group homes

shows four people posing for a formal photo, two seated, two standing behind them. The two seated people are residents at a group home for people with intellectual / developmental disabilities and traumatic brain injury.

Proposed bills would bump up pay for people caring for NC’s most vulnerable

June 9, 2021 by Mona Dougani

Proposed bills would bump up pay for people caring for NC’s most vulnerable - North Carolina Health News

Lawmakers look to address the staffing crisis and increasing pay for those working in direct care facilities. This could help patients with various conditions receive the care they need.

By Mona Dougani

In 2004, two weeks after her high school graduation, Brittany Stone was driving to pick up her younger sister from vacation Bible school during a storm. She hit a pothole and lost control of her vehicle. In the accident, she suffered a traumatic brain injury.

Seventeen years later, Stone has landed a place at Whittecar Group Home in Raleigh, where she and five other residents get the help they need to live their lives. For the most part residents at the group home can take care of their basic needs, but Stone, for example, has trouble washing her back and hair because of tremors. She uses a walker to get around, but she does chores around the house. She can’t drive or run to the store independently.

The people who help the six residents live their lives start at a salary of $11.50 an hour. For Lutheran Services Carolina, the agency that runs Whittecar, it has been challenging to hire employees to help those with conditions similar to Stone’s. This year, with the pandemic, has been a particular challenge, especially since there needs to be a staff member at the house 24 hours a day.

Rholanda Artis, the program director for Whittecar, said the low wages turned away some potential employees.

“We had a job fair back in March,” Artis said. She said they had six job candidates. “It went okay, but the pay– they just didn’t want the pay.”

“When we said $11.50, and that was because of their experience, some had no experience, some had experience, and when I went up to $13.00, they said, ‘I just can’t make a living off that,’” Artis said.

Starbucks pays better

Across North Carolina, the average hourly pay of direct care workers is roughly $5 an hour lower than retail jobs at corporations such as Target, Walmart, Starbucks and Costco, according to Karen McLeod, head of Benchmarks, an umbrella advocacy group for organizations that provide care for children and families. With an average pay rate of $10.31/hour for direct care workers, it is challenging to hire and retain staff.

House Bill 665 addresses the staffing crisis impacting care for individuals with disabilities, and House Bill 914 focuses on increasing the pay for long-term care workers. Both bills passed through the House Health committee Tuesday with overwhelming support, which bodes well for facilities like Whittecar.

Rep. Tim Moffitt (R-Hendersonville), the primary sponsor for HB 914, has a personal connection to that bill. Moffitt’s younger brother has severe autism, he told the committee, and Moffitt is the direct caregiver for his brother during homestays for about 60 days each year.

“It’s an important role. It’s a role that I treasure. It’s an appropriate role for an older brother, and we wouldn’t have it any other way,” Moffitt said.

For a long time, Moffitt said he didn’t know how much his brother’s care providers received.

“When I found out what the wages were, candidly, I was embarrassed,” Moffitt said. “These direct care workers are so valued in our lives. We haven’t really appropriately valued them from a compensation standpoint.

four people sit in a couch talking. They're sitting in a comfortable looking, but spare, living room. — Shari Webb (l) and Rholanda Artis (r), both employees at the Whittecar Group Home, share a moment with residents Brittany Stone and Mike Johnson. Photo credit: Mona Dougani

“So I’m on a mission. I’m on a mission to make sure that we have enough resources to appropriate to that group of direct care providers to where they can take care of those that are most vulnerable in our society. That’s their role. It’s our role as policymakers to make it happen.”

The Support Our Direct Care Workforce bill, would provide a Medicaid rate increase for the agencies that employ these direct care workers in a variety of settings:

Workers who support people with disabilities on the Community Alternatives Programs for Children and for Adults;
Workers supporting Medicaid recipients on the state’s Innovations Waiver program;
Workers providing care for traumatic brain injury survivors;
Personal care services providers;
Workers at intermediate care facilities for individuals with intellectual disabilities (ICF/IIDs), including ICF/IID-level group homes;
Home health providers;
Nursing home employees;
Workers at a variety of residential behavioral health facilities.

The lowest payer

Adam Sholar from the North Carolina Health Care Facilities Association said that about two-thirds of all nursing home residents in the state receive Medicaid reimbursement. He also explained that Medicaid reimburses for care at the lowest rate of any other payer. He argued it’s the main factor contributing to nursing shortages in the state and he said he’d like to see more funding from Medicaid.

Medicaid’s low rate, “really constrains what we’re able to pay in wages,” Sholar said. He said that in the cost report data submitted to federal agencies, he can see that many facilities operated at a net loss in recent years.

Medicaid reimbursement is set by the state, and state dollars pay for a third of costs, with federal matching dollars making up the difference.

“We’re doing as much as we can to increase wages to try to attract more caregivers into the profession,” he said. “It’s the Medicaid piece of that we need to see meaningful movement from. We need increased funding from the Medicaid program.”

McLeod said about 92 organizations have banded together to push for passage of HB 914, ranging from providers of direct care to people with disabilities to mental health agencies to advocacy groups.

