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A
A
I've
been
given
a
no
to
reminders
before
the
roll
call
members
that
are
participating
remotely.
Everyone
should
be
muted
unless
actively
speaking,
please
use
the
chat
feature
to
notify
staff.
If
you
would
like
to
be
recognized
for
a
question
and
when
answering
the
attendance
roll
call,
please
indicate
if
you
are
at
your
lrc
office
or
district
office
and
another
note
of
housekeeping
monday
october
18th
at
1
pm
will
be
our
next
meeting.
A
A
A
It
looks
like
we
have
a
couple
that
are
going
to
be
remote
and
do
we
have
any
that
are
in
the
room,
all
remote,
okay?
Well,
if
you
all
could
for
the
record,
make
sure
that
you
introduce
yourselves
and
then
continue
with
your
testimony,
and
then
we
will
have
questions
for
you
once
all
of
the
presenters
have
have
given
testimony.
D
D
D
My
name
is
jason
vincent
and
I
have
the
honor
of
serving
as
the
executive
director
of
the
pinterest
area
development
district
located
in
hopkinsville
and
I'll
be
beginning
my
eighth
year
as
director
here
in
january
this
past
june,
I
became
the
chair
of
the
kentucky
association
of
district
directors,
which
is
comprised
of
the
directors
of
the
15
area
development
districts
across
the
state.
Joining
me
today
is
jarrett
haley
who's,
the
executive
director
of
the
kipta
ad
located
in
louisville
and
then
jessica,
elkin,
director
of
social
services
at
kipta.
D
We
do
a
lot
of
different
things,
but
with
one
thing
in
mind
and
that's
to
make
life
better
for
the
citizens
that
we
serve
now,
the
ads
are
owned
and
operated
governed
by
our
citizens
through
a
board
of
directors
and
our
boards,
as
you
all
know,
includes
county
judge,
executives
of
each
county,
mayors
and
private
citizen
leaders
from
each
of
the
counties
that
we
serve
and
we
have,
and
since
the
beginning
been
the
convener
of
our
region
around
a
multitude
of
issues
reflecting
the
needs
and
challenges
of
a
particular
point
in
time.
D
Well,
I'll
keep
moving
jared
while
you're
working
on
that
the
unique
thing
about
the
ads
is
that
we
are
guided
by
local
leaders,
as
I
said,
which
of
course
makes
us
nimble
allows
us
to
understand
what
the
needs
of
the
region
are.
So
we
can
plan
or
in
some
cases,
react
to
whatever
situation
arises.
D
We
also
help
our
communities
plan
for
the
future
as
it
pertains
to
infrastructure,
whether
that
be
transportation,
housing
hazard
mitigation,
workforce
and
I
could
go
on
and
on.
In
short,
we
partner
with
our
local
communities,
state
and
federal
funding
sources
to
bring
all
the
available
resources
to
the
table,
so
communities
can
do
what
needs
to
be
done.
D
A
E
Can
see
it's
amazing,
hey!
Thank
you,
sorry
for
the
technical
difficulties
earlier
sure,
but
again,
as
jason
said,
I'm
jared
haley
the
executive
director
at
the
kipped
area
development
district
here
in
louisville,
the
15
area,
development
districts
also
house,
the
area
agencies
on
aging
and
independent
living.
E
E
These
meals
are
served
at
congregate
meal
sites,
including
senior
centers,
senior
housing
and
adult
day
care
centers
or
delivered
to
the
homes
of
frail
or
home
browned.
Older
adults,
nutrition,
education
and
counseling
is
also
included
over
the
course
of
the
pandemic.
Providing
mills
to
older
adults
has
remained
a
priority,
and
older
adults
have
received
over
5
million
mills
since
march
of
2020
across
the
commonwealth,
through
the
ombudsman,
legal
services
and
elder
abuse
prevention
programs,
the
aaa's
are
advocates
and
work
to
assure
basic
rights
of
the
most
vulnerable
older
adult
community
members
are
protected.
E
In
short,
we
are
the
experts
on
our
communities
from
many
angles,
including
care
that
comes
not
only
through
waiver,
but
through
many
other
service
areas.
Not
only
that,
but
it's
also
important
to
note
that
we
focus
heavily
on
enhancing
the
lifespan
of
older
adult
community
members
through
health
promotion
and
disease
prevention
activities.
Assuring
individuals
have
access
to
available
insurance
and
keeping
the
community
active
and
informed,
so
they
can
make
decisions
allowing
them
to
thrive.
E
It's
important
to
highlight
these
activities
because
they
are
so
interconnected
with
the
goal
of
keeping
individuals
to
remain
in
their
homes.
As
is
the
goal
of
waiver
programs,
I'm
going
to
hand
it
over
to
jessica
to
speak
on
the
importance
of
investing
in
the
waiver
programs.
The
challenges
to
serving
and
recommendations
jessica
brings
a
unique
understanding
of
waiver
having
worked
in
various
roles
requiring
her
to
view
the
program
through
different
lenses.
E
These
roles
include
a
service
advisor
performing
case
management,
task
intake
and
eligibility
coordinator
where
she
was
responsible
for
the
initial
engagement
of
a
waiver
participant
with
services
and
completed
initial
care
plans
for
all
persons
entering
hcb
waiver
at
kipta
waiver
coordinator,
where
she
managed
sel,
michelle
p
and
hcb
waivers
and
finally,
home
and
community
supports
manager
prior
to
undertaking
the
area
agency
on
aging
division.
Director
role
in
november
of
2019.
E
F
Thank
you,
as
director
harley
just
mentioned,
my
name
is
jessica
elkin.
I
am
the
area
agency
on
aging
director
here
at
kipta.
We
thank
you
for
the
opportunity
to
speak
with
you
today
as
dedicated
partners
on
this
waiver
redesign.
F
Thank
you
triple
a's,
as
said
are
dedicated
to
assuring
that
community
members
thrive,
and
we
know
that
waiver
services
are
a
key
part
of
achieving
that
goal.
For
nearly
15
years.
We
have
served
our
community
of
all
ages
through
waiver
by
providing
participant
directed
and
traditional
waiver
services
via
service,
advisement
and
case
management.
F
As
director
smith
said
in
a
prior
presentation.
This
role
is
the
team
lead
in
the
community
in
this
role
we
are
the
guiding
hands,
performing
tasks
such
as
coordinating
team
meetings
and
regular
home
visits,
assuring
that
all
areas
of
available
service
options
are
known
and
considered
by
each
participant,
as
we
draft
and
implement
participant,
focused
care
plans
based
on
their
needs
and
wants.
We
monitor
and
adjust
those
care
plans,
as
the
participants
needs
change.
F
F
F
F
F
According
to
the
census
bureau
of
data
here
in
kentucky
today,
roughly
17
are
for
rounding's
sake.
Nearly
one
in
five
kentuckians
are
age
65
and
over
today
there
are
over
one
million
adults,
age
60
and
over
in
kentucky,
as
you
can
see
from
the
statistics
listed
here
from
national
population
projections
over
the
course
of
the
next
20
years.
The
older
adult
population
across
the
nation
and
here
in
kentucky,
will
continue
to
grow
more
than
twofold
in
some
age
groups.
F
F
There
are
many
challenges
and
we
can
spend
hours
talking
about
the
challenges
in
our
current
environment.
If
there
were
not
significant
or
known,
then
we
would
not
be
sitting
before
you
today,
but
identifying
and
discussing
these
challenges
is
a
great
opportunity
to
work
together
for
change.
Here
are
a
few
that
we
have
identified
application
processes
in
waiver
intake
and
application
first
space
step.
One.
Whichever
phrase
you
choose
to
use
is
the
initial
contact
for
applying
for
waiver
services.
F
More
often
than
not
the
waiver
process
for
hdb
waiver
and
others
begins
at
the
triple
a's.
Our
aging
and
disability
resource
center
staff
do
their
best
to
navigate
the
mwma
system
in
a
timely
and
efficient
manner.
The
staff
are
often
left
in
a
holding
pattern
due
to
things
they
do
not
have.
Access
to.
F
This,
unfortunately,
creates
lack
of
trust
or
confidence
and
service
staff
spend
far
beyond
the
reasonably
expected
amount
of
time
that
it
should
take
to
process
these
applications
and
community
members
in
need
of
services
are
in
a
holding
pattern,
while
everything
lines
up
in
our
systems,
universal
service
categories
and
requirements,
they're,
not
standard
service,
univer
services,
universal
across
waivers.
The
service
menu
varies
in
each
waiver.
In
some
instances
the
service
names
may
be
the
same,
but
the
definitions
are
entirely
different.
In
others,
the
service
is
not
available
under
one
waiver,
but
is
under
another.
F
An
individual
being
served
by
the
same
payer
does
not
have
access
to
all
available
services
serving
older
adults
and
those
with
physical
disabilities
becomes
more
challenging
under
these
service
categories
by
the
day,
because
their
needs
have
changed
significantly
over
the
years
and
will
continue
to
change
as
we
move
forward.
They
often
have
dual
challenges,
for
example,
declining
ability
to
perform
activities
of
daily
living
in
combination
with
a
severe
mental
illness
or
a
cognitive
decline.
F
F
Initial
training
and
ongoing
training
haven't
taken
place
at
timely
intervals,
every
level
of
waiver
implementation
teams
from
the
cabinet
to
departments
to
providers.
