYMENT OR NOT. CHAIR HENDERSON: EVEN FROM AN ADMINISTRATIVE STANDPOINT. IT FEELS VERY NICKEL AND DIME-ING. CHAIR HENDERSON: VERY NICKELING AND DIME-ING. IF YOU HAD TO NAME ONE

IMPROVEMENT, WHAT WOULD HELP, AS SOMEONE WHO IS ACTIVE IN THAT PROCESS RIGHT NOW? SORRY, I PUT YOU ON THE SPOT. >> THAT IS OK. COMMUNICATIONS WOULD BE MY FIRST -- WOULD BE MY PRIORITY. WHEN I SAY

COMMUNICATIONS, IT HAS TO BE A RELATIONSHIP WHERE THE SUPPORT BROKER AND THE PARTICIPANT OR PARTICIPANT'S REPRESENTATIVE ARE FITTING LIKE A GLOVE BECAUSE, IF NOT, MY EXPERIENCE HAS BEEN THE PCA OR O

PCW'S ARE IMPACTED. I HAVE BEEN THROUGH A FAIR HEARING TO GET PAPER ONE PERSON. IT TOOK TWO YEARS AND I AM DEALING WITH THAT AGAIN. MOSTLY BECAUSE OF THE LACK OF THE PRESENCE OF A BROKER. I HAVE BEEN

WITHOUT A BROKER FOR SIX MONTHS AND THINGS SLID OFF THE RADAR SCREEN THAT SHOULD HAVE BEEN AVOIDED AND COULD HAVE BEEN AVOIDED HAD WE BEEN CONNECTED. FOR ME, THE COMMUNICATIONS. THAT INCLUDES MORE

FACE-TO-FACE MEETINGS, STAKEHOLDER MEETINGS. I THINK THIS YEAR, WE PROBABLY HAD ONE. THERE IS A HUGE, FOR ME, THERE IS A GAP THERE AS IT RELATES TO COMMUNICATIONS THAT I THINK WOULD SIGNIFICANTLY

IMPROVE THE FLOW OF THINGS FOR US AS WELL AS FOR THEM. BECAUSE WHEN WE ARE IN PAIN, THEY WILL BE IN PAIN BECAUSE WE HAVE NOWHERE ELSE TO GO. WE ARE TIED TOGETHER. I THINK THERE ARE A NUMBER OF THINGS

THAT COME THAT WOULD FALL UNDER THE COMMUNICATIONS PIECE. HAVING A SUPPORT BROKER WHO IS AVAILABLE, WHO IS KNOWLEDGEABLE, AND CAN SUPPORT, THEN WE SHOULD BE ABLE TO STAND STRONG ON OUR PART, OUR ROLE

AS SELF-DIRECTED. CHAIR HENDERSON: OK, THANK YOU. THAT MAKES SENSE. COMMUNICATIONS IS THE KEY OF ALL. MS. BUELL, WHAT STRUCK ME ABOUT YOUR TESTIMONY, I HAVE ALL THIS BACKGROUND IN HOUSING AND THEN

WHEN I HAD TO DEAL WITH THIS ISSUE I WAS UNPREPARED. WHAT WOULD YOU SAY IS THE BIGGEST THING THAT SURPRISED YOU OR THAT YOU WISH YOU HAD KNOWN? I DON'T EVEN KNOW IF YOU KNEW TO KNOW THAT PRIOR TO. >>

TWO DIFFERENT THINGS. I SIT ON THE D.C. BRAIN HEALTH ADVISORY COALITION FOR D.C. HEALTH AND PEOPLE ARE NOT AWARE OF IT. IT WAS HARD TO GET PEOPLE OUT, DESPITE HOW MANY WASHINGTONIANS HAVE THE DISEASE.

MICHELLE OBAMA CALLED IT OLD-TIMERS. THEY THINK IT IS A MATTER OF COURSE, PARTICULARLY FOR THE AFRICAN AMERICAN COMMUNITY. WE ARE LESS LIKELY TO GET DIAGNOSED COME GET REHABILITATIVE DRUGS, GET

REHABILITATION, SO AWARENESS IS A REALLY BIG ISSUE. WE TEND TO SUFFER IN SILENCE AND BE MORE IMPACTED. AND THEN, THE COST. BECAUSE MEDICAID IN THE DISTRICT WILL COVER ASSISTED LIVING. THEY WILL ALSO

PROVIDE AT-HOME SERVICES. BUT IF YOU ARE ON MEDICARE, YOU DON'T GET ANY SUPPORT. EVEN THEN, THOSE FACILITIES ARE INADEQUATE TO TAKE ON THOSE WITH MEMORY CARE ISSUES. HAVING TO PAY $10,000, $12,000 A

MONTH FOR HOUSING AND CARE, PLUS CARETAKING, IT IS NOT PART OF THE CONVERSATION. AS SOMEBODY WHO HAVE BEEN IN THE HOUSE IN ROME FOR OVER 20 YEARS, WE DON'T TALK ABOUT IT. WE TALK ABOUT WORKFORCE

HOUSING, WE DON'T TALK ABOUT THE FACT THAT THE AGING POPULATION IS FILLING UP OUR HOMELESS SHELTERS BECAUSE THEY ARE ON A FIXED INCOME. THERE NEEDS TO BE A MORE STRATEGIC WAY WE TALK ABOUT IT. NOT

JUST WITH THE DEPARTMENT OF HEALTH BUT ALSO AT THE DEPUTY MAYOR'S OFFICE ON THE ECONOMIC AND PLANNING DEVELOPMENT SIDE BECAUSE THERE'S A LOT OF OPPORTUNITY TO MAKE SURE THERE IS REAL SYNERGY SO WE

CAN, AS WE ARE TALKING ABOUT HOUSING AFFORDABILITY, ALSO LOWER THE COST FOR THOSE WHO NEED CARE. CHAIR HENDERSON: IT IS CARE WITH SUPPORT. I ALSO NOTED IN YOUR TESTIMONY YOU TALK ABOUT HOW WE DON'T

HAVE ANY MEMORY CARE REGS, IT CAME UP YESTERDAY, BECAUSE I FEEL LIKE WE ALSO HAVE TO RELOOK AT ASSISTED LIVING DELETIONS AS WELL. THERE -- ASSISTED-LIVING REGULATIONS AS WELL. THERE ARE PEOPLE WE HAVE

IN ASSISTED-LIVING FACILITIES WHO PROBABLY SHOULD NOT BE IN AND ASSISTED LIVING FACILITY BECAUSE IT SHOULD BE FOR MEMORY CARE. BUT RIGHT NOW, THAT IS THE ONLY OPTION. CORRECT. THEY ARE NOT REQUIRED TO

HAVE 24 HOUR NURSING STAFF. THINGS CAN AND HAVE GONE WRONG BECAUSE OF THAT. BUT AS YOU SAID FROM A PAYMENT STANDPOINT, MEDICAID WILL PAY FOR AN ASSISTED LIVING FACILITY BUT IT IS COMPLICATED. CHAIR

HENDERSON: THERE IS AN OPPORTUNITY TO DO A DEMONSTRATION PROJECT. WE NEED TO START SOMEWHERE. WASHINGTON STATE DOES HAVE REGULATIONS THEY PASSED AND THEY DO REQUIRE ASSISTED LIVING FACILITIES TO GET

CERTIFIED IF THEY ARE GOING TO MARKET THE FACT THEY ARE DOING MEMORY CARE. WE HAVE MODELS WE CAN LOOK AT INCLUDING 24-7 STAFFING, INCLUDING OUTDOOR AREAS THAT ARE WANDERER-FRIENDLY. THERE ARE SOME

BEST PRACTICES WE CAN START TO EMULATE. THERE IS AN OPPORTUNITY TO CREATE MODELS HERE AND TEST HOW THEY WORK SO WE HAVE THE DATA TO SHOW THIS IS A GOOD USE OF THE MEDICAID DOLLARS OR SOME SORT OF

PUBLIC LAND AND PUBLIC SUBSIDY. >> WE HAVE ASSISTED-LIVING PROVIDERS WORKING WITH THESE RESIDENTS BUT THERE IS NO ADDITIONAL PAYMENT TO THEM FOR TAKING CARE OF THOSE RESIDENTS. THEY ARE GETTING THE

$225 A DAY OR WHATEVER AND NOTHING ADDITIONAL. THEY NEED TO BE THOUGHT OF THE SAME WAY AS THE NURSING HOMES. THERE NEEDS TO BE ADDITIONAL FUNDING. CHAIR HENDERSON: I WOULD DEFINITELY SAY THAT IF WE

ARE GOING TO ASK FOR MORE, THEN WE HAVE TO PROVIDE THE RESOURCES TO ALSO DO MORE. BUT NOT FROM A BURDEN STANDPOINT BUT BECAUSE THIS IS WHAT RESIDENTS NEED. RIGHT NOW, SOME FOLKS ARE NOT GETTING SERVED

FOR THEIR CONDITION MIGHT BE WORSENING BECAUSE THEY ARE NOT GETTING THE SUPPORT THEY NEED. CORRECT. I WOULD LIKE TO ADD THERE IS NOTHING PREVENTING DHCF FROM REWRITING THE AUTHORIZATION. THEY CAN

REWRITE ESTATE PLAN. THAT WILL HELP THOSE ALREADY DOING IT ABLE TO ACCESS THAT AD-ON MORE EASILY. CHAIR HENDERSON: YES, THEY CAN REWRITE THE STATE PLAN. IN OUR CURRENT TUSSLE WITH THIS ADMINISTRATION,

IF THE COUNCIL WERE TO PASS LEGISLATION SAYING WE NEED TO UPDATE THE STATE PLAN, THEY WOULD SAY WE ARE NOT GOING TO DO BECAUSE YOU SAID WE HAVE TO, EVEN IF THEY AGREE WITH IT. WORDS MATTER. I THINK OF

IT FROM A PERSPECTIVE OF, DO WE WANT TO DO THIS RIGHT? WE CAN REWRITE ESTATE PLAN AMENDMENT AND SEND IT TO CMS AND HOPE CMS IS STILL CMS. LATELY THEY ARE A SELL OF THEMSELVES. I THINK OVERALL, IT

WOULD BE GREAT TO SEE ON THE NATIONAL LEVEL FOLKS WANT TO TAKE ON THIS LEVEL FROM A CARE PERSPECTIVE, ESPECIALLY WHEN WE SEE A LOT OF PEOPLE TALK ABOUT MEDICARE FOR ALL, MEDICAID FOR ALL. I TELL

PEOPLE, DO YOU REALLY KNOW? MEDICAID IS NOT EVEN COVER HEARING AIDS. WE REALLY WANT THAT FOR ALL? [LAUGHTER] A LOT OF PEOPLE DON'T REALIZE THERE ARE LIMITATIONS IN EVERY PROGRAM. BUT THIS IS SUPER

HELPFUL. ALSO, MS. BUELL, THE PIECE THAT YOU TALKED ABOUT CONNECTING HEALTH AND DEVELOPMENT. IT WAS SUPPOSED TO BE A DRAFT RELEASE. NOW IT IS DELAYED UNTIL 2027. THIS IS SOMETHING WE WILL BE THINKING