“We brought all the industries together,” McLeod said. “What’s been happening prior to this, is each of our industries would go after money specifically for our independent agency. We reached out to all the different industries and said, we’re just robbing Peter to pay Paul, we all share the same workers and will have a much greater voice, and people will understand how important this need is in the crisis we’re in if we do a collective bill.”

With support from the 92 agencies and the movement of the bill to the Senate, some challenges that Artis and others at other residential facilities face will be mitigated.

two women sitting on different chairs laugh. One looks at the other. You can see that there's someone just off camera. — Shari Webb (r) and Rholanda Artis (l), both employees at the Whittecar Group Home, share a laugh with resident Brittany Stone. Photo credit: Mona Dougani

“Here, it’s home”

Reps. Gale Adcock (D-Cary) and Hugh Blackwell (R-Valdese) both expressed concern about how the money in the bill would be appropriated. One mechanism is through putting the measure in its entirety into the state budget, which has yet to be written. Another way to push for the pay increases would be to pass HB 914 and HB 665 as standalone bills.

“I don’t like being even remotely a harbinger of doom, but we lost this last time,” he said, referring to the state budget in 2019 that contained increases for direct care workers. That budget was vetoed by Gov. Roy Cooper in a disagreement with the legislature over Medicaid expansion. “We need to be sure we don’t lose it again, if there’s consensus on this, and we’re going to do it, seems to me the sooner we do it the better.”

“If we tie something that’s critical like this to that budget, we could be tying it to an anchor and dropping it off the boat,” Adcock said after the meeting. “That’s not what we want to do.”

That’s not what they want either.

For Artis and other employees at Whittecar, increasing wages could mean less overtime and more staff and could alleviate stress for their workers who sometimes need to work multiple jobs to make ends meet.

Despite the challenges of the work, Artis said the residents are like family. Her co-worker Shari Webb sat on a couch next to Stone, the two of them giggling as Webb elbowed Stone in the ribs.

“I’ve lived in Greensboro,” Stone said, referring to one of her previous homes. “It’s a lot nicer [here.]”

“We’re here because we love what we do,” Artis said. “That’s what we want to promote here, and that’s what we want to bring in is someone that’s going to treat them the same way that we treat them.”

Though both HB 914 and HB 665 had an easy path through the House committee Tuesday, the future of long-term care facility worker pay and retention remains to be determined by the full House of Representatives and the Senate in the coming weeks.

NC Health News editor Rose Hoban contributed to this story.

Correction: This story originally stated that the Whittecar Group Home was run by Easter Seals UCP of North Carolina and Virginia.

A man with white hair looks into the distance, he's Mike Sprayberry, director of emergency management and he's at a press conference about coronavirus.

Coronavirus Today – April 2 – Cases in NC prisons, unemployment system strain, state requests FEMA help

April 2, 2020 by Editor

Coronavirus Today – April 2 – Cases in NC prisons, unemployment system strain, state requests FEMA help - North Carolina Health News

The coronavirus outbreak has resulted in more than 350,000 unemployment claims to date, officials said on Thursday. Meanwhile, the state's prison system reported COVID-19 cases.

By North Carolina Health News staff

State unemployment system stretched thin

The state’s unemployment system has been swamped with thousands of claims, an official from the Department of Commerce said Thursday afternoon.

Social distancing measures, including the closures of salons, massage parlors, and bars and the prohibition on eating out, have taken an economic toll. Since the crisis began in mid-March, the state commerce department has received more than 335,000 claims related to COVID-19, said Lockhart Taylor, assistant secretary of the Division of Employment Security, during a press briefing held remotely from the state emergency operations center.

Before the crisis, he said, the department received 3,000 claims a week.

The state already paid $8.2 million in unemployment claims, he added, and that figure is expected to “increase exponentially” in the coming days. The swell in unemployment claims has strained the system, Taylor said, and the department has hired additional staff and made some technology upgrades to the phone system and website system to accommodate the sharp rise.

“We know our job is just beginning and we will not rest until we’ve processed every claim [and] answered every question and every phone call,” he said. – Liora Engel-Smith.

Coronavirus by the numbers

According to DHHS’ data as of Thursday morning:

16 people, total in North Carolina, have died of COVID-19.
1,857 have been diagnosed with the disease. Of those, 184 are in the hospital.
More than 28,000 tests have been completed thus far, though not all labs report their negative results to the state, so the actual number of completed COVID-19 tests is likely higher.
Most of the cases (42 percent) were in people ages 25-49. While 20 percent percent of the positive diagnoses were in people ages 65 and older, seniors make up 75 percent of COVID-19 deaths in the state.
Nine outbreaks are ongoing in group facilities across the state, including nursing homes, correctional and residential care facilities.
There are 2,818 ventilators in hospitals across the state, and 624 ventilators are in use, not just for COVID-19 cases but for patients with other reasons for being in the hospital.

Protective equipment for health care workers first

Mike Sprayberry, director of emergency management, said the state received a third shipment of protective equipment from the Strategic National Stockpile. With the three shipments, the state has received:

Almost half of the N95 masks requested,
More than 100 percent of the surgical masks requested,
92 percent of gloves requested,
No hair covers, shoe covers or goggles requested by the state.

