 Good afternoon. This is the afternoon meeting for the Vermont House human services on January, Friday, January 19. And the first part of our committee meeting. We're continuing a discussion that that we've had over the past two weeks on the goals or principles that will frame our, our deliberations that we hope to frame our deliberations this this year. And when we finish that at quarter of two, we will be continuing the testimony that we had this morning, in terms of the coven 19 response what we've learned and maybe what we need to think about for the future as it relates to older Julie, if you would put the draft principles up again. The guiding principles. Thank you Julie they are being shared and we can see them as can folks who are listening for reviewing it later. So I am looking for some feedback. Topper, Topper spoke before, and as did both Taylor and Teresa, I didn't know. I'm waiting to see if anyone else in the committee had comments or questions. And I have to apologize. I don't see, I'm not seeing hands. Julie, could you make me a representative Rosenquist and then representative Redmond. Thank you. I continue to have a problem with issues instead of problems issues can be either positive or negative. And if it's positive, we don't want to prevent it. So, you know, I don't quite understand why we change that because a problem is a problem. And that's what we're working to prevent or address through affordable and effective service and support. So I just, just by feeling I just think issues is wrong work. I appreciate your, your consistency Carl. And I believe, and I would then look to anyone on the, who was drafting for something else to say we were in using that word, we were actually on. And for some people, it was very important. Make sense to me actually to, to have a more neutral use of language, because in fact something that we might want to work on is how to improve something, how to prevent something becoming a problem. We're putting something in place. So I believe that that may have been part of the thought in terms of that. I see a bunch of hands. My problem there is that it says prevent it. So if it's an issue that we'd like to put forward the same prevent it. So, okay, thank you. Thank you. And I have a suggestion for this. What if it was ensuring that issues are addressed through affordable preventative and effective services and supports. So you add preventative as a way that you address issues, rather than something that you prevent. That sounds sounds better to me. Okay. I'm not, you know, I don't want to prevent us dragging this thing out for a long time. I just brought it up. It was my desire but I'm happy with the consensus of the, of the committee. Carl, I love having you on committee. I have a suggestion and we can talk about that and think about that. And, but right now, why don't we just get everyone's feedback. Mary Beth, then James, then Jessica. I really think the guiding principles document is wonderful. I think it's well stated. I think Danes suggested change in language for that one particular bullet. I have two really minor punctuation grammatical things. Just in the very first bolded paragraph, I would add a comma after public health, just because you have several and there and I think it just makes it clear that social and economic security goes together. And then the only other suggestion would be the in the last bullet. Since you're talking about Vermonters as a collective and plural, I would change level to level to that they attain their highest levels of independence. Other than that, I think it's wonderfully done and thank you. Thank you Mary Beth. That's a question of Mary Beth. Certainly dapper. I didn't know what you meant by the first statement that you made about the comma behind public health and then, and then you said something I didn't quite get it. Sure. Sure. Happy to reiterate. So in the very first paragraph at the, at the end of the last sentence, it says, consider matters relating to human services, comma, public health and social and economic security. And I'm suggesting that a comma be added after public health, so that you wouldn't think it's public health and social goes together. Yep, yep, yep, yep. Okay, yep. And then do you want me to do you understand the, and then the second change with is again extremely minor it's the final bullets. And then there it talks about ensuring all the monitors have equitable equitable access to services and supports that enable them to attain their highest levels of independence. Again, I got it. Okay, thanks Mary Beth. You're welcome. Okay, I believe it was James and then Jessica. Okay, sorry. On this new version, I can't find the mute button, but can you hear me. Yes, we can. I actually was going to just mention the comma in the first thing, and then kind of semi agree with Carl about the issues you don't want to prevent something positive but it does say or so I guess you'd have to really think hard about that one. Just, we don't want to prevent anything positive but I think, I think it'll be okay. And how are you in terms of the suggested editing change from Dane. I think it's a little different. I still think that when the word preventing prevent is in there with anything that could be positive which is issues is still an issue but it's not that big an issue we know what it means. Well, that's what really matters. You know, I don't have big I don't have is not a huge problem. Okay. Thank you James. And Jessica. I just wanted to say first of all love it. I really like the preamble at the beginning I think that that just makes it so much stronger overall and I'm good with Dane's suggestion of, you know, changing ensuring that the issues are addressed through affordable preventable and effective services and supports is that right. I don't know is something close to that and I liked it so I just wanted to say thanks. Does anyone else have anything to add or any comment. I like things. Okay. Otherwise, I think it looks great. Okay, Dane may have to repeat that. Because we all have our own views on topper. Does everybody talked now. Madam chair. Dan has not spoken. I'll wait till everyone's done. Okay. Okay. I'm here. I'm, I'm, I've got my own document here. I'm tracking the changes on so I have Danes language. And do you have the and the punctuation additions. Okay. Dan, if you would go, then topper would like to go. Madam chair. Um, what about adverse issues are prevented. So ensuring that adverse issues are prevented and addressed. Um, through affordable effective supports and services. Just throwing that out there. Thank you. Thank you. And topper, everyone has gone now. I believe unless. Taylor and Teresa. Right now. Go ahead topper. Okay. I would like to bring up my, my public health. Piece again about COVID vaccines and testing. I think that it's extremely important. It is our responsibility. And I think for at least the first year of this biennium, we're going to be involved in this in a big way. So I think that we should have something in there. I'm saying that we're going to ensure that these vaccines are distributed safely. And that the testing is, is for the virus is, is carried out in a, a manner that. Provides to the maximum and equitable. Maximum and equitable access for all of them on us. I just really think that we're responsible for public health. This is a big public health issue. And I think for at least the first year, we should have something in there that talks about us being involved with it. Thank you topper. Um, and it's clear you feel very, it's very important. Thank you, Jessica. Thank you, Madam chair and thank you topper. I am. I'm sorry. Representative. No, I think we're allowed to be, we can be what we want to. But I believe, I believe the, the, the thing is use the language we want to. I mean, the names we want that we prefer in our informal discussions. Okay, I, I get what you're saying and I totally understand how important vaccines are and how much a huge part of public health that is in public health falls within our jurisdiction. Here's my problem is that how can we say that we're going to ensure all of those things with vaccines when we know so clearly that this whole thing is so complicated. Everything I listened to, not only from in my household because of my husband being the head of the healthcare system, but also the, what the governor says, and then what you hear from the physician that we hear from all the time I can't think of his name right now but I'm not sure if it's for for Couchy or you know who I mean. And so many others that for us to really go out there and say we're going to ensure that there is going to be you know that everything's going to go perfectly smooth and that we're, I'm just really worried about that