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The first question which the priest and the Levite asked was: “If I stop to help this man, what will happen to me?” But….the Good Samaritan reversed the question: “If I do not stop to help this man, what will happen to him?” -- Martin Luther King, Jr.

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Ohio Adult Care Facilities Association Winter Newsletter and Membership Drive

Ohio Adult Care Facilities Association Leadership Meets with Governor Kasich and Ohio Department of Mental Health Director Plouck at Holiday Reception at Governor’s Residence! On Monday, December 12th, home operators Addie Whaley, to bring more revenue into the state by creating more jobs Cassandra Burns, and Mark and Annette Mayle were invited and getting people to stay in Ohio. His presentation was by Governor Kasich and Director heartfelt especially when he Tracy Plouck to a reception talked about those citizens who at the Governor’s Residence. by no fault of their own, need a WHAT AN EVENING! When safety net provided by the state. they walked into the residence, He talked about the families’ pain it was amazing. The home was when help is not available. He filled with holiday decorations. pledged to the best of his ability Touring the home you walked to support services to these into a heated tent where music special individuals. was playing and tables were set After an opportunity for pictures, to eat appetizers and mingle with the Governor led the sixty people other attendees including NAMI in attendance in prayer for those Ohio’s Board of Directors and dealing with mental illness and their guests. their caregivers. The Ohio Adult During the evening the Care Facilities Association cannot OACFA representatives had an thank the Governor and Director Front row: Annette Mayle, Director Plouck, opportunity to talk with Tracy Plouck enough for allowing them Governor Kasich, Addie Whaley Plouck, Director of the Ohio to attend an unforgettable event. Back row: Mark Mayle, Cassandra Burns Department of Mental Health. If you would like to be included They all walked away feeling that our industry has become a part of Ohio’s community mental in future activities of this association, please complete the health system. The Governor spoke for fifteen minutes. He enclosed membership application! The Ohio Adult Care discussed the problems facing the state of Ohio. He felt Facilities Association is making a difference. strongly that the only way to correct these problems was

Ohio Adult Care Facilities Association Training Opportunities MARK YOUR CALENDARS! The Ohio Adult Care Facilities Association will be providing training opportunities to home operators and their staff. The first training will be held on February 15, 2012 in Columbus, Ohio and will provide six hours of training on the mental health needs of adult care Facilities residents.

statewide conference. A limited number of scholarships will be available to cover the cost of the overnight stay.

On Friday, April 27th and Saturday, April 28th, the Ohio Adult Care Facilities Association in conjunction with NAMI Ohio will provide home operators an opportunity to attend a

Please mark your calendars and look for additional information closer to the dates of the trainings!

In June 2012, trainings will occur in Cleveland (June 19th), Toledo (June 20th), Dayton (June 21st)and Cincinnati (June 26th) for home operators and their staff.

How do you mend a broken heart? The Youngstown Resident Reunion The Ohio Adult Care Facilities Association, the Mahoning County Mental Health Board, the Ohio Department of Mental Health, Turning Point (mental health agency in Mahoning County) and 15 adult care facilities from northeast Ohio recently rescued 43 residents of a residential care facility. The operator of this Facilities could not pay the gas bill or taxes and stated on a Tuesday that on Thursday the gas would be turned off and he did not have sufficient resources to purchase food. To say that living conditions for the 43 were deplorable is an understatement. On September 22nd fifteen adult care Facilities operators in conjunction with case managers and supervisors from Turning Point moved all the residents to more suitable and safer housing. Even though the move had to happen quickly and without time for planning, the end result was that these very ill, special people have renewed hope now that this housing nightmare is over.

Terry Russell, who traveled from Columbus to Cleveland to share the occasion with the residents. Russell interviewed each of the 12 residents from Youngstown and he was thrilled that each one expressed without reservation how happy they were in their new homes.

