So, Ginny and I will try to recognize everybody, but thank you all for joining us this way. Ken and Christine and Sarah, we're very happy to have you. The first subject really is the closure of Woodside, which was fairly abrupt and moving it to St. Albans, and then what is going on with Woodside? I think those are the two subjects for the first hour, really, is how is that working? And what is the plan with the current Woodside, which I guess I should call the other one Suite 12. Ken, do you want to start? I don't mind starting. This is Ken Schatz. I'm the commissioner of the Department for Children and Families. I do appreciate the two committees coming together so that we can consolidate our comments. I know you do appreciate we're all working very hard to address the pandemic. Sarah and I have been in close contact over the past weeks to try to do our best to manage our concerns. And this may be a bit of a repeat for the Senate Judiciary Committee, because we talked about this last week. But to confirm what Senator Sears just said, the background is essentially going back to Sunday, March 22nd, Sarah notified us at DCF that the Department of Mental Health recognized working with the other hospitals caring for psychiatric patients, that there was a very emergent concern about how to appropriately care for those patients who exhibited COVID-19 symptoms. Sarah can talk more about it, but with respect to recognizing we needed a separate facility potentially to care for those patients. And recognizing that Woodside with only four youth there was essentially an underutilized facility. We got together and quickly recognized that the facility would be better suited to meet this emergent need. So we quickly looked for another site to move those youth. We got a lot of support from the Department, from the State Emergency Operations Center and all the staff. Quickly identified through NCSS in St. Albans that they had a site that was not currently being utilized, which is known as Suite 12 because that's where it is in the building. And so we quickly moved to set up that facility to move our youth there. And we did so within a matter of days with the support from the Department of Mental Health and other people to enable them to ready the Woodside site for, in effect, its new use. So we did temporarily, this is all responding to the emergent need with respect to the pandemic. We temporarily closed Woodside for youth, moved over to Suite 12 to enable the Department of Mental Health to provide a new use for that facility. Maybe I should stop there and then turn it over to Sarah if that's what the Committee's interest for her to give you more information about what's actually going on there. Yeah, that would be fine. How many kids are at Suite 12 right now? There. OK. And are those the four from Woodside? No, actually, it changed. OK, it's as you may know, the youth who who have issues requiring residential care is literally a day by day dynamic. So we do try to place youth in the most appropriate, least restrictive setting. Suite 12 at this point is a staff secure program that, in one sense, enabled us to open the doors, if you will, to children who are in custody as chins that is abused or neglected or unmanageable, not for delinquency, because it's not a locked facility that gave us more flexibility, but to be candid also with the reduced level of security that has posed some other issues. So to cut to the chase a little bit, I don't want to take time away from Sarah. But frankly, we're looking for another site because we did think that we would be able to lock the doors and put alarms on the windows. But the landlord indicated we were not able to do so. So we're quickly looking for a secure facility to stand up for this purpose. Are so all of these children are under some type of court order? They're not not adjudicated necessarily. They're in the they're in this, the juvenile justice or chin system. Yeah, which does clearly involve court. Yes. Yeah. Thank you. Are there any DOC kids there? There is one youth in the custody of the commissioner of corrections. I I had no I I had heard an inkling that you weren't able to alarm the doors or or windows and I grew very concerned about that. So I'm glad you brought it up. Having operated 206 people going to get my depots right. What's one of the first things we did, even before we took kids, was put alarms on the windows and doors. And I don't know how you can operate a secure program without without that. So I'm glad you're looking for another facility. We are. And again, let me be clear, we're working really hard and really quickly to try to address all of the the needs that have arisen with respect to COVID-19. And this is just one of those things we had thought we had a site that would really work and honestly discover that it doesn't. So we're looking for another. OK, thank you. Any other questions for Ken? So I Alice, I just like to say so, Ken, are you able, at Suite 12, to take in a child who might need a secure facility? Or where would you put a child such as that if one came? So it would depend. So the reality is we do have a substantial number of staff where we have can't hear you. So we can provide a substantial amount of supervision. We also do have some other programs around the state that are still operating that can meet some unique needs if they arise. So we're definitely doing our best to manage the population with what we've got. Can I ask a question? Yes, sure. Ken, thanks very much. You remember from the Judiciary Committee meeting, I tried to forward some concerns from workers. And at that time, you hadn't had a chance to connect directly with them. Can you just update us on that? Sure. So we have had direct conversation formally through Christine and myself connecting to the VSEA, the Union leadership. We've also encouraged our staff at Suite 12 to have direct communication. With staff, we've addressed a lot of their needs. For example, one of the concerns that staff raised that Senator Ruth mentioned was concern about sleeping arrangements for overnight staff. And so what we did was we actually thought that the Union had a good idea and we responded immediately to set up a hotel room that they could sleep in if they were staying overnight. And so that's certainly one example of how we did respond to their needs. And so the certainly the discussions continue as we figure out the best way to manage and operate this program. Thank you. Other questions for Ken or Christine, Ken, hang in there. Thank you. Thank you. Ginny, do you want to? This is more your area of the mental health field issues. But Commissioner Squirrel, if you could kind of go over now, what's happened? The last time I knew you were going to take over the woodside property in bulldozer, we had this picture of you driving the bulldozer. That's all changed. Yeah, so happy to speak to what we're thinking about in terms of creating emergency inpatient capacity. So Sarah Squirrel, Commissioner of the Department of Mental Health, thanks to the committee for inviting us to testify today. I did want to note for the committee. I do have an emergency meeting at 11 o'clock that I do have to attend. So I will try to address everything and all of your questions between now and then and can certainly try to pop back on after that. But I just wanted to flag that for you all. So as we at the Department of Mental Health are grappling with this public health emergency and certainly when you're dealing with an infectious disease outbreak, you're always behind where you think you are. So we have been trying to think proactively about in two to three weeks when our health care systems are possibly going to be overwhelmed. What kind of inpatient capacity do we need to have in the system of care? So on Friday, March 20th, we convened all of hospital leadership from across the state who manage inpatient psychiatric hospitals and patients. That includes the University of Vermont Medical Center, Martland Regional Medical Center, CBMC, the VA, the Vermont Psychiatric Care Hospital and the Bridal Brewery Treatment. And the goal of this convening was really to assess the current risks to our system of care and to make a recommendation to ensure the health and safety of patients. So the recommendation that we came up with as a collective group was that we needed to quickly identify and establish an alternative psychiatric facility with anywhere from 10 to 25 beds for individuals who have very significant psychiatric needs who are COVID positive, but their COVID positive symptoms might be mild. So these would be individuals who absent their significant psychiatric needs from a medical standpoint would be asked and have managed their COVID symptoms at home. As we all know, the individuals who might be involuntarily under the care and custody of a commissioner who have significant psychiatric needs, they would not have that option. And we know that it's only a matter of time until we have COVID positive patients in our inpatient facilities. It's only a matter of time before we have a COVID positive psychiatric patient waiting in an ED. And it's possibly only a matter of time until our current medical bed capacity across the state is briefed. So our recommendation was to identify a facility as we looked across the state system, identifying a facility quickly that had that capacity and also was a place where we could treat individual safety safely, meaning minimal ligature risk. The Wood-Futside Facilities certainly emerged as an option that we could move quickly on so we could stand up what was clear was a resounding need across the state. And this recommendation, we think, will achieve three primary goals. Number one, we will maintain capacity to provide treatment and care to COVID positive patients who have mild symptoms, but very significant psychiatric needs. We will mitigate the spread of COVID-19 and inpatient facilities across the state to ensure the health and safety of individuals who are already receiving treatment and will preserve resources and capacity within the broader medical system for those who are the most medically acute. Clearly, no one wants to be making these kinds of decisions, but we're facing a public health emergency that I haven't seen in my lifetime. It requires decisive and proactive decision making to keep them safe. And as the Commissioner of Mental Health, I did not want to wait for our health care system to be overwhelmed until we started to create an alternative facility. So that was our thinking. And from a parody perspective, when we look at the