ABOUT AND TALKING WITH OP ABOUT IN TERMS OF HOW WE GO FORWARD. THE FLETCHER JOHNSON PROJECT, I THINK THERE WAS ALREADY SUPPOSED TO BE SENIOR HOUSING THERE. I FEEL LIKE WE HAVE BEEN TALKING ABOUT THIS

PROJECT FOR YEARS, DECADES. [LAUGHTER] AND THIS IS SORT OF WHERE THE TENSIONS ARISE. THERE ARE COMMUNITIES THAT SAY WE WANT FULL MARKET RATE BUT YES WE ALSO HAVE THIS NEED AROUND SENIOR LIVING IN A

DIFFERENT WAY , AND WE KIND OF HAVE TO MARRY THE TWO TO FIGURE IT OUT. I THINK THERE IS MORE THAN ENOUGH LAND AT FLETCHER JOHNSON TO FIGURE OUT BOTH SIDES. YOUR SUGGESTION IS A VERY GOOD ONE. >> THEY

ARE SUPPORTIVE AND OPEN TO SUGGESTIONS WHICH IS REALLY GOOD. WE HAVE FOLKS IN THE OFFICE OF PLANNING THAT WOULD LOVE TO PUT LANGUAGE IN THE PLAN SO IT IS NOT JUST FLETCHER JOHNSON BUT THERE ARE OTHER

SITES LIKE PROVIDENCE HOSPITAL WHERE THESE HEALTH CARE ASSETS ARE INTEGRATED INTO THE REDEVELOPMENT PLANS IN A WAY WE HAVE NOT TRADITIONALLY SEEN. CHAIR HENDERSON: THANK YOU SO MUCH. PLEASE SUBMIT

YOUR WRITTEN TESTIMONY TO THE RECORD. WE WILL GO TO OUR FINAL PANEL OF PUBLIC WITNESSES. JEUDY ASHBURN, WILL DOYLE WHO WILL BE JOINING VIRTUALLY. CATHERINE CROSLAND, ALSO VIRTUAL. MOLLY SMITH FROM

CATHOLIC CHARITIES, AND SANIQUE LYNN FROM COMMUNITY CONNECTIONS. JUDY, WHEN YOU ARE READY. YOU JUST HAVE TO TURN YOUR MIC ON. THERE YOU GO. >> GOOD AFTERNOON, CHRISTINA, MEMBERS OF THE COMMITTEE. I

NAME IS JEUDY ASHBURN. I AM SENIOR VICE PRESIDENT OF BEHAVIORAL HEALTH INTEGRATION AND THERAPEUTIC HOUSING DEVELOPMENT. SAMARITAN HAS BEEN A NONPROFIT AGENCY SERVING SUBSTANCE ABUSE CLIENTS SINCE

1985. WE HAVE 170 BEDS. THERE IS A VERY LARGE AND EGREGIOUS GAP IN THE DISTRICT BETWEEN RESIDENTIAL TREATMENT AND PERMANENT, STABLE HOUSING. THE FIRST PHASE OF WHAT I WOULD CALL RESIDENTIAL TREATMENT,

THE GAP BETWEEN WHEN THEY COMPLETE RESIDENTIAL TREATMENT, WE HAVE BEEN VERY FORTUNATE TO GET GRANTS FROM THE COMMISSION AND DEPARTMENT OF BEHAVIORAL HEALTH TO OPEN A SOBER THERAPEUTIC HOUSING PROGRAM.

THAT HAS BECOME OUR PHASE TWO AND IS LONGER-TERM CARE FOR CLIENTS WITH COMPLEX NEEDS. THAT PREPARES THEM TO MOVE INTO THE PHASE 3 WHICH I'M CALLING THE STABLE, PERMANENT HOUSING. WE HAVE OPERATED THIS

PROGRAM SINCE JANUARYIT HAS BEEN HIGHLY. IN MY 26 YEARS OF LEAVING THE SUD -- LEADING THE SUD CHARGE IN THE CITY, THIS HAS BEEN THE MOST SATISFYING AND MOST REWARDING OUTCOMES I HAVE SEEN IN 26 YEARS.

I PUT SOME OF THAT DATA IN THE TESTIMONY I SUBMITTED. IT IS WAKING UP EACH MORNING WITH ONE CLIENT AT A TIME GETTING THROUGH AND HAVING A STRONG FOUNDATION. THAT SOLUTION HAD BEEN REALLY HELPFUL AND I

AM GRATEFUL TO THE GRANTS. THE CURRENT TRANSITIONAL HOUSING IS VERY CHALLENGING TO GET INTO. IT IS INADEQUATE. IT IS MOSTLY FOR MENTAL HEALTH CLIENTS. THERE ARE LONG WAITLISTS TO GET N WHICH IS WHY WE

CREATED THIS PROGRAM. SINCE THE OPENING OF THAT PROGRAM, WE HAVE BEEN WORKING ON THE SUSTAINABILITY GOAL. IT IS ONE THING TO START SOMETHING GREAT AND GET THE OUTCOMES. BUT AS OF NOVEMBER 30, NEXT

MONTH, WE HAVE 44 RESIDENTS AND WE HAVE TO FIND HOUSING. BY THE END OF THIS MONTH, WE NEED TO HELP THEM FIND WHERE TO GO, WHICH IS PART OF THE PROBLEM IN THE DISTRICT. WE HAVE SUBMITTED GRANTS THIS

SUMMER UNSOLICITED PROPOSALS. WE HAVE NOT HEARD ANY CONFIRMED OR DENIED. WE DO NOT KNOW THE STATUS OF THAT. WE ARE ASKING IN TERMS OF RECOMMENDATIONS THAT WE HEAR FROM DBH, THE ABATEMENT COMMISSION,

WHERE WE STAND, BECAUSE WE ARE TRYING TO BUILD LONG-TERM, WE WANT TO KEEP THIS CONTINUUM OF CARE THAT WE HAVE BUILT. WITH THAT SAID, WE ALSO HAVE DEVELOPED A RELATIONSHIP WITH THE DEPARTMENT OF

CORRECTIONS AND WE CLIENTS FROM THE PROGRAM AT THE JAIL WHICH HAS BEEN HIGHLY SUCCESSFUL. THEY CALLED AGAIN TODAY. I HAD TO SAY THAT I AM NOT ABLE TO ACCEPT CLIENTS BECAUSE I DO NOT WANT TO BE

INCREASING OUR CENSUS WHEN WE DO NOT KNOW WHERE THAT WILL GO. WE HAVE OPENED DOORS TO AGENCIES OUTSIDE OUR OWN BECAUSE WE SEE IT WORKING. IT CONSISTS OF INDIVIDUAL THERAPY. CLIENTS ARE REQUIRED TO

SAVE 30% OF THEIR EMPLOYMENT, REVENUE, GETTING A JOB, THEY ARE REQUIRED TO BE IN SOME KIND OF INDIVIDUAL THERAPY. WITH TRAUMA AS A GATEWAY TO ADDICTION, I BELIEVE TREATING THE UNDERLYING FACTORS IS

ONE THING WE ARE MISSING. THAT IS ANOTHER REASON FOR SUCCESS. I THINK ANOTHER BARRIER IS THE OVERALL BEHAVIORAL HEALTH SYSTEM IS BROKEN. EVEN AS THE CLIENTS ARE REFERRED TO ALL OF THESE DIFFERENT

PROVIDERS ACROSS THE CITY, THEY GET LOST IN THE SAUCE. WE ALREADY KNOW THE MCO'S ARE AWAKE AT NIGHT LIKE, WHERE ARE THE CLIENTS? ORGANIZATION. WE BELIEVE THIS CONTINUUM WILL WORK. WE HAVE SEEN IT. WE

HAVE SEEN IT. WE JUST NEED NOW THE SUSTAINABILITY FOR THAT TO KEEP GOING. WE HAVE APPLIED TO THE NATIONAL ALLIANCE AND WE WANT TO BRING THAT TO THE DISTRICT AS WELL. MY NAME IS WILL DOYLE AND I AND

THE VICE PRESIDENT HOUSING FIRST. WE APPRECIATE YOU HOLDING THE HEARING AS WE HAVE MANY EXAMPLES OF CLIENTS NEEDING LONG-TERM CARE. BUT INSTEAD, THEY EXPERIENCE BARRIERS. THIS HAS IMPACTED CLIENTS IS

PRINTING HOMELESSNESS. COME NEEDS ALSO -- COMPLEX NEEDS OFTEN PREVENTED APPROVAL. AS A RESULT, CLIENTS EITHER HAVE TO STRUGGLE WHILE RESIDING IN EMERGENCY SHELTER WORK MOVE FORWARD. DELAYS IN THE

PROCESS OR THE INABILITY TO TRANSITION TO LONG-TERM CARE HAS MEANT THEY NEED TO REMAIN IN THEIR APARTMENTS WITHOUT ADEQUATE SUPPORT. THAT CAN RESULT IN UNNECESSARY DECLINE IN HEALTH AND CHALLENGES FOR

THE LANDLORD. IN ONE PARTICULAR EXAMPLE, A CLIENT EXPERIENCING HOMELESSNESS WAS DENIED FOR AN ASSISTED LIVING FACILITY DUE TO LEGALLY BLIND AND NOT HIGH FUNCTIONING ENOUGH. HE WAS LATER DECLINED FOR

LONG-TERM NURSING HOME PLACEMENT DUE TO INSUFFICIENT INCOME. THE ALTERNATIVE FOR HIM WAS TO REMAIN A RESPITE BAD AT AN EMERGENCY SHELTER. WHEN OUR CLIENTS EXPERIENCE BARRIERS TO LONG-TERM CARE, THEY

ALSO INCREASE INCREASE IN HOSPITALIZATIONS AND SHORT-TERM NURSING HOME PLACEMENTS. WHILE INSTITUTIONALIZED, SUPPORT FROM STAFF IS CRUCIAL WHILE SECURING LONG-TERM CARE BUT OFTEN INADEQUATE. THE MAY

ALSO SEEK ASSISTANCE INITIATING GUARDIANSHIP BUT RARELY GET THAT SUPPORT. WHEN CLIENTS REMAIN IN THE COMMUNITY OR THEIR APARTMENTS, CALLS TO APS MAYBE THE ONLY MEANS TO INITIATING MOVEMENT TO LONG-

TERM CARE. THERE ARE OFTEN GAPS BETWEEN ROLES AND CLIENT NEEDS LEAVING THE PURSUIT OF APPROPRIATE INTERVENTIONS UP TO THE CASE MANAGER. WHAT IS INTENDED TO BE A NO-WR ONG OFTEN FEELS LIKE NO-RIGHT. WE

NEED OVERSIGHT AND SUPPORT TO ENSURE A SUCCESSFULLY SECURE PLACEMENT IN LONG-TERM CARE. THANK YOU FOR HOLDING THIS HEARING. I WOULD BE HAPPY TO ANSWER ANY QUESTIONS. CHAIR HENDERSON: THANK YOU.