Richard Ward and others from Shaker Clinic’s Management Team were also in attendance. Shaker Clinic served as the agency in Cuyahoga County that was prepared to receive the new clients through providing them with appropriate case management. To support her new clients, case manager Emily Ambramov worked tirelessly to make sure all clients had essential case management services which included a doctor and payee representation. She was also on hand to answer transition questions from both the residents and operators. I was also in attendance that day and in my role as a Collaborative Patient Care Coordinator and Consultant, I assisted Seven of the adult care facilities that came operators with identifying appropriate forward to help these individuals were from medical care and services. Cuyahoga County. These home operators Cheryl Smith (left), former resident of drove from Cleveland to Youngstown, told the residents what they offered and drove Hope House located in Youngstown, OH During the program people spoke about the future, but no one more eloquently 12 of the residents back to Cleveland. Five seated with her new home Administrator, Darlene Darby Baldwin than Cheryl Smith, a new resident at the of the homes agreed to house two residents Braveheart Adult Care Facility. Cheryl was each while the other two were welcomed of Braveheart Manor II, located overcome and could not hold back her in Cleveland, OH into two different homes. words or emotions. Teary eyed, she stated “I want to speak,” and she gave testimony On the trip back to Cleveland, the home operators comforted the residents the best they could. about how thankful she was to be moved from the Youngstown Understandably, the displaced residents were upset to be Facility to Cleveland. Her words: “I thank God, I thank God, and I thank God for moving me from that leaving long-time friends. They asked the awful place. I now live in Cleveland Ohio home operators if they would ever see and I have a new family.” With tears running their friends again. This question sparked an down her face, she stated, “Every morning idea of Northeast Ohio Adult Care Facilities and every evening for twelve years I prayed president Addie Whaley and operator Pat to God to move me from that awful place. Adams. A “kind inspiration and grace” fell Every morning and every evening for twelve upon Addie and Pat. They decided that in a years I prayed to God to move me from few weeks a Youngstown Resident Reunion that awful place. Every morning and every would be held. This reunion would give the evening for twelve years I prayed to God residents an opportunity to not only see old to move me from that awful place.” Then friends but also reflect on their new family she sat down and I gave her a big hug and life. responded, “The Lord works in mysterious The reunion took place on Wednesday, Residents enjoy the reunion ways, his wonders to behold, but He sure October 19th, at the Warrensville Road doesn’t like ugly.” (Quote from Shakin the Community Baptist Church in Maple Heights, Ohio. Under the Mess Outta Misery by Shay Youngblood). leadership of Reverend Gregory Walker, Pastor, the church has three main focus agendas which include: Community Outreach, In Cuyahoga County which these special people now call home, Ministry Excellence and Unity. The occasion made for a perfect we the operators, pledge to the best of our ability, to enhance way to demonstrate community outreach. The residents were the quality of life of our new family members. happy to see each other as they participated in fellowship.There was a short program, and the cook and church’s deacon, Deacon We thank Deacon Howard and all who worked to make the Howard, gave words of inspiration and led the group in singing. “Youngstown Resident Reunion” a very special occasion. The group was joined by NAMI Ohio and OACFA Director, Continued next page....

As I finish writing this article, I would be remiss if I didn’t question how we as a society could allow this abuse to go on for so long. Are there other (and I am sure there are) facilities not serving these individuals with dignity and respect? Mental illness is a terrible disease but it does not diminish the needs of each of these lovely people. I ask that everyone reading this story to work with our association in finding ways to give hope and love to all the “Cheryls” living in darkness. With God’s help,

we can be a beacon of light and we can provide not only for the physical needs but the love that each of these individuals need desperately. God Bless, Darlene Darby Baldwin

ACF and AFH Licensure and Oversight

Governor Kasich’s state budget for the 2012-2013 biennium transferred responsibility for licensing of Adult Family Homes (AFH) and Adult Care Facilities (ACF), as well as oversight of these housing options, to the Ohio Department of Mental Health (ODMH), effective July 1, 2011. The licensure duties are performed by survey and support staff in the ODMH Office of Licensure and Certification. There are three regional offices for surveyors as well as six surveyors based in the Columbus office. Now several months into managing the licensure program, surveyors and support staff have had many positive experiences working with home operators, as well as others who provide support and advocacy for residents of Adult Care Facilities. ODMH is looking forward to continued collaboration with the Ohio Adult Care Facilities Association and NAMI to support the work of these housing programs.

Front row: Becky Murray, Holly Stone,Vince Giammarco; Middle row: Kathy Yokum, Kisha Stewart, Denise Cole, LaTaunia Pitts-Wilson,Teri Hill, Anita Lieser; Back row: Susan Sekely, Leeann Kapp, Greg Lewis, Ann Engle

Join OACFA today!