broader health care system, we're all preparing for the surge. That's why field hospitals are being erected and alternative facilities are being located. I want to be clear that this is designed to be a short term emergency contingency youth of Woodside. I would not, as the Commissioner of Mental Health, be recommending that in its current form and its current structure that we would utilize a correctional facility for care and treatment of psychiatric patients. So the future of Woodside will remain a discussion and a decision for the legislature. This is simply a short term emergency precautionary step to ensure that we have appropriate inpatient capacity. So I'll I'll just pause there as an overview. I can also provide an update on what we're doing in terms of the middle sex therapeutic community residents as well, if that is helpful for folks. Can I start, Dick? Yeah, please. OK, I have airplanes flying over me soon so I can hear him coming. If it sounds loud, that's what it is. Sorry. Commissioner, thank you very much. We we all understand how busy you are, and we very much appreciate your being here, as well as Commissioner Schatz. But at the point of the two committees, obviously, is to get as much information as we can to to save you some time. My questions really go to the fit up of the of the facility of Woodside and all the very practical questions about providing medical services while they're there. You did say that these were for those cases that are not as not as compelling. So there are some people who will have to be hospitalized. Yes, I actually have two questions in this. One is how is the how is Woodside being fit up with the the materials and provisions that you need, the equipment you need to take care for these people while they're ill? And then how are they being provided with the mental health care folks and treatment that they need because they're going to need both, obviously, while they're there. So how how what's that conversation about? How's that happening? When is it happening if it isn't already? And then the second part of that, maybe I'll just hold off on the hospital question for a minute. But so let's go. Let's go first to the sort of the fit up, both for the medical services and the psychiatric services that are needed during this process. Yeah, it's it's a great question. And certainly our team, as we've arrived at this recommendation on behalf of all of the inpatient hospitals across the state, we immediately established kind of a leadership operations team that could be on the ground at Woodside, really assessing the facility, ordering the appropriate equipment that would be needed. BGS was there kind of cleaning and getting everything ready. Food service, laundry, pharmacy. I mean, there is a long list of operational pieces that need to be put in place. Our leadership team includes existing staff in the Department of Mental Health, our medical director and social work. And then what we've been doing is working closely with our staff at VPCH, the Vermont psychiatric care hospital and the University of Vermont Medical Center to try to assess what clinical and medical capacity will be necessary so that we can provide adequate care. I also just want to know that this is designed to be emergency surge capacity. As of right now, if there remains capacity within our medical system, that any mental health patient who is COVID positive would be referred to the medical hospital unit and they would try to triage with site consultation. What we're preparing for is at the point that that capacity might be overwhelmed and what do we need to create to support that. So I think we also understand and recognize we are thinking about this from those individuals who have very mild symptoms. You know, so we want to make sure that we are understanding where the scope of our practice and expertise ends, which is why we're trying to work with UVM to assist with the appropriate medical personnel that we would need to have on site to provide that care and treatment. Knowing that currently with the Vermont psychiatric care hospital, we already contract with UVM for all of our psychiatry and our medical and physician support. So we'd be thinking about a similar model at Woodside. And this is all overlaid, of course, against the reality of just the overall staffing shortages that we're facing across the state and our ability to recruit nurses and mental health specialists right now is certainly one of the most significant barriers that we're looking at. But that's just to give you a snapshot of some of the operational pieces that we're looking at on the ground. And that work has been is well underway. So what I'm hearing you say is that you're looking at the current the patients who are currently under the state care for this facility. There is that is that true accurate and saying that it could be it could be individuals who might be in one of our inpatient facilities who start to present symptoms are tested and are positive. Obviously, the individual facilities across the state are going to immediately put their protocols into place in terms of isolation, et cetera. But we also want to mitigate the spread within our inpatient facilities to protect that capacity. So this essentially becomes if it's medically appropriate and the symptoms are mild, that they could be that they could receive a primary psychiatric care here and manage the mild covid symptoms. The other area that we're thinking about might be the individual who also arrives in an emergency department who is experiencing a psychiatric crisis and who also is covid positive. So I think it's existing within our inpatient system. It's also an individual who may emerge having psychiatric means. And we want to ensure that we have appropriate capacity to provide care and so then what I'm hearing you say, secondly, is that someone who maybe is currently under the care at Howard Center would go into the E.D. and might because of their the level of illness that they have might be sent to Woodside to isolate them from others in a residential facility with the Howard Center. Right. So essentially, if there was an individual who, you know, perhaps was, you know, a C.R.T. client from the Howard Center, for example, who was deemed to meet hospital level of care for their psychiatric needs. Normally, we would be looking to admit them in one of our psychiatric facilities across the state. But then when you add on, if they are covid positive or they're being tested for covid positive, obviously. Introducing that individual to an existing inpatient setting who doesn't have any covid cases might not be in our best interest because we risk infecting that whole unit. So this, of course, would provide some capacity where that individual could receive care and treatment for both their inpatient psychiatric needs and monitor their covid symptoms. So I don't want to prolong my questioning because I think others might have questions, but it seems to me that the capacity at Woodside is insufficient to cover what we're going to see as the needs going forward. That I don't know, as I said, we are I am not waiting until the health care system to be overwhelmed to try to create capacity. That's exactly what we're trying to do. Our ability to recruit and have staffing, adequate staffing there will also impact the capacity we're able to stand up. Are you using any or will you be using any of the current staff at Woodside for this, knowing, of course, that they're more tuned to kids and adolescents, but how will that staffing take place? You're talking with all the hospitals. You're talking with psychiatric care facilities. Yes. So we have been actively looking at the Emergency Operations Center at AHS also is trying to create some centralized functions for recruitment across our system of care, nurses being one of them, mental health specialists being another. We are also experiencing significant staffing shortages at the Vermont Psychiatric Care Hospital as it stands. So we are actively looking to recruit additional workforce for Woodside at this time. A one last comment and that is and then I'm going to let others ask their questions. But is there any consideration for offering incentives? By that, I mean salary incentives for people who might be invited to apply for these jobs. Yes, we are certainly looking at and in the process of implementing, I guess, for lack of a better word, a hazard pay premium, if you will, for individuals that might be working in these facilities. Could you expand on that a little bit, Commissioner? Because that issue has come up. I believe I spoke to you about it individually, actually. But that issue has come up in a number of ways. You've got people who are working at fairly low salaries and designated agencies and group homes and so forth. Will there be some effort to make it so? Because now that the $600 a week from the federal care program plus their unemployment, some people are saying, wow, it'll be cheaper to, it'll be better for me to go unemployed, collect unemployment, then go to work and face the possible hazard of transferring COVID-19 to my family, et cetera. Yeah, it's a great question and just pivoting a little bit to some of the fiscal strategies that we're trying to provide across our state system and are particularly focused on our community mental health partners, our designated agencies and their SSAs. Both DMH and Dale immediately moved forward with creating flexibility within our existing funding streams so that our designated agencies and specialized service agencies could continue to maintain their current staffing levels to the best of their ability. So what I need to quickly is that DMH funding is through payment reform. We have a case rate. So we pay all the designated agencies a monthly prospective payment. So that has not changed. So all of our designated agencies and specialized service agencies continue to receive their monthly prospective payment and we can adjust what will look differently on the back end in terms of utilization, the work use of telephonic billing, et cetera. The next phase that we're moving into is trying to assess the fiscal distress and additional pressure that COVID-19 is putting on our community partners. One of the areas that has emerged as a priority from our discussions with our community mental health partners and our specialized service agencies is this capacity to provide hazard pay for direct care staff, particularly in residential settings. So we actually have asked all of the designated agencies, most of whom operate significant residential