I feel that that we can't really promise that we can hope for that we can try and listen to you know folks who someone like the commissioner of health have him come and keep us updated we could ensure that we would, we would listen and be updated but to ensure that we would make it. I'm not sure it's ours to ensure. Anyhow, that's just my feeling sorry. Okay. In terms of responding topper topper. Yes, I think it's important. We've all heard you we've heard you twice. Okay, and now it is time for the rest of the committee members to respond to your suggestion and Carl Carl has his hand up. Thank you. I, I'm returning back to what we talked about in the beginning of all this, and that was that these are supposed to be overarching principles and not terribly specific to a specific issue. And I think that's what we're getting into here. We're getting into a very specific area that's very important. I'm not getting away from that. I don't think it belongs in our overarching principles and our guiding principles. So, I would not be encouraging its introduction into these guiding principles. Thank you, Carl. Teresa. Thank you. I personally feel like promoting public health for all Vermonters is the broad category under which that falls and we certainly are going to be keeping an eye out for that and I think everybody on our committee feels like it's important. And we, it's, I'm going to, I'm going to quote coach on this he says. If we asked the right questions all means all and trying to, you know, make sure that all Vermonters have access to the things that Topper was talking about is really important and we are all going to be keeping an eye out on that under the first bullet so I agree 100% with Topper that it's important. And I feel like it's too specific to include in these guiding principles myself. Thank you. Would anyone else like to comment. I think that I guess I would ask folks to think about how they would like to comment this is very important to Topper and if the majority of the committee agrees with Topper. We will, you know, think about that if the majority of the committee does not agree with putting it in the guiding principles, then we would not tailor. I will reiterate what others have put forward and just saying that I agree with Topper in the respect of really promoting public health and making sure that vaccines and testing are going out in an equitable way. But don't feel like it should go into our guiding principles again because of the broadness that we are hoping for here, and instead would pose a question around is there, if there is agreement across the committee around an equitable release. I think that would be a statement that could be made on behalf of the committee that would move to that realm, or is there another action that can be taken. This is coming from the new legislator who is just figuring out how we can still push forward on this and really honor what Topper was bringing forward, while also not muddying our guiding principles. And that is clearly something that an issue that is not only not only an issue for us. It's an issue on some level that that but you know who knows that potentially government operations or appropriations or health care, or you know, all might want to have to be engaged in this through different kinds of ways. I think I have heard from almost everybody. In general, and in fact the governor commented on that in his press conference today that the legislature has put front and center dealing with the pandemic and responding to the pandemic. And, and then James. Thank you and I think I'll echo what a lot of other folks have said as far as well COVID-19 response is a huge issue for us right now and critical. I kind of like the idea that we can put promoting public health, and that includes that in that two years from now, we can look back at this document and it doesn't need to be revised because that that you know circumstances have changed. Another thing I want to say and I'm a I'm a relentless word smith or so feel free to stop me going back to the, the other draft that I offered earlier on the fourth bullet. I wanted to offer another version where we just strike out are prevented. So ensuring that issues are addressed through affordable and effective services and supports, because I think preventative, strategies are really included in affordable and effective services and supports. And I think that if we included preventative later it would somehow assume that everything was something we wanted to prevent. So it doesn't quite work as well anyway. I'll stop there. Okay, that's that I mean that. That makes sense to me but will go. James. First, I want to thank Dane for that one. That's the one I wanted. That is the best suggestion ever. You're my hero. Second, these are supposed to be by the definition broad open. So there are a lot of things that are going to be specifically in important to us as individuals and as a group. But it's supposed to be an overarching umbrella if you will that we can conduct our business underneath. And so I think it should be kept that way. Does anyone else want to say anything. I believe topper that you have heard from the majority of the committee and I would be. I would be joining them in both appreciating and thanking you for your relentless advocacy for the importance of the legislature and this committee in particular focusing on testing and being brought up to keeping that. Both testing and vaccines keeping that on our radar and keeping keeping the administration focused on that which they are. I do agree with. I'm going to say I agree with Carl, because sometimes Carl and I don't always agree. That these are. These are the idea years ago when we started doing principles was to have some broad concepts that would frame our work, no matter what came up, no matter what topic came up to us. But that these principles would frame whether or not we took them up. And then how we made our decisions. Not that we'd always make the same decisions, but we would do it that way. So, Madam chair. Yes. I would like to thank the committee. For having this conversation. And I, I will agree that we drop it. And we just do I do diligence in terms of what was supposed to do under the public health mandate that we have. But I want to tell all the members of the committee. How much I appreciate this free flowing conversation and. I think we should just drop it at that because we got some great principles to go by. Thank you. Thanks topper. And I believe that Carl has a comment he wants to make. I wanted to say that I agree with with Danes. Last change to bullet for, I think that really accomplishes a lot of the issues that some of us had. Thank you. Does anyone have any, thank you Carl. I've heard a couple of people I've heard you I've heard. James, I just want to give space for if anyone has strong concerns with taking up with what was what Danes suggested. And hearing none. Someone else topper. I can't hear you topper. Are we ready to make a motion. We are ready to make a motion. I would move that we adopt the guiding principles with the changes that were made today. Thank you topper and to those changes include take the last one that Dan suggested around taking out are prevented. Yes. So topper has made a motion. Oh, goody. I have to like make you all broad now. I'll second that. Okay, and it is seconded by Jessica. Would people please raise their hand. All those in favor of the of this please raise your hand. All those opposed. Okay. Well, thank you committee I think we have done. What sounds I mean, I appreciate and I think it's good that we have this frame and this will be on our committee webpage. Under the, I think there's an other category and there's, there is the organizational chart of AHS, and this will be underneath that. So it'll be with easy access, not only to us, but to the public in terms of that. Mary Beth. Just quick and hearty kudos to our new members who stepped up and really helped us with this very grateful. Very, very grateful. And yes, and Dane I don't know if you sort of heard or saw people are very excited that there's a wordsmith in our midst. So, thank you. And it is it is quarter of two. And so we're going to go to the second sort of half of our meeting this morning or this afternoon. And we have four people who are going to Gail sets to chase. Not Janet month. Janet Janet hunt and Molly do again who are going to speak from the community perspective. And I want to apologize to the four of you. I have been unexpectedly called away for about 20 minutes. So. Representative would will be running the committee and what I miss I promise I will look on on YouTube and hopefully I will be back before we're completely gone. So I will see you all later. Representative would if you