Montt House Human Services Committee on Thursday, April 2nd for our committee meeting and for the next two hours we're going to be focusing on the COVID-19 response and updates as well as issues in the short term immediately and in the short term from the Department of Disability Aging and Independent Living. And Commissioner Hut, we have you first on the list. Yes, hi. Good afternoon, everybody. It's nice to see everybody's face. So what I prepared was a pretty global overview of everything that the Department is doing, and I think if I walk through that, it might be helpful and then, but it stays pretty high level. So then if there are specific questions, I assume people will just ask those as they come up or at the end, however you'd like me to handle that. I think that for you to go ahead right now, I've asked people to hold their questions until you finish partly because I can't see everyone to figure that out. Okay, so let me just start then. And again, apologies if I miss big areas. Feel free to to cue me as we're going through or at the end. So just to consider Dale globally as a department, we do have obviously number of roles and responsibilities related to older Vermonters and Vermonters with disabilities. And we know that from a COVID-19 perspective, those two populations, older Vermonters and Vermonters with disabilities with underlying health conditions, are the ones that are most at risk for negative outcomes should they contract the COVID-19 virus. So the the agenda asked me specifically to speak to long term care. But I would just say that long term care for us is both facility based and community based. You know, all the work that we've done across the state of Vermont over the last 25 or 30 years has been to push our long term care system into community. So I think it's just really important first that people realize that when I talk about long term care, there is facility based long term care. But there's also long term care that's happening across the state through many different partnerships with many different provider groups. So I just want to be really clear that I toggle back and forth when I talk about that. And I'll try to be specific, but I want you all to hold both in your minds because they are equally important, especially as we consider our main goal, which is to try to keep people stable in community to avoid either the need for hospital placement or the push for hospital placement, not only because we need to maintain that capacity at hospitals, but because we know that hospitals for some of our more vulnerable reminders aren't necessarily going to be the easiest place to get their needs met for them to understand what's happening or for providers there to comprehend and support their really unique and complex needs. So there's a lot of reasons why this is so important, but it is really important. So just thinking about the big populations and the big kind of buckets that I look at, I look at our designated agencies and specialized service agencies who support a DS population, as you all know, but also who serve our choices for care population in terms of adult family care provision. And of course SLPs and shared living providers and developmental services. So that's a residential component of support that oftentimes people are not thinking about when they're thinking about long-term care. We also have TBI services that are provided through the designated agency and specialized service agency system. We have TBI standalone providers. We have our home health agencies who are supporting choices for care, high tech for adults through the Dale bucket or through the Dale column. Our area agencies on aging, so home delivered meals to older Vermonters, case management and choices for care, resource and referral, a lot of work on the senior health lines right now across the state of Vermont, and all of the older Americans Act services. And just as a connected to that is the work that's happening through the Vermont Center for Independent Living and home delivered meals for Vermonters with disabilities. That's a whole nother component. It tends to be a small component in normal times. In this time it's a burgeoning issue for all of us. Our adult day programs, although they are currently closed, we have got adult day providers that are still trying to support people across the state and trying to figure out how to do that in people's homes is at all possible. And so that's another component and service provider. And then we have all of our long-term care residential providers that we think of more traditionally and typically. So our nursing homes, residential care homes, therapeutic community residences, assisted living, there's a lot to what I perceive to be the scope of Dale. And it's a lot to hold and to pay attention to. So I wanted to make that you all had that as a committee. I know you know all those pieces distinctly, but as you're thinking about this particular response to know how they all sort of connect in. So let me just keep moving through. So we've worked hard to establish regular communication venues and options for all of those different populations. We're working and communicating with the designated agency executive directors on a weekly basis with the DS directors within those designated and specialized services agencies on a regular weekly basis. I talk with the AAAs or somebody from my staff does three times a week, early morning times. We've had phone calls with the Silk, the statewide independent living council, and with home health fairly regularly. So trying to just stay connected to each of those provider groups on the ground in the in the moment to hear immediate issues to try to address them as quickly as possible and to be responsive and available. I think that some of the biggest areas that we are seeing as a department kind of the big buckets of concern. It's really you know kind of workforce workforce workforce right now which is not new but has taken on a lot more urgency in the middle of all of this. So making sure that both our residential care facilities and our community-based providers can maintain their workforce because as we as we said earlier that's the workforce that knows this population and we can substitute in or if we could identify people we could substitute in but but really those primary people that that folks know it's critical to keep them as available as possible and that becomes challenging and I'll talk about that a little bit later but for for a variety of reasons throughout this some some expected and some unexpected. Also working really hard to try to support our provider community and to keep them stable as they have to cut back or or deliver services in a different way and there's so much involved in that there are the immediate needs there's trying to understand what Congress is doing and honestly it's it's kind of every day something new and different multiple streams of support coming through Congress so I don't want to be at all unhappy or ungrateful for that but it is it's confusing and there's a lot and trying to understand how it will impact the state has been really challenging so trying to assess that congressional package as much as possible and understand what it will do and won't do trying to figure out you know the available state resources as as the commissioner of diva points out he started calling it green money so it's that money that we know that we have available to us versus the federal government talking about kind of printing dollars if they need them the state doesn't have that and as we are reducing some of the requirements on providers across the whole system so just as an example you know if we get to a place where we can ask providers or tell providers hey it's okay not to pay your provider tax right now that reduces the revenues that we have available so it's a whole kind of circle of trying to understand what's available at a state level and then the older americans act is a whole another piece of legislation coming from the federal government that we keep trying to get clarity about to understand how it will help where it will help what we can do to leverage that so that's another big bucket a third big bucket is just reducing the barriers to service provision for our providers so people are um providers are really stepping up and being as creative as they possibly can in terms of how they deliver services can we do it telephonically can we do it on a video chat what does that mean how is that meeting people's needs how can we twist that around because we are really encouraging and and there have been requirements to limit that face-to-face interaction but it doesn't mean that interaction doesn't need to happen and that people aren't still relying on some level of interaction and so figuring out how to eliminate any barriers that we may have created to all that creativity has been a huge body of work lots and lots of conversations over the last several weeks about essential versus non-essential services and honestly it continues to be a little bit of a moving target as this gets worse and starts to peak you know we may be even rethinking that but there's been a lot of a lot of requests from providers across the board to help them define what's essential and non-essential not only for the safety of the individual but for the safety of their staff and also to avoid the risk of staff being unwitting um vectors of transmission for this virus right so there are just so many components to that um and I will tuck in under that uh the need in both our non-trudy you know the the provider community like home health and the designated agencies and meals on wheels delivers deliveries um the the need for personal protective equipment but not only to have it but to understand how to use it because it's not just having it and we are not the experts in that but so really trying to work with the Department of Health to to get out guidance about how to put it on how to take it off when you could reuse it when you can't that has also been guidance from CDC that has changed on a very regular basis and so keeping up with that has been um a body of work and I don't I don't believe that we're doing that as well as I would like but we're continuing to do that um then I think just thinking about that residential system and the capacity in that system you know we need to pay attention to the fact that it's dependent on staffing and the staffing is impacted by a positive diagnosis in a facility or even in a shared living provider and then having to take that that um idea of any staff that were connected to that person and if they're at all symptomatic or ill they they are required to be out of work for a period of time to make sure that they're not positive um this is all related to whether or not there's the capacity to do testing with somebody that's asymptomatic which we don't have right now we're certainly trying to test and I think that there's an aggressive approach to testing capacity for people that are just demonstrating symptoms but asymptomatic has not been a priority for testing um and again we're hearing every day different um and updated information from the CDC about somebody who's asymptomatic who could in fact be positive and so this is such a moving target I feel like it's always hard for me to do this kind of testimony and this kind of an overview because I get overwhelmed even as I'm talking about it myself because the targets just keep shifting so what you do you can understand in one moment but that is that shifts everything changes and our providers are trying to keep up with that as well our guidance is trying to keep up with that but they're trying to keep up with it but the staffing impact I think is the thing that we're most worried about and then I just I think I mentioned already home delivery meals is such a critical service much more critical now even than it was before and it was always critical but the need and the required and the requests have increased and the complications around delivery have increased you know exponentially and at the same time it's trying to really support and address that with our area agencies on aging um just going back to the idea that the conversations that we have with our long-term care providers our residential providers and with our developmental services providers to date have continued to emphasize the idea that our first goal is to try to keep people in place we have