We
all
work
very
hard
to
succeed,
but
we
are
all
working
past
our
capacities
conducting
change
across
this
number
of
waivers
takes
time
that
we
are
not
afforded.
F
F
Those
changes,
assist
with
the
technical
aspects
and,
most
importantly,
not
disrupt
services
to
an
individual
because
of
systematic
challenges
we
are
serving
the
most
in
need:
individuals
at
their
most
vulnerable
times
of
life,
with
the
current
provider,
reimbursement
rate
for
case
managers
and
service
advisors
and
its
budgetary
implications
on
staffing,
increasing
the
caseload
on
existing
case
managers.
There
is
not
enough
time
to
provide
the
service
we
strive
to
direct
service
providers
and
participant
directed
service.
Employees
are
severely
underpaid
and
we
are
losing
ground
with
that
workforce.
F
F
Recommendations
for
moving
forward
the
first
one
being
infusion
without
question:
there
must
be
a
financial
investment
to
redesign
and
we
must
continue
to
move
forward
at
every
step
of
that.
While
that
is
occurring,
there
must
also
be
infusion
of
funds
to
invest
in
the
network
and
current
providers
in
order
to
sustain
services
as
we
walk
through
this
redesign.
F
The
simple
fact
of
the
matter
is
the
current
lack
of
funding
will
only
end
up
costing
us
more
in
the
end,
and
it's
costing
us
now
senator
meredith.
I
believe
it
was
you
during
a
presentation
early
on
that
said
what
we
aren't
doing
or
seeing
is
costing
us
money.
That
statement
could
not
be
more
accurate.
We
see
it
out
here
every
day,
in-home
service
providers
are
struggling.
F
F
The
very
essence
of
participant
directed
services
is
person-centered
planning
and
implementation,
the
largest
portion
of
pds
employees.
Our
relatives
are
known
person
to
a
participant.
This
workforce
is
already
here
but
are
struggling
to
care
for
a
loved
one
because
they
have
to
work
outside
of
the
home.
Often
that
leads
to
institutional
care.
F
F
F
F
A
Thank
you
very
much.
That
was
very
enlightening
and
you
know
we
met
when
we
met
a
couple
of
what
maybe
two
months
ago-
and
I
was
surprised
I'm
like
I
didn't
even
know
that
you
all
did
this
and
and
so
it's
been
a
it's
been
important
to
me-
to
bring
this
into
the
broader
conversation,
because
you
all
play
such
an
important
role
in
providing
care
to
those
in
our
communities,
direct
care
to
our
communities
and
you've.
A
Also,
given
us,
you
know
a
list
of
options
that
I
think
are
right
in
line
with
what
we're
hearing
from
so
many
others
that
operate
in
this
space
workforce
issues,
provider
issues-
you
know
these
barriers
that
it's
time
to
remove
in
order
to
expand
our
our
reach
within
these
waivers,
and
so
thank
you
very
much
for
your
testimony.
B
Thank
you,
madam
chair,
and
I
appreciate
the
testimony
this
morning,
and
certainly
you
folks
have
a
heavy
lift
and
you
have
my
attention.
You
have
my
support.
You
know
I
always
have
a
great
interest
in
healthcare
equity
and
when
I
look
at
15
area
development
districts
across
the
state,
I'm
just
curious.
I'm
sure
each
one
operates
a
little
bit
differently.
B
B
Are
these
services
that
the
ads
provide?
Are
they
offered
directly
by
ad
staff?
Or
do
you
subcontract
those
services
or
is
it
a
hybrid
depending
on
the
area
development
district?
You
may
live
in.
F
You
so
those
services
that
we
provide
are
combined
senator
meredith.
Here
in
louisville
we
have
a
large
network
of
providers
and
each
area.
Development
district
has
a
relatively
same
percentage
of
providers
outside,
but
we
do
provide
services
working
together
with
other
community
organizations,
which
is
also
a
great
benefit
as
well
in
the
way
that
we
operate
and
benefit
those
members
in
the
community,
because,
as
you
can
see,
there's
a
small
list
of
the
services
we
provide
and
then
outside
of
the
services
we
provide.
D
Yes,
I
mean
I
would
just.
I
would
just
add
that
in
in
all
15
area
development
districts,
we
all
pretty
much
provide
these
these
level
of
waiver.
We
these
waiver
services
and,
for
the
most
part,
it
is
our
staff
here
at
the
area,
development
districts
that
are
performing
the
the
case,
management
and
financial
management
services.
D
Well,
that's
that's.
The
main
goal
senator
is
to
make
sure
that
the
services
that
we
provide
continue
to
stay
at
that
high
level
that
these
clients
deserve
and-
and
the
answer
to
your
question-
is
yes
and
we
are
constantly
looking
at
our
business
model
to
see
what
activities
and
how
we
conduct
those
activities
is
the
most
efficient
way
of
doing
that
business
and
the
best
way
of
providing
those
services
to
the
client,
because
again
that
that
is,
that
is
the.
That
is
the
main
goal.
But,
yes
to
answer
your
question
we
are.
D
We
are
continually
looking
at
at
different
avenues
to
to
provide
these
services,
but
you're
exactly
right.
The
the
workforce
piece
seems
to
be
the
workforce
piece
is,
is
increasingly
issue.
D
D
Right
now,
senator
we
typically
average-
and
this
is
across
the
commonwealth.
We,
we
typically
average
anywhere
between
50
to
60
cases
per
case
manager.
Now
we
we
will.
We
will
put
that
up
against
anybody
and
we
we
feel
like
we.
We
are
continuing
to
do
a
good
job
even
at
that
level.
However,
as
you
can
imagine,
you
know
that
that
increases
our
our
level
of
burnout
with
staff.
It
increases
the
chances
of
of
making
mistakes,
not
providing
that
level
of
service
that
we
want
to
provide
and
that
these
clients
deserve.
D
So
again,
just
we
are
constantly
looking
at
ways
to
do
things
better
and
more
efficient.
B
Unlike
madam
chair,
if
I
could
give
me
some.
B
Estimate
of
time
just
to
handle
the
bureaucracy
of
this,
and
the
reason
I
ask
is
first,
I
think
without
a
doubt,
we
need
additional
funding,
not
just
for
these
services
but
kind
of
across
the
board,
and
that's
something
we're
going
to
have
to
try
to
address.
I
hope
we
try
to
address
when
we
turn
in
2022,
but
healthcare
specific.
B
You
know,
I've
heard
me
quote
the
statistic
before
we
spend
30
cents
of
every
dollar
on
administration
of
health
care
in
the
united
states
and
that's
double
what
other
industrialized
nations
spend
and
you
folks
have
made
reference
to
the
the
application
process,
and
I
imagine
there's
an
annual
recertification
of
this,
but
how
much
of
your
time
do,
you
think
is
spent
just
on
the
administration
of
this
program?
Can?
Can
you
give
me
an
estimate.
B
F
A
large
majority
we
have
specific
staff
dedicated
directly
towards
waiver
services.
We,
for
instance,
here
in
the
kipta
region.
We
have
two
of
five
adrc
staff
dedicated,
including
almost
10
waiver
case
managers,
a
waiver
coordinator,
and
then
the
oversight
from
myself
and
others.
F
It
is
a
large
percentage
of
what
we
do
in
our
division
and
to
clarify
your
question
earlier,
senator
meredith.
I
believe
you
referred
to
slide
three
and
obviously
speaking,
to
slide
two
as
our
external
providers.
We
do
provide
all
of
our
waiver
services
with
internal
staff.
B
Manager,
I
just
really
would
be
interested
of
if
we
did
a
top
to
bottom
review,
the
regulations
associated
with
the
waiver
program
and
it's
kind
of
a
cost-benefit
analysis.
What
we
would
find.
I
think
we
would
be
alarmed,
but
that's
kind
of
the
nature
of
state
government,
but
thank
you
for
allowing
me
to
ask
my
questions.
A
Thank
you,
and
I
was
just
having
that
exact
same
conversation
with
staff
up
here.
It's
I
think
we
need
to
have
a
conversation
on
these
so
you're
right
on
the
mark.
G
G
The
the
workload
that
we're
putting
on
case
managers
continues
to
grow
without
the
numbers
of
case
managers
growing,
and
I
know
in
our
the
the
pad
office
in
mayfield
in
my
district,
my
part
of
the
state,
not
in
my
district,
the
the
turnover
in
case
managers
has
been
just
unbelievable
for
a
few
years
now
and
I'm
sure
the
other
districts
are
having
the
same
struggles.
My
question
for
you
all
is
specifically
with
the
evv
system.
G
I
have
heard
numerous
complaints
about
the
additional
workload
that
this
is
placed
on
case
managers,
as
as
providers
are,
are
trying
to
schedule
work
with
with
the
individuals
that
they
serve
that
this.
This
has
taken
up
a
large
amount
of
time
for
our
case
managers
to
to
navigate
the
evv
system.
Can
you
talk
a
little
bit
about
you?
All's
experience
with
that
new
system.
F
Absolutely
you're
you're
right
on
with
evb.
It
has
added
a
tremendous
amount
of
work
to
the
case
managers
and
the
fma
staff.
F
F
They
spend
multiple
days
working
on
the
financial
management
aspect
and
working
within
the
ebv
system,
just
a
rough
estimate
off
the
top
of
my
head,
if,
if
their
work
day
100
before
you've
added
at
least
20
percent
of
that
time,
in
addition
to
the
100
before
to
manage
ebv
tests,
so
we're
asking
more
and
more
and
more
of
them
in
time,
we
did
not
already
have.