Sprayberry said the state also placed orders of protective equipment that amount to more than $100 million, but much of those supplies have not yet arrived. Amidst these shortages, NCDHHS Sec. Mandy Cohen said the state will continue to prioritize providing equipment to health care providers and first responders.

Though the Centers for Disease Control and Prevention is considering recommending the public use masks, Cohen didn’t rule out moving to a similar recommendation, but only after more protective equipment is available.

“We still do not have the protective equipment we need to protect our health care workers and our other first responders,” Cohen added. “That is our first priority, to make sure we can protect those who are treating COVID-19 patients.” – Liora Engel-Smith

NC puts a COVID-19 request to FEMA

Sprayberry said North Carolina officials approached FEMA with a request to help cover the cost of providing thousands of rooms for people who are affected by COVID-19 but aren’t sick enough to be in the hospital. If approved, the request would reimburse the state for 75 percent of the cost of reserving hotel rooms and dormitories across North Carolina for COVID-19 housing response, Sprayberry said, with the state bearing the remainder of the cost.

The rooms would also be used to help people who are at risk for COVID-19, those who are symptomatic and those who are awaiting test results, he added.

“If we’re going to have a big surge of patients that need assistance or folks that need to be kept in a place that does not necessarily have to be a hospital or a part of the health care system, this would be a good solution,” Sprayberry said. – Liora Engel-Smith

First NC prisoners test positive for COVID-19

A male inmate in his 60s at the Caledonia Correctional Complex in Tillery was the first North Carolina prisoner to test positive for coronavirus on Wednesday.

This afternoon, Commissioner of Prisons Todd Ishee announced that three more inmates tested positive, as well as four corrections staff members. The inmates are located at Caledonia, Neuse Correctional Institution in Goldsboro, and Johnston Correctional Institution near Smithfield. The staff members who tested positive work at Raleigh’s Central Prison, Johnston and Maury Correctional Institution in Greene County.

“We’ve prepared long and hard for this day. This was not a surprise to us,” Ishee said during the daily press conference with state officials.

Just Tuesday, prison officials told state lawmakers that about 100 prisoners had been tested with no positive results at the time.

The first inmate started showing symptoms on March 24 and was isolated from the rest of the population and tested for the virus the following day, according to a Department of Public Safety press release.

The inmate’s positive test came back on April 1, and officials report that he is in stable condition.

Prison officials have identified other people the inmate had contact with prior to his quarantine. They are being monitored and tested based on symptoms. The housing unit of the inmate who tested positive is on lockdown, meaning inmates are eating meals in their cells and only coming out for recreation time.

All inmates and staff were given masks to wear and there has been increased sanitation of the housing area, according to the DPS release. –Taylor Knopf

Seven NC long-term care facilities see COVID-19 outbreaks

North Carolina outbreaks of COVID-19 have taken place in four nursing homes, three residential care facilities, one correctional institution and one at an unidentified location, the state Department of Health and Human Services reported Wednesday.

The department declined a request from North Carolina Health News to identify the locations, means of transmission and circumstances of the incidents in residential care homes. However, three adult care homes have been identified in press or corporate reports as having had incidents of the virus: Sunrise Senior Center in Cary, Woodland Terrace in Cary, and Pine Forest Rest Home in Northampton County. At Pine Forest, the number of cases rose from one to 24 within a week.

”We do not release names of facilities or information on specific residents,” Kelly Haight Connor, a DHHS spokeswoman, said in an email.

North Carolina Health News did not request the names of individual residents. The names of adult care homes and nursing homes that are the subject of investigations have been released for decades as part of reports by county adult home specialists whose work is made public and shared with state and federal regulators.

The listing of outbreaks at correctional institutions does not include every penal institution that has had a case of COVID-19, as the department counts an outbreak as two or more diagnoses by a laboratory.

State correctional officials said Thursday that new cases of inmate diagnoses took place at Caledonia Correctional Institution in Halifax County, Neuse Correctional Institution in Goldsboro, and Johnston Correctional Institution near Smithfield. The staff members who tested positive work at Raleigh’s Central Prison, Johnston and Maury Correctional Institution in Greene County. –Thomas Goldsmith and Taylor Knopf

Insurer waives costs for COVID-related care

Blue Cross and Blue Shield of North Carolina, the state’s largest health insurer, announced Wednesday it would waive all out-of-pocket costs for members – including deductibles, co-payments and coinsurance – for treatments related to COVID-19 for people who are diagnosed with the virus.

“This is a public health emergency that is requiring everyone in the health care community to do their part, and we’ll continue to respond and determine how to best serve our members in the face of COVID-19,” said Gerald Petkau, chief operating officer and interim CEO at Blue Cross NC, in a press release.

These moves come on top of other measures intended to cushion those with BCBSNC insurance from some of the costs related to the coronavirus, including expanded coverage for telehealth visits, waiving out of pocket costs for COVID-19 testing and making it easier for members to get three-month supplies of their medications.

The company also encouraged out of network providers to accept BCBSNC’s payments, rather than bill members for additional costs. – Rose Hoban

UNCC is swamped by student needs

The University of North Carolina system approved partial room-and-board refunds for many students but it may not come soon enough for students in need. UNC Charlotte stepped forward to help by establishing the Student Emergency Relief Fund to provide a one-time $500 grant to students impacted by the coronavirus pandemic.