would take over I'd appreciate it. Thank you, Madam chair. Okay, I think that when we left Gail was going to start us off so welcome Gail on behalf of the area of the I was going to say area agencies on aging that's not right it's the adult day programs and Sue it's so nice to see you here again. It's great to see you to Lisa. Okay, actually, we do represent the triple A's, but we're actually here I'm here testifying on behalf of the adult day programs. So I'm Gail sets, and I work with that's in Renfrew consulting Virginia Renfrew and I have worked for about 16 years with the Vermont Association of adult day services and it's nice to see you all and meet some of the new members and I'm probably more familiar with working with Virginia over the years. And Sue is here also to testify and before I go on Sue do you want to introduce yourself. Hi I'm Sue Chase. I'm with care partners adult day center up in St. Albans and very pleased to be here and it's actually been a few years since I've testified in front of house human services so it sort of feels like old home week, though through zoom. So I'm going to provide a brief overview of the adult day programs and how actions of the legislature over the past 10 months have kept the programs afloat. And, and I say brief because Commissioner had actually did almost all of my testimony. So she gave a really good overview. So I'll just highlight a few things. So there are currently 10 programs down from 13 from before the pandemic began and she was going to talk a little bit more about that, which provide community based non residential support to people who mostly have physical or cognitive impairments. The absence of the adult day programs allows people to age at home. It reduces reduces nursing home admissions which saves the state money through Medicaid as the majority of our participants use some form of Medicaid piece so people come during the day. And they get social and health services, nutritious meal social activities. But in addition to the services that are provided to the participants, the caregivers and family members also get some respite support and education. And programs that are existing, I thought I would mention them if some of them are in your areas. So there's the Bennington project independence and Bennington care partners in St. Albans, elderly services in Middlebury, the gathering place in Brattle borough day and Randolph will model day health services and Morrisville, the meeting place in Newport Riverside Life Enrichment Center in Lindenville, Scotland House and Creechy and UVM home health and hospice adult a program in Burlington. And every year we encourage the adult day programs to reach out to legislators to introduce them to their programs in their areas. And we also encourage you all if there are any programs, any of these programs are in your area to reach out and learn a little bit more about the programs. So over the past 10 months, funding support from the state and other sources have helped to keep the programs remain viable while they've been closed. And for the most part they've all been closed since March 2020, March 2020. And the reason I say for the most part is because they are providing some remote services, and she was going to talk about the adult day without walls program that she and others have helped to create within vads which is the acronym for the association. Without the help of this funding, then the programs would not have been able to survive. Currently existing quarter by quarter. So, excuse me at all. Sorry about that. So in the last quarter of FY 2020. The programs have survived had survived because of Medicaid retainer payments from diva PPP loans, ideal loans, other donations from from people who give the money periodically from time to time so. So after that last quarter in FY 2020, thanks to the members of this committee and your colleagues in the house in the Senate last session, we were able to access CRF monies for the first quarter of FY 2021 to the tune of $2.45 million. And the second quarter of FY 2021, the CRF appropriation was $2 million. Of that $2 million as a commissioner stated there are some monies that were unused about $160,000. So right now we are working with Dale to try to figure out how to redistribute that 160 throughout the programs and that's that's a work in progress right now. So now that brings us to the current third quarter of FY 2021. So, really as of now we do not have any money to speak of that is coming in so we're working on the exact numbers but we estimate that we will need approximately $1.9 million for this quarter that we are in right now. And the programs have told us that without more financial help, they are going to anticipate more programs permanently closing. So we are trying to do whatever we can to try to avoid that given both the services that we provide to the participants and the assistance that we provide to their caregivers and family members. Not to mention the strain that that will potentially put on the nursing home system, if there are not services like ours that can help them either through the pandemic and after the pandemic. So with that, I will turn it over to Sue. Thank you so much. Great. So in terms of the impact of COVID for adult day that as Gail had mentioned there were 13 adult day providers at the beginning of the, the pandemic, the state mandated that we close in mid in mid March. And as Commissioner Hut mentioned that adult days are fee for service so we only receive funding for people physically being at our programs. And so that, you know, without having any source of revenue coming in our financial bill viability was really in question and we really do appreciate the support that we've gotten from Dale is what we've gotten from the legislature. And unfortunately, there have been two, three programs total that have closed because it was they were not it was just not financially viable for them to stay open so right early on in the pandemic. I think that the state of the state in Rutland announced that they would be permanently closing and very project independence also decided that they needed to close, which was a huge concern for people in the community because these are were, you know, definitely important programs and in those in those areas. I would say that what adult day and as I mentioned earlier I have testified through the years at the legislature that adult days are lean organizations there's not a lot of wiggle room in that and so that many adult days have struggled through the years and so that in some ways this was just kind of there wasn't any pathway in terms of kind of moving moving forward. The latest program that decided that they were not going to be able to reopen was oxbow senior independent living in Newberry. And they permanently close the end of end of September. And so that you know it's been it's been hard and the rest of us are really sort of struggling to kind of keep things keep things going in late September the state issued guidance reopening guidance. And so that most of the adult days were working towards reopening, you know, bringing things together to kind of be able to safely serve people at their programs a couple of us did actually open our doors again to then in care partners situation we were open seven days and then we got notice notice from the state that because of the the surge we were going to need to close close again. And so right now we have all pivoted back to the virtual services that we've been providing now, since the beginning of the, the pandemic. And so that we've been we've been very concerned from the get go around and we can and you've heard this from other people today the impact of social isolation. Not all of us, but especially for older older adults, and we've been concerned about loneliness depression that adult days provide health monitoring services and so that the inability to kind of be able to check people who were in their medics their feet or to be monitoring blood saturation levels for people that have respiratory illnesses. Those have been really concerns that we've, we've had. And he as a result of that have have created adult day without walls that protects nurturers and supports adult day participants and their families and caregivers during during the pandemic and most adult day programs are providing telehealth, telephonic companionship as Commissioner Hutt described and then also activity based active services such as zoom activities, chat groups. Actually, care partner staff just headed off to deliver 45 activity packets that we do about every three weeks for our participant includes kind of pencil games you know we may be sending yarn to somebody that needs to do yarn. We're not a huge bingo fan but we're sending out bingo