G
I
understand
why
that
is
the
case,
and
it
just
seems
that,
as
we
have
expanded
the
technology
in
an
effort
to
to
make
it
more
our
system
more
efficient,
we're
not
quite
there
with
that
system
at
all,
and
I
know
that
they
are
working
on
it
to
make
it
better,
but
it
sure
does
have
several
flaws
at
this
point
and
in
madam
chair,
I
think
this
the
time
study
and
the
way
we
do
the
pds
services
and
if
you
all,
could
comment
on
this
I'd,
I
know
that
there's
often
a
reluctance
for
private
providers
to
to
get
into
pds
services
talk
a
little
especially
the
case
management
aspect
of
it.
G
F
That
is
actually
not
our
function
to
recruit
other
providers,
external
providers
for
traditional
case
management,
that
is
a
function
of
dms.
They
are
have
the
oversight
of
traditional
case
management
providers
if
you're
speaking
to
actually
hiring
a
case
manager
from
the
community
into
our
kipta
staff.
We
experience
what
you've
seen
in
other
testimony.
F
It
is
very
difficult
to
get
responses
to
job
ads
and
even
then
it
is
very
difficult
to
keep
someone
on
staff.
We
do
have
an
echo
to
what
you
said
earlier,
as
well
tremendous
problems
and
overturn
with
staffing
I've
been
in
this
program
for
almost
11
years
now,
and
as
we
walk
through
those
11
years,
we
have
tried
multiple
ways
to
keep
staff
on
board,
to
pay
staff
appropriately,
and
we
just
haven't
gotten
there
and
that's.
F
F
We
can
see
that
all
of
us
are
working
together
and
have
the
same
challenges
and
issues
in
in
regards
to
a
study
of
time
and
a
study
of
the
funding
that
we
need
and
the
money
that
we
spend
on
waiver
navigate
requested
all
of
that
information
and
we
work
together
with
them
as
partners
to
show
exactly
what
I,
the
navigate
rate
study,
broke
down
our
time
based
on
just
about
every
task
you
could
think
of
I'm
recalling
in
my
head.
It
was
about
a
13-page
spreadsheet.
F
It
is,
it
is
possible
for,
like
our
adult
daycare,
centers,
some
of
them
are
case
managers
and
then
individual
organizations
or
case
managers.
We
just
do
not
corrupt
contract
directly
with
that
particular
agency.
F
They
can
be
providers
and
we
work
with
them.
We
work
with
them
because,
for
instance,
we
may
have
a
pds
participant
that
we
call
it
blended,
so
we
might
have
a
pds
participant
that
needs
a
traditional
service
such
as
adult
daycare.
We
would
work
with
that
adult
daycare
center.
We
also
have
people
in
our
community
that
are
case
managed,
for
instance,
say
by
I'll
just
call
it
case
management
provider
service
because
general
name,
and
then
they
seek
out
services
through
other
traditional
providers
as
well.
D
I
may
also
comment
on
that.
Just
from
the
pinterest
region
perspective
similar
to
kipta,
we
work
very
closely
with
the
pinnerworld
mental
health
center
here
in
hopkinsville,
who
covers
very
similar
area
that
that
we
do
and
we
work
closely
with
them
again,
just
like
jessica
just
alluded
to
making
sure
that
those
individuals
are
receiving
the
proper
case
management,
whether
that
might
be
coming
through
the
mental
health
agency
or
coming
through
us.
D
F
We
we
call
them
sister
agencies
here,
so
our
cmhc
here,
seven
county
services,
which
you
heard
testimony
from
earlier.
They
are
our
sister
agency,
so
we
work
frequently
on
michelle
p
and
seo
with
them.
A
All
right,
thank
you,
and
I
appreciate
y'all's
testimony
and
if
we
have
any
follow-up
I'll
be
in
touch
with
you
all
next
on
our
agenda
is
the
adult
day
health
services,
and
we
have
mr
kelly
upchurch,
who
is
live
and
in
person.
So
please
have
a
seat
at
the
table,
introduce
yourselves
for
the
record
and
then
proceed
with
your
testimony.
A
H
H
H
H
But
I
want
to
thank
the
committee
for
the
opportunity
to
to
speak
the
purpose
of
the
waivers,
as
many
of
you
know,
computing-based
alternatives
to
institutionalization
folks.
We
are
there's
no
mystery
to
anybody
that
our
our
kentucky
population
is
aging.
It's
a
graying
population.
H
The
purpose
of
those
waiver
programs
is
to
provide
a
combination
of
natural
supports
and
services
to
keep
that
person
in
their
home.
As
long
as
we
possibly
can,
and
a
victory
here
would
be
to
postpone
or
eliminate
the
need
to
go
to
a
long-term
care
setting
the
advantage
that
it
has
to
the
commonwealth
just
budgetary-wise.
It's
the
most
cost-efficient
service
that
we
that
that
is
provided
for
those
frail,
elderly
and
disabled
folks.
H
This
is
going
to
be
no
new
news
to
most
of
the
folks
on
this
committee,
but
sometimes
it
gets
confusing.
I
got
a
call
on
my
drive
up
here,
someone
who
had
reviewed
my
powerpoint
told
me
I'd
made
a
terrible
mistake
regarding
the
the
waiver
program,
so
I'm
going
to
try
to
clarify
that,
while
I'm
talking
but
the
homey
community-based
service
waiver
has
these
five
waivers
in
it:
the
abi
home
community
based
model
2,
michelle
p
and
scl.
This
committee
has
already
heard
from
the
abi
michelle
p
and
scl
providers.
H
This
is
homey
community
based
services,
so
I'm
going
from
that
viewpoint,
not
speaking
to
any
other
waiver
other
than
the
home
community
based.
So
the
home
community
based
waiver
is
part
of
the
1915
sea.
We
provide
assistance
to
the
elderly
and
adults
with
physical
disabilities
to
keep
them
community
and
independent
as
possible
as
much
as
we
possibly
can.
H
We
do
that,
with
with
the
understanding
and
you're
going
to
see
this
theme
throughout
my
powerpoint.
Every
person
who
goes
into
the
home
community
based
waiver
program
qualifies
for
nursing
home
level
of
care.
Just
hammer
that
home
these
folks
could
go
to
a
nursing
home
qualifies
for
a
nursing
home.
Their
physician
says
they
could
go
to
a
nursing
home,
but
instead
of
that
they
they
choose
to
get
some
support.
Services
and
utilize
natural
supports
in
their
home
to
stay
in
their
home
as
long
as
they
can.
H
Okay,
just
the
the
basic
staff
there's
118
adult
day,
centers
throughout
the
commonwealth.
We
are
the
safety
net
for
those
those
patients.
We
are
the
safety
net.
For
these
folks,
there's
nothing
in
between
us
and
long-term
care.
That's
that's!
That's
our
purpose!
That's
our
function!
It's
an
all-inclusive
model!
Some
folks
don't
realize.
If
the
person
comes
in,
we
don't
say
well
your
acuity
level.
H
We
don't
really
take
folks
with
hard
problems,
hard
issues.
We
we
don't
do
all
the
cart
type
services.
We
don't
unbundle
services.
So
if
somebody
needs
personal
care,
we
don't
charge
them
extra
for
that.
We,
when,
when
someone
comes
in
an
adult
day,
we
take
them
all
inclusive
and
we
try
to
serve
them
within
our
scope
of
practice
and
again,
patients
first
must
qualify.
H
They
must
meet
nursing
home
level
of
care
to
attend
a
nursing
home
or
adult
day
health
care
setting
some
of
the
services
that
we
provide
if
you've
never
been
in
an
adult
day,
setting
the
the
thing
that
sets
us
apart
from
most
other
services,
we
provide
skilled
nursing
care,
there's
not
a
lot
of
skilled
nursing
care,
as
you
were
aware
of
in
the
waiver
program
adult
day,
health
care
provides
that
including
medication
management,
chronic
disease
wound
care,
iv,
medications
and
injections,
trait
care,
urinary,
catheter
care,
ptot
and
speech.
H
We
provide
meals,
in-home
attendant
care
case
management,
day
supervision,
socialization
respite
transportation,
all
those
are
included
under
the
umbrella
of
adult
day
healthcare.
I
know
a
lot
of
you
if
you've
seen
adult
day,
you
think
of
of
bingo
popsicle
sticks
and
glue.
Folks,
it's
a
lot
more
sophisticated
than
that
these
are.
These
are
folks
who
are
sick.
These
are
folks
that
have
at
least
two
chronic
conditions.
That's
going
to
eventually,
if
not
taken
care
of,
is
going
to
is
going
to
cause
them
serious
problems.
H
We
take
care
of
those
folks,
one
of
the
services
that
I
want
to
talk
about
today
and
I'm
going
to
get
a
little
more
specific,
because
it's
very
pertinent
to
the
1915
navigate
study.
But
one
of
the
services
that
we
provide
is
this
service
and
I
just
went
ahead
and
copied
the
907
kar
of
the
definition
of
attendant
care
services.
H
H
That's
a
aarp
type
of
study,
where
I
can't
put
my
finger
on
it,
so
the
lrc
folks
will
probably
be
upset
with
me,
but
one
in
four
folks
has
been
a
caregiver
for
a
frail
and
elderly
person.