More information may be found on the ODMH website: http:// mentalhealth.ohio.gov/what-we-do/protect-and-monitor/ licensure-and-certification/adult-care-facilities.shtml. You may also access the lead surveyor for your Facilities directly, or by calling 614-752-8880. Note: The Ohio Adult Care Facilities Association has been pleased with the new relationship that has been developed with Anita Lieser, Chief, Licensure and Certification, and her staff as adult care facilities become a major element of the public mental health system in Ohio.

All ACF/AFH Homes serving Ohio’s severely and persistently mentally disabled should have a voice in the organization that is advocating on behalf of you and your residents. Why you should join: • • • • • • •

The OACFA is repairing the negative image of the ACF industry We are advocating for additional resources that will enable you to provide enhanced quality of care We offer training that meets your licensure requirements We can intervene and mediate when conflicts occur at the local and state level We can help build new partnerships between your home and Ohio’s community MH system We can help find resources for capital improvements But most importantly we have become a trade association that gives you a voice that has been silent for too long!

Complete the application form and join OACFA today! Membership benefits include a plaque that notifies all visitors that you are a member of this association.

What is a Medicaid Health Home? For people with serious or multiple chronic health conditions, especially if one of those conditions is a mental illness, navigating the health care system can get very complicated. Medicaid “health homes” are an attempt to change that. Rather than being a physical place, health homes are a strategy for helping individuals with chronic conditions manage those conditions better. An eligible individual – for example a person with a mental illness and diabetes – selects a provider or team of health care professionals to be his or her health home. Under the Medicaid health home concept being developed in Ohio, the health home could be the community mental health center where that individual currently receives his or her mental health treatment. The health home will then become accountable for all of the individual’s physical and mental health care, including: • Managing and coordinating the services the person receives from multiple providers • Helping with transitions from one setting to another • Offering referrals to community and social support services • Providing support to both the individual and his/her family members • Promoting good health

Under the existing health care structure, if a person is seeing more than one doctor for their physical health care and mental health care, those doctors usually do not communicate with one another. They simply treat the illness for which they are seeing that person, rather than treat the “whole” person. Under the health home concept, Medicaid will reimburse providers for the time they spend on such vital tasks as coordinating a person’s care whether in person or by phone, or meeting with family members to help support the individual’s recovery. These services currently are not reimbursable under Medicaid. In July 2013, Ohio will begin offering health homes to Medicaid eligible individuals with severe and persistent mental illness who live in one of the selected regions in the state. Ohio has not yet selected which regions of the state it will target, although it has estimated that approximately 60,000 individuals will be served in this program once it is up and running. Stay tuned for more information about this exciting initiative as it gets closer to the date of implementation. To learn more about health homes, visit www.healthcare.gov or www.mh.state.oh.us/what-we-do/protect-and-monitor/ medicaid/health-home-committees.shtm.

Why is Ohio targeting individuals with Serious and Persistent Mental Illness to benefit from Medicaid Health Homes? The answer is simple, to save money. Medicaid Hot Spot:

Medicaid Enrollees with Severe Mental Illness (SMI)

Medicaid Hot Spot:

Enrollment and Spending for Severe Mental Illness 100%

SMI Qualifying Condition

Number

Cost

Per Person

Psychosis

9,486

$268,079,490

$28,260

Schizophrenia

39,021

$784,961,862

$20,116

Bipolar

52,547

$663,630,548

$12,629

Depression

86,759

$1,062,375,477

$12,245

All Other

66,164

$607,983,192

$9,189

Total SMI

253,977

$3,387,030,569

$13,335

10%

80%

26%

60%

40%

90%

Adults with Severe Mental Illness (SMI) All Other

74%

20%

0% Source: Ohio Colleges of Medicine Government Resource Center and Health Management Associates, Ohio Medicaid Claims Analysis (February 2011)

Enrollment

Spending Source: Ohio Colleges of Medicine Government Resource Center and Health Management Associates, Ohio Medicaid Claims Analysis (February 2011)