CATHERINE? >> GOOD AFTERNOON, CHAIRPERSON HENDERSON. THANK YOU SO MUCH FOR HOLDING THIS IMPORTANT ROUNDTABLE ON THE LONG-TERM CARE NEEDS FOR D.C.'S MOST VULNERABLE PATIENTS. MY NAME IS CATHERINE

CROSLAND AND I AM A PHYSICIAN WITH UNITY HEALTH CARE. I HAVE BEEN SERVING PEOPLE EXPERIENCING HOMELESSNESS IN D.C. SINCE 2009. I AM ALSO THE COMMUNITY REPRESENTATIVE TO THE INTERAGENCY COUNCIL ON

HOMELESSNESS AND THE CO-CHAIR FOR THE HEALTH COMMITTEE. I'M TESTIFYING AS AN INDIVIDUAL BASED ON THE EXPERIENCES AS WELL AS MY ROLE AS MEDICAL DIRECTOR DURING THE COVID PANDEMIC. AS REFERRED TO MANY

TIMES, WE ARE SEEING AN INCREASINGLY OLDER AND MORE MEDICALLY VULNERABLE POPULATION EXPERIENCING HOMELESSNESS REQUIRING A HIGHER LEVEL OF CARE. I WANT TO MAKE THREE POINTS TODAY. THE FIRST IS THE

CURRENT LONG-TERM CARE SYSTEM DOES NOT MEET THE NEEDS OF PEOPLE EXPERIENCING HOMELESSNESS. OFTEN, THEY ARE NOT ACCEPTED BY LONG-TERM CARE FACILITIES OR THEY ARE DISCHARGED FROM LONG-TERM CARE

FACILITIES BECAUSE THOSE FACILITIES CANNOT MEET THE NEEDS OF THE PATIENTS WORK THEY ARE DISCHARGED BECAUSE OF SUBSTANCE USE ISSUES. THE OTHER POINT IS THAT A LOT OF TIMES, MY PATIENTS DO NOT ACCEPT

LONG-TERM CARE PLACEMENT BECAUSE OF THE FINANCING STRUCTURE, THE FACT IT REQUIRES THEM TO GIVE UP ALL OF THEIR INCOME EXCEPT FOR A PERSONAL ALLOWANCE WHICH IS USUALLY $100 A MONTH WHICH IS JUST NOT

ENOUGH FOR SOMEBODY WHO DOES NOT HAVE SOCIAL NETWORKS TO HAVE ACCESS TO OTHER RESOURCES UNLESS THERE ARE OTHER WAYS TO THINK ABOUT CREATING ALTERNATE SYSTEMS TO MEET THE NEEDS OF THIS POPULATION IN

THE MEANTIME. JUST TO DELVE IN QUICKLY TO A COUPLE OF THESE, THE CURRENT LONG-TERM CARE SYSTEM DOES NOT MEET THE NEEDS OF. PEOPLE EXPERIENCING HOMELESSNESS. I WILL GIVE A QUICK EXAMPLE. ABRAMS HALL

DURING THE PANDEMIC WAS AN ASSISTED LIVING FACILITY THAT CAME ONLINE THAT WAS SPECIFICALLY SUPPOSED TO MEET THE NEEDS OF PEOPLE EXPERIENCING HOMELESSNESS, AND IT WAS NOT SUPPOSED TO BE A DRY FACILITY

BUT WE HAD PATIENTS DENIED BECAUSE THEY HAD ALCOHOL USE DISORDER. THEY HAD TO COMPLETE AN-PATIENT TREATMENT PROGRAMS BEFORE THEY WOULD BE CONSIDERED. THAT WAS ONE THING. I ALSO HAVE PATIENTS THAT HAVE

BEEN COOKED -- KICKED OUT OF SKILLED NURSING FACILITIES BECAUSE ALCOHOL USE. THESE ARE NOT EVEN ILLEGAL DRUGS. I HAVE OTHER PATIENTS THAT COULD NOT GET INTO NURSING HOMES BECAUSE OF HEROIN USE. BUT

THIS IS JUST FOR ALCOHOL USE. THE OTHER THING IS MY PATIENTS OFTEN CHOOSE NOT TO GO INTO THE ASSISTED LIVING FACILITIES. ABRAMS HALL, THIS WAS MEANT FOR VULNERABLE POPULATIONS. WE HAD A NUMBER OF THE

MOST HIGHLY VULNERABLE POPULATIONS IN THE PROTECTIVE HOTELS. WE OFFERED ABRAMS HALL TO ALMOST EVERYTHING A PERSON WE THOUGHT COULD BENEFIT FROM ASSISTED LIVING AND A HIGHER LEVEL OF CARE. EVERYBODY

WAS EXCITED ABOUT IT UNTIL WE TOLD THEM ABOUT THE PERSONAL NEEDS ALLOWANCE. ALMOST EVERYTHING A PERSON DECLINED. THE ABRAMS HALL WAS FILLED, UNFORTUNATELY, WELL, GOOD FOR THEM, BUT WITH PEOPLE FROM

THE COMMUNITY. IN MY EXPERIENCE, MOST OF THE TIME SOMEBODY IS MOVED INTO AN ASSISTED LIVING OR NURSING HOME PLACEMENT IT IS BECAUSE THEIR LEGAL GUARDIAN, POWER OF ATTORNEY, HEALTH CARE PROXY,

SOMEBODY, A FAMILY MEMBER DESIGNATED BY THEMSELVES, HAS MADE THAT DECISION, THE DAUGHTER, THE SON SAYS IT IS TIME TO GO IN. A LOT OF MY PATIENTS DO NOT HAVE THOSE FOLKS DESIGNATED. SHORT OF HAVING A

STATE-APPOINTED LEGAL GUARDIAN, IT IS IMPOSSIBLE TO FORCE SOMEBODY TO GO INTO THAT KIND OF SETTING. FINALLY, JUST IN TERMS OF AN ALTERNATIVE TO TRADITIONAL ASSISTED LIVING OR LONG-TERM CARE NURSING

FACILITIES THAT MIGHT MEET THE NEEDS OF THIS POPULATION, SOMETHING I HAVE OFTEN RETURNED TO AS PSH+ CARE WHICH IS FINANCED SIMILAR TO PSH, ONE THIRD OF YOUR INCOME, BUT IN ADDITION TO HOUSING CASE

MANAGEMENT SERVICES, IT ALSO HAS MEALS AND MEDICAL SUPPORTS ON-SITE AS WELL AS BEHAVIORAL HEALTH SUPPORTS ON-SITE. THE PROGRAM WAS LITERALLY A PILOT PROGRAM IN HOW ACCESSIBLE THIS CAN BE. I KNOW IT

WAS INCREDIBLY EXPENSIVE THE WAY IT WAS FINANCED DURING THE PANDEMIC BUT THERE ARE SO MANY LESSONS WE CAN LEARN FROM THE SUCCESSES OF THAT PROGRAM. THE PRIVATE ROOMS, DIGNIFIED SPACES WITH A PRIVATE

BATHROOM. PEOPLE CAN LOCK THE DOOR. WE HAD SO MANY PATIENTS WHO HAD "FAILED HOUSING" MULTIPLE TIMES, FAILED CRFS, FAILED INDEPENDENT HOUSING, WHO CAME TO THE HOTELS AND LIVES WITH A SUCCESSFULLY FOR

THREE YEARS, SOME OF WHOM HAD TO LEAVE TO GO TO CRF AND WERE DEVASTATED TO DO SO. THANK YOU VERY MUCH FOR THE OPPORTUNITY TO TESTIFY. CHAIR HENDERSON: THANK YOU. MOLLY SMITH. >> THANK YOU FOR THE

OPPORTUNITY TO SPEAK TODAY ABOUT LONG-TERM CARE FOR DISTRICT RESIDENTS INCLUDING THOSE WITH COMPLEX NEEDS. MY NAME IS SISTER MOLLY SMITH AND I AM THE CLINICAL SUPERVISOR OF CATHOLIC CHARITIES D.C., A

TREATMENT PROGRAM, A CRITICAL COMMUNITY-BASED PROGRAM THAT PROVIDES CARE WI FOR INDIVIDUALS WITH MENTAL ILLNESS. I'M HERE TO ADVOCATE FOR CONSUMERS WITH COMPLEX NEEDS INCLUDING SERIES MENTAL HEALTH

ISSUES AND SUBSTANCE ABUSE ISSUES. OUR TEAM HAS SUCCESSFULLY HELPED NINE CONSUMERS TRANSITION INTO NURSING HOMES WHERE THEY ARE RECEIVING NEEDED CARE IS. THESE CALL FOR CONSISTENT ADVOCACY AND

EXTENSIVE COLLABORATION. WE HAVE SEEN SUCCESSFUL PLACEMENT CAN BE POSSIBLE WHEN THE SYSTEM WORKS AS IT SHOULD. HOWEVER, WE CONTINUE TO FACE SIGNIFICANT BARRIERS. ONE IS SOMEONE RESIDING IN A FACILITY

THAT SEVERELY LACKS THE ABILITY TO MEET HIS NEEDS PRETTY IS WHEELCHAIR-BOUND AND HAS A DIAGNOSIS OF PARANOID SCHIZOPHRENIA. HE IS AN ARTIST AND LOVES TO READ. HE IS GIVING HIMSELF BED BATHS BECAUSE

ACCESS TO ADEQUATE BATHING IS UNAVAILABLE. HE CONTINUES TO WAIT OVER SIX MONTHS FOR HOME HEALTH CARE TO MEET HIS DAILY NEEDS. DESPITE HIS NEEDS FOR ADDITIONAL SUPPORT, HE IS IN A SETTING THAT CANNOT

ADEQUATELY PROVIDE FOR HIS CARE. HE WAS WAITLISTED FOR OVER A YEAR AT ONE FACILITY THAT LATER STATED IT HAD 48 BEDS AVAILABLE. WHEN HIS APPLICATION WAS RESUBMITTED, HE WAS DENIED WITHIN THREE HOURS

BECAUSE HIS CURRENT NEEDS EXCEED THE LEVEL OF CARE. IF HIS NEEDS EXCEED WHAT A NURSING HOME CAN PROVIDE, SURELY THEY EXCEED WHAT HIS CURRENT SETTING CAN SAFELY PROVIDE. WHEN OUR CONSUMERS ARE DENIED

PLACEMENT, WE ARE NOT ALWAYS GIVEN SPECIFIC INFORMATION ABOUT WHY THEY WERE DENIED OR WHAT WE NEED TO CHANGE FOR THEM TO QUALIFY. WITHOUT THAT, IT BECOMES EVEN MORE DIFFICULT TO CONNECT PEOPLE WITH

THE SUPPORT THEY NEED LEAVING THEM WITHOUT AN APPROPRIATE PLACE TO RECEIVE CARE. A BEHAVIORAL HEALTH DIAGNOSIS SHOULD NOT MEAN SOMEONE FALLS INTO A GAP BETWEEN SYSTEMS. THERE MUST BE AN APPROPRIATE

PLACE FOR THAT PERSON TO RECEIVE CARE. WHEN THERE IS NOWHERE APPROPRIATE FOR THEM TO GO, THE BURDEN FALLS ON EMERGENCY DEPARTMENTS, PSYCHIATRIC HOSPITAL, GROUP HOMES, FAMILIES, ADULT PROTECTIVE

SERVICES, AND THE CONSUMERS THEMSELVES. WE NEED A SYSTEM IN WHICH PEOPLE WITH SERIOUS MENTAL ILLNESS AND COMPLEX MEDICAL NEEDS CAN ACCESS APPROPRIATE LONG-TERM CARE INSTEAD OF WHERE THOSE BECOME