programming group homes, to let us know what would that look like over the next 8 to 12 weeks? What would it look like to be able to provide that kind of enhanced pay to direct care staff? And then we're going to take that kind of back at AHS and look at that within, how do we map that against additional funding that we are looking at across our provider network that we might be able to provide to those providers? So that is certainly something that has emerged very quickly as a priority from our providers. And when we look at the work that AHS is doing, there's multiple tracks that we're looking at for providers. We're looking at our hospitals. We're looking at QHCs, other providers. And then we have a specific track where we're focusing on the needs of the designated agencies and the SSAs. So thank you. That's, Joe, I could just finish. That's very helpful. If you could send us any information on that. I can tell you that based on an all Senate meeting this morning, there's an awful lot of us concerned about this issue. And Ken will be asking you about it later. So and as a as a follow-up, I know that I would be, it would be helpful, Commissioner, if you could send along the information. I know you sent some information along to some folks this morning. I will respond to that email and ask that I also get on that list if you don't mind because we will be, we're taking up our discussion. I did have, I have had an opportunity to talk with some of the DA's on this and looking at what their deficit spending is right now, given the emergency, it's significant, as you know. So $270,000 a week for one organization. And then what that means is if we're going to do what Senator Sears is suggesting and providing, as you said, hazard pay, the reconciliation of that is going to be extremely important. But the cash flow issue right now is pretty critical. So if you don't mind keeping us informed as much as possible, just when you send out an email, send it to I think probably Senator Sears and myself as well. And then we'll, we can share that with our committees. Yes, absolutely. And so yeah, what you see us doing is trying to ensure that within existing resources and funding that all that money is going out the door. So those prospective payments going out to the DA's on a monthly basis, $8.3 million a month, those are still going. You know, looking at getting any other levers that we can pull to get money out the door in an expedited way, that money is going out the door. Some of our fee-for-service programs, particularly school-based mental health is a little trickier simply because school is not in session and we're trying to create flexibility within that. But for many of our DA's, they rely on that billing and providing those services in an area that we're looking at as well. And then this phase two is what is above and beyond? What fiscal costs and distress are they experiencing? And then how do we overlay that against what additional federal dollars might be coming in and try to figure out how to support the designated agencies in the community? Thank you. We appreciate that. The work that you're doing is significant. So a couple other questions coming up. Okay. Senator McCormick, I think was first and then Senator Ingram. Thanks. What is the protocol for a psychiatric patient who gets into the, whose symptoms are severe enough that they need ICU? We just send them to the hospital or? Yeah. We've had a lot of conversations, almost daily conversations with our hospital partners. And as of right now, if we had a psychiatric patient who had significant mental health needs and significant medical needs related to COVID-19, they would be admitted to the medical facility. That's what we're operating under right now. And then we're preparing for, you know, what happens when our healthcare system reaches a capacity and we're looking at med surge. And I could see where the argument, maybe if someone is in ICU, they're probably sick enough that they're not going to be a problem anyway. But what if someone is violent? You know, what do we do for security at ICU? Yeah. Well, I think that our inpatient facilities, looking at some of our larger ones, like a UVM, a CVMC, a Rutland, they have, they also run inpatient psychiatric units. So they have their own internal capacity related to psychiatric consultation, folks that are used to working with individuals with mental health challenges. So I think overall, many of our hospital partners are well poised to provide that support, you know, for the individual who is, you know, maybe level one at the highest level of acuity. We probably as systems partners will have to triage around ensuring that an individual has the appropriate mental health supports and can keep everyone safe. Thanks. That's my only question, Mr. Chair. Thank you. Debbie Sacks. Thank you. Yeah. So, Commissioner Squirrel, how many patients, what is the capacity with these psychiatric patients? Well, yeah. So the physical capacity of the building, I believe, is 25 to 30. We do not have anywhere close to adequate staffing capacity for that right now. So we've basically been creating, you know, our first tier is, you know, okay, one to five patients, what's the minimum staffing grid that we have to have in place for that level of surge, if you will, five to 10, 10 to 15. I'd say we're quite a ways from having the adequate clinical and medical staffing capacity to meet the full physical capacity of the facility right now. And then I'm assuming that the, like the best case scenario would be that a patient would go there and would get over COVID, would get better. And then, so is there a, like sort of a, has the, has your department been able to do kind of a trajectory of maybe perhaps moving people then back to go back to the facilities that they originally came from? Is that right? And is there a sense of how long, you know, how much time they would be at Woodside and before they could go back? Yeah, I think our goal would be, as long as there is capacity within our inpatient settings that are designed to be actually therapeutic treatment environments, I would not say that Woodside would fit that category, that it would be our goal that individuals be transferred back to a therapeutic inpatient facility as soon as possible. Again, you know, that's all pending, that there is capacity in that system that we can, that we can utilize. Just to be clear, because I've had some criticism from some regarding warehousing. We're not warehousing people there. We're treating sick people who are ill from a virus and trying to get them through that. And at the same time, trying to help treat their mental illness. Is that correct or am I, because what you had just responded to, obviously it's a temporary facility, but you're still providing treatment, correct? Absolutely. I mean, we will have our clinical treatment teams will be there. Is Woodside ideal from a therapeutic standpoint? Absolutely not. We are far from ideal conditions right now. And we want to ensure that, again, I don't want individuals who have significant psychiatric needs to be in an unsafe situation in the community or anywhere. And we can't provide care to them and someone gets hurt, particularly for individuals who might be suicidal or having other risk of harm to the cells or others. My priority is to ensure that we can still provide safety and care for them. This is absolutely temporary. And this is absolutely an emergency measure. Will the staff have emergency protection gear, masks and etc.? Yes, we have been working with the Emergency Operations Center to ensure that we have appropriate and adequate access to PPE. This morning, I read a horrifying story about the veterans home in Holyoke, Mass, where I think 10 or 12 people have died. And it's really horrifying. That's the sort of thing that can happen in an institution fairly quickly. Other questions for Commissioner Squirrel who has to get to an 11th? Hopefully you're meeting right where you are, not having to go far. Yes, I am meeting here. I am happy to provide a quick update on the residential system of care. I think that was one of the other agenda items that the committees wanted an update on. So I can speak generally about the residential system is under stress due to staffing shortages. Obviously, individuals who work in our residential facilities across the state are managing their own, whether it's having to take care of their children at home or self-quarantining for good reason. But we are certainly experiencing staffing shortages across the state. I just have to say our providers, community mental health programs are just doing a tremendous job in trying to step up to continue to provide that 24-7 care to individuals. Our community mental health agencies and others are being very creative in terms of how do we redeploy staff from other areas? So for example, school-based mental health staff that might not have as much of a workload right now, how do we redeploy them to our residential system? Across the adult system, for all of our intensive recovery residences, they are all open and currently accepting referrals. Many of them are currently full. Some have, again, managing staffing shortages that we are. That is quite a feat that they've been able to continue to do that. I think everyone is looking very carefully at their referral processes, obviously implementing appropriate screening that's aligned with the guidance that comes from the CDC and BDH. Our crisis beds are running at about 50% capacity right now. Our emergency services teams, they're also working, everyone's adjusting to more of a telehealth kind of approach to emergency services and crisis teams. So I think we are adjusting to that. I think an area where we are a little bit vulnerable right now is some of our adult crisis beds facilities across the state that are operating at much lower capacity or needing to close temporarily. Another area would be group homes. Many of our designated community mental health agencies have group homes, again, experiencing some challenges trying to, many of us are looking to combine programs so that we can kind of maximize staffing. So whereas you might have been staffing two facilities, can you consolidate so you only have to staff one? Again, individuals are being very thoughtful about that, doing the best that they can. An example of this is the Department of Mental Health is actually, we are moving the residents from the Middlesex Therapeutic Community Residence to VPCH because we use the same staff to staff both of those facilities in two different locations and