HOUSING! HOUSING! HOUSING! Message from the President Marty Falin

The Ohio Adult Care Facilities Association is starting to hear the professional community acknowledge the need for housing. During the last biennium budget process, NAMI Ohio utilized the theme, “You can’t get better without a roof over your head, food in your stomach, and someone who knows your name.” Most recently, Tracy Plouck, Director of the Ohio Department of Mental Health, announced her intention of making housing a priority. We have seen more contracts offered to adult care facilities from local ADAMH Boards and in emergencies, we have seen real partnerships develop between our Association and many of the local communities. We understand and agree that when discussing housing, it is a continuum and must be based on each individual’s specific needs. One type of housing does not always work for everyone. We certainly realize that adult care facilities are not the appropriate housing for the majority of Ohio citizens suffering from mental illness. But, we also recognize that so many of the individuals walking the streets, in our prisons, jails, and nursing homes due to their mental illness, could be better served in our homes. The dilemma continues to be the lack of financial support to provide the desired quality of care that everyone wants and our residents deserve. We understand the financial barriers of maintaining the existing mental health treatment system and at the same time expand the housing services we provide. Our hope is that policy makers recognize not only the savings that occur when utilizing our homes but, more importantly, the enhanced quality of life of each of our residents. If we are to truly make housing a priority, then it requires us to question past decisions and the utilization of new funds. We know from last year’s budget process that seven million dollars was made available from funds once used by the state hospital system. Instead of earmarking some of the seven million dollars to serve those who utilize the hospitals, it went to local communities for general purposes. Wouldn’t the seven million dollars have been better utilized as a replacement of the $600,000 reduction to the Residential State Supplement (RSS) program? Or even better than that, replace the RSS reduction and increase the RSS program to open up more housing opportunities for those on waiting lists? In all probability, in

fiscal year 2013 the state will increase the budget for mental health services. Shouldn’t we discuss how these funds could, in fact, promote the housing priority that Director Plouck has identified? The Ohio Adult Care Facilities Association’s relationship with the Ohio Department of Mental Health has never been stronger. The transition of the licensure and surveying process and the RSS program from the Departments of Health and Aging to Mental Health has certainly benefited all of our members. Although much progress has been made, there is still much work to be done. Recently, the Association was informed that the Ohio Department of Mental Health had earmarked $500,000 of Block Grant Funding for housing initiatives. It appears that the Department’s first use of some of the $500,000 will be to provide statewide training. Our Association believes that anything we can learn to more effectively serve our residents is worthwhile. However, if we were asked, the best way to utilize these resources would not have included training. Our priority would have been to utilize these funds for direct service and to have the Ohio Department of Mental Health take whatever action is needed to utilize these funds to leverage other funding sources to support housing services to those we are here to serve. We don’t mean this to be critical but we are requesting that in the future, the Ohio Adult Care Facilities Association have the opportunity to provide input into these decisions since many of our residents are affected by them. We could fill this newsletter and many more with story after story about the lives of our residents and their courageous struggles. All of these stories would include the misery spent during the time housing wasn’t available. It is for this very reason we applaud the Ohio Department of Mental Health and all of the local systems who are beginning to recognize the importance of this vital service…housing, housing, housing.

Cuyahoga County Christmas Party On December 19th, NAMI Ohio continued a nine year old tradition of having a Christmas party for residents living in adult care facilities.This tradition started in Steubenville and was held there for four years, then moved to Malvern, Cincinnati, Toledo and, this year, Cleveland. Next year, the party will be in Dayton. With the help of the Northeast Ohio ACF/Group Home Association, 97 residents of adult care facilities were treated to a Christmas meal and all received individualized gift bags and cards. This year the gifts were given out by a surprise guest, Santa Claus (Ed Fields). We were also honored to have NAMI Ohio Board Member and former State Senator Bob Spada and ADAMH Board Executive Director Bill “Chief” Denihan participate in the festivities. The food was excellent and everyone joined in singing Christmas songs. A short story While Santa was passing out gifts, we realized that a few extra residents we were not expecting came to the party and we were a few gift bags short. A gentleman at one of the tables turned and said, “Please give my bag to them.” In all likelihood, this would be the only gift this man would receive this year. We made other arrangements and he was able to take his gifts back home with him. For those of us there, this man’s generosity and kindness was certainly a Christmas message to which we should all aspire.