BARRIERS TO PLACEMENT. WHEN I HAVE ADVOCATED FOR CONSUMERS CAUGHT IN THE GAP, I HAVE BEEN TOLD TO TAKE IT UP WITH CONGRESS. RESPECTFULLY, THIS IS AN ISSUE THAT REQUIRES ACTION IN THE DISTRICT. OUR

TEAMS ARE COMMITTED TO DOING THE WORK BUT WE CANNOT CREATE LEVELS OF CARE THAT DO NOT EXIST. I'M ASKING THIS COMMITTEE TO WORK TOWARDS SOLUTIONS CLEAVING -- INCLUDING INCREASED LONG-TERM CARE

FACILITIES, APPROPRIATE OPTIONS, AND STRONGER COORDINATION BETWEEN BEHAVIORAL HEALTH AND LONG-TERM CARE SYSTEMS. THANK YOU. CHAIR HENDERSON: THANK YOU. AND MS. LYN. >> GOOD AFTERNOON. I AM THE

ASSOCIATE VICE PRESIDENT OF CLINICAL HOUSING AT HOMELESS CONNECTIONS. FOR OVER 42 YEARS, COMMUNITY CONNECTIONS HAS PROVIDED SUPPORTIVE HOUSING AND HEALTH CARE COORDINATION FOR THE DISTRICT'S MOST

VULNERABLE RESIDENTS. WITHIN OUR PORTFOLIO, WE OPERATE SIX RESIDENT FACILITIES AT BE SUPPORTED READABILITY RESIDENTS LEVEL OF CARE. THESE HOMES PROVIDE 24/7 SUPERVISION AND DAILY REHABILITATIVE

SUPPORT FOR INDIVIDUALS WITH COMPLEX BEHAVIORAL HEALTH AND MEDICAL NEEDS, INCLUDING THOSE TRANSITIONING FROM INSTITUTIONAL SETTINGS. WE ARE HERE TODAY BECAUSE THE DISTRICT CURRENT REIMBURSEMENT

STRUCTURE IS UNSUSTAINABLE. THE STANDARD PERDIEM RATE HAS REMAINED STAGNANT AT 106 -- 20 -- $126.25 CENTS 2023. MEANWHILE, THEY ARE FACING RISING WAGES, A 5% INCREASE IN FOOD COSTS, AND NEARLY 23%

SPIKE IN ENERGY COSTS. THESE EXTERNAL INDICATORS UNDERSCORE THE ECONOMIC REALITY OPERATORS FACE TODAY. CONSEQUENTLY, OUR PROGRAM HAS OPERATED AT AN AVERAGE OF 15% FINANCIAL LOSS OVER THE PAST FEW

YEARS. THIS FINANCIAL CRISIS IS DRIVEN BY FACTORS SUCH AS AN MANDATED -- UNFUNDED MANDATED WHICH CHAPTER 38 REQUIRES A 128 RATIO AND TWO TO EIGHT RATIO DURING PEAK HOURS. WHEN RESIDENTS EXPERIENCE

MEDICAL DECLINE, WE MUST PROVIDE INTENSIVE ONE TO ONE SUPPORT. STAFFING REPRESENTS OVER 50% OF PROGRAM COSTS. YET THESE HIGHER INTENSITY NEEDS ARE NOT REFLECTED IN THE PER DIEM RATE. THE ABSENCE

POLICY, IT IS CAPPED AT 30 DAYS PER FISCAL YEAR YET REGULATION REQUIRES REGULATORS TO HOLD BEDS FOR A MINIMUM OF UP TO 90 DAYS DURING RESIDENT HOSPITALIZATION. WHEN THE 30 DAYS EXPIRE, FUNDING STOPS

COMPLETELY WHILE OUR FIXED OPERATIONAL COSTS CONTINUE. REVENUE LOSS FROM NONPAYMENT. WHEN RESIDENTS ARE UNABLE TO PAY OR UNWILLING TO PAY ROOM AND BOARD, CURRENT INVOLUNTARY DISCHARGE RULES FORCE

PROVIDERS TO ABSORB THE FULL COST OF CARE FOR MONTHS. CHAPTER 38 LACKS A PROVISION TO SECURE RELIABLE PAYMENT. THESE CHALLENGES REFLECT A BROADER DISCONNECT BETWEEN CLINICAL EXPECTATIONS, REGULATORY

REQUIREMENTS, AND OPERATIONAL FUNDING. WE RESPECTFULLY URGE THE COUNCIL TO CONSIDER FIVE RECOMMENDATIONS. FIRST, CONDUCT A COST REVIEW, PROVIDE IMMEDIATE FUNDING TO BRING REIMBURSEMENT TO AT LEAST A

BREAKEVEN LEVEL AND ESTABLISH ANNUAL ADJUSTMENT TIED TO RELATION AND MINIMUM WAGES TO ACCOUNT FOR OPERATING COSTS. SECOND, EXTEND ABSENT REIMBURSEMENT TO COVER THE FULL PERIOD PROVIDERS ARE REQUIRED

TO HOLD BEDS. THIRD, ESTABLISH A COORDINATED DISCHARGE AND READMISSION PROTOCOL AMONG DBH, PHCF, HOSPITALS, MANAGED-CARE ORGANIZATIONS, CSA'S, AND RESIDENTIAL PROVIDERS. FOURTH, AMEND CHAPTER 38 TO

ADDRESS PROLONGED NONPAYMENT THREE CORPORATE DISCHARGE PROCEDURE AND REPRESENTED PAY PROVISIONS WHILE ENSURING STAFFING AND COMPLIANCE MANDATES ARE ADEQUATELY FUNDED. FIFTH, AMEND CHAPTER 57 TO

ESTABLISH A TRANSPARENT, PREDICTABLE, AND REGULARLY UPDATED REIMBURSEMENT PROCESS. THESE ARE NOT SIMPLY FINANCIAL CONCERNS. IF PROVIDERS CAN NO LONGER SUSTAIN THESE RESIDENTS, THE DISTRICT RISKS

LOSING CRITICAL COMMUNITY-BASED PLACEMENTS, DELAYING HOSPITAL DISCHARGE, AND INCREASING RELIANCE ON MORE COSTLY INSTITUTIONAL ASSISTANCE. COMMUNITY CONNECTIONS REMAINS COMMITTED TO RESIDENTS RIGHTS,

QUALITY OF CARE, AND SAY COMMUNITY LIVING. WE WELCOME THE OPPORTUNITY TO WORK WITH THE COUNCIL AND DBH TOWARDS A SUSTAINABLE RESOLUTION. CHAIR HENDERSON: THANK YOU SO MUCH. THANK YOU TO THIS PANEL OF

WITNESSES. SOME OF YOU HAVE NOT SUBMITTED YOUR TESTIMONY. YOU GAVE US 6, 7, 8 RECOMMENDATIONS. YOU KNOW WHO YOU ARE. HOPEFULLY, YOU WILL SUBMIT THE TESTIMONY. >> OH, YES. CHAIR HENDERSON: OK. IT IS

INTERESTING SEVERAL OF YOU HAVE TALKED ABOUT THE REIMBURSEMENT PIECE. IT GOES BACK TO THE FIRST PANEL. I WAS THINKING OF HER REFRAIN OF JAMES CARVILLE WHERE HE SAYS IT IS THE ECONOMY, STUPID. REALLY,

IT IS THE REIMBURSEMENT, STUPID. IT IS NOT EVERYTHING BUT IT IS THE FOUNDATION FOR THE NUMBER OF BEDS, THE QUALITY OF STAFF, THE CAPACITY ISSUES. LIKE, I FEEL LIKE THAT -- OR AM I MINIMIZING IT? I

THINK YOU ARE GREATLY KIND OF MINIMIZING IT. EVERYTHING IS SURROUNDING THE COSTS OF THINGS. FOR STAFFING, FOR THE OPERATION OF THE BUILDINGS, EVERYTHING IS SURROUNDED BY COST. IF WE DO NOT HAVE THAT

REIMBURSEMENT RATE TO BE ABLE TO SUSTAIN THAT, WE ARE LEFT WITH HAVING TO CLOSE OUR DOORS. CHAIR HENDERSON: YEAH. UNFORTUNATELY. >> CAN I ALSO ADD THAT WHILE THE REIMBURSEMENT IS IMPORTANT, THE COST

TO THE INDIVIDUAL THAT PROHIBITS THEM FROM ACCEPTING AN APPROPRIATE PLACEMENT IS EVEN DISPROPORTIONATELY GREATER. I KEEP DOING THE MATH AND I THINK IF SOMEBODY IS LUCKY ENOUGH TO GET $900 A MONTH AND

THEY HAVE TO PAY $800 AND THEY ONLY GET TO KEEP $100, THAT IS $800 THAT GOES TO THE FACILITY. IF ON THE OTHER HAND THEY PAY $300 AND GET TO KEEP $600, THEY GET TO KEEP $600 VERSUS $100. THE DIFFERENCE

IS ONLY $500. OVER A YEAR, THAT IS $6,000 THAT IF ONE HOSPITAL ADMISSION IS AVOIDED BY HAVING THEM IN THAT PLACE AS OPPOSED TO ON THE STREET, IT HAS MORE THAN PAID FOR ITSELF. IT IS CREATIVE THINKING

AROUND HOW WE THINK ABOUT WHERE THOSE COSTS COME FROM. CHAIR HENDERSON: I DEFINITELY HEAR YOU. THE ISSUE AROUND PCA HAS COME UP. NOT THIS PAST BUDGET BUT MAYBE THE BUDGET BEFORE THAT, WE RAISED THE

AMOUNT OF PERSONAL CARE ALLOWANCE. I WISH I COULD HAVE DONE MORE. WE DID NOT HAVE THE FUNDING IN COMMITTEE TO BE ABLE TO DO THAT. I THINK IT IS A BROADER QUESTION OF EXPLAINING THIS ISSUE TO

COLLEAGUES. EVEN OUTSIDE OF THE HEALTH COMMITTEE. THIS IS DEFINITELY SOMETHING FOR HUMAN SERVICES TO THINK ABOUT. THERE ARE PEOPLE FOR WHOM WOULD CHOOSE TO LEAVE THE STREETS AND OTHERWISE IF THEY WERE

ABLE TO DO THIS THING BUT ALSO KEEP MORE OF THEIR FUNDING. I THINK A NUMBER OF YEARS AGO, SOME WERE DESCRIBING IT IN TERMS OF WHAT WE DO LONG-TERM CARE IN THIS COUNTRY WHERE WE ESSENTIALLY HAVE TO

FORCE PEOPLE. THERE ARE DEFINITELY PEOPLE THAT ARE LOW INCOME AND THERE ARE DEFINITELY PEOPLE WHO ARE WEALTHY. THEN THERE IS EVERYBODY ELSE IN THE MIDDLE. WE THEN IT ESSENTIALLY FORCE FOLKS TO MAKE

THEMSELVES POOR IN ORDER TO ACCESS SERVICES WHICH IN THE LONG RUN DOES NOT HELP THE FULL PROBLEM OF THINGS. THIS IS ONE OF THE REASONS THE COMMITTEE DID THE MEDICAID BUY-IN PROGRAM BECAUSE WE HAVE A