to remember that when we're talking about long-term care facilities or shared living providers we're not talking about somebody in a in a bed that's transitory we're talking about people's homes so we're operating with this idea that the first line here is to try to keep people in their homes and cared for in their homes while they might be sick right and and hoping that that all of our clients fall into that 80 percent of people that are going to that are going to contract this virus and have only a mild case or mild symptoms where you want to be when you're ill is at home and so trying to really maintain that we're putting energy most of our energy and focus into how do we do that how can we support additional staffing if it's necessary how do we maintain what facilities need what providers need in terms of equipment and supplies to care for people in their own homes the second piece of that certainly is trying to figure out what happens when that can't occur when there is something that there's a level of staffing that's no longer safe or staff that can't provide that or or um a fear and anxiety response creates staff that that can't and won't be able to continue doing what they're having to what they need to do to keep people at home and so that's the constant conversation I know you've heard a lot about the state planning for a medical surge we are also trying to plan for what we call tier two I have no idea why it's called tier two I think it's a kind of a CDC thing based on level of care but recognizing that there will be people who need some level of support you know kind of an ADL level of support so think about our residential care providers across the state who might not be able to stay in place stay at home and might need some place to go to recover um we're we're trying to plan around that but it is a really challenging conversation you know we don't have a site at this point in time we're exploring different ideas but staffing that is the challenge because the issue that drives people into this probably is going to be staffing so to imagine that there's another body of staffing somewhere is is optimistic but that is what we're planning for right now I don't think that that that level is going to suffice if our nursing home level of care starts to collapse I think that that's a really different thing but again we've been working with nursing homes as has the Vermont Department of Health to to keep people in place even when there are outbreaks occurring and we know that that's happening um so um one of the areas that we've been trying to really support and enhance is our long-term care residential and kind of reaching out to them and so that includes nursing homes and residential care it also includes the group homes through our designated agency and specialized service agency system um and and there have been multiple calls there was one last week there's another one next week where we bring together our our division of licensing and protection and the vdh infection the epi team the the infection and prevention team from vdh to just answer collect questions and answer them directly so that we're getting people information as quickly as possible have another call like that scheduled on Tuesday those calls are well over 100 people 140 150 people every time and we're trying to keep them as ordered as possible but also get information out as readily as we can um Manika this is Anne as you're going through this um what and I'm just cognitive of the time it's you've been speaking for about 20 minutes um we need to I mean you're doing incredible amounts of work and we know that um I'm wondering when you're going to get to both people with disabilities and what um just I'm wondering how how you're doing in terms of what you're sharing I'm trying to get a sense of time so most of what I've been talking about is is um I guess I was talking about it at a high level and it in it sort of captures both older vermoners and if there are specific things that I'm not touching on please please let me know well okay um it's a little nerve-wracking to hear that you're preparing for for tier two and you have no site and no staffing so what are the what are the immediate needs right now um and how um it's one of the questions so I think again we have a team that's dedicated to that I've pulled staff from across the department to focus on that exclusively and they are certainly looking at different sites and trying to identify them um and really also cautious of the fact that we have to be cautious about communities and and and talking to communities about um about that before we take any massive steps and that's also something that we're doing as part of the work with the state emergency operation center so it's not happening just it's not just Dale trying to figure that out that's happening under the rubric of the state emergency operation center because they have the resources to assist us to do that so that you know we that just started on Friday that particular body of work and what day are we on Thursday right now so I think it is moving along really quickly we started it by reaching out to every single residential care provider nursing home group home to get a sense of what their needs are because this is hard to plan if you don't really know what you're planning for so assessing their staffing capacity right now on a good day staffing capacity on a bad day um number of people in the facility their capacity to isolate and treat somebody that might become ill um and then what their needs are for for protective equipment so we're that body of work has come together um and we gathered that information we met this morning with Vermont Department of Health because they're deploying or redeploying their public health nurses to assist with the kind of response to residential facilities so I feel like that work is moving forward I didn't mean to be unnerving I was just more giving you kind of a timing of where we're at okay that's and I'm going to have to stop you right now and we will come back we have questions but max has to leave by 1245 and so I'd like to hear from him as the representative of individuals with disabilities yes thank you so um for those who don't know me I'm Max Barrows and uh thank you so much for reaching out to me uh to testify and we want to thank each of you for working so hard uh to do what is best for Vermont and I hope you and your families are doing okay um I work for Green Mountain Self-Advocates uh we are a disability rights organization with more than 600 members I'm a person with autism and I received developmental services I receive services to help me with my job so you are you want to know what how my services are going my services have changed due to the COVID-19 outbreak instead of going to my office I'm working from home uh the support I get from an assistant who works with me is done virtually through video on my computer having autism uh plays a role in how I understand and cope with changes dealing with the COVID-19 outbreak has been an adjustment for me uh in that regard uh people with autism take things uh literally an example of that is that I had to clarify with people that the stay at home order does not mean you literally have to stay inside uh your home their home I had to let folks know uh that if they are not sick that they can still go outside for as long as they want to they just need to make sure to stay six feet apart from others people with disabilities are worried about uh that the police would arrest them if they went outside and the reason for this is because in some parts of the country law enforcement are being used as part of a restricting part of restricting people from going places and staying outside of their houses too long during this time of uncertainty green mountain sub advocates uh we've been uh have been responding to uh this by doing the following we have created plain language documents on what is coronavirus tips for working with support staff during the COVID-19 outbreak and plain language glossary on words to know about the coronavirus for 25 years gmsa has been supporting 23 pure support groups across the state on march 17th we started having zoom meetings three times a week geared for people with intellectual and developmental disabilities these meetings are a mix of presenting information and giving lots of time for people to check in also people come up with topics they want to discuss for the next time we have had up to 70 people on these video chats and at night our staff uses facebook to video chat uh with up to eight people at a time in general we want to thank the developmental service providers for all they are doing to support us most of most most are doing all they can the problem is the changes are drastic and people with developmental disabilities are having a hard time understanding what is going on yesterday afternoon uh dale put out guide guidance for agencies providing developmental services to be honest we are still trying to understand what it says and here are our concerns this does not seem to be the time for guidance dale needs to put out rules about how services will be provided and when we do not agree with dale allowing each agency coming up with their own plan when self advocates are on our zoom meetings we hear how things are different for example one agency is calling each person every day whereas another agency has instructed some people to email their case manager if they need help number two once there is a set of basic rules there needs to be one primary communication strategy some agencies are sending letters some are posting on their websites yes it is a good idea to reach out in a variety of ways but there should be one primary place to find the rules number three the information from dale needs to be in plain language this is an ongoing issue we have been asking about for years here is what we are worried about a we are alarmed when uh we read in the new york times that alabama in washington state put in writing that people within uh severe intellectual disabilities should not be given medical equipment like ventilators if supplies are limited we understand that at times doctors have to uh to uh uh doctors have to uh make decisions that many people uh you know have to be treated and not enough equipment uh or personnel is uh but we want the state to clarify uh to clearly say uh that decisions about who gets help should not be based on age or disability status that is discrimination be uh we are hearing that hospitals in some places are not allowing families to uh to be with sick loved ones please do what you can to allow people with intellectual disabilities to have family or a support person be with them when hospitalized if someone is deaf a hospital provides an interpreter we may need someone to with us to understand what is going on uh with our health this is an accommodation just like an interpreter is for someone who is deaf one parent slash guardian told us if their adult child with the disability gets sick they are not seeking medical treatment because they do not want the person to die alone as far as we know as far we know um the person with with the disability was not told about this idea see at our board meeting on monday uh four out of seventeen self-advocates said they wish their agency was checking in with them more often again we have heard that uh many agencies are checking in on people every day there needs to be an individual plan made with the person it should include dale's basic rules it should be in writing some agencies have done this it also needs to include what will happen if the person gets sick or somebody they live with gets sick if it is in writing a person can get help reviewing it often so they truly know what is going on with their services d we are worried about people who get services who live alone we ordered a thermometer for someone yesterday they thought they had a fever and they couldn't check because they didn't own a thermometer e another issue is that um agencies should be uh should not be just relying on a person to call or text or email them the agency needs to also initiate the contact on and agreed upon schedule we need another person uh do a three-way call with the doctor with their doctor we when we asked them why we didn't email their case manager the person said quote he is home with his kids and i don't want to bother him to keep us safe we need we can't rely we can't