dobbers and and bingo sheets and they love it. I mean bingo is probably one of our most popular zoom activities and it really helps people stay connected. We have caregivers from adult family care homes that basically set their person up in front of an iPad and they play bingo with us or they may do a virtual tour. It's really incredibly rich and it really makes a difference and I, and I know I hear every day from our participants that this kind of being ability to be stay connected and, you know, checking on their friends and, and, you know, learn new things and be mentally stimulated has been huge during this unprecedented time. In addition to providing caregiver support. We, our staff are doing telephone calls that both to participants and their caregivers. And, you know, we've, we've heard from caregivers they say you know we're the only ones that reach out to them to see how things are going and try to support them, help them get hooked up to other services and, and, and, and what not so it's been incredibly rich. I will say that a couple of adult days have are only able to offer limited virtual services because their employees have been deployed to other critical services within their organizations. But, you know, all of us are doing something to try to remain in touch and connected to to our participants. I think that the coronary relief funds and the health care stabilization funds all of these financial support has been incredibly important to our ability to maintain these kinds of services and our board met yesterday trying to figure out okay what do we do now with with all this, and, and, and, and, and, and we are committed to, to kind of making this work for the next little bit because we don't want to lose that connection with, with people as Commissioner Hut mentioned Dale has worked with us in terms of trying to come up with some flexibility around funding, and that they have created some opportunities where we can access companionship funds through the choice for care program and flexible funds through moderate needs group. And I will tell you that only a couple of adult day providers have actually worked on accessing these funds at this point in time and they are indicating to me that this represents only about 1% of their, you know, what has been typical operating revenue. And here at Care Partners we're gearing up to start doing this in January, but already running into some roadblocks the moderate needs group application form doesn't indicate that the money is going to be coming from the adult day pot of NG funds and so the case management agency is reluctant to sign off a form because the form says it's going to come out of the case management pot. They have to apply for variances under the choice for care program and again, the paperwork doesn't doesn't line up with how do you make those adjustments and the families quite frankly are also concerned that, sometimes these companionship dollars are what are being used to bring in caregivers and support them in their caregiving role. And are they going to lose out on some of those services because the adult day is looking to get some token reimbursement for what we're, what we're doing so I see it as being a first step, but is definitely not an answer and is not going to be what is going to remain us over the next, next few months. And, you know, I'm very encouraged that Dale is wanting to look at coming up with payment reform because I think it the day has dawned when, you know, fee for service hourly rates just isn't are not going to meet meet our needs and meet the needs of our of our, our participants. And equally, I, and I'm, I'm feel very strongly about this, I think virtual services are here to stay. You know, I've been a care partners over 20 years. And it's a numbers game, you know, we need to have a certain number of people coming out our tour program to make it financially viable. I do not believe that we're going to be able to serve that many people at our center going forward. And so that, you know, for people to be able to feel a part of our program to access that we're going to need to have a hybrid. We experimented that in the seven days that were open that we were offering a simultaneous activities here and projecting them through zoom for for folks. And so that we are very committed to resuming in person services. I really see there's a huge role for adult day going forward I mean hearing that possibly nursing homes are going to have to be closing. Already, you know, we're getting referrals from family members that are reluctant to place loved ones in long term care facilities primarily for the reason because it's difficult to visit. So that they are seeking adult day services. But we need financial support to make this all work. Thank you very much. And if I could just add something to, to what I said before, given that we are in the third quarter now and there is essentially no more money coming in right now programs are at a critical stage where they need to determine whether to let staff go. You know they have they have a lot of fixed costs rents mortgages maintenance, etc. And so I know you're not the appropriations committees but committee but just to keep you in the loop. We have been in conversation with Senator kitchen. We're talking about the health care stabilization fund that still has some money left over and so we're trying to access some of those funds for the immediate need right now. Before we move into budget adjustment and to help us through the balance of this fiscal year. I see represent you has returned so I'll turn it back to you. Oh, and I was going to have you finish out. I don't have a question. Okay, if you would like. I would thank you. So, Gail that is one of the questions that I had for you and Sue, you mentioned approximately 1.9 million and I was looking at the, the timeframe that's for the this third quarter of fiscal year 2021. I believe that you've conveyed a sense of urgency about that. What is, what is the timeframe under which you would need to receive that for us to prevent any further closures of adult day programs. That's a good question. I'm actually in the process of gathering information from all the programs as to how imminently, or how imminent it is that they would close without receiving any further funds. There is the opportunity to apply for the new PPP loans and possibly some other federal assistance, but that is going to take a while, and, and waiting for budget adjustment is going to take a while which is why we are trying to access the healthcare stabilization fund monies if possible because that could be immediate. I talked with one program who said that they have about three months months of reserves but I don't think all the programs have that much money and reserve. And then, Sue, if you, if you could give us some sense of you're able to bill for some of what you're, you know, for some money that you have in your allocation. So is that like 25% of that 50% of that what's what's the gap like for an individual program and then on the people side of things have you seen in your program people who were receiving supports in the community and then had to be were admitted to a skilled nursing facility or other long term care facility because of the lack of support in that, you know, during this time. Okay, great. Um, so I have done a little bit of analysis around kind of what the revenue might look like for us, or a frame it a slightly different way we presently have 55 people that I'm saying that are sort of on our roles so to speak, and 25 of them are on the choice for care program, which includes this companionship funding seven of those people are an adult family care homes, we cannot use companionship dollars for those people we have there's no revenue source for seven of those people. The scale is very specific we have to be talking to the participant, not the family member. We have one person who's dementia is advanced enough that she is unable to communicate so we're down to 17 people there. We have nine people on the moderate needs group program that the state is indicating we could be accessing flex funds for. And so we come up with 25 people, and we're going to be able to bill maybe an hour or two a week for each of those people. Um, so it's not. I know, um, Heather Philanou from UVM home health and hospice and said that in their billing they've been generating maybe 300 $400 a month. That's it. It's very little. And in terms of here at care partners we've been really pretty fortunate. We only, we've had some people that have gone into for short term nursing home stay. We only have actually one participant who has been placed in a nursing home and I would not say that that is due to co but I think there were other other factors