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External Program Review Committee (EPRC) minutes

Date: Oct. 5, 2023
DSD liaisons: Stacie Enders, Linda Wolford and Ari Dionisopoulos
Type: Whole committee
Attendees: Jodi Greenstein, Kim Frost, Dan Baker, Laura Daire, Lindsay Nash, Victoria Anderson, Stacy Danov and Susie Haben
Not present: Danielle Bishop, Melanie Eidsmoe and Toni Puente

Agenda items

Public comments

There were no public comments at this meeting.

Vote

Vote to approve the whole committee meeting minutes from September:

· Dan Baker: yes

· Kim Frost: yes

· Laura Daire: yes

· Lindsay Nash: yes

· Stacy Danov: yes

· Susie Haben: yes

· Victoria Anderson: yes

· Jodi Greenstein: yes

Updates to share

Direct care workforce shortage

· Nursing Home Workforce Standards Board: Nursing home direct care professionals already make several dollars more per hour than community-based direct care professionals. We will follow this board to see how their work and policy recommendations might affect community-based caring careers.

· DSPs: Ask Congress to Recognize DSPs as a Profession!: Email campaign by American Network of Community Options and Resources (ANCOR). Change in any sector is unlikely to pass given the current unwillingness of federal representatives to negotiate with other parties.

· AASD and DSD eList: Remember to apply for the PCA training stipend grant initiative: DHS reviewed billing data and discovered that hundreds of PCA providers could be eligible for but are not taking advantage of the PCA enhanced rate or budget. This means those direct caregivers could be making higher wages (7.5% higher) when supporting people who require 10 or more hours of PCA services per day. DHS will notify those providers of this issue through a MN-ITS drop box message.

· All eligible PCA Choice, CSG, CDCS, and CFSS budget model professionals can now receive a $1,000 retention bonus. This agreement was won by the PCA union called SEIU. DHS is working to notify people about the bonuses but a lot of people think the messages are spam.

Subcommittee updates

Emergency use of manual restraint subcommittee

· This subcommittee will share a conversation they had regarding 911 calls and possible policy changes providers are making regarding calling 911.

· There is a possible link between the workforce shortage and providers not feeling comfortable with behaviors, and therefore using 911 as a crisis response mechanism when they don’t have experienced staff.

· Providers might be changing their policies from using restraint to using 911 instead because of high staff turnover or not having someone physically present to respond.

· Using restraint can sometimes lead to staff turnover. When staff have to go through an investigation, what is the consequence to them and do they receive any kind of support?

· When you don’t have enough staff, they might not be able to implement procedures or positive supports safely.

· This subcommittee will listen for this issue and possibly bring it up as they work with and get to know provider organizations.

· For investigations of Intermediate Care Facility (ICF/DD) providers, the Minnesota Department of Health (MDH) is seeing this as well. Issues are often related to staffing problems. Staff might use restraint to protect themselves or other residents. Staff might not give a person an opportunity to calm down before using restraint. Staff often do not have the tools or experience to implement positive supports.

· Some staff have been harmed by residents in the past.

· Some staff are working constantly with clients and don’t get relief from high behavioral residents.

· Facilities don’t always do a good job of debriefing with staff.

· Does DHS/MDH do a good job explaining what a good debriefing should look like? The committee is unaware of any resources for this.

· What is the impact of not having enough staff to do a proper debriefing?

· Providers often scramble and are afraid MDH/DHS will be excessively punitive.

· There are not a lot of good systems to bring in additional professionals to provide assistance to providers and to have staff feel safe in that process. Intervention services are short-staffed and sometimes have waiting lists of over six months.

· Debriefing and implementing positive supports is difficult to do when you are trying to keep people safe and fill shifts.

Discussion

Review of annual recommendations:

2023 Goal 1: Provide resources and guidance for improving communication skills

In addition to the notes in the agenda, members also shared:

· People should be given opportunities to have fun with communication.

· Devices should allow the person some privacy (for example, not announcing a person needs to use the restroom but using an alternative way to communicate private needs).

2023 Goal 2: Simplify and organize online DHS materials and training resources related to positive supports or intervention services

DHS staff continue to work on this manual. While the process is slow, we are making progress each month.

2023 Goal 3: Explore ways to improve access to positive support services

The intervention services study and redesign work is on track. We will make an announcement soon to start recruiting a vendor to implement the study findings.

2023 Goal 4: Support efforts to improve the direct care workforce shortage

· DHS is having a meeting of interested parties in November and will look at topics like new Americans being granted work visas.

· Employers need to be willing to work with immigrants.

· Asylum seekers cannot work for a period of 150 days.

· Students are limited to only working on campus during their first year and must work in something directly related to their field.

· Linda Wolford has been sharing these issues with a U.S. senator.

· DHS is working with DEED on these issues as well.

· Immigration and refugee processes are still on paper so they are slow.

· How you come into the country and your background significantly affects what the process is like – it varies widely by person.

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