I
want
you
to
think
of
it
in
this
context.
If
this
was
your
mother,
if
this
was
your
father
and
they
were
in
a
hospital
with
a
stroke
or
a
hip
replacement
or
a
knee
replacement,
some
type
of
debilitating
condition,
what
do
you
need
from
your
from
your
service
delivery
person
in
the
community?
H
What
do
you
need
from
them
and
as
we
go
through
this
list,
I
want
you
to
think.
Is
this
something
that
you
might
want?
Do
you
want
general
household
activities,
including
cleaning,
cooking
and
chores
personal
care
services
like
bathing
grooming
dressing,
eating
tilting,
transferring
assistance,
self-administration
of
medications,
ambulation
assistance?
H
Do
you
want
transportation
to
and
from
the
grocery
store
the
pharmacy
or
to
appointments
to
your
doctor?
Think
about
how
value
and
beneficial
that
would
be
for
you,
as
you're
seeking
services
to
try
to
avoid
sending
your
mother
or
father
your
aunt,
your
uncle,
your
husband,
your
wife
to
the
nursing
home
folks,
that's
what
attendant
care
does.
This
is
the
current
definition
of
attended
care
right
now,
and
this
is
just
the
specifics
that
I've
been
asked
to
get
into.
H
H
The
highlighted
section
is
the
section
that
I
want
to
talk
about
in
home:
communicates
bayern
adult
day:
healthcare
9713
folks
that
were
served
this
last
fiscal
year,
the
total
cost
to
the
the
the
commonwealth,
198
million
nine
hundred
nineteen
thousand
four
hundred
and
ten
dollars
cost
per
participant.
Twenty
thousand
four
hundred
479.
H
If
you
look
at
all
the
other
services,
the
only
one
we
really
compare
ourselves
is
through
long-term
care.
But
if
you
look
at
all
other
services,
we
are
the
lowest
cost
provider
in
the
home
community-based
waiver
program,
and
I
know
senator
meredith.
This
is
an
important
key
issue
to
you.
What
is
the
value
that
someone
that
the
commonwealth
is
getting
for
their
dollar
of
service?
What
is
the
value
that
they're
getting
across
the
boards?
Not
only
in
rural
but
not
only
with
urban,
but
rural
settings
as
well?
This
is
the
value
that
kentucky
is
getting.
H
I
put
this
in
a
pie
chart
because
everybody
loves
pie
chart
that's
basically
what
we
were
having
before
it's
the
same
numbers
that
we
have,
but
it
gives
you
an
idea
of
kind
of
what
the
total
spending
is
for
for
our
services.
I
threw
long-term
care
in
there
because
I
just
think
it's
a
it's
an
interesting
number
when
we're
looking
at
the
value,
okay,
going
to
the
navigate
study
and
I'm
not
going
to
spend
a
great
deal
of
time
talking
about
the
navigate
study
and
what
we
do.
H
I
know
that
we're
at
a
new
day
and
it's
a
new
time.
I
was
involved
in
all
18
months.
I
only
missed
two
days
of
those
18
months
as
we
were
going
and
discussing,
and
stakeholders
meetings
and-
and
you
know,
birthday
parties
and
and
holidays.
We're
trying
to
work
around
sounds
a
lot
like
someone
in
the
general
assembly,
but
we
were
trying
to
do
all
those
things
and
trying
to
come
up
with
solutions,
and
we
came
up
with
some
after
the
navigation
study
was
over
and
it
was
and
the
suggestions
were
made.
H
There
was
not
a
lot
of
follow-through.
It
wasn't
the
same
discussion
that
we
were
having
before
the
recommendations
that
were
sent
to
cms
were
not
the
recommendations.
H
H
I
was
involved
in
that
process
and
what
we
were
seeing
is
that
when
there
was
homemaking
personal
care
services-
and
there
was
a
a
a
time
amount
associated
with
that,
and
if,
if
you
were
involved
in
care
during
that
period
of
time,
you
know
this
is
true.
No,
mrs
smith,
you
got
to
stay
in
that
bathtub
for
another
three
minutes,
because
I
don't
get
a
unit
of
service.
If
you
don't,
how
ridiculous
is
that,
so
in
the
2016
that
was
changed,
we
didn't.
We
no
longer
put
a
value
on
this.
H
H
It
wasn't
broken
down
like
that.
The
change
in
the
216
allowed
it
or
in
2016,
allowed
attendant
care
to
say
this
person
needs
all
of
these
services
and
if
it
takes
longer
to
clean
their
house
and
and
clean
their
bed,
linens,
then
they're
gonna
have
the
time
to
do
that.
We
can
approve
that
service
if
it's
gonna,
if
they
need
extra
time
with,
if
someone
needs
to
prepare
their
meals.
H
So
that's
the
primary
issue
that
we
had.
The
other
issue
that
we
had
with
the
definitions
were
the
definitions
of
of
of
the
the
folks
they
had
to
have
a
24-hour.
They
had
to
have
24-hour
supervision.
They
had
to
be
disabled,
they
had
to,
and
all
of
those
were
to
decr
decrease
services
if
it
would
have
been
implemented.
H
H
We
are
opposed
to
the
current
qualifying
debt
to
the
qualifying
definitions
that
was
proposed
at
the
end
of
the
navigate
study,
those
folks
that
that
that
are
delivering
service
now,
if
that
would
have
been
put
in
many
of
them,
would
be
eliminated
from
the
service
all
together
or
some
of
the
folks
just
need
a
little
help
during
the
day.
They
may
not
have
a
caregiver
there
all
the
time,
but
they
just
need
a
little
help
during
the
day.
H
The
idea
that
that
they
would
have
to
have
a
24-hour
caregiver
to
qualify
would
eliminate
most
of
those
folks
that
are
getting
attended
care
services.
What
we're
asking
really
and
you
can
see
at
the
top
and
I'm
not
gonna.
I
know
that's
a
big
slide
with
a
lot
of
information,
but
I
wanted
to
include
you
what
the
what
the
thinking
was
regarding
changing
in
the
attendant
care
model
and
I'll
bring
you
attention
to
almost
a
lot.
Well,
it
is
the
last
line.
H
I
read
slide
eight
to
you
and
it
had
the
definition.
The
current
definition
of
what
attendant
care
was,
if
you
read
that
bottom
and
I'll
say,
shall
not
be
of
a
general
house
keeping
nature,
including
tidying
cleaning
kitchens
bathrooms
dusting
vacuuming
mopping
emptying
a
disposal
of
garbage
making
beds.
Folks,
if
you've
got
a
frail
elderly
person,
they're
going
to
need
that
they're
going
to
need
that
and
the
the
idea
was
to
restrict
some
of
the
some
of
the
hours
that
were
associated
with
that
to
break
it
down
in
hourly.
H
I
don't
know
a
lot
of
folks
who
do,
but
I
do
know
a
lot
of
folks
that
need
homemaking
services
for
40
hours,
folks,
that
need
to
have
their
laundry
done
and
their
house
cleaned
just
to
make
it
a
decent
place
for
them
to
stay
folks
that
that
that
need
someone
to
take
them
to
to
grocery
shop
or
take
them
to
get
their
medications
or
take
them
to
a
doctor's
appointment.
I
know
some
folks
that
need
more
time
to
do
that,
so
the
restrictive
language
we
we.
H
I
There
we
go
it's
important
to
note
that,
with
the
changes
a
few
years
ago
in
the
waiver
program,
home
and
community-based
waiver,
independent
case
management
went
into
place,
and
so
our
aaa
spoke
to
that
they
provide
in
the
htb
waiver
the
traditional
waiver.
They
provide
case
management
for
around
800
clients.
I
think
they
said
so.
This
is
not.
This
is
very
carefully
regulated.
The
case
managers
are
involved
and
they
help
they
help
the
the
client
the
family.
The
providers
decide
how
many
hours
they
need.
I
So
the
cabinet
was
concerned
that
there
might
be
over
utilization,
but
we
have
those
independent
case
managers
in
place
to
help
make
certain
that
those
services
are
used
accordingly
and
that
they
receive
everything
they
need
and
not
more
than
they
need.
H
The
other
recommendation
other
than
definitions
and
paying
attention
to
the
definitions,
and
I
know
that
this
is
a
song
that
you
have
all
heard
through
seo,
michelle
p
and
other
providers.
Folks
we
were
struggling
before
covet
hit.
We
were
struggling
with
keeping
staff
before
this
pandemic
ever
took
over
us.
I
don't
know
what
the
end
results
are
going
to
be
for
adult
days,
I'm
going
to
testify
on
friday
with
the
budget
subcommittee.
H
I
don't
know
what
has
happened
to
adult
days.
I
do
know
I
sent
out
a
email
this
morning.
It
is
national
adult
day
week
and
I
got
eight
bounce
backs
from
my
email.
I
don't
know
where
those
folks
are.
I've
tried
to
call
each
and
every
adult
they
provide
or
whether
they
remember
the
association
or
not.
I
I
don't
even
know
the
effect.
That's
happened
for
adult
days
and
what
kobe's
going
to
do,
but
I
know
that
it's
bad
and
I
know
that
you
do
too,
but
before
covet
we
were
struggling.
H
We
were
struggling
with
those
to
get
to
put
this
in
in
some
type
of
monetary
level.