for us to have adequate staffing for both of those. We have moved those individuals to VPCH. They're not admitted to the hospital. They're in their own unit, which is very separate from the rest of VPCH. Granted, some might argue that VPCH is actually nicer than the current Middlesex, but that's just an example of how we're really having to be nimble and creative so that we can maintain appropriate staffing. In terms of the children and youth programs, there has been some decompression that has occurred over the past few weeks. So for youth or children who are placed through DMH, all of our programs have communicated with families and with the department. Some have determined that it's clinically appropriate to have the child or youth go home temporarily during this period with support via telehealth. So again, where it's appropriate and where a discharge makes sense temporarily, trying to work on those pieces, programs are also determining what capacity and what space they have for isolating COVID positive youth should that happen. So our residential programs are really assessing that across the state and creating their own, I think, internal plans. We've asked that all of the programs keep the Department of Mental Health informed of any significant staffing concerns or significant loss of capacity. So currently, I think we're managing within our residential system of care. I do feel like on any given day, we're all kind of on the edge of if a program has to close entirely, how do we create capacity for those individuals? On the funding side of things, sorry, I don't want to jump around too much, but it is connected. DMH and DCF are working with the Division of Rate Setting, DEVA, to also identify mechanisms within the P and MI rules to alleviate some of the fiscal pressures of low utilization. Again, kind of in that same approach of we want to ensure the flow of funding for residential programs so they can support adequate staffing and continue to serve children and youth in their care. So that's another kind of fiscal strategy because where there's appropriate discharges makes sense. It helps them manage. We also want to make sure that their cash flow remains positive so that they can continue to operate. So that's another area that we're looking at. And then again, looking at the hazard pay for those programs as well. So before I ask my question, Dick, maybe we should go around and see if anyone has a specific question. I have a question that might is a different topic. It's a topic about this, but it's not it's not anything that I've heard the commissioner mention yet. I think the commissioner has about five to ten minutes left. So we should probably take advantage of that if there are any questions. Jenny, go ahead. Okay. So commissioner, as all of this is going on in it, you know, you're on the fly and we completely understand that and trying to make some very good decisions that are going to help people and keep them protected as much as possible. Are you keeping track of the decision making process than the protocols that are being used for triage or for whatever decisions are being made around individual patients and then collectively around the various organizations you're working with? I can think of some scenarios that would come up in the future that would involve both judiciary and the medical environment. So are you keeping track of how those decisions are being made? And I include in that all the individual decisions about who goes where, when and how. Yeah, it's a great question, Senator. And certainly as we are moving quickly, but making all of our decisions in the best interest of continuing to provide access to care for Vermonters, we're making sure that we're taking into consideration, you know, like for hospital level of care, we have the opportunity to have more flexibility under 1135 waivers. So that creates some cover for making sure that everything is vetted through our legal teams, through licensing and protection. So there isn't a decision that's made without collaborating with our local CMS authority to make sure like, yes, this move is warranted, yes, you know, we can do this. So we're kind of ticking those boxes. And at the same time, working very closely with other partners and advocacy partners, like disability rights of Vermont, legal aid, NAMI Vermont, Vermont psychiatric survivors. So we have been working very hard to include those groups in our decision making and ensure that they are looped in and apprised as we move forward. And then of course, there's the entire legal system, particularly for those who are involuntary under the care and custody of the commissioner. So it's been a huge lift behind the scenes to try to figure out how do we create capacity for Hela court, if you will, given, you know, some of the legal connections as well. So I can assure you that we are we are putting taking all those things into consideration as we're making these decisions and trying to check all of those boxes as we go, in addition to, you know, we're talking about moving individuals under stressful circumstances who are already experiencing some significant mental health needs. So being thoughtful about including their family members, using our social work teams to include their guardians, etc. So trying to be nimble, but also be very thoughtful about our decision making. And it's going to get worse. I mean, I'm thinking that having some of this work done up front, it sounds like you're everyone in it that you're working with the right groups. And but having some of the decision making up front to avoid the conflict later on is, of course, important. I appreciate all the work you're doing. Thank you. Thank you. Thank you, Commissioner. Okay, thank you. Any any other questions for the Commissioner squirrel before she has to leave? Thanks so much, Commissioner. Okay, thank you all. Thank you. Do you want to take a couple of minute break, Jenny? Or do you want to plow right in? We lost Jenny. I guess we lost her. No, I'm here. I'm here. I'm sorry. We had scheduled a five minute break, but let's let's do that. Let's do that. Some of us, we've been on Zoom quite a bit. Why don't we just take ourselves off video and mute ourselves and take a five minute break? We do that. Sounds good. Following 11 o'clock? Yes, please. One of the issues I don't, is Jenny back? Hi. Hi, Jenny. I'm back. How are you? Good. Maybe we could start the with Commissioner Hut and try to fill her in a little bit about where we we talked with the other two commissioners about how they're handling the surge and the problems that are arisen from COVID-19. But there is one issue that Judge Greerson's here for, and that is the Supreme Court decision. I don't know if it's decision or they're about parent-child contact in light of the governor's stay at home safe order. And that involves obviously DCF and maybe other departments, the state government. But I know a lot of us over the weekend, I think all of us over the weekend got emails from the Vermont Foster Parents Association, very upset about having to provide parent-child contact during this crisis and how they were going to keep themselves safe as well as their foster children. So I don't know. Maybe Judge, if you want to start with that. Is that okay, Jenny? Sounds good to me. Good idea. You have to unmute yourself, Judge. Sorry. Good morning, everybody. And thank you for the invitation. If we're keeping a record for the record, Brian Greerson, Chief Superior Judge, I obviously did have correspondence. Again, I think with Commissioner Schatz requesting the court consider a stay of any in-person parent-child contact with children in DCF custody. I also received a correspondence from Senator Sears that he had received from a Foster Parents Association, as well as Representative Haas from her committee, all relating to the same issue. The court did consider Commissioner Schatz's request over the weekend. But their response to that request was that they did not feel that a stay of all in-person contact should be the subject of a blanket order, but rather would leave it to the individual circumstances of each case to be addressed by the judge in the county where the issue arose. I would add to that that although the request came from Commissioner Schatz and the Foster Parents involved with the children in custody, the issue is certainly much broader than that. It involves issues relating to parent-child contact, whether the children are in custody or whether it's a domestic order that's in effect. And so the courts have been fielding questions both from DCF as well as from domestic cases on how to handle these situations. And they have been addressed in the courts on an individual basis. The difficulty is that every case is fact specific. And I think even Commissioner Schatz have to admit that because the children may be in custody of DCF, it may be that there was significant contact between the parents and their children, even though in DCF custody, leading to a reunification plan. And parents are oftentimes in a different phases of that contact. In other words, it may be contact that is limited to only a couple of hours a week. But there may be, on the other end of the spectrum, there may be situations where the parents have had significant contact, maybe overnight contact with the hope that within a relatively short time the children would be back with them. So I think that's where the court thought it was important that each of those different circumstances be considered rather than a blanket order in those situations. I think that's, they haven't changed their position since then, but that's that's the substance of that request. How available would be a court hearing if a foster parent was very concerned, relayed that concern to the social worker who then asked for a court hearing, how, I mean, we know that we're having trouble right now. How difficult would that be? I don't want to say it won't be difficult. It's difficult because we are operating all the courts on reduced staff levels and judge time. But having said that, every court is operational. And when those requests come in, they are included as one of the priority cases under the court's so-called administrative order 49 and specifically request to suspend parent-child contact either with cases in DCF custody or domestic cases are proceeding that will go ahead with the court. So we will get those cases in for hearing as quickly as we can. Would Ken or Christine like to comment on this? Sure. This is Ken Schatz, commissioner of department for children families. I appreciate