that are that are there, but definitely, there are, I mean, to be honest with you I think some, some families and some people are seeking placement but there's a lot of facilities are not taking new new admissions. So they are really just trying to hang in there and make this this all work work. Okay, thank you very much do any committee members have any questions for around adult day services for either of the witnesses. Thank you both very much and Gail. I wanted to say I kind of wish Commissioner hot was still on because I just wanted to say that Commissioner hot and Megan Tierney Ward, literally moved government mountains to get the CRF monies out to us in an incredibly timely manner they recognize the, the, the timeline that we were under the time crunch and they, they were really amazing when the legislature appropriated that money they turned it around and got it to us right away and worked with us to, you know, have it all work well. Thank you. Good to hear. Now madam chair back to you. And thank you I'm just going to highlight that it is to 11. And we have two more witnesses and the committee is over at one of the witnesses has to leave at three. The committee is hopefully over at three and so I sort of say that to both our witnesses I apologize in terms of the kind of talking you're going to do. So, Janet, and then Janet and then Molly. Janet. Thank you. Thank you madam chair and committee. I just want to just highlight some, some areas specifically and then talk about a couple of scenarios that are area agencies on aging have experienced. My name is Janet hunt for the record. I'm the executive director for the Vermont Association of area agencies on aging. And with the onset of covert in March, our area agencies worked expediently and seamlessly to maintain all of the services for older adults. The staff worked at home remotely and continued to provide those service services, regardless, there continues to be areas of concern to meet the usual needs and the increased demands due to the pandemic. So I want to highlight some of our key services in my testimony today and that's nutrition and meal services, family care, caregiver supports, mental health care, and the information and services and care and service coordinator and case management. So with our nutrition and meal services, I'm sure you've been quite aware that all of our congregate meal sites closed to the public and shifted to the home delivered meals and take out meals or pickup meals. The meal providers are generally generally seeing an increase in expenses due to the pandemic and the increases are affecting our food purchases, as well as supplies. The agencies are continuing to work with providers individually to see how we can help meet their needs. And the support to the meal providers has been provided through an increase in meal reimbursement rate or additional monthly funding to offset some of the increases in the cost of supplies. There's been an increased demand for home delivered meals as you can imagine throughout the state. Not only are we seeing an increase in the number of people who need the meal, but an increase in the number of meals per week to each client due to the lack of other in home services. In addition to the regular expenses for meals, funds have been needed for emergency meals, hand sanitizer for those who are delivering the meals, the food carriers, money to replace equipment to help other necessary expenses with our contractors. And some contractors are needed to close when experiencing some possible COVID exposure among their staff or volunteers. We've continued to see a significant cost in terms of what we have contracted with providers for versus the amount of meals being served. We've continued to focus on the need and have adjusted our budgets to make sure there's adequate allowances to meet the higher demand. The agencies claim indicate that we're in our first quarter and significantly significantly off budget. We've had reserved some of the care act funds received through the older Americans Act, as we're able to expand through September. But it will not fill the need given the demands. On to family caregiver supports. There's just not enough respite options for caregivers to the leading to increase caregiver stress and fatigue and burnout. We've seen a number, a higher number of caregiver fatigue and burnout, which can lead, unfortunately, to abuse and to neglect, as well as contributing to nursing home admissions that families hadn't intended to move forward with. The closure of the adult daycare centers has placed additional stress on families and caregivers in the home. And then moving on to mental health care or behavioral health care, we recognize an increased need in this. We believe the longer that physical distancing is in order, the greater the need will become. We anticipate that our contracted service providers may reach capacity if the current trend continues, where they're meeting the expected need will require increased partnerships and increased funding. Some of the elder care clinician programs continue to see challenges in meeting the needs, and there's been large turnover in those programs and referrals are not processed in a timely manner. We've outlined our case management and our care coordination. I have all experienced shifts in working remotely with limited in person contact or face to face contact, except under unusual or case by case on a case by case basis, and in person was only with regard to the warmer so now with a cooler temperatures of course the cold temperatures were not even able to to necessarily do that. We've seen an increase in need for homemaker services and caregiver support and assisted tech, assisted technology and devices. Individuals are experiencing reduced availability of those in home services from the local home health agencies due to the staff and worker shortages, some service plans for choices for care, clients are not being filled to do the worker shortages. And the choice for care regulations that only allow services from Bayotta, or home help have led to an inability to staff care plans the V&A and Bayotta clients are unable to switch to flexible choices because of wait list for some and an inability to select directly self direct for others. The reduced availability in home services has led unfortunately to an increase in nursing home admissions and unsafe home situations for people requiring that nursing home level of care. With fewer providers entering people's homes. This is leading to unchecked worsening of home environments of health and safety for individuals. There's a significant increase in self neglect referrals leading to the need to hire additional staff to specialized staff for this need. There's a significant shortage of providers that go into clean homes, deep cleaning or ongoing homemaking. Again, this leads to unsafe and unsanitary conditions for individuals, increased loneliness, increased social isolation for those who previously had regular contact with providers. Horting symptoms are expected to increase leading to increased falls and worsening health conditions for individuals with hoarding disorder. So I just want to wrap up a bit with some individual scenarios that our staff from the triple A's have provided for me today that I think are rather startling and this is only, you know, the tip of iceberg. The home health care providers have an extensive waitlist that predates October of 2019 in some areas we currently don't have they currently don't have the case management management capacity to take anyone off of their list. They're asking for our help, many of the clients who continue to receive care at home, choose to stay at home knowing that there will be large gaps in coverage due to the shortages. People are spending hours alone. Families are putting in extra hours, shuffling their personal schedules and even leaving jobs because there aren't enough caregivers available. So not one person has had all of their approved hours covered. We have a significant significant number of clients that are not and have not for a long time than accessing all of their hours that they've had available to them because of the lack of staff available. And it's individuals tolerated because they won't they don't want to move into a facility, even if the option was available. There's some individuals that have had to wait in nursing homes until there's staffing available to meet their needs at home. We've had several individuals where both their husband, the husband and wife who are on choices for care, and to gather qualify for well over 80 hours. Every couple of weeks are now only getting a couple of hours a week. And in one of these situations the wife who's unable to provide her own personal care