Folks,
we
provide
adult
day
healthcare
for
11.32
cents
an
hour.
I
will
challenge
anybody
here
to
try
to
hire
a
nurse,
a
registered
nurse
to
work
for
you
for
11.32
cents.
I
challenge
anybody
here
to
do
it.
If
you
can,
let
me
know,
because
I
got
a
job
for
you
folks,
we
we
are,
we
were
struggling
beforehand
every
every
year.
H
It
seems
like
for
the
last
25
years,
certainly
17
years
since
I've
been
the
legislative
chair
of
come
before
this
this
body
and
asked
for
a
rate
increase
folks,
we
don't
come,
we
don't
come
every
long
session
and
ask
for
money.
That's
not
what
we
do.
It's
been
five
years
since
we
asked
for
our
last
one
before
that
it
was
seven
years
folks.
We
are
struggling
to
be
able
to
be
competitive
with
other
people
around
us
and
we're
not
asking
for
the
moon.
H
We
understand,
there's
a
limited
amount
of
money
available
and,
and
it
gets
a
little
thin
at
times,
and
only
you
know
that
more
than
me,
but
we're
asking
we'll
ask
for
a
rate
increase
to
help
us
just
stay
competitive.
You
know
it
it.
It
is
becoming
increasingly
challenging,
as
I've
heard
testimony
before.
H
H
It
is
a
desperate
time
I
know,
but
I
I
appreciate
the
opportunity
that
you've
given
me
to
to
chat
with
you
and
I'll
address
any
questions
you
might
have
ma'am
chair.
A
Sure
well,
first
of
all,
thank
you,
and
I
appreciate
your
testimony
and
as
what
we
found
with
most
of
the
presenters
in
front
of
this
task
force,
it's
very
sobering.
A
What
you
have
to
tell
us
and
it's
no
longer
if
it's
when
I
mean
we
have
to
make
these
decisions
and
to
your
you
know
the
presenter
before
you
said
one
in
five
kentuckians
is
over
65
years
old,
and
how
do
those
resources
are
so
much
better
spent
on
the
front
end
in
keeping
them
out
of
institutional
care
than
it
is
on
the
back
end,
and
so
I
agree
with
your
assessment
that
one
of
the
things
that
we
really
need
to
do
is
work
on
those
definitions
and
make
sure
that
we
have
a
realistic
understanding
of
how
we
care
for
our
aging
population
and
allow
them
to
stay
in
their
home.
A
Allow
them
to
still
be
engaged
on
that
front,
so
that
was
loud
and
clear
workforce
I
mean
it's
it
you're
right.
We
have
to
come
to
grips
with
a
realistic
figure
and
and
how
we
attract
and
retain
these
workers
to
care
for
our
most
vulnerable.
A
You
know
one
of
my
good
friends,
her
son
goes
to
adult
day
and,
and
she
says
that
it's
the
greatest
six
hours
that
he
spends,
that
he
just
enjoys
it
tremendously
and-
and
she
suddenly
gives
me
an
opportunity
to
pick
up
my
house
and
to
you
know,
run
to
the
grocery
store
and
do
all
those
things
that
I
need
to
do
to
care
for
him
when
he's
when
he's
at
his
facility.
A
So
I
appreciate
what
you
all
do
I
do
have
a
question
do
and-
and
you
alluded
to
it-
I
don't
know
if
you
have
any
definitive
answers
to
this,
but
I
think
that
covid,
what
sent
adult
day
for
a
real
loop
and
were
you
all
shut
down
during
covid,
I
mean
how
did
that
work?
I
know
that
we
struggled
with
reaching
out
to
the
participants.
H
Yes,
ma'am
chair,
we
were
shut
down
in
in
march
2020
and
we
opened
back
up
we're
able
to
open
back
up
in
july
at
the
end
of
the
latter
part
of
july.
H
One
of
the
amazing
things
and
I'm
very
proud
of
our
industry
for
doing
is
we
almost
overnight,
switched
our
services
from
adult
day
to
attendant
care
services
in
the
home.
So
no
nobody
missed
nobody
missed
services
or
were
left.
Now
I
say
nobody,
that's
not
true!
Madam
chair,
I
don't
know
about
other
the
adult
days
that
haven't
opened
their
doors
back.
Okay,
there
are
still
shuttered
adult
day,
centers
in
kentucky.
I
know
four
for
certain
that
that
is
closed
permanently,
another
eight
that
doubts
their
ability
to
reopen.
H
So
I
don't
know
where
those
patients
delete
got
their
services
delivered.
I
just
don't
know
I
wish
I
did,
but
it
was
a
difficult
time
and
adult
days
did
what
they
they
could
do
and
one
of
those
things
and
I'm
going
to
talk
about
this
on
friday,
but
one
of
those
things
would
was
feed
the
folks.
I
heard
testimony
about
that,
but
adult
days
provided
about
776,
000
meals
since
march,
to
the
end
of
this
fiscal
year
to
folks
in
their
homes,
we
also
provided
skilled
nursing
care
in
their
home.
H
That
couldn't
they
don't
qualify
for
for
home
health
services
right
and
they
were
going
to
be
dropped
left
relying
on
going
to
the
hospital
which
you
know
was
not
a
good
idea
at
the
time.
H
To
get
an
insulin,
syringe
field
or
get
an
injection
so
for.
H
I
A
Well,
I
do
appreciate
it
and
thank
you
for
what
you
do,
because
you
you
do
provide
such
an
outstanding
service
to
you
know
those
that
are
very
vulnerable.
This
point
in
their
lives.
We
do
have
a
question
from
senator
meredith.
B
Thank
you,
madam
chair,
and
appreciate
the
presentation.
Just
one
clarification
kelly.
You
said
that
we
all
like
pie,
charts.
I
like
pie,
preferably
apple.
B
You
bring
up
a
lot
of
great
points
and
I'm
sure
I'm
not
sure
where
we're
going
to
go
with
this
thing,
when
it's
all
said
and
done,
obviously,
we've
got
to
have
more
funding.
Certainly
the
opportunity
to
have
better
use
of
the
funds
is,
is
one
opportunity
for
us,
and
you
know
from
previous
committee
meetings.
We've
talked
about
changing
the
delivery
model
and
I
still
would
like
to
support
that.
You
know.
Presently
we
spend
we
know
a
minimum
of
10
cents
on
a
dollar
for
administration
of
our
medicaid
program.
B
B
Our
preference
is
probably
an
aso
and
if
you
look
at
connecticut's
experience,
I
think
presently
they're
spending
about
three
cents
of
every
dollar
on
the
administration
of
healthcare.
Now
I
haven't
been
able
to
substantiate
that.
I
do
know
in
2014
they
were
at
five
percent,
so
they've
even
gotten
better
at
it,
but
using
the
five
percent
number
and
if
we
are
just
spending
ten
cents
on
on
the
dollar,
which
we
know
is
not
true.
B
If
you
apply
those
numbers
to
our
current
medicaid
program,
14
billion
dollars,
there's
potential
savings
there
of
a
billion
dollars
in
administrative
cost.
That
goes
a
long
way
towards
addressing
your
issues,
but
also
all
the
other
folks
who
come
to
the
table
so
far.
It
really
goes
a
long
way
towards
doing
that,
but
I
think
our
challenges
also
finding
savings
from
providing
the
appropriate
level
of
care
which
you've
alluded
to
already.
B
But
historically,
healthcare
providers
have
kind
of
lived
in
silos
and
we
don't
work
collaboratively,
and
I
say
this
former
hospital
administrator.
You
know
if
you
do
something
maybe
appear
to
be
in
competition
with
me.
I'm
not
real
keen
to
the
idea,
and
we
really
need
to
have
a
major
paradigm
shift
here
and
look
more
like
john
nash's
theory
of
economic
equilibrium
that
if
we
all
work
together,
there
can
be
a
savings
for
everyone
that
results
in
higher
pay
higher
profit
margins
for
everyone,
and
I
look
at
the
services
you
provide.
B
I
think
the
natural
competition
would
probably
be
a
long-term
care
facilities,
but
you
know
the
last
I
heard-
and
I
know
it's
not
a
current
number,
it's
several
years
old-
that
we
have
a
shortage
of
ten
thousand
nursing
home
bids
in
the
state
of
kentucky.
So
there's
enough
business
there
for
everyone
within
healthcare
marketplaces.
B
How
do
we
get
it
to
proper
level
care
and
whatever
savings
we
can
realize
by
having
people
come
to
that
appropriate
level
of
care
can
be
used
for
higher
rates
for
everybody
else?
We
have
to
do
that
to
substantiate
that,
but
I
don't
know
how
we
we
get
that
thinking.
You
all
know
that
the
department
of
medicaid
is
challenged
right
now
with
also
this
appropriate
level
of
care
issue
that
there's
not
adequate
housing
for
a
lot
of
seniors
and
they're
going
to
nursing
home.
B
As
a
result
of
that-
and
this
is
a
major
deficiency
that
we're
going
to
have
to
address
over
the
next
year,
two
years
at
the
very
most
but
again
mountain
chair-
I
think
just
whatever
we
do.
We
need
to
do
a
better
job
of
making
sure
we're
working
together
and
in
a
collaborative
fashion
and
pursuing
just
symbiotic
relationships
means
everybody
win.
I
don't
see
any
losers
in
this
whatsoever,
but
the
winners
are
going
to
be
everyone
who's
involved
in
health
care,
but
also
the
ultimate
prize
of
better
care
to
everyone.
