Council Colleagues:

One of my Council members works for a provider and is dedicated to transforming her agency from facility-based to 100% community-based. She's terrific and the agency as accomplished much so far but is confronting major challenges.  As she put it: "We are struggling to figure out how to logistically support large groups of people daily in community settings.  Below are areas we are looking for guidance on."

MD has accessed ODEP-contracted consultants and the Council has helped providers access others. I think she would most benefit from providers that have had some success with these issues. I'd appreciate any leads that I could share. This is a critical juncture and we need to see success. Thanks. Brian

What my thoughts/reactions are per VA’s prep for this…

Her challenges:

1.       How do you transport large numbers of people throughout the community daily, if the people you are supporting are living and/or working outside of the area in which public transportation runs?  VA building in non-med transportation to assist.  Rate for the community includes transportation.  Still at time 1 to 3 ratios, but less possible.  And, people should be able to live where they can access public transportation and services should be located (day services) in dense areas of cities/towns to increase ability to walk.

2.       Because individuals all have very different schedules (possibly based on part-time work hours), how are complex weekly schedules managed so that each person has an individualized week?  We find that it is logistically a nightmare to figure these things out week to week and day to day as things come up and shift.  The concept of the electronic calendar that allows shifting of services should help. And helping develop opportunities that individuals may decide to do as a group.  Don’t think going to have 100 people at a center going to a 100 different places every day. People are social and do prefer doing things together…otherwise the theaters would be full of single people….

3.       How do you keep staff supported when they are used to being in a building together and are now spending their day in community settings without their old support system? Many services are provided in communities by lots of agencies, example elderly, personal care; respite.  Agencies have to send their supervisors out of their offices to coach, mentor, monitor and manage.  Also, staff can be organized in to teams of three, etc.  Empower the staff to make decisions on the ground an empower them.

4.       How are staff staying connected?  Is there technology people are using? How is staff completing ‘paper work’?  Texting, texting, texting….

5.       What are the organizational structures that are being used by agencies shifting to a more community-based model (as opposed to facility)? Move away from centralized structures to more people work or start work from home; gathering spots across the community (YMCA or Senior Centers or store fronts…)

6.       We have a hard time finding meaningful activities consistently throughout the year that are low cost, that make up a 6 hour service day. Any suggestions?  Have to get out of the box of thinking meaningful day happens during a fixed six hours. Meaningful day starts at time one gets up until when one crashes….and that doesn’t mean 9 to 3 for a day.  Doing this gets access to when activities happen…the morning exercise walking group in a mall, the evening choir practices or evening religious activities or recreational activities….following sporting games—etc.  People still want opportunities to be a part of a group just not 6 hours every day from M to F….

7.       We support many people with significant challenges (medical needs, sensory issues, behavioral issues).  What are the typical, everyday places that people are being supported?  How did you build the comfort level in those locations?  What do you do when something goes wrong without the fall-back of a building?   Somehow still place bound.  Should be what an individual can manage and want.  And finding where other people go with challenges.  For some it may be an hour a day or two hours across 7 days…look at the whole week…

 

 

 

Brian Cox