rely on a person with a disability to be the one to call letter f the department of health is testing health care workers they should also test home providers and staff we should also be a top priority to get masks and gloves and other protective supplies g before the coronavirus outbreak gmsa clearly said that a person with a disability should not be paying their parents to take care of them but now during this crisis if an agency does not send staff to help and a parent has to quit their job to take care of their son or daughter then now under these circumstances the state should reimburse the family for the money they are losing in wages because one of the parents had to quit their job the money in their waiver should not should be used should be used to cover the lost wages this is not an option after the coronavirus uh this is not an option after uh the coronavirus crisis and h we are worried about uh losing staff turnover is already a problem we understand that you probably cannot do everything about an agency's personal policy the personnel policies however we think that staff should be able to use sick time during this crisis it seems unfair to us to uh that that some agencies are not allowed uh of not allowing staff to use sick time to make up for missed hours thank you again for asking me to testify um during this time uh the disability community needs the Vermont legislature to be proactive the state of Vermont is doing a great job protecting our most vulnerable citizens we ask that you continue to have our backs during this crisis thank you very much max thank you very much um and do you have that in writing i do did um have you already sent that to us uh not sure at the moment but um i have it and i will make sure it's sent okay thank you very much max i appreciate it and we do have um we have a question um from Teresa representative wood all right go ahead thank thank you thank you max for being here um i i just want to um i just want to i guess maybe double check on a couple of things so it's it sounds like um green mountain self advocates is continuing to provide a significant amount of peer support um through its networks and and using meetings and things like that is that accurate yeah i mean a lot of people um at our meetings have been giving us uh feedback about how things are going for them uh during this crisis so everything that we are giving you is coming from the voices of people that come to our board meetings and also um the communication we've been doing throughout the state with our members through uh meetings uh via uh zoom um so then that my follow-up to that is it it sounds like that that has um actually significantly picked up in terms of volume you know in terms of the amount of support that you are um that people are requesting but also that that green mountain self advocates is providing and uh i'm just wondering um if it's possible for you to to track any additional expenses that you might have as as our uh other agencies and providers and uh if you're able to track track those uh at some point in time uh it would be um helpful i think to make sure that uh dale has a copy of that as well uh in terms of thinking about what the future lies and your ability to continue to provide that higher level of peer support to people okay all right all right thank you very much we'll look into that thank you are there other questions for um max max thank you very much really appreciate um the clarity of your uh testimony as well as the outlining of the various help and support and perhaps changes in either agency policy or hospital policy those kinds of things um so be very helpful to have that uh in writing um as i was trying to write them all down i might not have gotten them all in so thank you very much max all right thank you very much for the time okay bye bye bye manaka i don't think you've got a chance to finish sorry i keep muting and unmuting um i didn't but i i don't know if there are well the only piece that i didn't really cover in what i had prepared to talk about was just the financial work that we're trying to do right now um so i can cover that and then move back through either questions or the rest of the witnesses so um i think we we do have a question and when you go i mean let me ask is the financial work that you're going through was you've asked all the agencies to to create something um and give feedback no there were there's a there was a that was phase two for the designated and specialized service agency phase one was to develop some strategies to stabilize them immediately which happened within um a couple of days really of this all starting to unfold so at this moment oh i'm sorry no sorry this is it's hard to manage i know there are two um two people um have questions so hold that thought because the questions that people have may in fact be around something you've already said or whatever and the first um is uh representative wood teresa and the second is represented from stead jessica thank you madam chair um commissioner um you talked about wanting or planning for in sort of the next phase of this of of uh standing up a recovery facility of some sort and and still looking at um you know where that might be and and even how that might be staffed dr levine um you know talks uh every day about the modeling that they are doing i'm just wondering have they provided any assistance to dale in modeling how this might impact the particular population that um dale has overall responsibility for so that you have some idea about uh you know maybe worst-case scenario in terms of the numbers um that you'd be looking at for such a facility and then um the the second thing is um which i guess you alluded to i was going to ask you about um the financial assistance that's being provided to designated specialized service agencies and the other um providers that um dale contracts with both in the near term and then looking at the long term because as you i'm sure are aware we're continuing to get um emails from a variety of providers outlining um you know their significant additional costs that they are anticipating and incurring at this time so um and if you were going to go through that then just leave that for that but if you wouldn't mind talking about the the modeling yeah so the modeling that's starting to happen now or is i think actually there are probably going to be some conversations this week about it the modeling is um is across the entire state of Vermont in terms of what what what the anticipation is for infection and certainly more even more specifically about the necessary um components of hospital care that will have to be matched against the rate of infection so kind of what what do we imagine is going to happen in terms of people testing positive what do we imagine the needs are going to be across um hospital settings for personnel and equipment and beds in those arenas i think it trickles down into some of the conversations that we're talking about in terms of our own planning um but as i said we're also working on that ourselves and we'll and we'll have a better sense of what the need is across the residential care community and then are working directly with the ds directors to consider what's happening in their own communities in their own in their own agencies what they're looking at in terms of stabilizing shared living providers and and families and individuals by community so the modeling that we're talking about is really more global across the state of Vermont and remember that the biggest risk to to everybody or the biggest risk of this virus is really very specific to our population and so i look at that modeling and i think about it as as ours um almost collectively so you'll be able to get help with that for sure but we're also doing some of our own work to try to pull that together and to think about it with both of those in mind so so do you have only be more specific do you have an estimated number of individuals that you think may require an alternative living situation that that will not be able to um stay in place i i don't have that number today but that's what we're trying to to okay and center and when do you think you'll have that number i don't know that i'm going to ever have that number absolutely because i think that that's going to shift and change day by day depending on what's happening in the community it really depends on where you see any kind of an outbreak and what the severity is of the needs i think that the again the planning that we're really trying to focus on is how do we support providers to continue providing services what will it take there this the idea of a surge is something far beyond and and when when that kind of provider system collapses so the focus today has been trying to stabilize the provider system as much as we can because that's where your best care is going to be delivered um in the world of um child care in terms of um supporting the provider um providers are getting um money from the state whether or not there's someone there um so how are what kind of financial um support are you giving the providers right now so when we're talking about the designated agencies and the specialized service agencies so developmental services specifically what we did immediately or fairly quickly was to to basically articulate that the same um billing that they were accustomed to to receiving the same payment that they were receiving was just going to stabilize through this time so even though we know service delivery was going to be changing even though we knew that some services were not going to be able to be delivered we're stabilizing the providers by actually continuing their regular billing rates and continuing to push those out to them so they should be experiencing some predictability and some level of relief because of that that has stabilized that's the phase one that I talked about phase two is a consideration of all of those additional expenses on top so what are the costs that you're incurring because of this crisis that are on top of normal billing um normal expenses and then that's going to that's something that we're collecting now that level and trying to figure out how we can support that and that's happening between Dale and DMH because of course most of our providers support both populations so that's the phase two conversation that I was happening but for for right now although I'm sure you know agencies are feeling um under pressure they should feel stabilized in terms of the developmental services side of the house and in my conversations with them that is what we're hearing is that that's been helpful and that that has enabled them to continue to think about how to be creative about service delivery knowing that there is that stability in place another whole component of that that we are working on right now is is there additional support that we can provide to families because there's a lot of families that are picking up the slack around this especially as service providers can't come into their home or people can't leave home or shouldn't be leaving home so that's a package that we're trying to pull together right now I can't talk really specifically about that because I'm still getting some fiscal approval around that but we're trying to develop a package that will offer some direct supports to families and even to shared living providers some of those within the budgets that they have and some in addition to so that's I'm sorry Monica you're you're talking a bit I'm needing some more crisp and perhaps some maybe in regards to max max's uh request one of which is to when a provider because providers the aids what the case aids the people who are working with people with developmental disabilities and others who are going into their home who are being aids who are no longer going because they're sick or they're for various reasons so instead the family member is needing to take care we're needing needing to be at home and do the care that they hear too forward not have been able to max said okay pay family members that's not been something that the state has done before if we wanted to do that is that a legislative change or is that a rule change on your part it's it's something that we can do with an amendment to our waiver and we we are exploring that in addition to some other ways of of doing that without without necessarily shifting all the way to paying parents because then that becomes a