Judge Geerson providing that information and to back it up a little bit. I just want to be clear that this was an incredibly difficult place for us to be. This is one of the incredible, difficult challenges posed by a COVID-19 pandemic. Our mission, our charge is not only to protect children, but also to support families. We appreciate the value of contact with respect to children and families, even within the abuse and neglect system. The reality is, let me be clear, we're not restricting all contact. We have worked very hard with families to have the capacity for remote contact, video conferencing or by phone. But based on the recommendation of Dr. Levine, the commissioner of health, we did submit the request to the court that Judge Geerson referred to. We know how difficult this situation is. We respect the decision made by the court, and so what we are doing is working with our family service workers, our foster parents, and our assistant AGs and state attorneys as appropriate. If we do have a disagreement with families about in-person contact, then we will be submitting those motions as a center seers and Judge Geerson reference again. We're doing our best to try to resolve these without having to go to the court. The overwhelming majority of cases to be clear have been resolved to have remote contact rather than an in-person contact. But there are some that have not agreed to do so. And so we're carefully looking at each one of those situations individually to address them on a case-by-case basis. I do want to mention one thing here, and that's Judge Geerson. Thank you very much for being here, and I want to remind everyone who may be listening outside of the committee on YouTube that you are the messenger, not necessarily. So to be clear, your messenger is from the Supreme Court. You are not. You're delivering the message. Thank you for that clarification, Senator. I will add, though, that what the court in considering this issue, what they really said was that in response to Commissioner Schatz's question was that the governor's order of stay home, stay safe in and of itself was not the reason to issue a blanket order suspending contact. And as Commissioner Schatz has indicated, it doesn't mean that we're going to not modify the contact that's going forward. And in many, many cases, the contact may have to change, but it may go to remote. And I think that DCF has done a good job in making that available to any of these parents. So it's not as if the trial judges are saying, okay, we're not going to change the contact that's in place. We're not going to deny it, but we're looking for other ways when those cases come in to allow that contact to go forward, perhaps in a different way on a temporary basis. But that's... Senator Sears, can I weigh in here? Please do, John. This is for the benefit of all who have not heard this conversation before in a different committee or in some other manner. But as somebody who has practiced law for 37 years, I've spent a considerable amount of my time in family court. And I've been involved in DCF cases representing both the parents and the children from time to time. I want to say, first off, that the statutes that we have that deal with DCF taking children out of homes are designed for really two things in priority. The first is to keep children safe. The second is to develop a case plan that can reunite parents with children under the safest circumstances possible. And those two things are critically important in this discussion. Case plans are developed that often require programming wrapped around parent child contact. And if parent child contact is interrupted, the case plan's ability to be completed becomes more difficult. In divorce situations, there are lots of times when one party would love to have this current emergency as an excuse not to have to deal with the other side. And I think we have to be cognizant as a state that our statutes are designed in such a way that in divorce cases, we try to maximize parent child contact with each parent for the benefit of the kids. So I am very happy to have heard Judge Grierson's response to all of this because I think it is imperative that these situations be handled on a case-by-case basis. There may very well be a situation where one parent, for instance, gets a positive reading in a COVID-19 test, and that might actually be very important for the courts to take on as an emergency basis. But the blanket rule issued by the governor was not intended to cease all parent child contact as it normally occurs. And we had that answered specifically some time ago, and I forget which committee we were meeting in at that time. It might have been joint rules. But the long and the short of it is parent child contact is supposed to take place as it normally does. And unless and until you can come up with an argument that somebody is potentially in the line of fire for a COVID-19 infection, we should not be trying to revise things that would make parent child reunification in DCF cases or the custodial battles that we often see more difficult. And I just wanted to leave it at that and hope that the committees listening here now can take that message back to constituents. Thanks. I appreciate that, Joe. But I must caution that if you're a foster parent and you're worried about this crisis that we're all facing and you're worried about a parent coming in who may or may not have been found out of the COVID-19, your concern is, you know, is legitimate. And so I can't discount that. I understand the law and understand the rules. But these are extraordinary times and uncharted waters. So I appreciate that. Are there other comments for Judge Greerson or Ken about this issue? I have a question, Dick. And I think Dick McCormick does also.  Thank you. Judge Greerson, did the court take into or did the court give consideration? I'm getting an echo here. Senator White is back on. Okay. Judge Greerson, did the court consider simply shifting the burden of asking for an exception? In other words, extending the separation order, which is universal otherwise, that could be extended to visitation. And people who want an exception come to court and ask for that exception, explaining why their need to be with their kids is Trump's the public health issue. As opposed to now, what we're being told is if you want to protect public health, you need a court order to do it. And I don't think you get into court real fast. So I guess was that any part of the court's deliberations or the court's finding? I might have to have you clarify the question, Senator. When you talk about the separation, you're talking about the distance, the six foot. The best way to defend against the epidemic is for people to have physical separation. I mean, I'm living at home. My wife and I are not seeing anybody. We're home all along all the time because we were asked to do that because of a public health emergency that Trump's people's right to make a living. I mean, Trump's everything apparently but this. And my sense, what I'm asking is, did the court consider the possibility that it could respect that public health necessity? And as you would said, every case is individual. It should have a court order that the court order would be, okay, in this family's case, we don't impose the separation by separation. Yes, I mean, we're all separating. It's why we're meeting electronically. I think it would be fair to say that the court was certainly cognizant of the public health risks involved in this decision. But when you have, and it's a balancing of risks in some respects, you have to also look at not only the public health risks, but some of these cases, the attachment between the parent and the child is so critical that we've got to find a way of maintaining it. And so that's why I think it has to be handled on a case by case basis. And I think recognizing this new, as Senator Sears said, this new world, that this distancing is critical to everyone's health, particularly the child. Yeah, I have not expressed myself clearly. I understand the need for it to be a case by case. I understand the need for a case by case court decision. What I'm asking is, in that the decision that the court would be asked for, you have a rule, now you're going to deviate from the rule. The rule could be the parents get to see the kids. And someone who thinks that's not healthy, that's not safe, would ask for an exception. Or the rule could be that the separation, the quarantine that's applying to the entire universe except this is the rule here too, unless you want an exception, in which case you come and you ask the court for an exception. It's the same two possibilities. I'm saying, one is the rebuttable presumption, the other is the exception. And it could go either way. And I'm not wondering if the court looked at that. You know, Senator, I can't say that the court looked at it exactly that way, because I wasn't privy to all of their discussion. But I will say that the fundamental rule that we've gone forward on is that if there is an order that's in effect of parent-child contact, whether we're talking about DCF, or whether we're talking about some of the domestic cases like Senator Benning pointed out, what we've saying is if there's a rule in effect, we expect the parties to honor that rule. If they are aware of, if they have information that the risks of COVID-19 have changed dramatically, the risks involved for that existing order to change, then they come into court to ask for that change. No, no, I understand what the, what the ruling was. I'm asking, okay, I, I think, I, I guess I'm not getting it. You're not giving me an answer to my question. Maybe because I don't understand the, the question. So it may, it's my fault. Could someone, my guess is other. Well, I think that Senator McCormick. Someone else rephrased my question. I think Senator McCormick is asking, is did the Supreme Court look at it from that the, that the default was you don't visit versus the default that you do? No, they did not. They did not. Thanks. My question might be related, but it's a, it's probably a dumb question. Sorry. But we're under emergency rule. And one of the things that I continue to try to understand is the extent to which the emergency folks, Department of Health, take charge and the relationship between the Department of Health or the emergency folks and the judiciary. And so this is, I think this, for me, this really underlies the discussion we're having. And I don't know whether we, we tried to look at this a little bit in our committee before we began any of our