Ohio Adult Care Facilities Association Hires Legal Consultant The Ohio Adult Care Facilities Association has entered into a contract with David E. Schweighoefer, Esq. from Hudson, Ohio to work on two specific projects. Since the inception of our organization, we have advocated that home operators provide 80% of the case management services the residents of these homes require. Due to funding cuts in the mental health treatment system, case management services are less available. The crucial services that our residents need to maintain recovery are dwindling. The vast majority of residents in our homes have many physical health issues that are not related to their mental illness. The home operator is required to get residents to and from doctor appointments, hospital visits, and meetings with the community mental health providers including psychiatric visits for medication. All of our homes would like to have the resources available for social activities as well as meetings with our residents’ families. All of these activities fall outside of the adult care facilities’s responsibilities and certainly have never been funded. With the tremendous work being done today to integrate behavioral health with health care, we believe that state policy makers must be educated about adult care facilities in order

to make informed decisions. Mr. Schweighoefer is currently developing these materials. The second issue includes the Residential State Supplement Program (RSS). Mr. Schweighoefer’s task will be to review the reimbursement policy that was utilized by the Ohio Department of Aging and continues now that the program has been transferred to the Ohio Department of Mental Health. We believe that the federal government issued guidelines years ago and those guidelines were never followed by the Ohio Department of Aging. We will be developing a position paper and asking that the Ohio Department of Mental Health correct this discrepancy which will allow adult care facilities to receive approximately $300.00 more a month from the RSS program to care for their residents. As stated in another article in this news letter, we are extremely optimistic that the new relationship being developed with the Ohio Department of Mental Health will be positive and less adversarial then our past interactions with the Ohio Department of Aging. We will keep members apprised of any further developments.

At a Crossroads Keith Turvey, Director; Mercer, Van Wert, and Paulding Counties Alcohol, Drug Addiction and Mental Health Services Board Guest Columnist Since beginning my career in behavioral healthcare in 1983, a conversation with a client and a conversation with a State Hospital Superintendent have formed my core beliefs as to what are the cornerstones in client recovery. Both conversations occurred prior to Ohio’s Mental Health Act. The first conversation occurred with the State Hospital Superintendent of whom I asked “Why are so many people readmitted?” His response “let me place you in an unfurnished apartment with $200 a month to spend and we will see how you fare after a month or two.” The second conversation was with a young male awaiting discharge from a State Hospital. I inquired as to what he wanted when he returned to his community. His response, “my own apartment, a car, a girlfriend, and a job.” And so I got it. Our severely mentally ill citizens want what we all want. It is that simple. No PhD required. Unfortunately their disease presents barriers to fulfilling their needs on their own. They need support to overcome those barriers. The path to recovery is equally simple - fulfilling basic human needs. A very basic human need is shelter. In the context of recovery for our citizens who have the disease of mental illness it is critical. This Board has prioritized residential services via development of a formal strategic plan for residential services in 2000. The plan called for a continuum of residential services beginning with 24 hour supervised settings and encompassing down payment assistance for home ownership. As the plan was implemented positive outcomes were achieved. Client hospitalizations trended downward and the need for client crisis stabilization was reduced.

Today, residential services to adults comprise this Boards largest non-Medicaid investment at $630,000 per year for a three county catchment area with a population of 89,000. Our net cost overall for this critical service is $41.00 a day which is much less expensive than inpatient stays costing hundreds more per day. However we are at a crossroads. This Board receives only $412,000 a year in State funding which places a severe strain on local levy dollars to continue to provide appropriate essential core non-Medicaid community supports to the citizens most deserving of our care. With the “effective” repeal of Ohio’s Mental Health Act, we must insure that those currently residing in our communities as a result of the repealed legislation continue to have financial support to meet their basic human needs. The current erosion of non-Medicaid funding serves to place these clients in harms way along a path toward homelessness. We must rigorously advocate for those who cannot advocate for themselves to insure homelessness, incarceration, or long term institutionalization do not become the norm. Note: The Ohio Adult Care Facilities Association appreciates Mr. Turvey’s recognition that the need for well-funded, 24hour supervised settings in every community is a cornerstone of Ohio’s Mental Health Act of 1988. One of the ugliest chapters in the development of a local community support system has been the lack of support for Adult Care Facilities. These homes have been used for placements from the very first day state hospitals were closed. However, the very system that placed residents in these homes never assumed responsibility for funding this critical service. The time has come to correct this injustice to so many of Ohio’s most vulnerable citizens.

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OACFA Annual Membership Drive Please complete the enclosed application form and mail it in the attached envelope and join our association today!