a tax issue it becomes kind of a daily rate kind of an issue which we are trying to address that need with the package that we're developing right now I recognize that it's a need I'm totally hearing and who are you developing the package with that is a legislator uh no one okay noted um there is an appropriations committee and the human services health care health and welfare um this is not a time for the administration to to I mean we need to keep our communication clear and together so that you don't come to us with something that we're totally surprised at we've been working really well together let's continue to do that um we've got two more questions um Jessica hi thank you thank you and then and then Mary Beth thank you commissioner hot for being with us I've seen you on the press conferences and I can only imagine how busy you are I um my question is a question that max posed when he um testified about the guidance on consistency among agencies and consistency among commute on communication in particular seemed sort of something that is um that we should be able to do so I'm kind of curious what's happening with that right so we certainly have there's been a lot of guidance out to agencies um in terms of how kind of best practice and also the precautions that they need to take so I think that we have issued guidance about what we think is best practice in terms of staying connected level of contact um and and we can certainly um I didn't necessarily know that the conversation was going to be so specific to this so my apologies for that I can get more information from Selena the dvst director about what's what's happening there but I will be honest and say we've issued guidance and best practice direction but we've also asked our agencies to absorb that and to do what they can to follow that so it's not rules at this moment in time you know every provider is under an enormous amount of pressure right now to maintain what they're doing and I don't know um that issuing a set of rules that then we would need to somehow figure out how to police is the best way to support this entire system to rally around and do what needs to be done it it does create a lot of um quick decision making it may create times when we're working on things and aren't including all of the right people that need to be included there's a lot happening um so I think I can certainly bring back I wrote down everything that max said bring it back to our ds director directors and to our executives to share with them back what the angst and the concerns are and we can talk about if there's a way to make sure that there are standards that are in place in terms of contact you know we did just issue guidance I know that Selena did that talked about level of contact that should happen with each individual and I think that what agencies are also doing is really prioritizing people that are living on their own um and that have fewer sort of family supports as well to make sure that we're not losing sight of that um so I I can certainly talk about that um and if we feel collectively as a system like setting a rule is the right way to go I think we can explore that but I to be really candid I I kind of hesitate to start there because I think if we put people in a position where they can't follow a rule you know and is that I think that what max said that was really salient to me was this idea of an individual plan I think that agencies need to understand what each individual person needs and to figure out how to do that so daily contact with everybody isn't what everybody needs or wants so I think what agencies are doing at this moment really is trying to go individual by individual understand what they need understand what their options are what the supports are and then to fill in those blanks as much as possible so I think that that's really the the better direction than here's a specific rule about a specific level of contact right um and um a commissioner what I also realize um is that you are talking about private non-profit agencies you are not talking about state government so they all they they're it's they not only do we have individual need and the being individually responsive but also the fact that these are separate organizations that that is certainly true across our entire provider community we're not talking about anybody that we direct um but I I just want to say I I I think that our provider system is doing a pretty extraordinary job right now okay I just just add to that I would just say that I know that they're separate outside of government and you're you know trying to but I do think that everyone appreciates knowing what's going on around them not just talking about the disability folks I'm talking about the um agencies may not realize that oh this is working a lot better than this and so this would be maybe this is where we need to be you know oh absolutely and and as I said I was on an hour long call that went far longer than what I could stay on for just this week with all of the DS directors exactly to do that best practice sharing what are you doing how is it working how are you making that work what what should be different I think that their desire to do what's right is is incredible um and and are are there going to be slips absolutely across state government and across the provider community but I don't think anybody's coming at this other than with the intent to do the best that we possibly can while maintaining health and safety and security for everybody thank you um Monica we have um one more question and then I apologize we have a whole boatload of people um so that we need to hear from and um so we'll probably circle back to you if not today but later Mary Beth thank you madam chair um I I really wanted to um really underline the issue that max brought up and we've spoken about this about um families in my community who have kids with serious disabilities like high disability levels and are really in crisis mode and and I guess I I really hear and I appreciate the value of trying to keep people in their provider locations whether they're living at home or whatever but I don't I don't understand I guess why we can't we're in an emergency mode we're in a state of emergency and I don't understand why we are not flipping into kind of these temporary um resolutions for people based on what they're asking for and their needs I know we're trying to create systems but I feel like we're in a place right now where that's really not practical um so you know the issue about paying parents to take care of their kids when they can't work I mean my I know that's not a best practice and not a road we want to go down but I feel like right now that may be what people need in the in the short term so I just really want to encourage short term differentiated solutions that will keep people in their houses um so that we don't have to go to this surge issue where people have to leave their homes and I'm just hearing from and you you know the situations I'm talking about I'm hearing from a lot of people who are in deep crisis and and the DA's feel like you know they're they're trying to be responsive and helpful but they don't have the staff that can handle the level of disability that that they're you know that they have so that's that's kind of that's more of a comment my my other question and definitely you know I know you're you're working hard I can't even imagine being in your shoes honestly um the other issue is I'm just wondering there's been this this concern raised about unemployment insurance potentially offering people more compensation than um you know if they weren't on unemployment and I'm wondering if you're seeing any of that relative to your staff pool because I'm really concerned about that we don't want to lose those essential people it's a great question I can't say that I have seen it across my staffing pool or across the pools for the providers I think that you've got a couple of multiple representatives from provider groups here that can probably speak to it I'm certainly a little bit worried about it when I think about um frontline workers direct line workers I think about you know the the direct service workers at the designated agencies I think about our LNAs and the PCAs and nursing homes and residential care um I think it does probably equal more than what they might be making if they were working um and it was uh it's a well intended policy that I think could have um unexpected and unintended consequences but again I think for the most part people are um are hanging in so far that's what that's what I've heard mostly and and certainly are connecting with providers pretty frequently to check in about that so Monica thank you you actually have one more question um then committee I'm gonna say we have one two three four five people in one hour so um let's figure out how we're gonna do this but Monica Teresa has a question and I think if you're staying on the the call for for the rest of the time you will hear that people are very concerned about the last point that Marybeth brought up and um are hoping that as you are looking at phase two or three that you are considering um extra payments or things like that to these direct service workers who have not been making very much money to begin with but just ask you to put that in your box Teresa okay thank you madam chair um we've been talking about designated and specialized service agencies quite a bit in terms of and appreciate the the efforts that you've already taken to stabilize the financial situations for that group of providers there's a whole other group of providers the area agencies on aging the the adult day providers the um home health agencies and I'm sure I'm missing some but um are you doing similar things for for those groups of providers um and also thinking about um I'm just going to throw this in there uh you know home providers right now whether it's in the choices for care program or it's in the developmental services or tbi program for that matter um are now being faced with having people there 24 7 and um whether or not there's any consideration being made to being providing additional uh financial compensation to those individuals um you know through you know you know any kind of um uh estimates being done about what that might look like um so there was one other thing that I wanted to I forgot so I'll leave it at that for right this moment thank you yeah so um there were two questions in there so uh the provider community that kind of the healthcare provider community which is everybody that you just mentioned basically there is a process that's been created already through diva for people to apply for what they're calling like Medicaid retainer payments um so that would include the area agencies on aging it would include adult day um home health residential care providers to just articulate kind of what was what were their losses in the in a month thinking about April what are their additional expenses and there's a very sort of down and dirty application through diva and those are all going to be sorted through at an agency level which is incredibly helpful with representatives from each of the departments on those teams so that we can understand the scope of the need and and push funding out um to those agencies as quickly as we can there as I said the other portion of this is really trying to analyze what's coming in through the congressional stimulus packages through all of the cares act there's a tremendous amount of um information out there and trying to know what's available through those so that we're not duplicating and we can stretch the state dollar as much as as as possible um recognizing that even those revenues are being impacted by this so there's this kind of terrible catch 22 circle that's happening um in terms of home providers the the proposal that I um spoke to earlier does include a component of that for home providers I know that the designated agencies are also putting that on their um list of needs in terms of their phase two request there's a whole conversation with them about all of those additional expenses so we are really aware that I don't need to make it sound like we're sitting around looking at proposals and outlining options trust me it's it's happening really fast and it's happening you know 12 and 13 and 14 hours a day right now so that's that's we're absolutely at the top of my list to consider that to