Cowley County CDDO System Capacity Report – June, 30 2017

I.  Service Area: Describe the IDD service landscape for the catchment area.

a.  Cowley County CDDO serves one County with a population of 36,311. Projected number of potentially IDD program eligible individuals based upon national trend data is unknown to me at this time. Cowley likely has a higher number of potentially IDD program eligible based on the information in the ELOC grant and state hospital closure 20 years ago. Many residents moved into the Cowley Community as a result of the closure and still reside in Cowley County. This also is reflected in the number of individuals served with complex needs.

b.  Total number of individuals determined eligible as of 12/31/16 was 252.

c.  Total # of individuals eligible for HCBS & on the State waiting list in Cowley County as of 12/31/16 was 16

d.  Total # of Tier 0 individuals age 5 and over needing services as of 12/31/ 16 was none.

e.  Total # of IDD eligible under the age of 5 needing services as of 12/31/16 was none.

f.  Data related to items d. & e. above should be included if available. There is only one tier 0 over age 5. That person only need and is receiving TCM services.

g.  Total # of individuals currently receiving HCBS services as of 12/31/16 was 236.

h.  Total # of affiliate providers as of 12/31/16 was 14.

(Other pertinent information not already included in other sections of the report) Cowley has had four major providers of Residential, Day and TCM services since 1998. All are core to our service system. One independent Targeted Case Management agency has been in place for a number of years, and was in place in 2016 serving 9 individuals. Cowley has two limited license agencies serving 3 people. Two agencies in Cowley are approved to provide the residential option of Shared Living (SL). One is very active in this service option with 9 SL providers in place the other with 2 SL providers. The majority, 71% of the residential services in Cowley are group homes. One provider indicates interest in the expansion of Shared Living given state approval for this service to expand. Cowley would then have three agencies offering the Shared Living residential option. In 2016 Cowley had four Financial Management Service (FMS) Providers serving 15 individuals with self- directed Personal Care Services (PCS.) Agency directed PCS is limited to two providers with only one serving children. Interest in expanding Supported living (agency PCS) appears limited. Two individuals utilize Special Medical Care (SMC) each from a different provider. Cowley has 5 providers affiliated to provide this service.

Three agencies are similar in numbers of individuals served. The smallest of the four is diversified serving a few individuals on the PD waiver and providing separate Home Health services and Medical Transportation. One agency also provides a Public Transportation Service and has recently contracted with the local school districts for printing services. They have also been recognized by the business groups. Of the four major providers in Cowley three are associated with companies that provide services across the state and the nation and are responsible to their home company directives. One provider is a locally run organization with direction from a local board of directors. All are very involved in outreach and accessing the community.

Day services for each agency has something different to offer. Numbers reflect 71.67 % of the day services occurring in the community; 41.5% in a day service location and 35% in a sheltered workshop. Although there is employment occurring for many individuals, Supported Employment in the area is not utilized. According to the provider survey interest in expanding supported employment appears limited.

II.  Business Environment:

Describe those circumstances or issues which may have an impact on IDD system capacity not otherwise indicated by the Key Indicators. CDDO’s may exercise discretion regarding the information to include in this section of the report. Information may include but is not limited to the following:

a.  Unemployment rate for Cowley County 2016 is reported to be 4.5%. Industries that offer employment opportunity are numerous Cowley First and Winfield and Ark City Chambers are active in recruiting business and workforce to the County. No data is being reported related to general population changes for Cowley County during 2016.

b.  (Primary competing industries or large employer in the area ) Cowley has two Industrial Parks with numerous businesses, small and large. Some of the primary or large employers in the area include ADM Milling Arkansas City Industries, Columbia Elevators Solutions , Conco Construction, Cowley County Farm Bureau Association, Creekstone Farms Premium Beef, Galaxy Technologies, Skyline, Rubbermaid GE Aviation, Hospitality Management, LLC Jet AirWerks, KanPak ,Morton Buildings, Husky Liners,Community National Bank, RCB Bank, RPPG, Inc, ,Southern Kansas Telephone, Southwestern College, Cowley College, The Stock Exchange Bank , Union State Bank, Winfield Publishing Company, Westar Energy Western Industries. Competing industries include William Newton Memorial Hospital, South-central Medical Center, The Kansas Veterans Home, Winfield Correctional Facility, numerous Home Health and Hospice agencies, professional medical offices, Numerous Nursing Homes and assisted Living providers such as Medicalodge, Presbyterian Manor, Good Samaritan, Rest Haven and others, Kings Drug Treatment Center, Four County Mental Health. Close proximity to Sedgwick County also presents Sedgwick county industry and business as a competing factor for employment for those willing to commute.