debate on our legislation related to the emergency understanding our role, what, what's doable, what's not doable, what's essential, what isn't, but so that relationship. And I guess I might, I might be throwing this question out to Bryn. And I don't know if it's something that can be answered or is it that the judiciary is separate? How does this all sugar off? Well, Bryn may want to weigh in on this, but clearly there is a separation of powers issue in these, in many of the questions that have come before the court. And unrelated to parent child custody, there have been similar requests about stays being imposed, for instance, on evictions and mortgage foreclosures. I'll be addressing a committee on that later this afternoon. And this court has taken the position that in those cases, those are policy decisions for either the executive branch or the legislative branch to, to impose that type of stay. This, this process though, these issues are developing every day. And the court meets regularly to consider all of these issues so that I don't want to, anyone to think that the court isn't considering issues as circumstances change. But there is that issue of who has the authority to issue certain types of orders. And going back to Senator McCormick's question, I think I understand it better now. If we created a default position that was different than the existing orders, that would essentially be a blanket order. And that's what they have so far indicated they are not inclined to do that. Ken, but, but, and I don't want to belabor the issue, judge, but could, for example, I'm familiar with the case that where the child was in a residential program and the child got just like we're doing today. I don't know if it was over Zoom, Skype or FaceTime or whatever, had a great deal of contact with their parent just as they would have had in person. And is that meet that need? Is that an agreeable thing or the remote contact? Yeah, this was in a program. So it may be considered different in terms of the contact, parent-child contact. I hope that what I'd said earlier, the court isn't looking to deny contact. They're looking for different ways of preserving that contact. And if it can be done remotely, and I know that in talking with Commissioner Schatz of the over a thousand families that are involved with the department in custody, there's a relatively small number of cases where they haven't been able to reach agreement. And obviously those are the cases that are coming our way. That doesn't mean that our order would end up being exactly what the Commissioner's office is looking for. In other words, we would say we have to change the contact you have now because of COVID-19. And we agree that in your case, that remote contact is the best solution. And so we're looking for those types of solutions. Thank you, Judge. I appreciate it. And with the half an hour we have left, and it's okay with you, Jenny. I'd like to hear from Commissioner Schatz and Commissioner Lett about how they're dealing with their residential population, as well as what plans they have for hazard pay that we asked Commissioner Squirrel about. Is that all right to move on? No, that's fine. Just so you know, we have Commissioner Hutt scheduled tomorrow as well as Commissioner Squirrel. So I'm hoping that we can cover some of this. Some of it will not be redundant with what we're doing. Some of it will be. So this is good. We can triage. Thank you. Judge, thank you very much. Okay. Thank you. Thank you. You need to get somewhere out. You're welcome to stay and listen in. But I've got to, if you don't need me, I have a few other things that I think we appreciate your joining us. Thank you. Thank you. I just also want to let you know there's a handout from Ken Chatz on the website that I just posted. Yep. There's a handout about the capacity. You want to lead off Ken with both of those questions or you and Christine? So I will ask Christine to take the lead in describing the status of our residential and foster care system in light of COVID-19. Ken and I have both of our computers in the same room. So it makes it a little interesting when I switch over. So what I would like to start off with is if you haven't had a chance to look at the handout that we just sent over, I want to give you an update of our residential system of care. Largely, a lot of the topics that the items that Sarah Squirrel highlighted are similar things that we're experiencing in our system as well. And so clearly COVID-19 is causing many of our residential programs in Vermont to reduce their capacity. And that was the handout that I sent. So in a normal environment, we have approximately 144, is that the number I came up with? Maybe it's 114 beds in our in-state residential capacity. And so we are currently down 63 beds. And this is in response to, as Sarah mentioned, staffing shortages. Frankly, we have people, whether they're exposed or hunkering down and not able to show up at work. And that is certainly causing some pressures in our system. You'll also see in the handout that most of our programs in-state are full. One has closed. And of course, we now have five beds at Sweet 12. We have 30 at Woodside, but let's be clear, we weren't, we were, we've really been at three to five for the last six months at least. So we, so that really... When it says full, does that mean that, like, Allen Brooke has a COVID capacity of three? And does that mean there are three there? Yes, that's correct. Okay, thank you. You're welcome. So also, most of our out-of-state programs are no longer accepting referral, new referrals. And so where we might have had a youth, for example, previously at Woodside or at Sweet 12, that was slated to interview at an out-of-state program and moved there. Once COVID hit, those bed options were no longer available. And so what we're doing is we're managing those kids in-state. What I do want to say is that in the middle of March, right as COVID was really hitting here, we had 104 children and youth that were placed in-state, in-state residential programs. And just about a week and a half later, we reduced that to 80 children and youth placed in-state residential programs. And we did that intentionally. So if there were kids that could move back home or into foster care from residential placements, we made that happen through, I think, very much a huge effort on behalf of our staff and our partners, frankly, through a multitude of education planning and treatment team meetings and conference calls and transportation efforts to make sure that we got kids who could go home back home. And, you know, clearly we did this in response to COVID to make sure that we helped our programs to have the adequate capacity that they would need in light of COVID. So I also wanted to just touch briefly on the issue that we are, as you likely know, with the Agency of Human Services standing up what is called the AHS Wellness and Recovery Center in Plainfield. And so our expectation is that if we have youth either in foster care or in residential programs that become COVID-positive, they will have the option of moving there. What we are hoping in our system is that our kids and youth can stay in place, shelter in place in foster care or in residential programs. And that is certainly our expectations of both. But we do know that there may come a point in time where staffing capacity in our programs or in our foster homes, frankly, where those children may not be able to stay. And then we will have the ability to move them over to the site in Plainfield. We do think that we're working now to staff that appropriately. We have Brenda Gulley from FSD as our main point person there, and she is helping to manage that new site. And I think we are feeling quite good about the fact that we have that as an emergency backup option. And I think that's really going to help our system to have the capacity that it needs. We also, we have issued guidance to our field staff that if there are kids in foster care that were close to reunification, we wanted those kids to move back home wherever it was safely possible. Again, knowing that COVID was coming, and we wanted to make sure that anyone who could go home and was already on a track to do that could move in that direction. And so we did that as well. We are working to address respite for our foster parents. Clearly, that is an issue that foster parents need in a, you know, in a good, healthy environment and certainly even, you know, now even more of a pressure. And so we're working with foster parents to issue guidance about respite. And we're also looking to determine if we can support foster parents financially with a stipend if they are caring for a sick child with COVID. And so those are some of the things that we are working on standing up and investigating now to see if we can add those additional supports to the field. I do want to tell you that we have seen a 60 percent decrease in the numbers of calls to our child abuse and neglect hotlines compared to March of 2019. But we've also seen a 60 to 70 percent. We've seen actually 60 to 70 percent of those calls that we're getting now being accepted as intakes. And so we have a historical average of about 30 percent of our calls that get accepted as intakes. And so while we have a lower number of people that are calling, we do have a higher rate of accepted intakes. And I was just on a call this morning with other New England commissioners and I will tell you that every state is seeing the same thing happen. And there's a lot of speculation as to why, of course, kids are not in a lot of community spaces. They're not in schools. It's not unlike potentially a summer response, although a lot of kids in summer are still in summer camps and still in daycare. And so we are seeing this at least in New England and I'm guessing nationally as well. One other thing we are working to support our older youth in foster care and those who have aged out of foster care. Our youth development program has been communicating out to really try to get word out that that program is available to youth, especially if they were in college and their college closed and they didn't have a place to stay. They can certainly reach back out to that program and get help in terms of finances and all of the supports that are older youth in and formerly in foster care need. So let me stop there. I know I've thrown a lot of information at you. Any questions? I'm pretty thorough, actually. Senator Cummings, if you unmute yourself, we can hear you. I'm unmuted. Yeah. Needless to say, the plane field