The fund had almost $264,000 on hand after the first week but received more than $400,000 in applications from students in need. While some UNC Charlotte students could go home, that was not an option for some international students and others who depended on the university for housing, work study or a meal plan.

The Jamil Niner Student Pantry will remain open to assist UNC Charlotte students who struggle with food insecurity, university officials said. To avoid shopping and maintain social distancing, students can use an online order form which is fulfilled by a staff member. -Melba Newsome

Carolina steps up to help students

On Thursday, UNC Chapel Hill launched the COVID-19 Student Care Hub, a one-stop shop for guidance and information about available resources on everything from academics to financial aid to wellness. A dedicated team will be tracking emails, routing inquiries, and finding solutions for students who write in with issues.

In addition, UNC established the Carolina Student Impact Fund to help undergraduate, graduate and professional school students who may have lost a job, housing or food plan because of the pandemic. The fund will also help students who incur extra expenses because of canceled or shortened study abroad and exchange programs. -Melba Newsome

I/DD advocates worry about group home outbreaks

State Health and Human Services Secretary Mandy Cohen said during meetings Thursday that three residential care/group facilities in the state have had a COVID-positive person in them, along with a facility listed in the “other” category on the state’s coronavirus case-count web page.

This is a big concern for Julia Adams-Scheurich who lobbies on behalf of people with intellectual and developmental disabilities at the legislature.

“We understand the need to prioritize our hospitals and first responders to access PPE, but we also have a genuine concern that we have congregate living centers for people with intellectual and developmental disabilities that are community based, and house some of our most medically fragile people,” she said. “They need to be prioritized also to avoid spread that we are seeing in other states in similar facilities.”

These facilities are places where residents live full time, and they frequently come and go to community centers, events, the gym, etc., Adams-Scheurich said. She said they’re asking everyone to stay home. Even though there’s a stay-at-home order, there are federal regulations about their rights to come and go, and so it’s difficult for facility management to keep people in their rooms or in the facility.

“We need really clear guidance on protecting those two priorities,” Adams-Scheurich said. “Staying home, we support it, but we really need to know how to proceed.”

Adams-Scheurich said the I/DD advocacy community has been trying to work with DHHS, but she also said that their staff is overwhelmed and she fears this population will not have their needs addressed before it becomes a critical emergency.

According to the state Division of Health Service Regulation, there are 2,247 licensed group homes in the state which house people with mental health and intellectual disabilities. In addition, the state has about 700 intermediate care facilities which serve people with I/DD who are also medically complex. Some of these residents require extensive hands on care for bathing, dressing, and managing their medications and medical devices. -Rose Hoban

Mental health moment: Yoga flow, live in your living room

A Charlotte-based yoga studio is holding lunchtime flow sessions on Zoom. Starting next week, Yoga Dude Fitness will hold sessions from noon-1 p.m. Monday to Thursday. Sessions are free, but organizers said they welcome donations. Classes are open to all levels, and the instructor will share modifications for beginners. For information on how to attend and donate, visit the Facebook event page. -Liora Engel-Smith

shows several empty rocking chairs on a porch

Funding increases likely for NC personal assistance allowance, community services

June 24, 2019 by Thomas Goldsmith

Funding increases likely for NC personal assistance allowance, community services - North Carolina Health News

Some key lawmakers says the latest version of the state budget will support key aging priorities, including community-based services and spending money for low-income residents of long-term care.

By Thomas Goldsmith

A General Assembly budget likely to emerge early this week will include increases in several areas vital to older people, a Republican budget crafter said Saturday. The conference committee budget is the result of negotiations between members of the state House of Representatives and the state Senate.

Budget-writer Rep. Josh Dobson (R-Nebo) said older people and advocates can expect increases in funding for the personal needs allowance for lower-income people in long-term care and in the Home and Community Care Block Grants that fund county-run services such as home-delivered meals, in-home aides, senior centers, and transportation.

“There will be an increase in the personal needs allowance and the Home and Community Care Block grants,” Dobson said in a telephone interview, citing the advocacy of Rep. Donna White (R-Clayton) for older adults.

Increased funding is also likely for long-term care centers that serve Special Assistance residents, who are older than 65 and/or have disabilities, said Dobson, who would not specify amounts.

The conference committee, comprised of leaders from both chambers, has been adjusting multi-billion-dollar slices of a budget to present to Gov. Roy Cooper, who could veto it.

Paying for personal needs

A coalition of advocates has mounted a campaign this session to increase the amount of the personal needs allowance provided to the state’s lower-income long-term care residents. People getting public assistance in adult care homes — assisted living centers or group homes — have for years received $66 a month, comprised of state funds along with an income set aside, to cover clothes, prescription copays, hygiene items, snacks, travel and myriad other needs.

In its budget proposal, the House proposed increasing the state portion from $46 to $70 a month and the Senate included a lesser hike, to $58 a month. The income set aside adds $20 from residents’ incomes to their available funds.

Neither chamber recommended an increase for nursing home residents, who have more expenses such as drug copays covered, but whose allowance is $30 a month.

Judy Vines Hendrickson, of Sharpsburg, whose son has mental illness and lives in a group home, said she hopes that the legislature’s members know what the increase would mean to residents.