reason to think about it represent the public side that's okay thank you I just remembered the other thing I just feel like we're talking to you and we're in a public forum and we know that there has been one um death of a um uh an individual who received services via dale through uh Champlain Community Services um do we know of any other uh individuals are you tracking uh other individuals whether they are um self-applicates consumers people receiving services and or staff or home providers that have tested positive um as much as I get the information to me I'm tracking it I don't have a direct pipeline into diagnoses that are happening for individuals because that's still HIPAA protected but as guardians are finding out about it as agencies are finding out about it those are filtering up to me um it's happening less um it still seems to be centered in residential care facilities the positive diagnoses that I'm aware of but I cannot tell you that I'm tracking that certainly agencies are tracking that really closely for their own populations and letting dale know when that's occurring okay thank you sure and Monica you you thought that you were um able to go off but uh topper has a question for you Representative McFawn your hand is up I think you're muted Representative McFawn I don't have a question I'm sorry my hand was up I put it down because somebody else asked my question oh okay great um Monica thank you very much I know that you and your staff are working 24 hours a day on this um and we're just trying to wind our way through this and figure out what um is the best way to do it so thank you absolutely so I don't want to stay on I may close the video so I can grab some lunch but I'll stay on and listen okay that's all right that's important to take care of yourself yes um Mary Moulton yes good afternoon good good afternoon if you could introduce yourself to the record I will good good afternoon everyone thank you for having me I'm Mary Moulton and I'm the executive director at Washington County Mental Health Center where we serve people with mental health issues as well as developmental intellectual disabilities and autism and provides substance use treatment as well so I'm here to give you a bit of a picture and follow up to the comments that have already been made it let you know what it looks like on the ground from a designated agency standpoint and what we are doing right now and how we are also interfacing with the state on this which I'll get to toward the end um may I ask the chair uh 10 minutes could you give me a ballpark so I can watch my clock um I certainly will and um I'm just um committee and anyone who is listening um are watching us on YouTube um on the uh web page of the of um the house human services are your remarks and committee um is your preference to have uh the remarks up or on the screen for you to look at them or are you fine about listening without having them up I'd rather listen listening just listening is great yeah okay okay so um folks who want to pull it up um on the second device pull up the remarks thank you very much go ahead okay so um as we started this at the beginning of March um we realized that we needed to set up an incident command system because of it it's very overwhelming and um we speak to the amount of hours that go into the day the day just keeps going around 24 hours so um for us primarily what was most important is prevention and precaution information out to uh all of our staff and our clients and consumers as well as communication communication communication so for that that as I have referred with my colleagues across the state is what other designated agencies and specialized service agencies have been doing for washington county we have 30 sites we have uh six office buildings in that 30 rest our residential care group homes apartments staff departments um shared housing with peers crisis bed programs we have 28 staff departments and we have 122 home providers and you've been talking a lot about those this afternoon so um really wanting to communicate out uh the precautionary measures on COVID-19 um and we have a great director of nursing who's just been leading us communications once and twice a week and I communicate with my staff twice a week as well um supplies were another very very important factor uh making sure we had uh personal protective equipment making packet to get to all of our homes that I just mentioned getting those to outreach workers who were still doing face-to-face uh outreach and our emergency services teams so um we as uh monica was indicating you know needed to make sure that indeed we have personal protective equipment that um we could estimate would last through this episode and we are all struggling with that but at washington county we had a good amount of masks we added to that gowns goggles of course we have gloves and we did a video that went out to all of our residential homes uh around donning and doffing of that um of those of that equipment so that we enhance our procedures around infection control but we have a daily call and that we do ask and have since the beginning of march who has symptoms within our staff and amongst our clients and consumers what are what reports are we receiving if they've have symptoms can we get our folks who are staff in for tests and we've been very successful with that um and then we uh keep an ongoing um recording of that so that we look every day and double back to see what the results are and I'm happy to say that so far we have had 20 tests and 20 negatives we feel ourselves very very fortunate at this point in time we continue that daily report and this is where our team comes together across the agency uh for 30 minutes in the morning for a very concise phone call on um on symptoms on tests on supplies on communications um and uh other areas that of concern that are amongst our six different divisions between um mental health and developmental services so um having got that off the ground we then knew we had to reduce our footprint within our buildings and we've done that with the exception of our residential care facilities where of course we have to have direct service staff but we've even worked to do that a bit by taking out program directors that don't have to be there face to face and we move to telemedicine everywhere we could so that we maintain communication um I I have been a disaster responder for a long time and um I was moved by what Max said about family members not being able to communicate because when you go into isolation in the hospital that's it um you don't have that and I think it's a place where we could look to see how we get devices um into isolation uh within um institutions to try to have some of that communication it's been successful in other disaster settings and we haven't moved to that yet but we have gotten um devices as many as we can out into the community for our consumers and uh clients and we need more that is a definite need so we are tracking our supplies and equipment um lists as we've had to increase deep cleaning as we had to try to get more communication devices out we've moved from Washington County we didn't do a lot of telemedicine we're really you know the touchy feely agency so uh you know we do everything face to face but um we have changed and in one week's time uh moved from like 10 probably 10 hours a week of telemedicine with psychiatry to 60 000 minutes and I think last week uh this week we're at 144 000 minutes of tele um with um over a thousand uh contacts so we're we're doing the best we can to move that quickly and we have been um with our consumers and home provider situations that have had to go home um really been identifying individual needs uh as Representative Wood or one person was saying you have to do that it might not be every day but there are people that need every day contact and we're doing that we're actually tracking that so that um we are um as we move a workforce home and out of our office space so that we have accountability um just as I'm watching my clock here so as we moved through that quickly what we what we realized as program closures happened uh the programs we've had closed were two congregate uh type programs um day programs and a school and that was big and so our entire educational workforce our our bi's um that shifted and we we have been asked by the departments to hold on to our workforce as much as we can so um while they did phase one and we'll keep all your money in place we did do some layoffs um because we have people whose health is compromised uh and they can't work they shouldn't be in the workforce at all so we have a we have a small number of layoffs but other than that we've maintained our workforce and we went into redeployment mode um we set up a redeployment center we did a survey with all of our staff we had uh 450 respondents to our survey as to whether they would shift jobs work in a residential within their division whether it be children's ds or mental health whether they would work uh across divisions whether they would deliver groceries whether they would make meals um would they work emergency services which we also have succeeded in doing remotely in cases with the emergency room now and we still are going out with police in certain settings but otherwise we're working on remote with emergency so um we got very we had a very successful survey we now have a um we have had 45 people redeployed to different jobs this week and we've done a little statistical modeling uh based on how the virus might advance and our statistician who is really good at this stuff just looked at the general population and the progression and how that might advance amongst our uh staff and our clients and consumers particularly in residential and we are estimating that we need 20 to 25 percent more staff within our residential facilities than we currently have and as people become ill potentially and move in and out we are are trying to redeploy in line with that um we are looking to a couple of sites and actually have established two areas where we would do our own sites to support people's home provider become ill and can't take care of their uh of of their um family member family member person that is under their care um and so we we are trying we have identified staff that would staff that site that are currently working in a residential home and we'd be familiar with the um with the procedures around PPE very familiar although we're also once we identify someone to work at a site trying very hard not to move them trying to keep them with that site because we don't want staff moving around if that makes sense so CDC guidance um we we read it every day it changes a little bit on us every day as Monica has said this is a moving target um we have been working closely with uh department of mental health and um and Dale um the stabilization of our funding streams so we don't have to hit target numbers as you know with payment reform we have a lot of target targets to hit so those have been relaxed um how and we receive our our bundled payments the one concern we had was we you know within our agency um as many of you know are able to stay up above due to uh behavioral interventionist contracts with schools and so we're now working on a case rate there and on phase two we identified um what it would cost for us to go time and a half within our residential facilities um which is uh not a small number um we have a lot of residential facilities throughout the state and also providing a thousand dollars per month extra to home providers and we're submitting those numbers to DMH and Dale for consideration and we know that you know our response as we chat with with the commissioners about it is that they have to develop a methodology as these requests come in from different parts of the health care system in order to respond and uh we have got had great communication our of course our one concern of course our one very big concern is um how do we receive reassurance and how quickly could we receive that um given these numbers to move to that we have we have and we know that there are um sites being set up around the state I saw an ad put out just yesterday by the um by OEO uh 40 an hour to start to come in and staff that center and so we are doing it in residential facilities um throughout the state and we've got to move now to our folks up because of the um unemployment rate offer because people will become