is now having to change her husbands. That is his needs for personal care and overall safety. Another case is similar. But the couple has cancer instead of cognitive issues and don't have the physical abilities to safely perform the personal care needed for one another. We have a situation where the individual has recently been discharged from a nursing home with choices for care, but both home health agencies are are unable to consistently staff those those those folks. The individual has variants for a two person assist. And one of the agencies is unable to show the care and can't be unable to show to show up and can't provide that care for the assist. The individual has been unsuccessful with finding and retaining staff and now is unable to act as a surrogate and needs a new one to try to retrain any staff, or to retain any staff. She is unable to act as a surrogate. The individual now has skin breakdown. She's been in her beds for days on end due to staffing issues. It will not be long before she's hospitalized and readmitted to a facility. She is an open bed as she and she's the challenge is for his staff for the pre pandemic is almost impossible to staff and the individual has mentioned that she will look at taking her own life if things continue to get worse. She has been subjected to all her appropriate supports for both mental and physical health but there's just a not not enough resources to support her holistically. And this, as I said, just a few of the scenarios that our staff are trying to work through to try to make sure that people's people's needs are met, but I can provide a deeper impact report for you if you need that at a later time. Thank you. Thank you. I'm wondering if there's questions for Janet. Jen, I know I appreciate hearing both from you and the last part of what I heard from Sue, because I was sort of wondering if more people were moving into nursing homes, because they could not get the care that they need and I hear you sort of saying they're, they can't always get there and they're just living at home with fewer supports. It's a what I hear is a mixed. It is mixed there are I definitely heard that because families or spouses are not able to take care of their loved one anymore. They, their own or the adult day programs are closed, and they cannot get someone into their home. They have to resort to a nursing home admission which was not their choice. So that's what I hear more often than not. I wonder if I get some. We might want to try to get some data on that, rather than all of us sort of doing it on what we are hearing. Yes, we can provide that. Great. Thank you. Thank you. Welcome. Are there additional questions or comments. And chair. My hands up. Well, thank you. I need glasses. Representative McFawn. Thank you, Madam chair. I just want to make sure that I heard you right, Janet. You're paying for food from the food bank. No, I don't believe I said that work. I thought you said you couldn't afford the cost of meals. You're paying for food from the food bank. I don't think we can get the food for the meals. It, we are. The, the CRF funds have certainly been of help to us, but our demands for providing the meals. We are continuing to provide the meals. Okay, so do you deal with the food bank? The food bank is a partner of the triple A's, but we're not taking any money from them if that's what you were. No, no, it's your food. The food to make the meals. Yes, there's, yes, that's where partners with them and our meal sites might be getting some food from food banks or assisting individuals to be aware of the availability of food at food banks. Okay. The, the other question I had is you said there was waiting list among the home health agencies. Yes. Thank you. Thank you. Thank you, Janet. Sure. Thank you. And Molly. Thank you very much. My name is Molly Dugan. And I, sorry, I just want to get my testimony here. I work for cathedral square. And I know there's new members on the committee. So I'm really happy to be here today to see all members and especially provide some information about cathedral square and the sash program. Cathedral square is a not for profit provider of affordable housing and services, primarily in northwest Vermont, but we do provide consulting services and some development assistance across the state. And cathedral square has been the administrator of the statewide sash program, since its inception and sash stands for support and services at home. Until just a few weeks ago, I was the director of the sash program. Since its inception in 2011. I recently took a new position within cathedral square as director of policy. So I will continue to work on just kind of larger issues around sash and affordable housing. My brief comments today are going to focus on the sash response to coven 19 and sash utilizes the network of affordable housing providers across the state, including all the public housing authorities. In partnership with health and community provider organizations such as the area agencies on aging, home health agencies, the community mental health agencies to help coordinate health care and provide support to help approximately 5000 older Vermonters and Vermonters with disabilities stay at home throughout their lives. So when you think about kind of the continuum of support in long term care, the sash model is really focusing on the pretty trying to keep people in their communities preventing the premature movement to higher levels, higher level facilities higher levels of care. I just also want to make mention that the sash program is funded through the all payer model, the, the health care kind of transformation program that the state of Vermont entered into an agreement with the federal government on a number of years ago we're in like year three of the five year contract and the funding comes to us from one care Vermont and we are so the funding that we get is not fee for service dollars. It's a value based payment for the staff that support a population of participants in the sash program. So I just wanted to make mention of that because there's been a lot of discussion about, you know, just the challenges around fee for service so I wanted to make that clear. I did include in materials that I that I sent over this morning, a map that shows where the sash programs are throughout the state. And so pretty much we're in every county, because there are 140 different affordable housing communities throughout the state that are in the sash program, and we serve, not only the low income Vermonters that live in those affordable housing communities, but Medicare recipients that live out in the community as well. My, would you like us to, would you like Julie to put that map up or put any of your material up or. I think if that would be helpful for people to put the map up that would be great. Julie, is that something that might be helpful and while she's doing that. You mentioned that you get paid that it is fun that sash is funded through one care. The understanding is sash is also funded by direct appropriations from the state so that one care is not. It's not the sole funder is not the sole funder and so the. They're not holding the total risk themselves. Yes, Madam Chair, thank you for that there it's our staff on the ground this the care coordinators and the wellness nurses are paid for from one care. It's this, it's the sash administrative structure and partner payments for team meetings that actually is paid through the Dale budget and and so yes and actually I'm going to be talking more about that in my comments but the map has come up so especially for the new members on the committee hopefully you know when you look at your areas of the state, you'll recognize some of the housing affordable housing communities in your area. And they're that that operate the sash program so again they serve people living in their congregate buildings as well as older Vermonters living in single family homes or mobile homes or private apartments. And you can tell it's all those stars, those yellow stars are individual housing communities that are supported by the sash staff and the team of providers as well. All right. I'm probably going to make the understatement of the year here but it's been an extremely challenging time since early March. The foundational, I guess I'll call the foundational strength and value add of the sash program is the everyday presence and in person contact that our care coordinators and our wellness nurses have with their participants by being embedded in those affordable housing settings across the state those gold stars that you saw. And this type of presence had to stop abruptly early last spring. And that was a, you know that that was a big deal. And I'm happy I'm here, however, to be able