“My son goes to a day program where they can do different things like go to the grocery store, or get out in the community,” Hendrickson said in a phone interview. “They have to pay a dollar for their lunch. That’s pretty cheap, except that’s $30 of his $66.

“I really wish that the people making these decisions would have a panel of people like me come up there and talk to them.”

‘If we could vote’

Hendrickson first entered the personal needs allowance discussion in April, when she contacted North Carolina Health News with information about her late sister’s experience in adult care. In an example that’s unusual but not unprecedented, her sister had “gone with men for money” in order to supplement her spending money at an Eastern North Carolina residential center, Hendrickson said.

Rep. Cynthia Ball (D-Raleigh) proposed increases in the personal needs allowance for assisted-living and nursing-home residents with separate bills introduced later in April. However, consideration of both items has come instead in the conference committee.

“If we could vote on it, it’d probably pass,” Ball said Friday.

Within the details of the budget bill, there’s a likely increase in the prescription copays for people on Medicaid, a cost that will cut into any increase in their spending money.

Budget writers have been conducting negotiations in secret, leaving voters and advocates in the dark about the fate of additional items that affect older people.

Those include Adult Protective Services, the county-based services charged with preventing and responding to abuse and neglect of vulnerable older people. The House would direct $893,041 in federal funds for each of the next two years to hire more local APS workers to tackle bulging caseloads. The Senate would add $457,041, or a little more than half that amount, during the same period.

Regarding a smaller-scale effort, but one that’s been around for more than a quarter-century, the House recommended giving the Senior Tar Heel Legislature $12,000, while the Senate ignored the body completely. The Senior Tar Heel Legislature, with a representative from each North Carolina county, was set up in 1993 to keep older people informed about matters afoot in the General Assembly, encourage people’s involvement in aging issues, and establish a forum for discussing possible legislation.

Shows a boarded up cottage with plywood over the windows. On the plywood is spraypainted: "Go Away FLorence"

Telephone Becomes Lifeline for Mental Health Clients During Florence

September 26, 2018 by Rose Hoban

Telephone Becomes Lifeline for Mental Health Clients During Florence - North Carolina Health News

For the duration of Hurricane Florence in eastern North Carolina, people experiencing stress, anxiety and other mental health issues had phones as their link to help.

By Rose Hoban

Hurricane Florence roared ashore in North Carolina downgraded to a Category 1 storm with sustained wind speeds of 90 miles per hour. But that “reduced” storm intensity was still mighty, and mighty frightening.

Sarah Bishop, a physician assistant at Carteret Health in Morehead City, stayed in the emergency department for the duration of the storm working 12-hour shifts. The Pennsylvania native was struck by how powerful the storm was.

“There was times when EMS was coming in with patients, and you couldn’t believe how hard that wind was whipping and the rain was coming in,” she said. “It was impressive what the wind could do.”

Bishop was high and dry, in a building that was solid and above the storm surge. But many on the coast were in far less secure buildings that flooded and sustained damage from wind, falling trees and flying debris. Mental health workers in coastal counties said they heard from their patients about their terror from the storm and the rising waters.

It was stressful for everyone, but for the most psychologically vulnerable, it could be devastating.

Surge capacity

The call volume for mental health disabilities and substance abuse crises was higher than normal, especially throughout the weekend that Florence’s winds and rains raged, said Cindy Ehler, vice president for clinical operations for Trillium Health Resources, the mental health local management organization (called an LME/MCO) that covers 26 eastern North Carolina counties. Trillium usually fields 100 calls a day, but from Sept. 14-19 the organization took 812 calls.

We see a house that has floodwaters up to the threshold of the front door. the photo is taken from on a boat, we can see the bow of the boat and a man in bib waders with his back to the camera. Took place during Hurricane Florence. standing on the bow holding a rope. — Local fishermen use their boats to rescue neighbors from flooded houses. People in southern Carteret County said the waters that inundated the area were higher even than during Hurricane Hazel in 1954. For many people, the experience was terrifying. Photo credit: Glenn Skinner

She said that’s the expectation during these types of events and for that reason the organization has beefed up its phone response team.

“Most of the first responder systems or mobile crisis for mental health was down during the actual, you know, the action of the event, the flooding and the wind,” she said. “Responders can’t really get out in that. So our telephonic response is really the response that remains intact throughout that whole event.

“Like the calls that were suicidal, we may be on the phone with somebody for hours, helping them get to a place where they’re OK, because it’s us and them, and there isn’t anybody else to respond,” she said.

Many of the people who had to evacuate had developmental disabilities including the residents of 24 six-person group homes. Some of them won’t be able to return to their residences after the storm.

“We have at least one group home that flooded in New Bern that the state worked with us to relocate to the campus of Caswell Center,” a state-operated facility in Kinston, she said.

Ehler, a counselor with decades of experience, was one of the people answering phones. She said many of the supervisors at the LME/MCO take phone duty to increase their capacity for response. She said that’s one of the lessons learned from Matthew and other bad storms, to provide surge capacity with some of the most experienced clinicians.

“When we start seeing a certain volume of calls coming in, we immediately start adding resources,” she said.