B
That's
here,
so
it's
going
to
be
a
challenge.
There's
a
great
scholarly
paper
written
by
george
mason
university,
called
fences
in
frontiers,
and
it
talks
about
how,
when
you
move
the
remove
the
fences
from
an
environment,
it
spurs
innovation,
but
in
healthcare
we've
been
more
towards
throwing
up
fences
and
we've
got.
We
have
to
stop
doing
that.
If
not,
none
of
us
are
going
to
survive,
so
I
think
you
provide
a
very
quality
service.
I
think
it's
very
important
to
the
future
of
kentucky,
certainly
this
waiver
program,
but
to
to
all
of
us.
B
H
Senator
mayor,
the
the
two
recommendations
we
made
are
just
two
of
the
top
list.
I
have
plenty
of
other
ideas,
so
I'd
love
to
talk
to
you
about
it.
Madam
chair
and
senator
meredith.
A
C
Good
afternoon
everyone
I'm
back,
my
name
is
amy
state
and
I
am
the
executive
director
of
the
kentucky
association
of
private
providers.
We
are
the
trade
association
representing
providers
of
1915
sea
waiver
services
to
individuals
with
intellectual
and
developmental
disabilities.
This
is
typically
done
through
the
scl
and
michelle
p
waiver.
Some
providers
do
render
services
through
the
hc
gosh
sorry
through
the
hcb
waiver.
Beside
me,
I
have
brenda
wiley
and
julie
josephitis.
They
are
from
dungarvan.
C
Kentucky
dungarvan
is
one
of
the
largest
sel
providers
in
kentucky
and
they
support
individuals
in
locations
throughout
the
state.
They'll
be
providing
you
all
with
a
little
bit
of
information
about
their
current
experience
with
workforce
and
a
little
bit
of
the
financial
side
and
how
that
plays
into
that.
But
I
just
wanted
to
make
a
few
brief
comments
about
the
workforce
issues
experienced
by
generally
all
waiver
providers
in
kentucky.
C
So,
as
you
all
are
well
aware,
kentucky
is
experiencing
a
healthcare
workforce.
Crisis,
hospitals
and
nursing
homes
have
reported
critical
workforce
shortages.
We
talked
about
that
at
length
during
our
special
session,
but
as
we
talk
about
solutions
to
the
healthcare
workforce
storage,
we
must
include
1915
c
waiver
providers.
In
that
conversation,
1915c
weber
providers
provide
24,
7,
essential
healthcare
services
in
community-based
settings.
C
Our
direct
support
professionals
are
essential
healthcare
workers,
so
our
waiver
and
our
waiver
workforce
is
exhausted.
They're,
physically
and
emotionally
drained
they're
working
masses
of
amounts
of
overtime.
So
I
we
would
just
request
that
you
know
our
waiver
services
be
continued
in
that
conversation
as
we
move
forward
and
try
to
figure
out
solutions.
C
They
cannot
attract
applicants
with
the
wages
that
they
are
able
to
offer
some
provider
had
some
providers
have
been
able
to
use,
cares,
act,
ppp
funds
et
cetera
to
offer
bonuses
or
enhanced
pay,
but
obviously
those
funding
streams
have
run
out
and
those
are
one
time
funds
you
can't
raise
wages
with
one-time
funds,
so
pretty
much
waiver
providers
have
been
unable
to
utilize
those
monies
to
to
raise
wages.
C
C
As
you
know,
the
american
rescue
plan
act
included
a
10
percent
map
increase
for
one
year
for
hcbs
services.
Only
kentucky
may
only
use
that
the
money
drawn
down
from
that
additional
10
fmap
for
hcbs
services
and
kentucky
must
use
must
use
that
money
to
supplement
not
supplant
what
we
already
spend.
So
we
use
that
money
in
addition
to
what
we
already
spend.
We
cannot
reduce
our
spend
based
upon
that
additional
at
10
f
map.
C
Time,
yes,
so
there's,
let
me
tell
you
how
much
money
we're
going
to
get
and
then
let
me.
A
C
So
because
you
do
raise
a
good
point:
the
cabinet
for
health
and
family
services
estimates
that
kentucky
will
save
approximately
104
million
dollars
in
state
general
funds.
As
a
result
of
this
10
f
map
increase
additionally
chfs
reports
that
kentucky
will
receive
nearly
500
million
dollars
in
funds
to
spend
across
three
fiscal
years.
C
So
we
have.
The
f
map
is
in
place
for
a
period
of
one
year,
beginning
april
1st
of
this
year,
spanning
to
march
31st
of
next
year.
So
any
claim
that
is
billed
through
hcbs.
We
get
an
additional
10
percent
federal
match
the
state
during
this
period
of
time,
whenever
cms
approves
our
spending
plan
can
reinvest
some
of
those
dollars
this
year
and
essentially
draw
down
a
triple
match,
which
enables
enables
us
to
maximize
get
to
that.
C
500
million
dollar
figure
maximize
the
amount
we
receive
this
year
well
from
march
to
april,
and
then
we
have
three
years
to
spend
that
money.
So
we
don't
have
to
spend
it
all.
In
the
first
year,
we
have
three
years
to
spend
that
money
and
just
to
build
off
that
there's
legislation
right
now,
that's
going
through
federal
budget
reconciliation.
C
A
A
C
So
if
we're
gonna
triage
the
problem
right
now
for
waiver
providers,
it's
workforce,
if
we
do
not
invest
in
the
workforce,
our
system
will
collapse
in
the
past
several
weeks.
I
personally
know
of
four
waiver
providers,
who
have
significantly
scaled
back
or
closed
down
residential
services.
Now
keep
in
mind
that
residential
component
is
the
key
component
of
the
supports
for
community
living
waiver.
You
are
in
the
scl
waiver
because
you
have
no
place
to
live
or
you
will
soon
have
no
place
to
live.
C
C
We're
going
to
reinstitutionalize
people,
and
we've
talked
a
little
bit
about
that.
If
we
lose
our
providers,
not
only
is
this
bad
for
the
individuals,
it's
costly
and
could
potentially
put
us
out
of
olmstead
compliance,
which
triggers
a
department
of
justice
investigation
into
the
state,
which
is
also
not
great.
C
In
its
implementation
of
its
arpa
spend
plan
that
it's
submitted
to
cms
whenever
that
does
get
improved
to
implement
those
rate,
increases
immediately
to
help
solve
the
workforce
problem
and
prioritize
that
triage
the
problem
and
then
implement
the
rest
of
the
great
stuff.
Additionally,
after
that,
after
we
solve
the
workforce
issue,
so
I
will
turn
it
over
to
brenda
and
then
julie,
who
are
going
to
be
able
to
give
you
more
specific
information
about
the
workforce
crisis
and
their
experience,
and
then,
when
they
are
done,
we
are
all
open
to
whatever
questions
you
may
have.
J
J
J
J
But
it
was
because
we
support
60
individuals
in
that
area
who
have
lived
in
that
area
and
a
lot
of
them
have
lived
in
those
particular
homes
since
the
day
that
we
shut
down
higgins
learning
center,
those
people
that
is
their
home-
that's
the
only
home,
they've
ever
known,
and
we
gave
them
a
30-day
notice.
That
basically
said
we
don't
know.
J
J
With
our
with
our
rate,
we've
tried
staffing
agencies,
we
we
have
a
whole
host
of
hr
recruiters
that
every
single
day,
eight
and
ten
hours
a
day
all
they
do
is
try
to
recruit
direct
care
professionals
for
us,
that's
their
sole
job
and
can't
do
it
because
of
that
decision,
I'm
basically
living.
I
live
in
kentucky
live
in
lexington,
but
I'm
basically
living
in
owensboro
with
my
team
over
there
and
every
single
day
every
hour
of
the
day.
J
J
Can
you
imagine
what
it's
like
to
every
single
day
every
single
week,
knowing
that
your
employer
is
going
to
continuously
ask
you
to
work
those
numbers
of
hours,
and
this
is
not
a
job
where
you
go
sit
behind
a
desk
or
you
go
lay
down
or
you
go.
This
is
a
job
where
you
are
responsible
for
three
people's
lives.
J
J
J
We
can't
let
that
happen
for
the
people
we
support.
They
need
us,
there's.
No
one
else
out
there
to
do
it.
All
of
the
agencies
providers
you
have
in
this
commonwealth
have
decided
they.
They
will
do
that
they're
there
for
those
people
they
don't
want
to
make
the
decisions
that
we've
made
they're
there.
They
will
continue
to
do
it.
J
We
just
have
to
find
the
way
to
make
sure
that
we
have
the
ability
to
pay
for
it.
You
know
providers
every
single
month
pay
a
six
percent
provider
tax
back
to
the
state,
with
the
expectation
that
we're
going
to
get
that
money
back.
We've
had
one
increase
in
14
years,
related
to
that
provider
tax
that
comes
straight
off
of
the
dollars.
We
have
every
single
month
that
we
could
be
providing
additional
supports.
J
We
can't
continue
like
this,
so
you
know
we
just
ask
for
all
the
considerations,
all
of
the
ways
that
that
that
this
task
force
could
possibly
think
of
and
help
us
as
a
provider
nation
out
here
and
and
as
citizens
of
the
commonwealth.
We
have
to
support
these
individuals.