LOT OF PEOPLE THAT HAVE A PHYSICAL DISABILITY WHERE THEY MIGHT NEED ASSISTANCE BUT THEY ARE FINE COGNITIVELY. THEY CAN WORK, THEY CAN DO ALL THESE THINGS. I HAVE FOLKS IN THE DISTRICT WHO ARE EITHER

DECLINING PROMOTIONS OR WORK JUST SO THEY CAN KEEP THEIR HEALTH CARE. THAT SEEMS TO BE THE EXACT OPPOSITE OF WHAT WE WANT AND DESIRE IN TERMS OF PEOPLE BEING ABLE TO BOTH CONTRIBUTE, IF THEY CAN

CONTRIBUTE TO THEIR CARE, AND SEEK IT. IT IS UNDERSTANDING THE WHOLE SITUATION. WHILE YOU WERE PRESENTING YOUR TESTIMONY AND HEARING FROM CATHERINE AND JUDY, ALSO THE OTHER PIECES AROUND WE HAVE NOT

UPDATED THIS SINCE 2018 OR XYZ IS ONE OF MY BIGGEST FRUSTRATIONS WITH HEALTH CARE FINANCES. WE JUST LET IT LANGUISH UNTIL WE HAD A CRISIS POINT AND ALL OF A SUDDEN WE HAVE GOT TO PAY PEOPLE, WE HAVE

GOT TO CATCH THEM UP. WE DID THIS WITH DENTAL REIMBURSEMENT. DENTAL REIMBURSEMENT FOR MEDICAID HAD NOT BEEN UPDATED IN 12 OR 13 YEARS. WHEN DENTISTS IN THE CITY DECIDED TO STOP SEEING MEDICAID

PATIENTS, ALL OF A SUDDEN, WE WILL PAY YOU NOW. INTERESTINGLY ENOUGH, WE DO SOMETHING DIFFERENT IN TERMS OF EDUCATION. I WAS ASKING MY STAFF, BACK IN THE DAY WHEN THERE WAS AN EDUCATION COMMITTEE,

THAT IS A WHOLE DIFFERENT ISSUE, WE REQUIRED IN ADEQUACY STUDY EVERY YEAR. THEY BASICALLY DO A REVIEW OF WHAT IT COSTS TO PROVIDE A QUALITY EDUCATION IN THE DISTRICT OF COLUMBIA. DO WE ALWAYS FUND TO

THE ADEQUACY SETTING? NO, WE DO NOT. BUT THE REVIEW IS DONE BY AN OUTSIDE PARTY WHO REVIEWS THE DATA AND MAKES RECOMMENDATIONS. FOR SPECIAL EDUCATION STUDENTS, THEY SHOULD GET THIS. FOR PRE-K, IT

SHOULD BE X. IT FEELS LIKE WE NEED THAT HERE IN A REGULAR CADENCE. IS THERE SOME AGREEMENT ON THAT? I SEE SHAKING HEADS, GREAT. >> SO SORRY, CAN I ALSO PROPOSE SOMETHING I HAVE PROPOSED A BUNCH OF

TIMES. WHILE I HAVE NOT GOTTEN A DIRECT ANSWER FROM THEM, OTHER PEOPLE HAVE SAID THAT IS NOT POSSIBLE. ONE OF THE THINGS WE TRIED TO DO AT THE PEPV PROGRAM WAS TO MEET THE NEEDS OF OUR PATIENTS IN A

POPULATION WAZE AP -- WAY AS OPPOSED TO THE HOME HEALTH CARE MODEL. THEY DON'T NECESSARILY NEED EIGHT HOURS OF CARE EVERY DAY. YOU COULD HAVE A TEAM OF HOME HEALTH AIDES TAKING CARE OF 30 PEOPLE AND

THEN YOU COULD HAVE TWO PEOPLE GO TO BATHE MR. JONES AND TWO PEOPLE GOING TO DRESS MISS SMITH. YOU COULD DO TARGETED CARE THAT IT SEEMS WOULD BE A LOT MORE COST-EFFECTIVE AS OPPOSED TO JUST PAYING

SOMEBODY TO SIT AROUND FOR SEVEN HOURS A DAY AND THEN DO THE ONE HOUR OF WORK FOR THE PERSON. DOES THAT MAKE SENSE? CHAIR HENDERSON: IT DOES. BUT THAT GETS INTO THE COMPLEX OF IT DOES NOT SOLVE ALL

ISSUES. THERE ARE SOME PEOPLE THAT WANT TO AGE IN PLACE AT HOME IF THEY HAVE A HOME. WE HAVE WORKFORCE CHALLENGES THERE. WE ARE TRYING. WE DID AN OVERSIGHT ROUNDTABLE AT THE BEGINNING OF OCTOBER ON

CNA'S AND THE PIPELINE. WE HAVE SOME ISSUES WE HAVE TO WORK OUT. THERE ARE SO MANY DIFFERENT PIECES HERE. I'M TRYING TO BE MINDFUL OF TIME. I DEFINITELY WANT TO ASK THE QUESTION. WILL, YOU BROUGHT UP

GUARDIANSHIP. ELIZABETH DAVIS BROUGHT THIS UP AS WELL. OR SISTER SMITH, CAN YOU GUYS TALK MORE ABOUT, WHAT ARE THE CHALLENGES THERE? I WAS TALKING MORE FROM THE PERSPECTIVE OF OUR OUTREACH PROGRAMS

AND PSH WHERE THEY MAY OR MAY NOT HAVE A MENTAL HEALTH PROVIDER. TRYING TO DO THIS WITH OUT THAT OR THE EXTERNAL, SO WHEN THE PERSON IS IN THE HOSPITAL OR A NURSING HOME TRYING TO GET THOSE STEPS

MOVED FORWARD IS CRUCIAL. THAT CAN BE A REAL CHALLENGE BECAUSE WE NEED ASSISTANCE. IT IS VERY DIFFICULT TO GET IT DONE. WE ARE JUST TRYING TO CAPITALIZE ON THOSE MOMENTS. AS A CORE SERVICE AGENCY, I

WRITE GUARDIANSHIP PETITIONS. WE HAVE BEEN SUCCESSFUL IN THAT. WE ARE CONSTANTLY MONITORING OUR CONSUMERS TO SEE IF THEY NEED A GUARDIAN. USUALLY, YES. SOMETIMES, YES. SO WE CAN TRY TO ADVOCATE FOR

THEM TO BE ABLE TO RECEIVE A GUARDIAN. BECAUSE WE KNOW OUR CONSUMERS REALLY WELL, WE HAVE BEEN SUCCESSFUL IN GETTING THEM A LEGAL GUARDIAN. CHAIR HENDERSON: THAT IS GOOD. ARE THERE CHALLENGES IN TERMS

OF CAPACITY AND THE NUMBER OF GUARDIANS AVAILABLE? I KNOW THAT IS A COURTS ISSUE BUT I AM CURIOUS. >> YES, I HAVE RECEIVED THAT FEEDBACK SINCE I HAVE APPLIED FOR SEVERAL GUARDIANSHIPS IN THE LAST

YEAR. THEY OFTEN ASK IF THERE IS A FAMILY MEMBER AVAILABLE TO BE THE LEGAL GUARDIAN BECAUSE THERE IS NOT ENOUGH IN THE GUARDIAN PANEL. HOWEVER, FOR MOST OF THE CONSUMERS THAT I SERVE, THEY MAY NOT

HAVE FAMILY. THEY MAY NOT HAVE ANYONE. WE OFTEN USE ATTORNEYS WHO ARE LEGAL GUARDIANS. AND NOT ALL ARE EQUAL. CHAIR HENDERSON: HMM. WE HAVE SOME THAT ARE TRULY EXCELLENT. WE HAVE OTHERS THAT DO NOT

RESPOND TO US AND SEND EVERYTHING BACK TO US. WE HAVE SOME ISSUES BECAUSE OF THAT. I THINK THE CHALLENGE IS MAKING SURE WE HAVE APPROPRIATE GUARDIANS. THE OTHER PIECE WITH FAMILY GUARDIANS IS THEY MAY

NOT ALWAYS KNOW WHAT IS HAPPENING. ONE OF THE CONSUMERS, THE FAMILY MEMBER IS A GUARDIAN, SHE DOES A GREAT JOB BUT SHE DOES NOT KNOW THE SYSTEM. THE SYSTEM UNFORTUNATELY KIND OF USED THAT KNOWLEDGE TO

THE CONSUMER'S DEFICIT. CHAIR HENDERSON: GOT IT. >> WE HAVE THE EXACT SAME EXPERIENCES AS SISTER MOLLY. CHAIR HENDERSON: THANK YOU SO MUCH TO THIS PANEL. YOU KNOW WHO YOU ARE, IF YOU HAVE NOT PROVIDED

WRITTEN TESTIMONY, PLEASE DO THAT FOR THE RECORD. WE ARE GOING TO GO TO OUR GOVERNMENT WITNESS, DR. HANNAH KAUFMAN. THE AGE-FRIENDLY D.C. PROGRAM OFFICER. DR. KAUFMAN, I'M SURE YOU HAVE HEARD A LOT.

AND ALSO, I THINK THIS IS YOUR FIRST TIME TESTIFYING BEFORE THE COMMITTEE, SO WELCOME. >> THANK YOU. CHAIR HENDERSON: I DO NEED TO SWEAR YOU IN BEFORE YOU BEGIN SO IF YOU COULD RAISE YOUR RIGHT HAND.

DO YOU SWEAR OR AFFIRM UNDER PENALTY OF LAW THAT THE TESTIMONY YOU PROVIDE TO THE COUNCIL OF THE DISTRICT OF COLUMBIA AND THIS COMMITTEE IS THE TRUTH AND NOTHING BUT THE TRUTH? >> YES. CHAIR

HENDERSON: GREAT, WHEN YOU ARE READY. GOOD AFTERNOON, CHAIRPERSON HENDERSON AND STAFF. THANK YOU FOR THE OPPORTUNITY TO TESTIFY TODAY ABOUT AN ISSUE THAT AFFECTS MANY DISTRICT RESIDENTS, INCLUDING

SOME OF THE MOST VULNERABLE RESIDENTS, ACCESS TO HIGH-QUALITY AND RELIABLE AND COMPASSIONATE LONG-TERM CARE. IT IS MY HONOR TO SERVE AS THE'S DISTRICT OFFICER -- THE DISTRICT'S DISTRICT OFFICER. IN MY

ROLE, I AM UNIQUELY TASKED WITH MEETING AGE-FRIENDLY DC AND CORONATION OF LONG-TERM CARE. I JOINED IN FEBRUARY AND HAVE FOCUSED MUCH OF MY TIME ON LEARNING AND LISTENING TO COLLEAGUES IN DISTRICT

GOVERNMENT, COMMUNITY ORGANIZATIONS, AND DISTRICT RESIDENTS ABOUT WHAT IS WORKING, WHAT IS NOT, AND WHAT WE CAN DO TO MAKE THE DISTRICT A BETTER PLACE TO LIVE AND AGE FOR ALL. THAT INCLUDES THOSE