plans has kind of landed in the town. They say unannounced at the select board and there's all kinds of stories that mental health people and youth at risk are going to be there and you can't confine them and they can run into town and there's just a lot of kind of panic going on and can tell me what I can say to kind of quell that. I'm glad to respond, Senator Cummings. I appreciate you raising that issue and concern. The program there is being set up by the State Emergency Operations Center. We are very mindful of those community concerns. We're definitely, as Christine mentioned, we definitely will have staff on site to help manage the facility. I know in light of the concerns, we're also going to make sure there's appropriate security on the site to address those kind of concerns. I do believe you can tell your constituents that we recognize the issues, the concerns. We're committed to make this a safe place both for the people who are residing there but also for the community at large. Obviously, the challenges of this pandemic are significant for all of us and we want to take care of each other as best we can in a safe manner. Glad to talk offline with respect to more detail if that's helpful, Senator. But again, I think we are making sure that we stand up both enough care providers and supervision to make sure that it is a safe place. I think that's reassuring. I felt that that's the answer I'd receive but I think against the fact that because of the emergency, it's like the testing center that opened up apparently without any local information down at Landmark College. This one just kind of got sprung on people and people are stressed and tense and I think just need some reassurance that we're going to take all the reasonable precautions we can to protect their health and welfare and they're not going to have kids walking around town coughing on people. Senator White would like to comment if you could. Thank you. I think that it's one thing to assure people afterwards but I was the one that brought up the issue about the Landmark. It's very frustrating that decisions are being made without any contact or any involvement of the local communities and I know when the testing site was set up down here, no one had ever contacted Brattleboro Hospital or any of the practitioners and I understand the same thing is happening in Plainfield. So I have a call with Secretary Smith at noon as soon as we're done on this call because I think that we are making tremendous mistakes by not involving the community people first with the planning and the decisions instead of making the decisions and then trying to reassure people. That's my comment. Thanks to that. Commissioner Schatz, if you want to while we still have you and Christine comment on the hazard pay for people that are working on the front lines. Sure glad to do that. I understand and I was going to say that we appreciate the commitment of both state employees and all of our community providers in supporting the system as a whole and individuals who may exhibit symptoms. So we are as Commissioner Squirrel indicated carefully looking at what financial supports can we provide both to our state staff but also our community providers. So again as Commissioner Squirrel mentioned we are looking with respect to the residential system of care. We are literally meeting this afternoon with our rate setting folks because it is the PNMI system that operates to provide payments to those programs. We are going to look at and try to figure out what additional financial supports we can provide to residential providers. Similarly as Christine mentioned we're definitely looking with respect to foster parents who may be caring for children with COVID-19 system symptoms. We're trying to see what we can provide to them in terms of additional financial support. And again as I mentioned state employees are also on the line here and we're looking to support them also. So those things are all works in progress at this point. Thank you Commissioner. Are there questions for Commissioner Schatz? Thank you Ken and Christine. Commissioner Hott did you have a you know the questions really are about the the residential and how you're handling the folks in your care. And you've already heard the question from Christine. So if you could keep fill us in on what's going on there and I'm glad to hear you're meeting with Health and Welfare tomorrow so that may lead to more questions. It's actually Friday. It's actually Friday. Oh okay. Yeah well thank you. I was quickly looking when you said that Senator Lyons I'm thinking I don't think that's tomorrow. I apologize. No that's okay. We should just be able to stand in our backyards and yell to each other so that's 10 feet away at least. So let me talk a little bit about the global long-term care residential system which you know as a subset of that are the the residential care facilities that Christine and Ken have been talking about and that Sarah talked about earlier but but my my work and the work of the department has been up a couple of levels. We have 36 nursing homes in the state of Vermont and about 132 residential care homes so whether those are level three residential care homes level four therapeutic community residences different assisted living so different licenses different sets of regulations for each but it's an enormous number of residential care facilities long-term care residential care facilities across the state of Vermont. So that has been really focused on on those residential programs that are supporting their children. I know that Sarah Squirrel has been very focused on those that are supporting kids with mental health issues and and my focus has been much more global to just consider that whole group and some of the issues that that were up against. When you think about the Dale populations in general obviously they they hit they check all the boxes for those Romaners that are probably most vulnerable to this virus so older Romaners Romaners with disabilities that may have underlying health conditions and so it's been as it is true for every department and every commissioner overwhelming to try to kind of to understand how best to wrap our heads and our arms around supports for that. So we've been reaching out really specifically to the long-term care residential facilities to offer guidance direction trying to sort through what VDH has to offer in terms of best practices guidance documents looking at what the CDC has we've been assembling that and pushing it out at some level probably overwhelming some of the smaller providers but wanting to make sure that they do have information available to them and we've been hosting phone calls collecting questions pushing out responses to those questions on these phone calls where we bring in the Vermont Department of Health our division of survey and certification so that we can understand exactly what people are wondering about and answer those questions directly we did that for an hour and a half on Friday we'll do it again next week and continue to push information out that way I think that Christine noted this issue is talking about it the goal the first line of defense across all of this is enabling people to shelter in place when you think about long-term care those older Vermonters that are in residential care or nursing home care those are their homes they don't necessarily have other places to go to there aren't biological families or other alternatives and so trying to support those facilities to keep supporting the people that live there has been paramount and candidly it's the thing that's keeping me awake at night because as soon as the staffing becomes impacted as soon as there aren't enough staff to hold together especially some of these very small programs it's going to become problematic and that that staffing can be impacted for a variety of reasons you could see individuals that are sick themselves individuals that are caring for sick family members or individuals that are just afraid you know we can't no employer can force a staff to come in through this and I think what they're trying to do is just hold together their staffing as as well as they can we continue to try to support that and answer questions as we can so pushing out information about essential child care I was able to do that a little bit today because some of the smaller providers didn't realize that they might be counted as essential health care staff and could access that so I talked with the child development division this morning and pushed out that information but I think what's really I'm just looking at my notes really quickly what I think we are doing at the same time is trying to plan for that surge capacity that Christine talked about so is there a place whether that's the Goddard college site or alternate sites and we're not we're not there yet but trying to identify if there might be places where it would be logical to shift people if there is a staffing crisis in a provider the one other thing I will say is that the standards of information and capacity across those providers is really distinct and different depending on the provider and depending on the size of the provider so just to give you a couple of examples nursing homes are federally required to have infection prevention and control plans they're required to have on-site nurses that are trained specifically in infection prevention and control they typically have the capacity to isolate to cohort staffing the way that they need to to prevent additional infections I think we've seen examples when you think about Burlington Health and rehab of a place that was doing a good job but was struggling to get a handle on that because the virus spread so quickly there wasn't anything wrong with what Burlington Health and Rehab was doing at all they were doing good work but it is a very it's an aggressive virus and as we've heard more and more it's easy to spread even when somebody's asymptomatic so I think trying to keep up to date with that information about the virus and the standards that are required that's something that our nursing homes can do they have the capacity to do that it's a struggle but I think that they're managing that really well I start to worry more when we get into residential care because there are not the same requirements they don't have that capacity necessarily and the difference between a residential care home the size of Pillsbury which most of you know because that was in the news so much last year it's 150 people it's a part of a larger organization the resources that that