We
have
to
keep
everything
going
as
it
is.
We
can't
let
up.
J
I
I
Thank
you
worked
for
the
dungarvon
organization
for
20
years
in
three
states.
I
am
the
freshman
to
the
kentucky
operations,
having
just
been
here
for
a
little
less
than
two
years.
As
brenda
mentioned.
The
information
that
I
have
to
share
with
you
today
is
more
data
based
just
to
underscore
the
human
impact,
testimony
that
that
brenda's
provided,
and
while
this
is
data
related
to
one
company
to
dungarvan
kentucky.
I
think
it
is
representative
of
other
providers,
as
brenda
mentioned,
sharing
the
similar
struggles
that
that
we
are
at
dungarvan
in
our
organization.
I
It's
a
pretty
staggering
number
and,
as
brenda
mentioned,
takes
a
lot
of
time,
is
very
stressful
for
our
operations
team
and
trying
to
make
sure
that
we
have
the
staff
needed
for
the
health
and
safety
of
the
people
that
depend
on
us
that
translates
into
about
a
20
staff
vacancy
and
we've
seen
that
number
increase
quite
a
bit
from
last
year
to
this
year.
So
on
september,
1st
of
2020,
our
employee
head
count
was
575
staff
and
we
had
75
vacancies.
I
I
Our
employment
competition
was
primarily
just
within
the
industry,
and
the
competition
is
a
lot
different
these
days,
because
we're
competing
with
places
like
target
or
fast
food
that
are
actually
paying
higher
rates
to
employees
for
work
that
is
much
less
demanding
and
doesn't
require
the
employees
to
have
those
decision-making
skills
for
vulnerable
people
related
to
literally
kind
of
life
and
death.
Sometimes
I
noted
in
the
first
presentation
that
was
given
today.
I
There
was
a
comment
I
believe
it
was
jessica
that
she
made
about
you
know
getting
applications
in
the
door,
so
the
further
challenge
we
have,
in
addition
to
the
vacancies
is
also
turnover.
I
I
I
I
So
if
you
consider
the
metrics
that
were
reported
in
terms
of
the
number
of
staff
vacancies-
and
you
know
they
have
different
formulas
that
they
look
at-
you
know-
we
need
about
11
000
applications
to
fill
just
our
current
vacancies.
It's
not
accounting
for
the
turnover.
I
Overtime
is
a
big
issue
and
so
related
to
the
burnout
and
getting
staff
to
you
know
just
show
up
and
to
make
sure
that
we
have
the
home
staff
or
the
people
that
are
depending
on
us,
we're
projecting
for
this
year
about
20
percent
over
time
and
for
dungarvan
kentucky
that
translates
into
about
2.3
million
dollars.
I
We
did
do
some
analysis
just
to
consider
what
would
it
really
take
rate
wise
to
meet
our
costs,
and
this
doesn't
account
for
any
type
of
cost
of
living
increase
or
any
increase
to
the
hourly
rate
of
pay,
but
based
on
2020
2021.
Excuse
me,
our
actual
expenses
through
august
and
projected
for
the
rest
of
the
year,
but
cost
about
306
dollars
a
day
per
waiver
participant
for
us
to
to
cover
those
costs
and
so
just
to
provide
some
reference.
There.
I
As
far
as
recommendations,
I
think
you
know-
amy
has
touched
on
this.
Really.
The
immediate
crisis
is
for
the
dsps
and
funding
to
support
paying
dsps
the
rate
that
will
take
to
recruit
and
retain
staff.
To
do
this
important
work.
C
I
just
wanted
to
underscore
something
that
julie
said
the
financial
analysis
that
dun
garvin
completed
again,
that's
just
one
company,
but
we
do
feel
like
it
is
decently.
Representative
of
this
situation.
Statewide
that
60
increase
slash
over
the
base
rate,
which
is
a
10
percent
increase
over
the
covered
rate
again,
would
not
allow
them
to
issue
pay
increases,
that's
just
to
cover
costs.
C
K
Thank
you,
madam
chair,
and
we
appreciate
the
testimony
today
from
all
all
three
different
groups.
It's
very
enlightening
today.
My
question
is
aside
from
obviously
low
wages.
Are
there
other
factors
that
contribute
to
workforce
shortages.
C
I
I'll
go
ahead
and
start
and
then,
if
you,
if
there's
something
that
I
miss
the
basic
regulatory
requirements
of
a
direct
support,
professional,
which
is
most
that's
most
of
the
roles
we're
talking
about,
obviously
there
are
different
levels,
different
roles
and
requirements
for
each
service,
but
direct
support
professionals
can
do
a
majority
of
the
services
in
the
scl
michelle
p
waiver.
The
basic
requirements
required
by
regulation
are,
you
have
to
be
over
18,
you
have
to
have
a
ged
or
high
school
equivalent.
C
You
have
to
be
able
to
pass
a
drug
test
and
a
background
check.
It's
not
a
simple
background
check.
We
check
multiple
registries
like
the
child
abuse,
the
adult
abuse
registry
et
cetera.
Those
are
the
most
basic
requirements.
I
you
know
these
two
will
tell
you.
It
takes
a
special
kind
of
person
to
do
this
work
and
do
it
well,
but
at
the
most
basic
level
we
still
can't
get
people
to
apply
with
those
requirements
nationally.
There
have
been
several
studies
done
that
allude
to
the
level
of
stress
in
the
low
wages.
C
Are
the
number
one
contributor
to
incredibly
high
dsp
turnover
rates
nationwide?
The
number
two
thing
was
lack
of
training.
I
you
know
the
state
has
a
training
program
for
dsps.
The
college
of
direct
supports.
C
K
May
I
make
some
comments.
Thank
you
again.
Thank
you
for
this
testimony.
I
a
couple
experiences
I've
had
involved
in
this
is
when
I
retired
from
my
career.
I
did
my
honey-do
list
for
my
wife
for
about
three
months.
Then.
After
that
I
was
getting
a
little
bored
and,
and
she
said
well,
you
need
it.
You
need
to
do
something.
K
So
I
went
to
work
for
a
friend
who
owned
a
transportation
company
to
transport,
disabled
elderly,
mentally
challenged
people
of
low
income
to
to
doctor's
appointments,
dialysis
adult
day
care,
all
the
various
things
and
the
pay
was
nine
dollars
an
hour.
K
Now
that
wasn't
that
wasn't
any
big
deal
to
me
personally,
because
I
was
getting
a
a
pension,
so
I
was
perfectly
fine
with
with
that,
but
oftentimes
thought
about
the
the
pressure
and
stress
on
those
people
to
transport
them
and
for
in
the
little
money
they
made,
and
I
can
and
then
you
add
on
the
fact
that
people
that
have
to
do
more
of
the
hands-on
throughout
the
day,
the
stress
of
all
that,
with
wages
that
obviously
were,
were
very
low.
K
My
wife
worked
in
long-term
care
for
26
27
years
and
assisted
living
for
four
or
five
years,
and
those
rates
probably
longer
than
that
she'll
get
on
me
because
she's
she'll
say
she
did
more
years
than
that.
But
and
then
I
oftentimes
in
those
in
those
situations
they
have
setters
and
you
guys
are
that's
the
terminology
that
I
use
was
because
I'm
not
a
professional
in
that
area
and
and
the
difficulties
they
had
in
dealing
with
what
they
had
to
do
and
the
extremely
low
wages
that
they
had.
K
That
was
typically,
I
think,
around
ten
dollars
an
hour.
Something
like
that.
So
obviously
this
is
a
is
a
it's
a
great
problem
for
the
state
by
having
people
take
care
of
people
in
situations
that
are
stressful,
physical
and
deal
with
a
lot
of
and
deal
with
a
lot
of
other
issues
for
for
low
wages.
And
yes,
this
is
an
issue
and
yes,
we
need
to
figure
out
a
way
to
to
solve
that
or
we're
never
going
to
solve
these
issues.
B
B
J
So
what
happens
is
oh
sorry,
what
happens
is
once
we
give
that
notice.
Then
their
teams,
which
are
comprised
of
case
managers
guardians
they
seek
other
options.
Other
providers,
which
is
in
this
environment,
you
know,
I
have
to
be
totally
honest-
is
extremely
difficult
because
other
providers
right
now
have
the
same
challenges
that
we
have
so
it's
very
difficult
to
find
other
options
for
those
folks,
whether
it
be
moving
into
an
fhp
environment
or
another
staffed
residence.
J
So
everyone
is
struggling
with
the
same
problem,
but
we
by
regulation,
of
course,
have
the
responsibility
to
continue
to
support
them
until
they
find
an
alternative
provider.
So
it
puts
everyone
in
a
difficult
situation
that
you
know
we
have
to
continue
to
support
them
when
we
can't
support
them.
The
way
we
feel
like
it's
necessary
to
support
them
until
they
can
find
a
provider
who
can
support
them.
So
it
is
a
no-win
situation
for
everybody,
because
if
we
could
support
them,
we
would
certainly
not
be
doing
this.
You
know
we
would.
J
We
would
never
dream
of
doing
this,
but
there
are
other
providers
out
there
who
who
have
the
same
circumstances.
We
have
so
it
is.
It
is
just
a
no-win,
terrible
situation
and
it
puts
the
people
we
support,
which
is
what
tugs
at
at
my
heart
so
badly
is.
It
puts
them
in
a
kind
of
a
free-fall
situation.