ill because this is a very hard thing to ask folks to do and we need to be paying them for doing it so maybe I'll wind up there and take a breath and allow people to ask questions Madam Chair and I know Julie Tesla is also here I don't know if she had anything that might add to that whirlwind are you muted I'm unmuted now um thank you Mary um and I I thought it was important for Mary to present to the committee because she's at the ground level of Vermont Care Partners I was working very closely with each in every agency um so to ensure that we have a systems response and I'm sorry I apologize I was muted and so you didn't hear me there were three questions for um the previous speaker so sorry oh wait I love your background by the way um okay um committee we've got Mary Beth um uh Topper and Carl so Mary Beth go first I presume it was for um the previous speaker yes thank you Madam Chair um Mary I'm curious uh relative to that unemployment situation the question I asked previously are you is your staff hanging in there are you seeing folks staying healthy um and I appreciate your point about us moving fast to come up with those supports thank you um you know this we have a great culture and um yes we are maintaining our staff from the moment we started our message was we want to be sure you have a job at the end of this so we message that and we message that um we do have some folks who are just asking uh to go home and it's a small handful over uh under a dozen and we had some folks go and actually when the when the governor was saying you know um sign up for an employment with your you know he was just giving it was in a context but all they heard was sign up for an employment we were suddenly having people sign up who were working we're like no no not how it works so um we're hanging in there and um our message is strong that we want to redeploy you we do not want to have you um uh access unemployment if we have a job for you and uh however if you're in the category of being a primary caregiver or you're in a category of having a compromised health condition that is different and um you have a choice and we have often offered voluntary layoff solely so um we want people to understand that we're there for them should they choose unemployment we will call them back on April 30th and see how things are going other than that they could take vacation time or if it's in an undetermined period of time where we're talking to them we've continued to pay them under what we call our own COVID-19 admin leave and we figure it out we also have developed a sick bank where um some of our staff have donated their vacation time into uh into sick time and we have been using that bank which is very healthily stocked at this point in time does that answer your question yes thank you very much and for the work you're doing thank you okay Topper then Carl hi Mary hi uh i i have a question about people that might be food deprived i i know when i read you a piece you talked about a place in stow and another in your own kitchen um how is that working are you able to keep up we we are we actually have uh staff who are um access the food shelf and um we have a very good network with our clients and our delivering food delivering groceries even delivering meals and within our region we have a regional command that was set up and um we have people cooking um to make meals and deliver them to uh folks who are homeless and maybe food deprived in hotels and that number i didn't i didn't get on the report today but it's it's been um it's been several hundred meals a day in some cases one thing i will in our region we had our shelter moved to the Econolodge 38 rooms filled um individually and so that's a place that we um that not washington county but our region has been providing food through capstone and it's been a great group of providers coming together um to do that work so far so good there um we do know we have a lot of people that have come from other areas and are in hotels in our region and um that's becoming a challenge but um they're notifying that they're there and accessing food as far as i know yeah company is the galley involved at all that i do not know i think i believe they are because they they were making 400 meals a day and said they could do more yeah i believe they are the group that's doing the meals because 400 is the number that i heard okay all right i i know okay sorry did you have another question top well i talked to the director there yesterday and um they they they aren't involved the way they can be he said so just keep that in mind mary it might be okay good to know thank you carl thank you uh just to follow up to what mary was talking about we had our designated agency monthly meeting yesterday afternoon both the executive committee and our regular meeting and we're brought up to date on issues similar to what mary's talking about and her agency in our case we had 130 people most of them voluntarily but that went on temporary furlough we're continuing to pay their health insurance but they're going to be receiving unemployment the way we understand it and it's sort of going to be our pool of people to be able to bring back as we need to to backfill people especially in residential care environments when when or if they uh they become symptomatic uh need to be removed from from what they're doing in in those residential care facilities so at the moment it seems to be transitioning reasonably well but just like you said every day is a new day and in our case we had that number of people available primarily because we have a lot of people in the school system we we are doing support in in area schools and of course with all the schools out that's not a requirement right now at least for the most part and in addition we run a special school down in the bay the SOAR as a school for difficult students and and that's totally closed so we have this group of people available so we're hoping to work out as best as we can to recall those people as we need so thank you for bringing people up to date we're actually now going to have every two weeks an update of where agency is you know what's just on uh of the of the agency uh on a bi-weekly basis thank you thank you carl um and i have that teresa wood has a question and i'm presuming that mary beth topper and carl will be putting their hands down unless they have another question thank you madam chair um so uh represent rosin quest is bringing up a question that i meant to ask um commissioner hut but i'm going to ask it through mary now so when you're when you're receiving the stabilization uh you know essentially saying that you're going to continue to get the resources that you would have gotten um you know had you been at full service capacity both on the ds side and on the mental health side um did that come with the expectation that you continue to pay your staff and have them employed because it would concern me that um for instance ncss is furloughing staff if they're receiving payment to keep them on um you know to me that's that's a concern so was that part of the condition of um of receiving those payments you know it was not from uh the department of mental health monica um had said that uh in conversation i wasn't present for that and we had already made a few layoffs um voluntary layoffs uh due to conditions where people actually could not be in the workforce and couldn't work remotely so um but there's nothing unless i missed it nothing in writing to that effect um it was encouraged and i think we uh all embrace that with the spirit of it but um from what representative rosin quest was just saying we moved quickly before these conversations happened so i think that in his region there had been action on that prior to hearing hearing that there was a desire for us to hold on to our workforce um and so um nothing in writing that i know of um i don't believe agencies have laid off many folks and i don't know what that looks like out there but um that uh thank you that was um that was my impression as well from the folks that i heard from so i was just surprised to hear representative rosin quest talk about that that's quite a large number of layoffs at at one time if if money is continuing to flow um i think that's i'll talk with carlo about that offline thank you um monica one thing madam chair when could i absolutely absolutely um just in talking to other agencies i just would want to um say that you know as we put our numbers out there and we move forward with what we believe we need to pay extra uh and the departments are working really hard with us on this we know that um there are agencies that might have a really hard time waiting and we're not sure of the timeline so i did i did ask the commissioners this morning um if there would be some kind of emergency relief or ability to call for assistance and i know that um uh just that they will look into that and so at this point um we have put that question on the table just out of concern for some particularly some of our smaller ssas um we believe at washington county we can hold on um because expenses won't hit our books until mid april and um we we've spoken with our bank already if we need to go out on a line of credit uh but we you certainly would like to uh encourage and i'm sure they'll work with us on a on a timeline so that we can understand better what that will look like and there are so many uncertainties thank you i i would leave you yeah and i know there may be more questions but please thank you for yourselves thank you mary thank you hear yourself thank you mary julie okay i'll be just really fast um you don't have to be will people will come back or whatever okay i i want to say that um the teamwork and the the way the agencies are working together has been incredible at every level program directors the executive directors the human resource directors the cfo's every they're they're meeting constantly and sharing best practices problem solving together and that's also happening with other health providers um and jill allson who is going to be speaking later has been they organized over that and that's been amazing effort to keep health and human services moving forward um going to the finances it's true that the on their ongoing payments but there's new expenses right now which includes the the ppe the personal protective equipment agencies are trying to get tablets and equipment to folks so they can't communicate use telehealth we're now feeding people we didn't think about feeding before and enhanced pay and payments to the shared living providers some agencies that are going ahead and making those payments because there's a lot of fear that we could lose some shared living providers we're asking them to do 24 seven services when they that wasn't what they signed up for from the most part so there's a lot of of movement going on and agencies are tracking the expenses so that we'll be able to figure this out over time state government's been really supportive and helping us work it through and we're getting information of them all the time i was i was surprised to hear max say that some folks are not being monitored that it's being left to the people to initiate that that's not our understanding so if if you know i'll follow up with that um we have our case managers our nurses going you know checking with folks and and through telehealth um but that's pretty much ongoing it's particularly for people with developmental disabilities we're also using this time to a lot of cross training so that we can back each other up um and for the staff who aren't actively working in a school they can be cross trained now to do residential work as mary was saying um we're also learning how to do online activities online groups psychotherapy all that work is going on for all populations including people with developmental disabilities um the loss of routine the loss to day activities really does affect people particularly with developmental disabilities and autism folks on the autism spectrum so um you know some people are now not able to communicate because they don't have that uh the day staff there to help them do that um some some are concerned about loss of routine so folks are are feeling the stress um we're seeing it behaviors um and it's it's going to continue to be a concern but we're doing everything we can to address that so that's just kind of the the broader picture um but i i think it's a system