to share with you that, you know the investment that the legislature has made over the years in the statewide infrastructure for sash which is what Madam chair was referring to just a moment ago that comes from a discussion from the general assembly through Dale really allowed us to provide a swift, thorough, consistent and most importantly compassionate response to help keep thousands of older remoners and adults with disabilities living in your communities. Again, we serve roughly 5000 older remoners and adults with disabilities. We were able to do this and really pivot very quickly, even though we had to pull staff out of the buildings. Initially, we did this in a number of different ways, because we have this centralized administrative structure for sash that's housed at and then we have this decentralized delivery system of the actual services on the ground through, you know, it's 22 different affordable housing providers, we were able to really develop and deploy a resource resource and information section on our staff Internet that we were able to update for our staff, you know, the latest guidance and tools and resources that were coming directly from CDC, the Vermont Department of Health and Dale. What that meant was that, you know, our sash staff up an island pond, and our sash staff in Burlington and Bennington and St. Almond's were all able to access in real time, the same information and latest guidance, which really allowed for a much more consistent response to the questions and challenges that that were presented in early, early last spring. Right away, we, you know, asked our, our staff to be in contact with their sash participants by phone, at least once a week. And they were not not just to, you know, touch base them by phone but we actually developed an individualized COVID-19 questionnaire that they went through with every participant. There was an action plan that they developed. And what we learned from this process where in the standardized process was that the most pressing needs of our sash participants across the state were medication refills, access to food and healthcare, as well as social isolation, which you've heard now from I think every single witness today, the real challenges with social isolation. So it was really important that we were able to get that consistent feedback around the state on what the most pressing needs were, and that way we could then really focus our efforts on helping get those needs met. Through the sash program, we have a, it's a collaborative approach, as I mentioned with our valued community partners, such as the triple A's and home health and we, every sash program across the state has an identified sash team that meets on a monthly basis and has been doing so, you know, since the program started. So when the pandemic hit and we had to, you know, go remote. There were already these really strong and well established interagency relationships and in a meeting structure in place that was able to continue pretty much seamlessly I mean they would normally meet in person at the housing site. And now these teams were meeting either by phone or through zoom and importantly, you know, able to just continue the conversations and the action planning with their shared clients. So really important during that, especially difficult time in the spring. Another thing that we were able to do through our centralized administrative structure was use our single data management system so all of our sash staff across the state, gather regular information from our participants. All of our wellness nurses collect health information. We were able to develop reports for all of our sash staff that indicated those participants in there on their panel that were at highest risk for coven related complications, due to pre existing conditions, and then were then able to kind of quickly prioritize outreach and collaboration with their partners. So being able to really use that data and analyze it and shoot it back out to sash staff and all parts of the state was extremely valuable. I want to just move on to kind of some of our recent initiatives and it which are really responding to the challenges and the obstacles that we're seeing. I would want to think there's been a lot of talk today about, you know, telehealth and telemedicine and that's something that we saw pretty much immediately or our wellness nurses when they would be reaching out by phone early on with their participants. They were hearing very consistently that their participants were very fearful of leaving their homes at all, and that included going to see their health care providers, even when they had really important reasons to be seeing their health care providers. And that's something that our wellness nurses especially spent a lot of time doing with their participants was connecting them with their providers. So one of the things that we realize right away is that we needed to work on getting making sure our participants had access to the technology that would allow for the telehealth visits that, you know, we're burgeoning all over the state and we did not want our participants to be left out of that because they are lower income and, you know, maybe in more rural parts of the state, you know, it's a real health equity issue. We were able to obtain actually 270 Apple iPads from the Vermont program for quality and health care VP QHC just in November a couple months ago. And these are allowing us to create lending libraries of these iPads in all of our sash programs across the state. I actually included in your packet a flyer about this about this program. And I don't know if that's something that can be pulled up, but it just gives a little bit it's kind of easy on the eye and gets a little more explanation of the program. But what's important is, we're not only going to be setting up these lending libraries where participants can have access to these iPads but we've also realized that you can't just send out iPads, you have to make sure your staff is trained on how to use them, how to teach the participants how to use them. And so we're doing a major training that's actually starting in a few weeks with our staff and we've had to develop lots of policies and protocols, but we want to make sure that not only are the iPads there on site, but that our participants feel confident in how to use them and our staff will be able to be there and support them through a telehealth visit. So that's been an exciting development for us. So, Molly. This is Ann. I love the fact that you are directing us to what you gave us in the packet so and as this is really only week two of the legislative session we may. I'm reminded to, as we look at the agenda to whether it's during testimony or whether it is after we have heard to go back and to look at everything that people have given us. I'm just intersecting right now. I'm hoping that you'd be able to wrap up in five minutes so that as a committee we can finish up in terms of where we go from here. Absolutely like that. Yeah, absolutely just a few more minutes. So the other recent initiative based on what we're seeing as obstacles and barriers for our participants is a real focus on social isolation and loneliness. That has really become really our most pressing challenge as this pandemic has, you know, worse and then we've had to reinstate some restrictions that we'd loosened up in the summer months that had allowed for more informal, you know, gatherings outside. Everything is really ratcheted down again. So we're doing a real in depth training with all of our staff in early February and really working on helping our staff to do more and more of their programming virtually and via the phone so really making a lot of progress there. Food distribution is another thing. Sash has a formalized partnership with the Vermont food bank for what's called the direct distribution program. And food is provided at many of our SASH sites by the Vermont food bank across the state and our SASH staff help coordinate the delivery and outreach they're trained and safe food practices. They do a lot of programming now via Zoom on how to prepare meals with the food that's provided. So we are going to continue to utilize that partnership and it's the number of participants accessing food has has grown tremendously as Janet was saying with meals on wheels as well. And then lastly, vaccination sites we're starting to work with local pharmacies and to start having COVID-19 vaccinations I can report that just yesterday our SASH panel in Bradford had a very successful vaccine clinic for their SASH participants there and that was in collaboration with the local Walgreens. So we're working on that right now as well. So that's all for me. I'm happy to take any questions