Ehler, a New Bern resident, wasn’t at home, though, as the storm progressed. She had evacuated to Richmond, where she was taking those calls on her cell phone. Trillium’s system can route phone calls from desperate clients to someone who can answer. And because Trillium’s service area is so large, providers in areas affected less by the storm, in northeastern North Carolina, were also able to pick up calls.

“We stay online the whole time, although we’re also moving throughout that time,” she said.

“Forces beyond our control”

Mona Townes, director of the Integrated Family Services mobile crisis team that operates in Carteret County, said her team’s emergency response plan also specifies that her team shift over to responding by phone.

“There’s still some areas that we cannot physically get to because, you know, forces beyond our control,” she said. Members of her team were able to offer, “those de-escalating techniques and those coping skills and coping strategies.”

She said her team members checked in with all of their mobile crisis clients during the storm and all of the people they reached said they were happy to make a connection. She estimates there are 30 to 35 people served by her three-person team located throughout Carteret County. Mobile crisis is just what it says, a team of professionals that take services to people who need help to stay in the community and out of the hospital.

Stressed responders

Both Townes and Ehler said they were worried about some of the first responders who spent several weeks working flat out. Some of what those responders see can be traumatic.

“People in these first responder roles were, are constantly being faced with an incredible amount of trauma for other people, a lot of excessive sadness,” Ehler said. “It… can be hard to, to articulate what’s going on because you’re so emotional.”

“Those first responders have seen and heard it all that would be unimaginable for some of us,” Townes said. She said that debriefing after “critical incidents” is important so that the individuals can “have an opportunity to talk about what they’ve seen, talk about what they heard, talk even about what they smelled.”

One of the tragic stories that came out of Carteret County was an apparent murder-suicide which was reported even as the storm was raging outside.

Townes said that incident concerned her because Carteret County has such a high suicide rate, the ninth or 10th highest in the state.

“Especially after a critical incident such as this, for those individuals that may have already been struggling with thoughts of suicide and then for this to happen?” she said. “We’re genuinely concerned about what are those suicide numbers going to look like.”

A rundown of the many adverse effects of Hurricane Florence in North Carolina’s coastal counties.

Map of North Carolina’s county suicide rates: 2008-2014, Deaths rates per 100,000 by suicide, all ethnicities, ages, male and female. Source: Centers for Disease Control and Prevention

shows the silhouette of a boy, he's looking at a pool where others are playing.

Future Uncertain for Thousands of NC Children in Group Homes

July 13, 2018 by Carolina Public Press

Future Uncertain for Thousands of NC Children in Group Homes - North Carolina Health News

A new law will change the way federal money goes to pay for foster care, favoring care by extended family. But will the changes leave some kids without options?

By Michael Gebelein

Carolina Public Press

A sweeping overhaul of the nation’s foster care system has North Carolina caregivers, social workers and advocates scrambling to figure out how the new laws will affect thousands of children currently living in group homes.

The Family First Prevention Services Act, which Congress and the president enacted in February as part of the Bipartisan Budget Act, includes extensive reforms to the way the federal government funds state-level foster care programs.

The legislation eliminates federal funding for foster children residing in congregate-care settings, such as group homes. The intent is to encourage other types of placements, but the new law lacks a coherent solution to the expected influx of children who already live in group homes and will be forced to transition into family-based foster homes.

But those caring for children in group home settings say the new law is shortsighted and will leave many kids without options.

“There is a need for homes like us” said Joe Leggett, CEO of the Falcon Children’s Home in Cumberland County. “There’s nowhere for many of these kids to go. Group homes need to be part of the solution.”

Unintended consequences

Advocacy and governmental groups across the country, such as NC Child, the County Welfare Directors Association of California and the New York Office of Children and Family Services, have also expressed concerns about some major provisions of the new law.

shows a bjilding with a path in front. A group of bicycles are parked in front of the building which is part of a foster care group home. — Bicycles are parked in front of one the buildings at Black Mountain Home for Children, Youth and Families in Black Mountain. Colby Rabon / Carolina Public Press

The law’s full effects will remain unclear until the federal government sends guidance documents to the states; however, it appears that the law doesn’t include adequate funding for recruitment, retention and training of the new foster families who will be needed to care for the number of children who will be leaving group homes, say these groups.

The FFPSA was proposed and approved as a response to the growing need nationwide for foster care as a result of the opioid epidemic that is ravaging communities throughout the country. The idea is to provide services to the parents of children who are at risk of entering the foster care system in an effort to make that foster care placement unnecessary. The Children’s Defense Fund called the measure “long-overdue historic reforms to help keep children safely with their families and avoid the traumatic experience of entering foster care, emphasizes the importance of children growing up in families and helps ensure children are placed in the least restrictive, most family-like setting appropriate to their special needs when foster care is needed.”

Other observers don’t necessarily oppose this endeavor but are concerned about unintended consequences.

Specifically, any funding under Title IV-E of the Social Security Act that was formerly used to reimburse states for spending related to congregate care for foster children will be diverted to services and programs that are designed to keep children out of foster care entirely.

Title IV-E funds will be used for in-home parenting support, mental health support and substance abuse treatment for up to a year.

shows a boy in silhouette who's playing basketball indoors at a foster care group home — A resident of Falcon Children’s Home plays basketball in a gym facility located on the campus on July 6, 2018. Melissa Sue Gerrits for Public Carolina Press

That’s a significant deviation from previous funding strategies for child welfare initiatives.