INDIVIDUALS LIVING IN LONG-TERM CARE SETTINGS. I WILL BE SPEAKING TO THE GAPS AND OPPORTUNITIES AND LONG-TERM CARE SUPPORTS AND SERVICES AS WELL. ONE OF OUR GREATEST CHALLENGES IS AROUND THE DIRECT

CARE SHORTAGE. HOME HEALTH AIDES, CERTIFIED NURSING ASSISTANTS, AND PERSONAL CARE AIDES PROVIDE ESSENTIAL SERVICES THAT ALLOW OLDER ADULTS AND PEOPLE WITH DISABILITIES TO LIVE WITH DIGNITY AND

INDEPENDENCE IN MULTIPLE SETTINGS. YET LOW WAGES, LIMITED OPPORTUNITIES FOR ADVANCEMENT AND DEMANDING CONDITIONS MAKE IT DIFFICULT TO RECRUIT AND RETAIN THESE ESSENTIAL WORKERS. WHEN CAREGIVERS LEAVE

THE PROFESSION, RESIDENTS LOSE ACCESS TO VITAL SERVICES. FAMILIES EXPERIENCE GREATER STRESS AND PREVENTABLE HOSPITALIZATIONS BECOME MUCH MORE LIKELY. WE CANNOT BUILD A STRONG LONG-TERM CARE SYSTEM

WITHOUT INVESTING IN THE PEOPLE THAT PROVIDE THAT CARE. OUR SECOND CHALLENGES FRAGMENTATION. THE DISTRICT HAS DEDICATED AGENCIES, HEALTH CARE PROVIDERS, ADVOCATES, AND COMMUNITY PARTNERS DOING

IMPORTANT WORK. HOWEVER, TOO OFTEN, THESE EFFORTS OPERATE INDEPENDENTLY. WE HAVE WORKFORCE DATA BUT IT IS SPREAD ACROSS MULTIPLE AGENCIES. WE HAVE TRAINING PROGRAMS BUT WORKERS STILL FACE BARRIERS

MOVING FROM TRAINING TO EMPLOYMENT. WE HAVE SERVICES BUT RESIDENTS AND FAMILIES CAN STRUGGLE TO NAVIGATE THEM. THE CHALLENGE IS NOT JUST A LACK OF PROGRAMS. IT IS THE NEED TO BETTER CONNECT RESOURCES

WE ALREADY HAVE. THE GOOD NEWS IS WE HAVE A WONDERFUL FOUNDATION TO BUILD FROM. THE DISTRICT HAS INVESTED IN WORKFORCE DEVELOPMENT, EXPANDED TRAINING OPPORTUNITIES, AND BEGUN IMPROVING CERTIFICATION

PROCESSES. BUT WE MUST GO FURTHER. HERE ARE MY FOUR RECOMMENDATIONS. FIRST, WE MUST INVEST IN A SUSTAINABLE WORKFORCE WITH CAREER ADVANCEMENT OPPORTUNITIES AND STRONGER RECRUITMENT AND RETENTION

STRATEGIES. SECOND, WE NEED TO STRENGTHEN COORDINATION AND ACCOUNTABILITY ACROSS AGENCIES, PROVIDERS, AND COMMUNITY ORGANIZATIONS SO OUR EFFORTS PRODUCE MEASURABLE IMPROVEMENTS. THIRD, BY IMPROVING

DATA AND WORKFORCE PLANNING, WE CAN IDENTIFY SERVICE GAPS, ANTICIPATE FUTURE NEEDS, AND DIRECT RESOURCES WHERE THEY HAVE A GREATER IMPACT. FOURTH, WE NEED TO CONTINUE TO ENSURE OLDER ADULTS, PEOPLE

DISABILITIES, FAMILY CAREGIVERS, AND FRONTLINE CARE WORKERS HAVE A MEANINGFUL VOICE IN SHAPING POLICIES THAT AFFECT THEIR LIVES. MY ROLE IS TO HELP CONNECT THESE EFFORTS TO STRENGTHEN PARTNERSHIPS AND

MOVE THE DISTRICT TOWARD A MORE COORDINATED AND SUSTAINABLE LONG-TERM CARE SYSTEM. BUT LASTING PROGRESS IS GOING TO REQUIRE CONTINUED COLLABORATION AND COMMITMENT FROM US ALL. NO ONE SHOULD HAVE TO

ENTER A NURSING HOME SIMPLY BECAUSE THE SUPPORT THEY NEED AT HOME IS UNAVAILABLE. AND FAMILIES SHOULD NOT HAVE TO NAVIGATE A COMPLICATED SYSTEM ALONE. LONG-TERM CARE IS NOT JUST A HEALTH CARE ISSUE.

IT IS AN ISSUE OF DIGNITY, EQUITY, AND QUALITY OF LIFE. HOW WE CARE FOR THE MOST VULNERABLE RESIDENTS REFLECT WHO WE LET US BUILD A DISTRICT WHERE GROWING OLDER OR LIVING WITH A DISABILITY DOESN'T

MEAN LOSING ACCESS TO CARE, SUPPORT, OR DIGNITY THAT EVERY RESIDENT DESERVES. THANK YOU FOR YOUR TIME AND YOUR LEADERSHIP. CHAIR HENDERSON: THANK YOU. I DON'T EXACTLY KNOW WHERE TO START. I MEAN, YOU

HAVE BEEN IN THIS ROLE FOR HOW MANY MONTHS NOW? A LITTLE OVER 7, I THINK. CHAIR HENDERSON: OKAY. YOU ARE STILL FRESH AND YET NOT FULLY FRESH. YOU LISTED OUT SOME LEVEL OF PRIORITIES. WHERE DO WE

START? I THINK IN SOME WAYS, LIKE,-- THERE ARE SO MANY DIFFERENT THINGS. LET'S START WITH THE DATA PIECES. I THINK YOU RAISED THAT AS SOMETHING AROUND, LIKE, HOW WE STRENGTHEN COORDINATION. THERE ARE

SEVERAL AGENCIES THAT HAVE THIS INFORMATION VS. NOT AND OTHER PLACES. HOW HAVE THOSE CONVERSATIONS BEEN GOING AS YOU HAVE BEEN TALKING TO SOME OF THE AGENCIES IN THIS CLUSTER? THANK YOU FOR THE

QUESTION. I WILL POINT TO A RECENT OPPORTUNITY, AND THAT WAS AN APPLICATION FOR TECHNICAL ASSISTANCE THAT WE DID WITH THE NATIONAL COUNCIL ON AGING. IT WAS A WONDERFUL OPPORTUNITY TO BRING SOME VOICES

TOGETHER FROM ACROSS DISTRICT GOVERNMENT AND THE COMMUNITY. THAT IS WHERE MUCH OF MY TESTIMONY COMES FROM. THIS CONSENSUS THAT CAME TOGETHER. THAT INCLUDED D.C. HEALTH, THE INVESTMENT COUNCIL, THE

DEPARTMENT OF HEALTH CARE FINANCE, THE OFFICE OF THE DEPUTY MAYOR FOR EDUCATION, AND THE D.C. LONG-TERM CARE COALITION. DATA WAS AT THE TOP, I WOULD SAY, AT LEAST TOP THREE OF ALL OF THE PEOPLE WHO

WERE INVOLVED IN THIS PROCESS. AND THIS APPLICATION. I THINK THERE ARE AMAZING METRICS THAT ARE BEING COLLECTED, AND AS I MENTIONED IN MY TESTIMONY, BEING COLLECTED ACROSS DISTRICT GOVERNMENT. BUT

THEY ARE NOT ALWAYS EASY TO ACCESS, AND WE NEED BETTER COORDINATION. AND I THINK TRANSPARENCY FOR WHAT IS BEING COLLECTED AND BY WHOM. CHAIR HENDERSON: OKAY. SO LET'S START WITH THE D.C. SURVEY. WHAT

IS THE TIMELINE FOR US TO DO A NEW ONE? >> I JUST DID. CHAIR HENDERSON: OH, YOU JUST DID ONE. I'M VERY EXCITED TO SHARE THAT WITH YOU. CHAIR HENDERSON: OKAY. >> I HEARD YOU SPEAKING ABOUT IT EARLIER.

AND I'M REALLY EXCITED TO SHARE. IN AUGUST AND SEPTEMBER-- EXCUSE ME. JULY, AUGUST, AND THE BEGINNING OF SEPTEMBER, WE COLLECTED, WE HAVE NOW OVER 900 SURVEYS ACROSS THE DISTRICT. WE SHIFTED THINGS

THIS YEAR AND FOCUSED ON ADULTS AGE 50 AND OLDER THROUGHOUT THE DISTRICT. AND REALLY WORKED-- WE PARTNERED REALLY STRONGLY WITH THE DEPARTMENT OF AGING COMMUNITY LIVING TO GET THOSE OUT TO AS MANY

FOLKS AS POSSIBLE. I THINK 900 IS A GREAT PLACE TO START. I'M LOOKING AT THIS. WE REDESIGNED THE SURVEY IN MANY WAYS, TO MAKE SURE THAT WEE ARE ASKING QUESTIONS THAT WE CAN SHARE WITH PARTNERS, WE CAN

SHARE WITH AGENCIES, THAT ARE ACTIONABLE. THAT INCLUDES FOOD INSECURITY, CARE, CARE NEEDS, AND CARE PROVISION BY OLDER ADULTS WHICH I THINK WE OFTEN MISS. SO YEAH, I'M REALLY EXCITED TO SHARE THAT. WE

ARE PUTTING IN THE LAST OF THOSE RIGHT NOW ONLINE, AND WE WILL SHARE THAT WITH YOUR OFFICE. CHAIR HENDERSON: OKAY. WHAT ARE THE PLANS ONCE YOU HAVE ALL OF THE FINDINGS FINALIZED? WILL THIS BE THE

BASIS OF A STRATEGIC PLAN GOING FORWARD? HOW WILL YOU USE THE DATA? ABSOLUTELY. THAT IS A GREAT QUESTION. THANK YOU. ONE, WE WANT TO MAKE SURE WE SHARE IT WITH PARTNERS. BECAUSE WE DON'T NEED TO WAIT

FOR A STRATEGIC PLAN TO MAKE USE OF THE DATA. I THINK THAT IS REALLY IMPORTANT. SO WHEN WE ARE TALKING ABOUT FOOD INSECURITY AND, YOU KNOW, PEOPLE ARE, 50 AND OLDER IN THE DISTRICT, WE DON'T HAVE A

LOT OF MEASURES, DATA POINTS FOR A LOT OF THE THINGS THAT WE ARE ASKING PEOPLE. I THINK THAT IS REALLY EXCITING. SO SHARING WITH D.C. HEALTH, SHARING WITH COMMUNITY PART PARTNERS, WHO ARE THE PEOPLE

ANSWERING IN DIFFERENT WARDS ACROSS THE CITY AND WHAT THEIR EXPRESS NEEDS ARE. I THINK SOMETHING-- WE HAVE A WONDERFUL OPPORTUNITY IN THE FUTURE TO MAKE SURE THAT WE ARE TARGETING FOLKS WHO ARE HARD

TO REACH. WE, I THINK, MADE STRIDES THIS YEAR. WE WORKED WITH DHS TO GET THE SURVEYS OUT INTO SHELTERS. WE ARE ABLE TO REACH UNHOUSED RESIDENTS, UNHOUSED FOLKS IN A LOT OF LIBRARIES. THAT IS OFTEN

WHERE THOSE ANSWERS COME FROM. AND THAT IS NEW. I THINK THAT IS EXCITING. CHAIR HENDERSON: YEAH. LOOK, THE FACT THAT YOU GUYS FOCUSED ON 50 AND OLDER IS ALREADY AN IMPROVEMENT. SO IN TERMS OF THAT.

