Oregon Department of Human Services

1. Oregon Department of Human Services • Jane-ellen Weidanz, • Oregon Department of Human Services • Aging and People with Disabilities • Medicaid Long Term Care 1

2. Department’s History • The 1971 Oregon Legislature created a single state health and human services agency - Oregon Department of Human Resources. • Over the years parts of the agency were spun off, including: • The Oregon Department of Corrections, • The Oregon Employment Department, • The Oregon Youth Authority, and • The Oregon Department of Housing and Community Services. • The 2001 Legislature changed its name to the Oregon Department of Human Services. • In 2009 the Legislature transferred many of the health related functions to the newly created Oregon Health Authority. 2

3. DHS Vision, Mission and Goals • Vision • Safety, health and independence for all Oregonians. • Mission • To help Oregonians in their own communities achieve wellbeing and independence through opportunities that protect, empower, respect choice and preserve dignity. 3

4. DHS Goals • People are safe and living as independently as possible • People are able to support themselves and their families through stable living wage employment. • Children and youth are safe, well and connected to their families, communities and cultural identities. • Choices made by seniors and people with disabilities about their own lives are honored. • Partners, clients and stakeholders are actively engaged in a variety of collaborative and meaningful ways. • Culturally specific and responsive services are provided by highly qualified and diverse staff. • The department is committed to equal access, service excellence and equity for all Oregonians  4

5. DHS = More than 1 million served • More than • 1,048,000 individuals received food benefits. • 823,900 Oregonians received OHP. • 56,435 families received TANF. • 14,400 low-income families received child care supports. • 35,360 seniors and people with physical disabilities received assistance with needs. • 10,980 individuals were kept safe through adult and child protective services . • 20,290 individuals with developmental disabilities received ongoing supports • 8,000 domestic violence victims were offered emergency safety supports. 5

6. Individuals Served with TBI • Placeholder 6

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8. Key Divisions • There are 3 major divisions serving individuals with traumatic brain injury: • Aging and People with Disabilities • Office of Developmental Disability Services • Office of Vocational Rehabilitation Services • Each has separate missions, goals, target populations, eligibility criteria and service delivery systems. 8

9. Americans with Disabilities Act • Applies to states and public entities • “No qualified individuals with a disability shall, by reason of such disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity or be subjected to discrimination by any such entity” • 42 U.S.C. Section 12132 9

10. American with Disabilities Act • “A Public Entity Shall Administer services, programs, and activities in the MOST INTEGRATED SETTING appropriate to the needs of qualified individuals with disabilities” 28 CFR §35.130(d) • All individuals receiving LTC services are protected under the ADA 10

11. Olmstead Decision • In the “Olmstead decision", the Supreme Court said the ADA requires states to place qualified individuals in community settings, rather than in institutions. • What’s Least Restrictive Mean • What is the definition of an institution? • Traditionally • Nursing Facilities • State Hospitals • ICF/MRs 11

12. State Enabling Statues • APD – • State Statute ORS 410 • Federal Statute Medicaid Title XIX • DD – • State Statute 427 • Federal Statute Medicaid Title XIX • OVRS – • State Statute 344.530 to 344.690 • Federal Statute Rehabilitation Act 12

13. Aging and People with Disabilities • Oregon has been a recognized leader in serving individuals in alternatives to institutions. • The majority of individuals are served in the community • Goal: All Oregon seniors and people with disabilities will get the right services - at the right time - at the right place. 13

14. ORS • 410.715 Person suffering brain injury to be considered person with disability. It is the policy of the state that any person experiencing an injury defined as an injury to the brain caused by extrinsic forces where the injury results in the loss of cognitive, psychological, social, behavioral or physiological function for a sufficient time to affect that person’s ability to perform activities of daily living shall be considered a person with a disability. 14

15. APD Primary Focus • APD serves low-income seniors and people with disabilities who need financial assistance: • SNAP/Medicaid-OHP • APD provides long term “care” services individuals who meet the state’s criteria for being served in a nursing facility 15

16. OAR 411: APD LTC Eligibility • Service Priority Levels = NF level of care • SPL 1 = the most impaired • SPL 13 = the least impaired • Eligibility is driven by the need for assistance with: • Mobility (walking, getting out of bed etc); • Eating; • Elimination (Bowel and bladder care); and • Cognition. 16