Title IV-E funding has traditionally been used solely to support children whom state agencies have already taken from their homes rather than to help parents avoid the need for foster care placements.

Spokeswomen for the N.C. Department of Health and Human Services and the New Hanover County Department of Social Services told Carolina Public Press that their organizations have not yet received guidance from the federal government about how to actually implement the provisions of the law.

Some portions of the law, including federal reimbursement for residential child-parent substance abuse treatment programs and kinship navigator programs that help connect kinship care providers with services, will be implemented in October.

Reimbursements for most children in congregate care will be cut off in September 2019 unless states choose to extend that deadline for up to two years. However, reimbursements for prevention services won’t be made available to states during the extension.

The decision about when to implement the changes and whether to opt into the deadline extension will be made by the secretary of the N.C. Department of Health and Human Services.

The logic behind diverting funding away from group homes was the idea that foster children are often warehoused in those settings when a family-based foster home would be more appropriate. The law makes an exception for facilities that serve teen mothers and victims or potential victims of human trafficking, and facilities that meet the standards of being a “qualified residential treatment program.”

But for those facilities that house foster children in a residential setting without a clinical component, a major source of funding is going to dry up.

Unclear future for group homes

That eventuality has residential facilities concerned for their future — the president and board chair of the Black Mountain Home for Children, Youth and Families in Buncombe County, in an April letter to donors, called the passage of the FFPSA “course-altering” for facilities like theirs.

“For some children and youth, family-style residential care like we provide is the best environment for their situation,” Black Mountain Home President Tom Campbell and board Chair Bruce Henderson said in the letter.

shows a boy swinging at a ball with a bat, he lives in a foster care group home — Residents of Black Mountain Home for Children, Youth and Families cool off with a game of water whiffle ball with staff members at the facility in eastern Buncombe County. Colby Rabon / Carolina Public Press

“While some of our programs will continue to receive funding, our original residential program will be seriously at risk. This is an important piece of our continuum, providing care primarily for older youth, large sibling groups and youth who have faced multiple placements and for whom there are few viable options.”

Leggett, at Falcon Children’s Home, told CPP that the inclusion of the FFPSA in the budget bill was “shortsighted” and that he thinks representatives of group homes should have been included in the legislative conversations about how the law will affect foster children.

Falcon currently houses 90 foster children. Leggett said about 65 of those children would have to find new placements if the FFPSA were to be implemented today.

“We provide a place for a population that hasn’t been able to find a foster home,” Leggett said.

“If they could be in a foster home, they would already be there.”

Leggett said group homes are a “last resort” for many of the foster children whom Falcon serves, either because they’re part of a large sibling group, have had behavioral issues at family-based foster homes or are older children who have had a difficult time finding placement.

In North Carolina, about 2,000 children live in residential congregate-care settings that don’t include mental health services, according to Whitney Tucker, research director for NC Child, a Raleigh-based children’s advocacy group.

Should that number remain steady over the next several years, those 2,000 children potentially would be forced into new housing arrangements when the law’s provisions take effect unless the state and counties choose to make up the funding shortfall.

“The reason that they are in congregate care is often because they are part of a large sibling group where they’ve flown out of previous foster care placement and are stabilizing in a group home setting or they are just done with foster family settings and are just waiting to transition out of foster care altogether, so they’re older kids,” Tucker said in an email to CPP.

“North Carolina has a history of closing mental health residential group homes with the idea that kids would be better off in family settings and community-based services (which in intention is correct), but in reality what happened was that the community-based treatment options were not available and kids actually ended up in more restrictive placement as a result.”

The state’s foster care system is already overtaxed, with county social services agencies often scrambling to find placement for children, according to Michelle Hughes, executive director of NC Child.

While state and federal policies suggest keeping sibling groups together and keeping foster children in the same county and school system they were in when they were living at home, the absence of an adequate number of foster homes could mean that those sibling groups are broken up or that children are moved away from the area they’re familiar with.

“Without some significant focus and investment at the local level, it’s going to be challenging for county DSS agencies to significantly increase the number of foster families and then make sure that the foster families are available and make sure the foster families have the training and clinical consultation they need to care for the children,” Hughes said.

“The intent of all of the legislation is good for kids. In terms of the implementation, we’ll have to wait and see what the outcome is.

“Family First is a piece of legislation that has enormous potential to prevent children from experiencing trauma by going into the foster care system, as well as cost savings for the state. That has a huge potential to be beneficial for kids. The question, as with all legislation, is in the implementation.”

shows a group of people huddled around a desk

House Budget Wrapped Up, Heads Back to the Senate

June 2, 2017 by Catherine Clabby

House Budget Wrapped Up, Heads Back to the Senate - North Carolina Health News

Now that the House is done, the House and Senate move to negotiate out the differences in their visions for the state spending plan.

By Catherine Clabby and Rose Hoban

In a late night vote, House lawmakers passed their $22.8 billion dollar budget, that includes funding for more than $5 billion for health and human services needs for the coming year.