They
know
that
we
have
said
we
can't
support
them.
They
can't
find
somebody
else
to
support
them
and
it
it.
J
But
let's
face
it,
who
wants
to
live
with
that
kind
of
thing
hanging
over
your
head
and
they
do
know
that
they
understand
what
is
happening
and
it
is
brutal
every
day
to
to
walk
into
their
house
or
have
them
come
to
the
office
and
they're
like
what's
going
to
happen
to
me,
this
is
the
worst
question
somebody
can
ask.
You
is
what
is
going
to
happen
to
me
right.
J
B
J
J
J
To
think
that
you
know,
we
have
to
go
in
and
move
folks
out
of
their
home
and
move
them
into
a
day.
Training
facility
because
we
don't
have
staff,
is
just
unbelievable
and
unheard
of.
Never
I've
done
anything
like
that
in
my
career.
Certainly,
we've
made
those
preparations
for
natural
disasters.
If
we
have,
you
know
hurricanes
or
something
coming
through,
but
not
because
we
don't
have
staff.
J
B
Agree
dudely
noted
amy
for
you.
You
made
reference
in
your
testimony
that
the
cabinets
project
a
savings
of
104
million
if
cms
approves
the
spending
plan.
Where
does
that
savings
come
from.
C
It
comes
from
the
additional
10
match.
I
was
not
privy
to
their
mathematical
calculations,
but
what
that
is
what
they
have
reported
in
their
spend
plan
and
cms.
You
know
obviously
looks
at
those
things
pretty
carefully,
so
I'd
say
that
it
was
a
pretty
accurate
figure
that
104
million
is
the
current
fiscal
year
and
the
next
fiscal
year.
So
combined
it's
104
million
dollar
savings,
and
I
did
want
to
clarify
your
question
about
individuals
returning
to
their
families.
C
B
Well,
you
also
testified
that
if
that
is
approved,
you've
got
three
years
to
spend
the
money.
That's
the
timetable,
but
we're
hoping
praying
that
the
federal
government
will
extend
that
for
another
seven
years
and
I
think
that
may
be
a
stretch,
but
if
the
federal
government
doesn't
extend
beyond
a
three-year
period,
what's
the
plan.
C
So
the
seven-year
extension
would
actually
the
initial
three
years
is.
Fmap
is
a
10
f
map
for
one
year,
so
you
just
get
that
match
for
a
one
year
period.
If
it's
extended
the
additional
ten
years,
you
would
get
a
seven
percent
fmap
every
single
year
in
that
ten
years,
so
it
wouldn't
just
be
a
spending.
Extension
it'd
be
an
extension
of
getting
increased
fmap,
which
would
be
the
solution
to
all
of
our
problems
in
the
room
right
now.
C
So
the
cabinet
for
health
and
family
services
in
its
american
rescue
plan,
spend
plan
that
it
submitted
to
cms
had
to
demonstrate
that
it
had
the
ability
to
continue
any
changes
it
made
in
uses
of
the
money.
There
are
a
lot
of
conditions
on
how
you
can
use
the
money,
what
you
can
use
the
money
for
they
basically
have
to
be
program
improvements
and
that
can
be
rates.
You
know
things
to
strengthen
workforce,
etc.
C
C
So
I
would
assume
that
there
would
need
to
be
absent
the
federal
government
stepping
in
and
expanding
and
lengthening
that
federal
match
that
there
would
probably
have
to
be
a
some
general
fund
contribution.
There.
B
G
G
We
we
have
numerous
programs,
we
do
residential
services,
we
do
behavioral
health,
we
do
adult
day
training.
We
do
adult
day
foster
care.
We
do
employment
and,
in
the
strength
of
our
organization,
is
the
diversity
of
our
programs,
and
you
know-
and
I
don't
want
to
just-
we
have
a
whole
nother
division
where
we
do
child
programs,
but
we
have
been
able
to
you
know
to
survive.
G
If
we
just
depended
on
our
adult
programs,
we
have
been
able
to
sustain
those
programs,
some
of
those
lose
money,
some
break
even
and
some
make
money,
and
so
so
the
question
is:
what
are
your
thoughts
as
as
a
state,
and
you
know
more
about
the
various
organizations
throughout
the
state
than
I
do
far
more?
But
do
you
see
many
organizations
across
the
commonwealth
that
that
have
diversified
programs
where
they
can
spread
out
their
risk
and
in
most
of
ones
that
I
hear
that
are
really
struggling?
G
Are
those
that
do
residential
care,
the
the
the
homes
and
those
are
extremely
difficult
to
staff?
We
don't
we
don't
have
those
in
our
organization,
but
do
you
think
that
that
could
be
part
of
the
answer
where
we
perhaps
encourage
providers
to
to
be
more
diversified,
diversified
in
the
programs
that
they
offer,
which
would
help
to
balance
out
their
risk?.
C
Thank
you
for
that
question.
I
think
that
if
you
look
at
the
state
overall
and
I'm
just
speaking
specifically
about
the
supports
for
community
living
and
the
michelle
p
waivers,
especially
if
you
look
at
scl
and
those
residential
providers-
and
obviously
this
will
vary-
you
know,
depending
on
region,
but
most
providers
are
decently
diverse,
with
the
exception
of
our
case
management
agencies
generally,
our
independent
case
management
companies
only
do
that
and
sure
the
the
you
know,
those
are
that
are
diverse.
C
Some
of
those
other
services
definitely
do
help
with
the
bottom
line.
The
issue
still
becomes.
If
you
are
a
provider
of
residential
services
outside
of
those
other
services
that
may
be
helping
with
the
bottom
line,
you
still
have
the
staffing
issue.
That
is,
that
is
hurting
you
and
you
know.
Fundamentally,
if
you
can't
staff
the
homes
you
can't
provide
the
service,
and
so
diversifying
for
financial
reasons,
won't
help
you
with
that
aspect
of
it.
C
C
There's
there's
not
a
staffing
component
with
that.
For
those
who
don't
know
an
individual
essentially
goes
and
lives
with
a
family
that
family
contracts
with
a
provider
for
a
fee,
there's
a
little
bit
less
agency
involvement
with
that
model
and
obviously
there's
it's
not
shift
work.
That's
been
a
great
solution
for
a
lot
of
providers
now,
but
that
model
is
not
for
every
individual.
C
You
know
sometimes
individuals
with
incredibly
high
needs
that
have
extreme
behaviors,
etc.
That
would
just
not
be
an
environment
that
they
may
thrive
in
or
not
best
for
their
house
safety
and
welfare.
Additionally,
some
individuals
just
don't
want
to
live
with
an
fhp
model,
so
I
mean,
I
think,
diversifying
can
help
it's
just.
C
I
think
there
also
is
a
little
bit
of
fear
in
the
provider
community
with
starting
up
sometimes
a
new
service,
obviously
everyone's
afraid
of
recruitments,
etc
from
just
the
the
bumps
in
the
road
that
can
in
the
learning
curve
that
comes
with
starting
a
new
service
and
right
now,
frankly,
providers
can't
wouldn't
be
able
to
afford
any
sort
of
recruitment
action,
for
you
know
honest
to
goodness
bump
in
the
road
mistakes.
C
G
Okay,
and-
and
I
appreciate
that-
and
I
you
know-
and
I
know
the
experience
is
a
little
bit
different
throughout
parts
of
the
state,
but
I
know
here
we
had.
We
had
struggles
with
staffing
before
all
of
this
happened
and
and
I've
I've
been
here
a
little
over
11
years
now
and
and
it's
it
has
been
constant,
we've
been
able
to
survive
and
and
and
to
keep
our
numbers
up
and
continue
to
grow
and
and
prosper
through
those
years.
G
But
obviously,
with
all
that's
happened
with
the
issues
of
the
last
year
and
a
half
even
down
here,
it's
it's.
It's
compounded
our
problems
fourfold,
if
not
more
so
I
do
understand
the
struggles
and-
and
I
agree
with
everything
you
all
have
said
there
has
to
be
a
a
new
emphasis
on
this,
and
I
my
hope
is
that
with
the
waiver
redesign,
we
finally
get
to
a
point
that
we
actually
take
some
action
on
this.
G
We
we've
reviewed,
we've
studied
we've
restudied,
we've
re-reviewed
and
we
make
a
few
changes,
but
nothing
of
any
significance,
and
I
think
it
is
absolutely
time
that
we
did
that
to
so
so
these
providers
can
can
stabilize
and
and
start
growing
again
to
provide
the
crucial
services.
But
you
know
I
just
wanted
to
throw
that
out
there
with
the
diversification,
because
it
it
does
work
very
well
for
us.
You
know
I
don't
know
how
we
will
come
out
of
the
other
side
of
all
of
this.
G
You
know
we
again
we
have
two
different
centers
that
so
we're
diversified
even
further
with
other
programs
that
they
help
to
sustain
those
that
don't
produce
any
revenue.
So
I
just
wanted
to
to
throw
that
out
there
for
discussion,
because
I
think
it
is
a
viable
component
of
the
solution
moving
forward
to
what
extent
I
don't
know,
but
I
definitely
think
it's
worth
discussion
and
that's
all
I
have
thank
you,
madam
chair.
A
Thank
you
senator
carroll,
and
if
there
are
no
further
questions,
we
will
without
objection,
object
adjourn
our
meeting
today
and
thank
you
very
much.
Ladies.