17. Cognition • An individual must require full assistance in at least 3 of 8 components: • Adaptation • Awareness • Judgment • memory • orientation • demands on others • danger to self/others • wandering • The individual's ability to manage cognition is assessed by how the person would function without supports • For individuals under age 65 whose need is based on a mental or emotional disorder are not eligible 17

18. OAR 411: APD LTC Eligibility • Requires Full Assistance in Mobility, Eating, Elimination, and Cognition • Requires Full Assistance in Mobility, Eating, and Cognition. • Requires Full Assistance in Mobility, or Cognition, or Eating. • Requires Full Assistance in Elimination. • Requires Substantial Assistance with Mobility, Assistance with Elimination and Assistance with Eating. • Requires Substantial Assistance with Mobility and Assistance with Eating. 18

19. APD LTC Eligibility • Requires Substantial Assistance with Mobility and Assistance with Elimination. • Requires Minimal Assistance with Mobility and Assistance with Eating and Elimination. • Requires Assistance with Eating and Elimination. • Requires Substantial Assistance with Mobility. • Requires Minimal Assistance with Mobility and Assistance with Elimination. • Requires Minimal Assistance with Mobility and Assistance with Eating. • Requires Assistance with Elimination. 19

20. APD Services • Activities of Daily Living • Eating, • Mobility, • Cognition*, • Toileting, • Personal Hygiene and Bathing, and • Dressing and Grooming. • Instrumental Activities of Daily Living • Shopping, • Housekeeping and laundry, • Medication management, • Meal prep, and • Transportation. 20

21. APD Services • Medicaid long term care may be delivered through: • In-home programs, • Community-based care settings, and • Nursing facilities 21 21

22. Developmental Disability (DD) • Oregon is one of only 3 states that does not utilize institutional settings. • 67% of individuals are served at home with family. • Goal: Improved access to coordinated, community-based services, improved quality of life through community inclusion, improved health and safety outcomes. 22

23. DD Eligibility - Intellectual Disability • History of an intellectual disability must be in place by the 18th birthdate • If IQ is 65 or below, an adaptive behavior assessment may not be needed • If IQ is between 66-75 may be eligible as a person with an intellectual disability if there is a significant impairment in adaptive behavior that isdirectlyrelated to the intellectual disability. • The adaptive behavior cannot beprimarilyattributed to other conditions, including but no limited to mental or emotional disorders, sensory impairments, substance abuse, personality disorder, learning disability, or ADHD • The condition must be expected to last indefinitely. 23

24. DD Eligibility - Other Disabilities • History of the other developmental disability must be in place by the 22nd birthdate. • IQ scores are not used in verifying the presence of non-intellectual disability developmental disability. • There must be either a medical or clinical diagnosis of the neurological disability and significant impairments in adaptive behavior that aredirectlyrelated to the other developmental disability. • The neurological condition must originate in and directly affect the brain and be expected to last indefinitely • The significant impairments in adaptive behaviorcannotbe primarily attributed to other conditions, including but not limited to mental or emotional disorders, sensory impairments, substance abuse, personality disorder, learning disability, or ADHD. • There must be training and support needs that are similar to those required by an individual with an intellectual disability. 24

25. DD Eligibility • Most frequent other developmental disabilities: • Cerebral Palsy, • Down Syndrome, • Prader Willi, • Autism Spectrum Disorders, • Fragile X Syndrome, • Fetal neurological disorders (alcohol, lead, drugs, disease), • Klinefelter, • Traumatic/acquired brain injuries 25

26. DD Services • Behavior consultation for the development and implementation of positive behavior support strategies; implementation • Community inclusion services assist an individual to acquire, retain or improve skills. • Supported employment services assist an individual to choose, get and • keep a paid job in an integrated community business setting. • Environmental Accessibility Adaptations are physical adaptations to an individual’s home, which are necessary to ensure the health, welfare, and safety of the individual in the home. 26