FROM A TIMELINE PERSPECTIVE, WHEN SHOULD WE EXPECT A PUBLIC RELEASE OF THE FINDINGS? >> I THINK TOMORROW, THIS WEEKEND. WE WILL BE ABLE TO PUT IN THE FINAL NUMBERS. CHAIR HENDERSON: OKAY. BEFORE THE

END OF THE YEAR? >> OH, ABSOLUTELY. CHAIR HENDERSON: OKAY. DEFINITELY LOOK FORWARD TO HEARING MORE ABOUT THAT. ONE OF THE THINGS THAT WE HEARD A LOT ABOUT-- SO I KNOW YOU FOCUSED A LOT IN TERMS OF

WORKFORCE AND YOUR PRIORITY IN D THE STRATEGIES. YOU DEFINITELY HEARD A LOT AROUND THE FINANCING PIECE OF THINGS. DO YOU HAVE ANY THOUGHTS OF HOW WE MIGHT PROCEED IN THAT AREA? >> I WILL SAY-- THANK

YOU FOR THE QUESTION. I'M NOT A FINANCING EXPERT. I WILL SAY THAT WITHIN LONG-TERM CARE, I AM OPTIMISTIC FOR OPPORTUNITIES FOR LONG-TERM CARE INSURANCE IN THE FUTURE. I THINK IT'S AN AREA THAT HAS

BEEN REALLY DIFFICULT TO IMPLEMENT FOR LOTS OF DIFFERENT REASONS. BUT YOU KNOW, WE HAVE THE WASHINGTON STATE WITH THE WA CARES PROGRAM THAT IS STARTING TO-- IT IS A MODEL THAT STATES ACROSS THE

COUNTRY ARE LOOKING TO RIGHT NOW. THAT RECENTLY ROLLED OUT. THEY JUST STARTED REIMBURSEMENT. I THINK THEY ARE THREE YEARS INTO THE COLLECTION PROCESS. THEY STARTED THE ROLLOUT THIS SUMMER. I THINK

THAT IS REALLY EXCITING. SO I THINK LONG-TERM CARE INSURANCE HAS TO BE-- I MEAN, MAYBE IT IS A LITTLE BIT ASPIRATIONAL. IT IS SOMETHING WE HAVE TO LOOK TO TO THE FUTURE. PEOPLE CANNOT PRIVATE-PAY. WE

CANNOT, YOU KNOW-- NOT EVERYONE CAN PRIVATE-PAY. NOT EVERYONE CAN IMPOVERISH THEMSELVES TO GO INTO LONG-TERM CARE. IT IS NOT A SUSTAINABLE MODEL. CHAIR HENDERSON: YEAH. BASED ON YOUR RESEARCH AND

POLICY EXPERIENCE, ARE THERE OTHER APPROACHES IN OTHER JURISDICTIONS THAT WOULD HELP SERVING OLDER ADULTS WHO HAVE COMPLEX MEDICAL NEEDS? SO SOME OF THE THINGS WE TALKED ABOUT IN TERMS OF SERIOUS

MENTAL ILLNESS, SUBSTANCE USE DISORDER. WHAT ABOUT THAT PARTICULAR AREA WHICH IS A LITTLE BIT DIFFERENT THAN SOMEONE WHO IS JUST SEEKING STANDARD LONG-TERM CARE ASSISTANCE. YES. I'LL SAY IT IS NOT MY

AREA OF EXPERTISE. I THINK WHAT WE HAVE TO DO BETTER MOVING FORWARD GENERALLY FOR BOTH FOLKS WHO DON'T HAVE COMPLEX CARE NEEDS AND THOSE WHO DO IS BREAKING DOWN A LOT OF SILOS. RIGHT NOW WHEN WE ARE

TALKING ABOUT AGING, IT GOES IN A DIFFERENT BUCKET THAN PEOPLE WITH DISABILITIES. WE ARE NOT THINKING ABOUT A FUTURE WHERE MORE PEOPLE ARE GOING TO REQUIRE LONG-TERM CARE SERVICES AND SUPPORTS. WE

HAVE TO BREAK DOWN SILOS AND REALIZE THAT WE NEED CONNECTED COMMUNITIES AND OPPORTUNITIES TO HAVE INTERGENERATIONAL APPROACHES WHERE WE CONSIDER WORKERS AND OUR PLANS, WHERE WE, YOU KNOW, CONSIDER

HOUSING MODELS THAT INCORPORATE OLDER ADULTS AND DON'T ISOLATE OLDER ADULTS OR THOSE WITH SUBSTANCE USE DISORDER OR THOSE WITH DISABILITIES OF VARIOUS KINDS. IT HAS TO BE A COMPREHENSIVE APPROACH, OR

IT IS NOT GOING TO BE SUCCESSFUL. CHAIR HENDERSON: IT IS GOOD TO HEAR YOU TALK ABOUT BREAKING DOWN SILOS. BUT, LIKE, WHAT DOES THAT LOOK LIKE ON THE EXECUTIVE SIDE OF THINGS? ARE YOUR COLLEAGUES

ANSWERING YOUR CALL? ARE YOU ALL DOING-- I DON'T KNOW, QUARTERLY CONVENINGS OF ALL THE RELEVANT AGENCIES TO TALK ABOUT HIGH-PRIORITY ISSUES? LIKE, I THINK ONE OF THE THINGS THAT, WHEN THE COMMITTEE

ADDED FUNDING FOR THIS POSITION, TO NOT JUST FOCUS ON A SPECIFIC POLICY INITIATIVE OF THE MAYOR BUT TO REALLY FOCUS ON THE COORDINATING AND STRATEGIC ASPECT OF THE FACT THAT YOU HAVE D.C. HEALTH,

HEALTH CARE FINANCE, DISABILITY SERVICES, HUMAN SERVICES, HOUSING, ALL OF THESE THINGS KIND OF COMBINE TOGETHER, BUT IT DOESN'T FEEL LIKE THESE AGENCIES OFTEN ARE COMING TOGETHER TO TALK ABOUT THIS

PARTICULAR ISSUE. >> THANK YOU FOR THE QUESTION. I WOULD SAY THE HEART OF STRATEGIC COORDINATION FOR LONG-TERM CARE IS THE HEART F OF AGE-FRIENDLY D.C. IT IS MORE THAN A MAYORAL INITIATIVE. I AM VERY

GRATEFUL THAT THE INITIATIVE IS GIVEN PRIORITY AND EXISTS WITHIN THE OFFICE OF THE DEPUTY MAYOR OF HEALTH AND HUMAN SERVICES. AT THE HEART OF AGE-FRIENDLY IS STRATEGIC COORDINATION. BEFORE I CAME HERE

TODAY, I WAS AT AARP DC IN A ROOM FULL OF PEOPLE IN A ROOM TALKING ABOUT ABUSE, NEGLECT, AND UNDUE INFLUENCE AND HOW WE TACKLE THOSE ISSUES. LONG-TERM CARE AND THE NEEDS OF VULNERABLE POPULATIONS IS

AT THE HEART OF THE WORK THAT I'M DOING IN BOTH REALMS. WITH REGARD TO COMMUNICATION ACROSS GOVERNMENT, I AM EXCITED ABOUT THE OPPORTUNITY FOR THIS TECHNICAL ASSISTANCE AS A FORMALIZED WAY THAT WE CAN

COME TOGETHER. I DON'T KNOW THE RESULTS OF THIS APPLICATION YET. I THINK NO MATTER WHAT, IT HAS PUT US IN A REALLY EXCITING POSITION TO MOVE FORWARD NOW THAT WE HAVE BROUGHT TOGETHER PRIORITIES ACROSS

DIFFERENT DEPARTMENTS AND AGENCIES. I'M OPTIMISTIC THAT WE WILL HAVE MORE OPPORTUNITIES TO DO. THAT. CHAIR HENDERSON: OKAY. LET'S SAY WE DON'T GET THE FUNDING. >> YES. CHAIR HENDERSON: WHAT HAPPENS?

>> YES, WHICH IS OF COURSE, A DISTINCT POSSIBILITY. WE ARE WORKING WITH PARTNERS OF THE LONG-TERM CARE COALITION, PARTNERS OF THE NATIONAL COUNCIL ON AGING WHO BROUGHT THIS TO OUR ATTENTION IN THE

FIRST PLACE WHO HAVE OFFERED THEIR SUPPORT IN A MORE STRATEGIC AND TECHNICAL WAY MOVING FORWARD, NO MATTER WHAT HAPPENS WITH THIS. IF IT DOESN'T MOVE FORWARD, WE ARE PLANNING FOR WHAT THAT LOOKS LIKE.

CHAIR HENDERSON: OKAY. THERE WAS A WITNESS WHO TESTIFIED AROUND NEEDING TO INFUSE-- OR NOT INFUSE BUT RATHER, THE OPPORTUNITY FOR HEALTH AND DEVELOPMENT AND LONG-TERM CARE TO BE INFUSED INTO THE

COMPREHENSIVE PLAN. HAVE YOU BEEN HAVING CONVERSATIONS WITH THE OFFICE OF PLANNING ABOUT HOW TO MOVE THAT FORWARD? I HAVE, YES. THANK YOU. YES. WE HAVE TO BE WORKING WITHIN OUR PLANS. PART OF THE

MISSION OF AGE-FRIENDLY OR PART OF THE WAY THAT WE ATTACK THE WORK IS MAKING SURE THAT AGING IN OLDER ADULTS ARE PART OF EVERY ACTIVITY AND PLAN. THERE ARE A LOT OF PLANS AND A LOT OF ACTIVITIES. SO

THAT IS A TALL ORDER. BUT CERTAINLY THOSE CONVERSATIONS ARE ONGOING WITH THE OFFICE OF PLANNING AND THERE IS, I THINK, A WONDERFUL PARTNERSHIP BECAUSE WE BOTH-- WE ALL SEE THE NEED FOR PLANNING AND

WORKING TOGETHER WITHIN THIS LARGER STRUCTURE. I WOULD ALSO SAY AND TAKE ADVANTAGE OF THE QUESTION TO SAY THAT I AM A BIG PROPONENT AND VERY OPTIMISTIC ABOUT THE OPPORTUNITY FOR A MULTI-SECTOR PLAN ON

AGING IN THE FUTURE. TO TAKE THE SORT OF VISION AND MISSION AND MULTI-SECTOR APPROACH THAT WE HAVE WITH AGE-FRIENDLY AND TO TAKE THAT IN A MORE CONCRETE WORK PLAN AND WITH A TEN-YEAR OUTLOOK TO MOVE

FORWARD. I THINK THAT WOULD GIVE US A REALLY EXCITING OPPORTUNITY TO BRING LONG-TERM CARE AND AGING AND SOME OF THESE LARGER PLANS INTO MORE CONCRETE STEPS FORWARD. CHAIR HENDERSON: YEAH. I MEAN, I

THINK THAT IS REALLY WHAT WE ARE LOOKING FOR. RIGHT? WE HAVE LOTS OF PLANS. WE HAVE PLANS ON THE SHELF. DO WE ACTUALLY SEE IT FROM AN IMPLEMENTATION STANDPOINT? THERE ARE OTHER STATES THAT HAVE A

MASTER PLAN TO COORDINATE AGING WORK ACROSS HOUSING, HEALTH, AND LONG-TERM CARE, TRANSPORTATION, COMMUNITY SERVICES, ET CETERA. AND IT SOUNDS LIKE YOU ARE POTENTIALLY MOVING IN THAT DIRECTION. I WOULD

VERY MUCH LIKE TO TAKE AGE-FRIENDLY'S CURRENT STRATEGIC PLAN AND MOVING FORWARD, THE OPPORTUNITY TO HAVE A MULTI-SECTOR PLAN ON AGING IS VERY EXCITING. MARYLAND JUST LAUNCHED THEIRS VERY RECENTLY.