The vote capped a day that began with Republican budget chairs crowing about their budget plan and ended with lawmakers making jokes on the floor of the House as they waited for their final tally.

The Senate budget had set aside a billion dollars for tax breaks and sequestered another $150 million in Medicaid reserves, which left less for spending.

In the past, Medicaid had created headaches for lawmakers, who struggled to budget the correct amount for the year’s spending, in addition to having program spending spiral out of control during the economic downturn in 2009-2011.

House Speaker Tim Moore was surrounded by members of the House Republican caucus as he presented the House's budget during a press conference Thursday morning at the General Assembly. — House Speaker Tim Moore was surrounded by members of the House Republican caucus as he presented the House’s budget during a press conference Thursday morning at the General Assembly. Photo credit Taylor Knopf

But in recent years, the program has had a smoother ride, with more stable national finances, more robust financial growth in the state that lead to less program growth and a new information technology infrastructure that’s made budgeting more precise.

“So that the last four years, including this year, once again we will have a surplus on the Medicaid budget,” said House Appropriations Committee Chair Nelson Dollar (R-Cary). “I think our sound reforms have fixed that problem I think as sound as anyone in the country.”

Dollar explained that the House instead took $186 million that had already been set aside as a Medicaid reserve and put it into the fund to create a financial backstop for the program once it transforms from its current fee-for-service payment structure into one that’s capped and managed by outside insurance companies.

And House budget writers did not sequester new funds into a reserve, which left them more to spread around.

And spread around they did:

The House plan made cuts to so-called “single stream” funding that goes to the state’s mental health management organizations. Senate budget writers cut $171 million from the funding stream over two years, House budget writers cut $88.4 million and phased out those cuts by the end of next year.
$10 million in funding to help small group homes housing adults with intellectual, developmental and mental health disabilities bridge a structural problem in their funding.
Found $5 million in late funding to cover the costs of substance abuse treatment for people who have been using heroin and prescription opioids.
Created $500,000 in funding for a biomanufacturing training center at N.C. State University.
Ordered Cardinal Innovations, one of the state’s seven mental health management organizations, to invest $800,000 in cash reserves for capital needs at Carrboro’s Club Nova clubhouse for people with severe and persistent mental illness.

Environmental health takes the floor

One of the issues that generated the most debate on the floor Thursday evening was the House bill’s requirement that the Department of Environmental Quality make progress on testing chemical solutions to nutrient overloading in Falls and Jordan Lakes.

Supporters hope that strategy could delay or replace a next phase of nutrient control plans for the two lakes which would require sewage treatment plants, developers and others to make expensive changes to reduce pollution discharges upstream.

Rep. Pricey Harrison (D-Greensboro), citing safety concerns, proposed an amendment that would have replaced support for the chemical treatment with a command to “restart” Jordan Lake and Falls Lake nutrient reduction rules.

The General Assembly has managed to delay implementation of the full Jordan Lake rules since they were adopted by the state’s Environmental Management Commission in 2009.

Supporters of Harrison’s amendment said the plan to use chemicals resembles another recent plan that failed, namely the use of SolarBees to stir Jordan Lake to slow algae growth, which is stimulated by nutrient pollution. That project cost taxpayers more than $1 million but did not reduce the blooms that make the lake “impaired” by federal standards.

Rep. Larry Yarborough (R-Roxboro) said trying the chemical treatments, a mix of algaecides and phosphorous ”locks,” would not eliminate the rules. But he said he does not want to give up hope for finding an alternative path.

“We’re trying to put off phase II until we get a chance to see if this works,” he said.

One of Harrison’s biggest objections was the possible health effects of adding chemicals to the water.

Other elements of the House bill with environmental health implications that differ from the Senate language include continued funding for the FerryMon program, which uses state ferries to test water quality in the Neuse and Pamlico rivers, along with Pamlico Sound estuary.

Another difference was continued funding for a program that removes mercury from convenience light switches from older cars before they are crushed or shredded.

No kumbaya

The budget debate was mostly cordial, nonetheless, it featured moments of tension as Democrats proffered multiple amendments, a number of which were quickly killed by parliamentary procedures.

And Democrats said the budget didn’t go far enough in making investments to build up the state in the wake of lean years.

“For two years, I have voted for our budget that we put forth to the senate, but this year, I just cannot vote for this budget,” said Rep. Billy Richardson (D-Fayetteville). “I think that we as a body have missed a golden opportunity.

“For years we have used the excuse that we have carefully spent from 2008 and that we’ve had to adjust for that, but we have more than caught up from that… We have recovered from the downturn in the economy and we’re in a position now where we can reinvest in the infrastructure of the state.”

New Bern Republican Michael Speciale smacked down the Democrats’ arguments.

“We sit here and listen to how great things would be if the other side was in control,” he said. “I get tired of sitting here and listening to that, how bad things are and ‘we can do better.’ I don’t think there’s been a budget in the five years I’ve been sitting here that has not been a budget where the other side of the aisle hasn’t used that phrase, ‘we can do better.’”

“Of course we can do better, we can always do better… if we had more money,” Speciale said. “We have opposing views of what should go in the budget. That’s the reality.”

Now the bill goes into conference committee and will likely take weeks for the two chambers to iron out their differences before the final plan sees the light of day.

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