27. DD Services • Family Caregiver Supports assist families with unusual responsibilities of planning and managing provider services for the individual. • Family Training services are training and counseling services provided to the family of an individual with developmental disabilities to increase capabilities to care for, support and maintain the individual in the home. • In-Home Supports services are care, training, supervision and protection provided based on the needs of the individual that must be met for the individual to live in the family home. 27

28. DD Services • Occupational, Physical or Speech Therapy services are the services of a licensed therapy provider and supplement OHP benefits. • Respite Care services are short-term care and supervision provided on an hourly or daily basis because of the absence, or need for relief of, persons normally providing the care to an individual with developmental disabilities. 28

29. DD Services • Specialized Equipment and Supplies are devices, controls, aids or appliances specified in the IHS plan that enable individuals to increase their abilities to participate in or perform activities of daily living or to increase independence. • Includes items necessary for life support, ancillary supplies and equipment necessary to the proper functioning of such items, and • Durable and nondurable medical equipment • Positioning devices; • Age-appropriate hospital beds; • Continuous positioning airway pressure and apnea monitors; • Generators for technology-dependent individuals; • Equipment required to obtain urgent medical assistance; • Adaptive communication devices and supplies. • Transportation services allow individuals to gain access to community services, activities, and resources. 29

30. Office Vocational Rehabilitation Services • We help Oregonians with disabilities become employed through specialized training and new skills. • This includes helping youth with disabilities transition to jobs as they become adults, helping employers overcome barriers to employing people with disabilities, and partnering with other state and local organizations that coordinate employment and workforce programs. 30

31. Office of Vocation Rehabilitation Services • OVRS is a statewide resource for people with disabilities and is part of the Department of Human Services. We assist individuals with disabilities in getting and keeping a job. OVRS is a state and federally sponsored program. OVRS works in partnership with the community and businesses to develop employment opportunities for people with disabilities. 31

32. 279,001 working-age Oregonians experience a disability Only 34.1% of individuals with disabilities work vs. 71% of individuals without disabilities $16,047 is the median wage for an individual with a disability; median wage for non-disabled individuals is $26,668 9,310 youth exited special education last year OVRS 32

33. OVRS – Eligibility • Have a physical or mental disability that makes it difficult to get a job or keep a job that matches the individual’s skills, potential, and interest. • Need services and support, such as counseling, training, or assistance with a job search, in order to get or keep a job. 33

34. OVRS Eligibility – OAR 582-050-0020 • A determination that the individual has a physical or mental impairment that results in a substantial impediment to employment for the applicant. • A determination that the individual requires vocational rehabilitation services to prepare for, secure, retain, or regain employment consistent with the applicant's unique strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choice. 34

35. OVRS – Services • OVRS help individuals get information and make decisions around: • What type of job the person wants • What barriers the individual’s disability causes • What resources are available to help remove those barriers • Defining the steps needed to reach the goals of going to work 35

36. OVRS - Services • Assessment services to measure strengths, capabilities, work skills and interests. • Assistance in selecting a job goal and the OVRS services needed to reach the goal • Counseling and guidance services provided throughout the rehabilitation process • Independent living services help an individual understand and deal with disability issues including: • Training in self-care • Money management • Using community transportation • Assistive technology services assists with communication or doing tasks by using devices 36

37. OVRS - Services • Training services provide work skills needed to achieve the employment goal. • Job placement services including: • Assistance completing application forms • Developing a resume • Practicing interview skills • Identifying job leads • Keeping a new job • Getting the disability accommodations 37

38. OVRS Client Demographics 38

39. Client Cognitive Impairments 39

40. What has shaped the system • APD – Primarily serves individuals who would need Nursing Facility Care • Service Priority Levels • DD – Primarily serves individuals who would need to be served in a intermediate care facility for the intellectually and developmentally disabled. • Functional need for support based on intellectual or developmental disability that occurred during their developmental years • VR – Primarily serves individuals whose disability prevents gainful employment 40

41. Future Direction • Specialized services • Increasing in home services and supports • Less restrictive settings • Employment supports 41

42. What are the gaps • Lack of supports for individuals with less significant impairments • Identification of individuals • Lack of providers willing to serve individuals with disinhibited behaviors, violence, and sexually inappropriate • No TBI tracking mechanism across all divisions • Progress often means losing services 42