of care it's been pretty remarkable um and i think for the most part we're meeting people's needs julie thank you and i it is really clear that that the players have really worked together to try to um react as quickly as possible and to put things into place and i hear that uh the community health centers and the specialized service agencies they're needing money um are there any policy changes um specific to uh this pandemic that that that that you um and would would identify i think we've been in constant communication with state government about that and also through our national association so relaxing a lot of the Medicaid rules so we can do things by telehealth and using phone only going forward not what we're going forward next steps the phone only is the hardest thing right now uh for people who have only Medicare coverage or that's our primary coverage that we can't use it for anything except for evaluations and check-ins so you can do a psychotherapy session so that affects the elder mental health care that we do and the outreach um i think the other thing is just the documentation and outcomes and what those requirements are going to be and that hasn't been all worked out so okay so in terms of um um policy um expectations that are in the Vermont state law related to um the agencies that you serve that you that you coordinate for the organization does and the people they serve you do not need any policy changes you just need money i'm some just yeah that we and i'm not downplaying that i'm just trying to everything has been communicated and is is in the works um so there's nothing to add to that list that we haven't already communicated and i i think we've gotten good support from the legislature so i think we're in a good place with that now okay i can't say they won't be something the future but for now i think we're in a good place thank you are there questions for julie okay um laura thank you julie welcome laura palosi i'm here good afternoon representative thank you laura palosi representing the vermont health care association which is our long-term care facilities the nursing homes residential care and assisted living providers um i'm going to cut to the chase with uh how julie ended which was uh thank you for passing h742 which was the legislation that has really given us what we need to the extent you know anybody can manage this kind of a pandemic but in terms of the regulatory and um licensing flexibility that we really needed so we greatly appreciate the house's efforts in that regard uh and i'll go back to something commissioner hut said which which is this is a very fluid situation and a moving target as we learn every day about this virus um the facilities are receiving information and guidance daily from the cdc the centers for medicare and medicaid services the vermont department of health dale um it's really an amazing amount of information as the research changes on a daily basis as best practice and standards change on a daily basis and it covers you know everything that our long-term care facilities are doing to try and combat this virus with respect to um what we're doing regularly to work with the state on planning for surge you keep hearing about planning for surge nursing homes in particular play a pretty unique role relative to the hospitals and trying to make sure that we can take care of patients that don't require hospitalization but are acute enough to require to require medical care and so on a daily basis we are providing to the state um bed availability data as well as our personal protection equipment inventories with respect to our challenges um they are really three fold the first being workforce um before we left the state house in mid-march um i had spent every day visiting as many committees as i could to talk about our severe shortage based upon the work that we did in the world health task force over the summer and fall and what that work told us was that we need today 5000 personal care attendants lna's lpns rns so we entered this pandemic with a severe shortage of nurses um which has led over the last few years to a great increase in the use of our traveling nurses so workforce is a top problem and challenge area because as as workers become exposed to the virus and have to go out um on leave it presents us with a significant challenge we need more staffing to take care of folks during this crisis not less as i'm sure is pretty obvious um one of the things that we are currently evaluating um to get back to some questions that were asked earlier is the impact of the unemployment insurance um program that has recently passed and evaluating what the impact is going to be on some of our lower paid workers so we are talking with the administration with respect to how to better support those individuals and their jobs because they're critical and essential to our ability to do this work the second area and i'm sure you've heard a lot about this is the national shortage of PPE that's your masks your gloves your gowns your n95 respirators um the vermont department of health has prioritized long-term care facilities to receive PPE um you know they have to request it from the state inventory the department of health has been a fantastic partner all around in this i have to say they're working hand in hand with the facilities every day um they don't have enough access to PPE so i'll give you an example you know you can have a facility that will request a thousand masks um but they're only able to receive a hundred masks so the department of health is doing a great job of trying to get it out to long-term care facilities the v-trans trucks were traveling around the state last week delivering PPE to our facilities but it is still not enough i had a great call a couple of days ago um from a community member who's working to um sew masks for long-term care facilities so the association is organizing a mask drive and the cdc while they're not um really permitted as sort of a first course um in an extreme shortage and and with lack of anything else um we can use those so that was that was great um and then financial stress obviously there's going to be financial stress on all of our facilities as they have to expend resources um to combat this virus we are certainly working with diva in the short term around some emergency funding for erc and accs providers that went out on friday there's a process by which providers can let diva know what their needs are um with respect to nursing facilities we're still waiting on some guidance on what that process is going to look like it sounds like they're going to do a modification of our existing extraordinary financial relief process but these are emergency funds um they're not um you know we've heard about stabilization funds but these are emergency funds in the short term so we're working through that uh process now um and you know working i have to say the uh coalition of providers that julie referenced and that jill uh we we tasked jill olson with uh getting us all organized um has been great because we're able to share resources that are coming from our national associations um we realize that we all share common problems so we're tackling them together and that's been i think a great outcome of this so i'll stop for any questions that you might have because i know you're short on time well representative pew i think you're muted you're still muted there you go sorry uh mary beth do you have a question i do thanks laura um a question um i've seen a you know this whole mask issue um and i i know that the health department i mean i'm guessing i don't know this from them verbatim but i'm guessing they don't want to really push the the ppe um requirement because they want it to be available for their most kind of frontline people they're doctors and nurses first um but i i really feel like these are effective and more and more we're seeing that people should be wearing them most likely i'm curious in the long-term care facilities and nursing homes is everyone wearing something at this point so we are following cdc and department of health guidelines and because of the national shortage cdc has conservation measures that are in place so facility and for example if you're going to get um ppe from the state inventory you have to agree to comply with the conservation measures and so those measures are different depending on the type of ppe whether it's a mask whether it's gowns whether it's n95 respirators and those conservation measures really say this is when you use it this is when you don't need to use it this is how you can reuse it this is how many times you could reuse it so it's um you know these are guidelines that that you know providers are working with every day um if we weren't in a shortage situation things would be different probably yeah so what if what if someone wants to wear one but there isn't enough and they're you know the health department is saying oh you know what if they make one can they wear it in a facility well and that's what's so great about this mask drive that's going on it's a group of folks in waterbury representative wood uh who have started this up and got in touch with me this week um to to make handmade masks and so yes they can be used as a last resort under guidelines thank you are there other questions for laura um laura i guess i have a question is there anything that you um believe should be done differently um in terms of protecting vermoners who are in nursing homes since um and long and other long-term care facilities since i believe we're up to about six now um yeah we have two nursing homes and one residential care home and then um at least that's my current recollection and the remainder are in senior living communities which are not the health care facilities but 55 and up apartment complexes you know this is so challenging and no one's ever seen this before and i think that our department of health and the cdc are you know reacting as quickly as they can um and have been extremely communicative as has our national association who has been really i think ahead of the curve and looking at what's happening in other states and issuing best practice guidelines so i think you know we have had the benefit of that having said that what we're learning about the virus and the fact that asymptomatic people are really shedding virus makes this particularly challenging in a long-term care facility setting so you know i wish this weren't happening for sure but i can't think of anything um from a policy perspective that we we could be doing differently you know i'm sure we'll look back on this you know a couple years from now and say well now we know x and we should have done y but but we'll we'll we'll do that afterwards but i hear what you're saying but i think the best we can thank you um thank you very much uh really appreciate it laura um jill holson if you lose my picture um we have horrible internet here three and a half miles from our state capital in middle sex um i have to say i don't have a lot to add to what you've already heard um the challenges particularly laura's testimony i think are very similar in home health um as a reminder we have a medical role and a long-term care role so we're we're working both very hard and certainly in the long-term care realm we're really concerned about retaining our staff particularly with that unemployment insurance provision that you heard about earlier on the medical side our focus this week i just had a board call with my members not not more than a couple hours ago uh you know long conversation about ppe all of the questions that that you've been asking um but also uh really a focus on what we're doing to help hospitals not be so full so we have covid positive patients at home uh the the federal government just made some changes to oxygen supplies and where they can be utilized and so we're going to be able to take care of more people at home with oxygen who are covid positive so i think our role is going to increase um pretty quickly um we are we're doing things like blood draws and injections and infusions that would normally be done in the hospital we're doing them at home to take the pressure off the hospital and then as hospice providers what some of my agencies are doing is they're taking that hospice expertise and they're using it to create bereavement programs really just focused on covid-19 for staff for patients for families and so we're really trying