CHAIR HENDERSON: YES. >> LONGEVITY READY MARYLAND. CHAIR HENDERSON: WHEN DOES THE CURRENT PLAN RUN TO? THE END OF 2028. CHAIR HENDERSON: OKAY. OKAY. WHAT INPUT, IF ANY, DID AGE-FRIENDLY PLAY IN

DEVELOPING THE DISTRICT'S 2025-2027 PLAN? I'M NOT SURE. CHAIR HENDERSON: I THINK THERE IS WORK NOW HAPPENING ON THE 2027 AND 2029 PLAN ARE. YOU ENGAGED IN THAT CONVERSATION? I AM. CHAIR HENDERSON:

OKAY, GREAT. ALL RIGHT. I THINK ALSO-- I DON'T KNOW HOW THIS FITS IN YOUR WHEEL HOUSE. WE HAVE TO TALK ABOUT THE FUNDING AND THE FINANCE PIECE OF THINGS. I JUST HAVE TO FIGURE OUT HOW DO WE MOVE

FORWARD ON THIS. THAT PART OF THE ADEQUACY STUDY WAS SORT OF AN IMMEDIATE THOUGHT THAT I HAD. I KNOW WE DO THIS IN OTHER SECTORS WHERE THERE IS PREDICTABLE AND CONSISTENT REVIEW OF COSTS. AND A

DETERMINATION OF WHAT-- HOW MUCH, HOW MUCH SHOULD WE BE PAYING? AND WHILE, AGAIN, WE DON'T ALWAYS FUND DIRECTLY TO THE ADEQUACY STUDIES THAT WE DO IN EDUCATION FIELDS AND OTHERS, IT IS VERY UNNERVING

THAT WE CAN GO YEARS ON END WITHOUT MAKING ANY CHANGES IN THE LONG-TERM CARE SPACE, AND WE ARE JUST TELLING PROVIDERS TO GO ON HOPE AND MISSION. BUT HOPE AND MISSION DOES NOT HELP PAY LEASES. IT DOES

NOT KEEP THE LIGHTS ON. IT DOESN'T PROVIDE THE MEALS. IT CERTAINLY ISN'T PAYING FOR THE STAFF. I THINK SOMEONE TALKED ABOUT STAFFING REPRESENTS 60% OF THEIR COSTS, AND IN AN AREA WHERE EVERYBODY IS

COMPETING FOR TALENT, PARTICULARLY IN THIS AREA, FOR NURSING HOMES, SKILLED NURSING FACILITIES, LONG-TERM CARE FACILITIES, ET CETERA, THEY CAN'T COMPETE WITH THE HOSPITALS. BECAUSE WE NEVER CHANGE THE

REIMBURSEMENT. BUT THEN WE ASK THEM TO CONTINUE TO TAKE ON PEOPLE OUT OF THE GOODNESS OF THEIR HEART. THEY ARE BUSINESSES. RIGHT? THEY ARE NOT MAKING BILLIONS OF DOLLARS. BUT AT THE END OF THE DAY,

THEY STILL HAVE TO PAY THEIR BILLS. SO THAT IS SOMETHING WE HAVE TO TALK ABOUT AND WOULD LOVE THIS POSITION, YOUR POSITION AND SUPPORT IN SORT OF COORDINATING THESE FOLKS, DETERMINING WHO SHOULD BE AT

THE TABLE IN TERMS OF HOW WE MOVE FORWARD. SOMETIMES I THINK YOU ARE RIGHT, LOTS OF SILOS GOING ON IN A VARIETY OF DIFFERENT WAYS. THE MOST RECENT EXAMPLE, THE HOUSING COMMITTEE AT THE COUNCIL

RECEIVED A CONTRACT FROM DHCD ABOUT SOMETHING WITH REGARD TO AN ASSISTED LIVING FACILITY. LUCKILY OUR COMMITTEE ON HOUSING REACHED OUT TO US ON THE COMMITTEE ON HEALTH. IT TURNS OUT DHCD NEVER HAD A

CONVERSATION WITH HEALTH CARE FINANCE, AND IT'S LIKE, WE GOT TO TALK TO EACH OTHER BECAUSE YOU KNOW, THIS FACILITY IS ALLEGING THAT THEY ARE HAVING SOME ISSUES IN TERMS OF MEDICAID PAYMENTS. THE

HEALTH CARE FINANCE HAS NEVER HEARD FROM THEM. WE ARE ABOUT TO GIVE THEM MILLIONS OF DOLLARS OF THE DISTRICT'S MONEY, AND WE HAVE NO IDEA ABOUT THE FINANCIAL STABILITY OF THE WORK ALTOGETHER. WE HAVE

TO TALK. AND SO I THINK THAT MAKES THESE ISSUES MUCH MORE COMPLEX AS WELL. BUT I LOOK FORWARD TO WORKING WITH YOU. I LOOK FORWARD TO CHECKING IN ON THIS ISSUE. IT IS NOT GOING AWAY. IT IS NOT GOING

AWAY. WE JUST HAVE MORE AND MORE PEOPLE WHO ARE NEEDING THESE LEVELS OF SERVICES. SO THANK YOU. THANK YOU FOR BEING HERE. >> THANK YOU. CHAIR HENDERSON: I JUST WANT TO ASK ONE THING, THOUGH. YOUR

TESTIMONY, OBVIOUSLY, YOU HAVE PREPARED TESTIMONY AND THINGS LIKE. THAT WAS THERE ANYTHING YOU HEARD TODAY THAT SURPRISED YOU? >> I WON'T SAY THAT-- I WASN'T SURPRISED. I LEARNED SOME NEW THINGS. IT

IS A DIFFICULT, DIFFICULT POSITION THAT EVERY PART OF THIS SECTOR IS IN RIGHT NOW. PEOPLE ARE FACING A LOT OF CHALLENGES. I WORKED IN MENTAL HEALTH IN A PSYCHIATRIC HOSPITAL FOR A NUMBER OF YEARS. I

GOT TO SEE FIRSTHAND A LOT OF THE STRUGGLES. I HAVE WORKED IN THE COMMUNITY. I WISH, I WISH I WERE SURPRISED BY MORE OF IT. IT'S JUST THERE ARE SO MANY BRILLIANT, CARING, WONDERFUL PEOPLE WHO ARE SO

DEDICATED TO THIS. I THINK HAVING THESE CONVERSATIONS AND BEING ABLE TO THINK ABOUT SOLUTIONS TOGETHER IS A STEP FORWARD. CHAIR HENDERSON: ALL RIGHT. AND ON THAT, I THINK WE ARE GOING TO WRAP UP FOR

TODAY. I WANT TO THANK YOU. I WANT TO THANK ALL OF OUR WITNESSES WHO PROVIDED TESTIMONY AND THOUGHTFUL RECOMMENDATIONS. I THINK TODAY'S DISCUSSION DEFINITELY MADE CLEAR OR UNDERSCORED, RATHER, THAT

THE DISTRICT'S LONG-TERM CARE AND BEHAVIORAL HEALTH CARE SYSTEMS ARE ALL TOO OFTEN FRAGMENTED. RESIDENTS WITH OVERLAPPING NEEDS ARE TOO OFTEN DENIED APPROPRIATE PLACEMENTS AND REMAIN IN INSTITUTIONAL

SETTINGS LONGER THAN NECESSARY. OR EVERYBODY HOSPITAL SETTINGS LONGER THAN NECESSARY. WE DEFINITELY HEARD SOME IMPORTANT CONCERNS ABOUT CAPACITY DECLINING AT OUR COMMUNITY RESIDENTIAL FACILITIES. WE

NEED TO ADDRESS THAT. I KNOW THAT WE HAVE A SIMILAR ISSUE AT OUR RESIDENTIAL SUD FACILITIES. WE NEED TO ADDRESS THAT AS WELL. THE COMMITTEE WILL CONTINUE TO EXAMINE HOW TO REIMBURSEMENT AS WELL AS

WORKFORCE CAPACITY CHALLENGES. WE HAVE SOME WORK TO DO AROUND REGULATION WHICH I THINK SOME OF THE AGENCIES RESPONSIBLE FOR THAT KNOW, PARTICULARLY AROUND ASSISTED LIVING FACILITIES AND MEMORY CARE,

IN PARTICULAR. HOPEFULLY, WE CAN DO SOME CHECK-INS ON THIS BEHAVIORAL HEALTH ADD-ON. I THINK SOME OF THE REGS AROUND THAT, THEY MAKE SENSE, BUT THEY DON'T OPERATE LOGICALLY IN TERMS OF THE CARE THAT

WE ARE TRYING TO PROVIDE TO FOLKS. OUR OVERALL GOAL IS TO PROVIDE A CONTINUUM THAT OFFERS SAFE AND SUSTAINABLE AND APPROPRIATE CARE IN THE LEAST RESTRICTIVE SETTING POSSIBLE. AND I THINK ONE OF THE

QUOTES THEY WROTE DOWN FROM SISTER MOLLY WAS "WE CANNOT CREATE LEVELS OF CARE THAT DO NOT EXIST." RIGHT? AND SO WE HAVE SOME WORK TO DO. THE RECORD WILL REMAIN OPEN UNTIL OCTOBER 29, 2026. I WILL

ACCEPT WRITTEN TESTIMONY ON THE COUNCIL'S HEARING MANAGEMENT SYSTEM SITE. I KNOW SOME PEOPLE HAD SOME EMERGENCIES WHO COULDN'T JOIN US TODAY. WE WILL LOOK FORWARD TO THEIR WRITTEN TESTIMONY. PLEASE

SUBMIT IT AT DCCOUNCIL.GOV. THE NEXT HEARING FOR THE COMMITTEE ON HEALTH WILL BE A JOINT OVERSIGHT ROUNDTABLE WITH THE COMMITTEE ON HOW MAN SERVICES-- HUMAN SERVICES. ON THURSDAY, OCTOBER 29, 2026. IT

IS ON THE D.C. ACCESS SYSTEM. BUT REALLY FOCUSING ON THE IMPLEMENTATION OF THE NEW FEDERAL WORK REQUIREMENTS FOR MEDICAID AND SNAP. THE TIME IS 4:50, P.M., AND THIS ROUNDTABLE IS ADJOURNED. AGAIN,

THANK YOU, EVERYONE, FOR YOUR PARTICIPATION.