and I just really appreciate your time. Thank you. Thank you. Excuse me. I apologize. You're wrong. Thank you for your flexibility in terms of timing, as well as Janet and Sue and Gail. This has been I think very, very helpful in setting the stage and educating us. Are there any questions right now. This is not your last opportunity to hear from any of these people. But are there any questions right now. Thank you again. Thank you very much. The four of you really appreciate it. Thank you very much. Take care. Thank you. As I was listening committee as I was listening to them I'm sitting there thinking okay, social isolation. Well, you know, if we pass the law by the time we pass the law. Hopefully people, I mean it's like what can we do balancing in terms of what can we do that will help things immediately. And so we've got 15 minutes max, because two of us on committee actually have to be somewhere else at three. So in terms of what we have listened to. What do we want to, what's important that we hear more about or that we delve into, as we think about our work this, this session. Yeah. I'm just thinking we have now 14 minutes left and we have budget adjustment to deal with next week and I'm just I'm just if people have any feedback about your budget assignments me okay we might want to hear them and first. Okay. All right. So, thank you. This is why we, this is why we're a team. When you, if you are ruminating on what you heard today and what you want to hear more from, or what we need to be more in depth. Please send me an email or a text. I wouldn't I would encourage people to read the report that we got yesterday on from the adult abuse folks at Dale, because that ties in with that. Yeah. So there's the adult and the term here on Bootsman's recommendations are helpful as well. So, with a lot of help or input. I've created some teams. So we've created some teams in terms of appropriations and Julie. Do you send it or actually do you have it on one piece of paper so we could. So she's going to screen share so we can sort of see it as well. And given. So this is sort of how we have. And by the way, the budget adjustment was presented. I think I sent it. I sent you all. I hope I did send to you a copy of the budget adjustment. And if I didn't, it's available on the appropriations website and I'll send it to you later. It's not the narrative is about one page. And the issues seem to be mostly in terms of moving back and forth. Everyone should have the budget assignments in your email. But this is sort of read them. Does this make sense. I would like to continue my budget assignment with Teresa if she's if she's willing. We have you. We, you and Teresa are a team looking at Dale. Department of aging and dependent living. Okay, good. So we like to that that that one's okay. Mary Beth based on the fact that you have multiple responsibilities. That we would lean on you for pinch hitting when we needed something but that you also would bring an eye to BIPOC issues. Does that make sense to you. Are you still here. I am still here and I'm happy to bring that lens to the work that everyone's doing. Thank you. And does that fit with sort of your multiple responsibilities to maybe have that I and I think you're a member of the, or you sometimes follow the social equity caucus. Yeah, I'm I'm plugged into the social equity caucus. Yeah. Thank you. And that doesn't mean that someone else, one can't join you, or can't take that on or add stuff but this is a first guess. So, DCF family services which would is foster care. I think we had Dan and James that okay. Okay, with me. Fine on me. Okay, the, there's, I don't see anything necessarily right now in the budget adjustment at all. But we may need to pay attention to this in the budget, as it relates to the family first prevention act. And that, which is a federal act and that kind of thing. And then, Jessica, we have you focused you taking focused on economic services. And I think that the approach is reach up and it may also connect with child development if the, if the idea of moving CC FAP over there. And we have, we have you and Taylor doing that. And Taylor does that, does that, is that sort of okay with you or would you like to be elsewhere. That sounds good to me and. Okay, thanks. And we have, I have that then based on your other sort of, we have you with Topper in terms of OEO Office of Economic Opportunity so you'll be the link between economic services and the Office of Economic Opportunity which is a little bit of housing a little bit of other kinds of things, general assistance, and that. And, Jessica, you and Kelly, you get child development. Because between the two of you around. No laughing. You know, and then the Department of Health would be Teresa and Dane that leaves a few things that we might have to figure out as it relates to things that people get that we get interested in or connected with. For the most part, Diva Department of Vermont. Health access is more within the jurisdiction of the Health Care Committee but there may, you know, there may be monetary money things that are happening and Diva that would impact for instance the Department of Health. I may very well ask for help with central office, which is where a lot of the grants come out of as and depending upon what is in there in terms of that. And this work, if this is okay with you all. And I will send this to Mary Hooper, who will then distribute it to folks, actually, Julie, if you could send that I think the idea is to send it to Mary Hooper along and then copy. Kimberly and the other two, the other two people. I'm now forgetting who it is. I know David Dacabone a and who's whose health department. Yep, he had actually emailed something to Dan and I because we talked to him three years and I forwarded it to Teresa so he's already all over it. Okay, good. What we're trying to, we'll see how this work. I'm trying to keep all of health department and one you and Dan last year focused on health department but primarily substance use and that and a whole different focus this year. A whole different focus on sort of childcare and education you get all of that. Those kinds of things. Yeah, we will. We were going to have bill introductions on Tuesday afternoon just so people could hear from the sponsors, what I call their brief introductions there, what's the, what's the issue, what's the problem they're trying to address why it's not an opportunity to bring to bring witnesses it's more their, their opportunity to try to persuade us to make this a priority, but we're not going to be chair of appropriations. Once, once our recommendations by Friday. I think I did a quick look. It really looks like the only only question. The big questions have to do with seems like reach up out of economic services the caseload went down. Quite sure, I mean there's in terms of the information that we got. So on Tuesday afternoon we're going to hear testimony or presentation of the budget adjustment by folks from DCF, and then we'll know what the little teams if any need to do as it relates to the budget adjustment. Otherwise it may be nothing until the budget. Mary Beth you look like you want to say something. No. Okay, I am good. Thank you. Okay, good. It's been a long day. Madam chair. Yes, I just went through the budget adjustment. The only thing I see there is $375,000 for something. You were talking about reach up and all this other stuff. What was that in the budget adjustment to I think I've a new. I was reading it quickly last night. Late in the evening so I might have reread something but there is the numbers and then there's some. And then there's a page of sort of very quick explanations. Yeah, and I thought I saw something there. I may. This is why I'm not taking that part. That's why that's why we're a team because all I see is $375,000 for legal aid. Okay, well, well, then you may be fine. Your area may be fine. I just don't want to make want to make sure madam chair that I'm looking at the same stuff you are. Well, I can't promise that to opera. But you know, this is I mean, we'll we'll we'll hear the budget, the budget adjustment and we like it when there's nothing in the budget adjustment when really it really is just the mid year correction and moving the chess pieces so that it's all covered. And that's really all we're trying to make sure right now. This is a precursor for the budget, which is happening in a couple of weeks. There's no longer a blue sky in my out my window, but it was at lunchtime. So hopefully folks can get some time outside and not be socially isolated. This weekend and Monday. I'm always available by phone or text, and I will see you Tuesday morning. Thank you very much for the hard work that we all did. And see you later. Thank you. I