to sort of take all the tools in our toolbox um and uh and use them to to help our state at this time i can tell you that we are definitely seeing the downturn in revenues that many organizations have seen we're not doing much physical therapy occupational therapy because it's you know they're not really necessarily essential sometimes they are but often they're not so we have been really appreciative that diva has figured out the sort of i call it the lifeline process so if you're really about to go under you can't make payroll there's a process in place we haven't seen the same kind of stabilization program yet i think that's something i'm hopeful is in the future but because we don't have the kind of fixed revenue contracts that da's have there wasn't as obvious a way to to provide that support to us so but we're working in a very close partnership with the health department with dale with our other association partners which has just been such an incredible source of support and uh and effort and then with our national partners too we need a lot of help from medicare to meet this crisis and a lot of our focus has actually been on in that realm i'll stop there thank you oh but you have questions um oh okay and committee as you have questions we have eight minutes and we have someone else to testify uh so tarisa and jessica tarisa thank you um mine is quick and you just touched upon it a little bit jill uh what because home health agencies rely a lot on medicare what are you seeing in terms of any kind of flexibility from medicare with regard to payments for home health agencies yeah we had some good news and bad news this week uh on the good news side um they have relaxed the homebound criteria so that all of those covet positive patients who might not otherwise meet medicare criteria for home health now will so being covet positive and needing our services counts as homebound being quarantined counts as homebound so that's good those are people we can now care for and get paid to care for without any other changes what's bad is that we have all these services that we're not providing in person some of which actually can be provided uh over the phone but we cannot be and we're allowed to do it but not for money so they're not paying us to do those things over the phone and that's really a pretty significant disappointment that we saw in the most recent guidance we continue to push for that um at the federal level they also actually made a helpful change where they suspended the sequestration cut that was made during the obama administration at the two percent medicare cut so they've restored that temporarily so that's just extra cash flow uh coming to us for everything we can bill for okay thank you jessica i um thank you madam chair um and thank you jill i just um wondered i'm so happy to hear that we're going to be able to bring oxygen into people's homes and not i just wondered because i've gotten some concerns from constituents who just are afraid to go to the hospital right now and i wondered what that step would be not to mention that our rescue squads are it takes two hours to clean them after bringing someone who's COVID positive to the hospital and they only have one so um but i'm curious about what was the hold up was it medicare that was saying no yeah yeah it was medicare so the medicare waiver that we got it's all about the money so it's a medicare waiver and i think a regulatory thing too i literally got the notice this morning at nine o'clock so i have not dug into it and when i told my members that had come through they all demanded that i give them the information immediately so um i'll have more to report you know another time but um but i do know that the flexibility has been granted um i have to say actually you know medicare has been pretty good about granting flexibility in many areas um there are a few notable exceptions but um they have been really trying to make this work better fantastic thank you jill thank you very much christin thank you madam chair yes uh you all can hear me i assume yes um thank you madam chair and committee members um for the record i'm christin murphy i'm the executive director for the remote developmental disabilities council um and for the second time this week i'm just gonna say out loud that i have this very awkward situation of both wanting to express incredible support and gratitude to the state and to the agencies and our colleagues and at the same time we have a role under federal law of checking in with individuals with developmental disabilities and their families and then you know if there are concerns it's our job to to bring them bring them up so i i mean no disrespect or or criticism i know people are working really hard um during week one um we as a staff made a point of calling all of our council public council members many of our leadership graduates and talking we've talked every day with green mountain self advocates um oh and um we um then developed a set of of 10 recommendations many of them max is articulated so um and submitted them to developmental services uh division to commissioner hot we are um disappointed that we've not heard any response um but when did you when did you submit them um i would have to look at the date on the letter but about 10 days ago i believe okay and we understand how busy everyone is but they do seem like pretty common sense um concerns but i'm going to highlight three of them and i'm trying to talk as fast as i can so um one i have a significant concern about setting clear expectation for home providers about reporting when someone in the home is sick that is in guidance that was issued yesterday from dale that is so they have articulated that expectation but i it's very you know on page five and i think um i it is not inconsistent to have both minimum clear expectations that are rules or a matter of contract um and at the same time acknowledging that our system has a great deal of individualized planning to take place um the i won't go into it at length but the incentives for home providers are aligned in a way that might not everyone would respond this way but might cause um a home provider to be reluctant to report if a household member has um is exhibiting symptoms and yet it is urgently urgent that they talked not just to the health department like you're supposed to but to their agency so the agency can make an assessment about whether quarantine at home is appropriate whether somebody needs to be removed from that house um and i i bring this up also because my understanding of the the one death that has occurred through the choices for care system did involve a home provider situation with i don't know who got sick first but with a home provider and an individual who both had symptoms so i i feel like this is a protection that's pretty important um the second recommendation that i want to speak to mary beth um redmond representative redmond did um allude to and that is the situation that we're hearing from families who have a child or a teen with significant disabilities vermont made a reasonable decision many years ago that kids and teen would mostly be served through education so they have therapies and school nursing along with special other special education more traditional instructional services along comes coveted 19 and and a prolonged shutdown that we could never have anticipated but families that are used to having a very large chunk of five days a week knowing that their children are receiving the services they need um are now those children are now home and we make it more complicated often there are issues around the parents health or the child's health that mean that they cannot allow help to come into the home so the only only reasonable way to address the high needs of um some of these children are for the parents to be providing it and that may of course have financial impacts and cause the families to need to um to quit or um suspend paid work so we strongly recommend some type of financial relief for families in that situation um i wanted to say two things about that the optics here are really important so notice that i've said i've avoided saying paying parents i am saying financial relief for high needs families um now as a practical matter the state may need to wave temporarily the prohibition on paying parents um but it's my understanding that designated agencies i believe this was said today are maybe receiving some additional payments because the workload has increased and i think parody needs to kick in here for the families that are also doing that um second i just want to say clearly again the word temporary is important the council doesn't typically support this kind of approach um but we're not having a philosophical conversation about paying parents right now we have an emergency situation this needs to happen it needs to happen very quickly these families have already had these kids home for three weeks and i'm hearing stories of you know behaviorally challenging situations that um involve maybe aggression and um you know real um possible harm uh to people as well as um you know tremendous concern on the part of families for medically fragile children um who are already somewhat underserved so i think that can't happen fast enough i'm pleased that uh commissioner hut is pursuing some kind of family package i hope that she will reach out to families and for their advocates and allies as they craft that um that package um the other issue that i want to bring up another recommendation that we've had is um the need to look at the critical workforce that is independently employed um through um home providers or families themselves and this is the workforce that supports that provides respite or also the workforce that's families who self and family manage their services um that workforce doesn't have the same flexibility that those who work for agencies have so there's not a there's not an entity that can redeploy those folks when some of them may have to be laid off because of again this this concern about introducing the virus into the house especially as we know how sneaky this virus can be so i have a member for example who is trying to work from home he and his wife have significant health challenges so they they have had to um not have the seven person team that supports their son come into the house but they have spent two years building that team and a lot has gone into that and it is his wish that he be able to continue to employ that team so they're there in a few weeks when he's going to need them again um so i hope that people can look at that issue i know in earlier versions of um age 742 there was some conversation in language around being able to pay for services when the services are not actually taking place specifically because of COVID-19 and my listening to those that committee conversation um i believe the language was pulled out but the reason it was pulled out is because um that can happen under existing authority and the committee didn't want to put things in a bill that were redundant so this the intent of of the other thing with senate health and welfare certainly was to again look at can we retain the this you know all of our work all of our important workforce and i just want to flag that the independent workforce build through eras and with that i will recognize the time and i'm a little over and thank you madam chair oh no thank you christin it really is important to hear all of what's working and we do acknowledge and appreciate your beginning that conversation your testimony with that conversation but also to point out um what what is needed what is needed to protect remunters with disabilities with underlying health conditions and other things uh are there questions um jessica i see your hand up is that from the last or do you have a question for christin no that was old sorry that's okay that's okay christin thank you very much thank you and committee it is um two o'clock um we have um we're going to work on scheduling kinds of things but we do have a committee meeting tomorrow where we're not having anyone testify but where we're going to have a committee discussion about where we're going forward who do we need to hear from etc and that is friday and we're also going to be having some technical uh training as well um so thank you all very much and james again happy belated birthday and we will see you all uh on zoom tomorrow thank you thank you