kind of an entity has or a Wake Robin has is very different than a very tiny residential care in the middle of the Northeast Kingdom who's supporting three people or four people and so we are trying to I had a group a cohort of our nurses in the survey department get trained in those infection control procedures so that they can be technical assistance to any facility that calls can talk them through can understand the layout of their facilities and help them to address that as it's happening so I think that there's this one track of trying to keep it stable in those homes and then planning for what happens when we can't and with 132 small residential care or medium and large sized residential care in addition to the nursing homes it's a pretty it's a pretty large cohort to be paying attention to so maybe I'll just pause there and see if there questions questions for Monica Monica thank you for that that's a great overview and I think but what we heard yesterday from the hospitals and and the linkage with the Burlington res care rehab and rehab folks was exactly what you have said that this is really very difficult given what protocols are required or not required in terms of public health my my question I think is and I'll ask this again on Friday perhaps what protocols are being put in place even though they may not currently be required by law um are are some of these um care facilities actually putting health protocols in place and and can you talk about what it is that they are I'm sure they're all doing something I think that they are all doing something and again it really depends on the size of the facility but I think that the basic precautions are are continue to be um even in the midst of new information the the most basic precautions are the ones that are are most easily um implemented in what most facilities are doing so things like trying to keep residents um somewhat separated from one another trying to cohort staffing so that specific staff are working with specific people as much as possible so you're not having a staff person be a vector for transmission basic hand washing a heavy-duty cleaning of all of those surfaces um we also are working very hard to make sure that if there are requests from residential care homes or nursing homes for protective equipment for PPE that those are prioritized with the Vermont Department of Health and they've been great about pushing in equipment out the door when it's requested and required they've been screening staff you know we got ahead of this early on in terms of early on in the in the life of this virus Vermont instituted the governor had an order around limiting visitors prohibiting visitors limiting visitors and that happened really early on as didn't as did the requirements even before the visitor prohibitions for screening screening of residents and screening of staff with some basic questions about their health and well-being so trying to really understand that and implementing that that's been happening across the board in residential care um one of the questions on the table right now that I know the health department is working to answer is um is in response to that screening of staff people so the best practice early on was was that if you felt ill regardless of whether or not it was COVID-19 symptoms but just ill you wouldn't come into work and if you were manifesting any symptoms of COVID-19 you would make a decision with your healthcare provider about whether or not to be tested but still you would not be going into work so so we may have separated from the ability to work healthcare workers that may or may not have actually been ill with COVID-19 and so that time period where they were self isolating has been a tremendous burden in the healthcare system makes absolute sense it's absolutely necessary but 14 days is a really long time to isolate if you are in fact not COVID positive and so I think we're trying to understand um and Mark Levine is digging into this now what are the most up to date recommendations about that because we are putting pressure on our workforce and if it's the right thing to do we've got to do it but if it's not necessary we need to mitigate that a little bit because it's wreaking habit across the system yeah I mean that's kind of the basic question isn't it uh what exactly what what protocols do you put in place what's the timing on all of this um and the Department of Health is probably the best place to um provide that information but it's protective um across the board now and in the future so and the guidance is changing I mean I saw last night and then again today nationally and I know that um Commissioner Levine was referencing it a little bit even in the governor's press conference maybe there are going to be new recommendations about protective equipment and masks and and the CDC is trying to keep up with this and and really acknowledging that asymptomatic people people who don't feel ill and aren't presenting any symptoms are are it seems more and more carriers potentially or could be and if you don't know that some of the precautions the basic precautions that we've been mandating may or may not be as effective it's it's it's somewhat overwhelming to try to get a handle on something that keeps morphing in the way. Senator, Senator Ingram had a question I think and also Senator Westman wondered if Senator Baruch's got a mask on. I was just gonna say he's up to date. Yeah thank you um yes Commissioner Hut um when you say that your screening staff could could you be a little more specific are you like actually administering uh tests or are we are you taking temperatures you know every day or what or what what does that mean? Yeah so the specific guidance originally you will recall was a screening going through a series of several questions and and even those changed in the period of time between when we started and and now but there were questions that were asking people to self-identify if they had traveled, if they were feeling ill, if they had temperatures. I think that most facilities at this point in time have moved towards I'm certainly no nursing homes are doing this because it's part of the CMS guidance and I think most residential care at this point in time and we did talk about this on the call with them last week our screening staff to see whether or not they have temperatures and again some of the basic questions that came back from them you know we we put out this guidance that said just as an example check your staff for temperature and the question that came back was well how high does it need to be like what's what's the demarcation point because some people tend to run cool some run warm so we were able to get some clear technical guidance out about that in terms of here's the mark that you need to utilize and some and some people are checking staff more more often during a shift recognizing that as they do that they're going to be impacting their workforce potentially which is a pretty intimidating thing when you're when you're tight like that that actually leads to a question that I have and maybe Ken or Christine can also respond do we have standards for staff and residential programs as to at what point should they not be working you know I've heard reports in other states where people are being asked to work when they're ill I haven't heard that in this state at all but are there any standards that you've developed for all programs that deal with residential this is Ken my view my understanding is we are simply looking to the guidance issued by Dr. Levine or the Department of Health we don't have anything separate that we have sent out so if somebody's feeling ill they should not be working in a residential program that's correct in any site because again regardless but certainly not in residential programs or or providing one-on-one care with anybody so the Vermont Department of Health also has a Han network health action network there are these alerts that they put out and we serendipitously added all of our licensed residential care and nursing homes to that Han network months and months and months ago for different reasons all together but it has proven to be a happy serendipitous move because the health department's health alerts go out to them directly they don't filter through us they don't have to filter through DCF or through DMH they go out directly from the health department just as they do to hospitals and so all of the information about staffing and screening and questions about protocols and procedures are pushed directly out to that network we try to filter it and and help it to be more understandable but it's coming directly from the source so in that way I feel like this has been coordinated in terms of the information that we've been able to push out even though again some information that's written for hospitals can seem very overwhelming to a small residential care provider better for the information to be there than for them to not have it. Thank you. Any other questions? Jenny do you have any closing remarks? No just thank you very much for all the information we're greatly appreciate appreciative of the time that you've taken to be here today and Commissioner Hutt will be asking you some different questions on Friday but certainly the information you've given us is exceedingly helpful. Great thank you. Thanks Christine. I thank you all as well and Ken and Christine and anyone else who has information could you update us after your meeting regarding the PNMI rate setting? Glad to do so. Thank you so much committee thank you all very much both committees I think it worked well. Judiciary we'll try to meet again Tuesday or Wednesday I'm kind of waiting to see if we get called back to vote on remote call back to vote remotely but so I'm kind of waiting is there anybody who wouldn't be able to make a Wednesday meeting? Okay good. We may be doing some training on remote voting um I don't know if it's just the house right now the house committees I'm waiting to hear on that but I might be in touch with you guys to set that up with the chief I guess it takes about an hour so just let you guys know that. Okay well we'll try to work that out with Peggy and Brynn and Eric for our staff to meet on Tuesday or Wednesday depending on what happens. Okay our committee will probably meet on Tuesday and Thursday given the training that's going on I don't know whether we'll meet more than that but we'll talk about that in committee tomorrow. Okay Brynn thank you very much for being here. Thank you. Thank you. I'm going to end the live stream now.