c.  (Available collateral community support programs/organizations to collaborate in meeting people’s needs. ) The” Third Thursday Group” is a group of service organization or those interested who get together once a month to share information about services available. Information is shared via email between meetings. The list that follows is not all inclusive but is a representation of the supports and collaboration occurring and available in Cowley County. Eagles Nest, Goodwill, and Council on Aging, Senior Centers, Meals on Wheels, Numerous Churches, Food Pantry, Circles, Helping Hands, Housing Authority, Legacy Foundation, public schools, Southwestern College , Cowley College, Local High Schools, Arts and Humanities, Camp Horizon, City Recreation Depts, Mitchell Theatres, Service Organizations such as Rotary, Lions Club, County K-State Extension Office, local law firms, Department of Children and Family offices located in the County, the Regions ADRC is located in Cowley County, County Health Dept, Four County Mental Health, newly established Community Health Center, Dental Clinic with ESCF, local law enforcement, Fire Dept and Emergency Management, Snyder Research Foundation ,several local businesses such as Graves, Hillcrest Lanes and others. Close proximity to Sedgwick County, Sumner County and Oklahoma also avail Cowley access to resources in these areas such as CPRF, KU Med Center, WSU, two major hospitals St Francis and Wesley Medical, Numerous Medical Specialists, Dental Clinic in Newkirk. Families’ Together organization offices in Wichita shares information with Cowley as we are in their catchment. Other entertainment, recreational and educational opportunities in these adjacent areas are also accessible to Cowley residents.

d.  (Impact of changes within local school districts.) There are five school districts in the Cowley and several private elementary church based schools. Cowley County Special Services Cooperative manages and provides school services for children with disabilities with both integrated and special classrooms. Head-Start, REACH, The Early Learning Center and several day care centers provide early childhood services. USD 465 in Winfield was awarded a Leadership Transformation Grant with a number one focus on early learning and readiness for school; and a secondary focus on post-graduation plans for special needs students. “Investing early for a great outcome later. “ The Coop in 2016 serviced 1,581 exceptional students with a wide range of disabilities; an increase of 250 students in 7 years. The grant proposal identified “an alarming increase in the number of student in poverty and from single parent households in Cowley County. Cowley is consistently in the top 10 % of schools across Kansas with the highest numbers of students receiving special education services. The level of service has reportedly increased proportionally with more students needing intensive support for learning and behavior management.” This group ELOC worked in 2016 and continues to work with community partners to develop goals and implement plans to achieve a positive impact.

e.  Other relevant information with potential impact on system capacity

III.  Key Indicators: Summary of local data for each quality measure.

a.  PROVIDER FINANCIAL STABILTIY: deferred to future per 4-19-17 communication

b.  ACCESS TO SERVICES: Number of providers of Day Supports-6; of these two are Limited License providers (one did not respond to the survey). Day services at each provider agency have something different to offer. Numbers reflect 71.67 % of the day services occurring in the community; 41.5% in a day service location and 35% in a sheltered workshop. Of the 4 major providers all provide services in a Day Activity Center; 3 provide day supports in the broader community; and 3 provide a Sheltered Workshop. No provider has indicated plans to expand Day Supports with the reasons given:

low reimbursement rates and near capacity.

Although there is employment occurring for many individuals, Supported Employment in the area is not well utilized. Supported Employment is offered by 2 providers. Only 1 of the 2 currently offering this indicates plans to expand this service. No other provider has plans on offering the service. According to the provider survey interest in expanding supported employment is limited to one provider. Reason for not expanding given is low reimbursement rates.

Residential Supports-6 (two are limited license and one did not respond to the survey) 5 agencies provide group home living (78.20%) This includes the Lim Lic response. 2 offer Shared Living as an option (13.5%) Both agencies indicate interest in expanding this option. One agency that does not provide SL indicates interest in expanding to provide this service if State approval were to be given.

Only one provider suspended acceptance of referrals for residential and agency Directed PCS( Supportive Home Care) for a limited period of time during 2016 due to staffing limitations.

Supported Living ( Supportive Home Care -Personal Care -agency direct )

The survey responses are not accurate and thus not valid indicating Cowley has 4 providers offering this service and one that does not. Not all 9 responded to this question. The reality is that Cowley has only 2 providers offering supported living ( PCS) agency direct. The survey indicates 2 providers interested in expanding this service and 2 not interested in expanding due to low reimbursement rates funding and staffing issues prevent expansion of this service at this time. These are the difficulties that have been shared previously by those providing the service. So it is unclear if current providers are planning to expand or not or if other providers are considering adding this to their service option.

Other services available with no specific CSP responses surveyed.

Assistive Services-4

Enhanced Care- agency direct -0

Enhanced Care Self Direct-4

Overnight Respite-agency direct -4

Overnight Respite Self Direct-4

Specialized Medical Care agency direct-3

Specialized Medical Self Direct-2

Financial Management Services (FMS ) Personal Care- self direct -4

Medical Alert Reminder-0

TCM -5

Wellness-4

Affiliations: No new providers have affiliated during 2016. No provider denied affiliation. One affiliate packet was submitted but not processed. Two reasons: Personal events of the applicant created a barrier to pursuing the affiliation and license. The applicant did not have a License with the KDADS and was pursuing providing only Shared Living. KDADS determined agencies not already providing the SL option could not add this to their service options. It was also understood at this time a license o provider only Shared Living was not an option. Without the license affiliation was not possible.

Number of individuals moving into the county accessing services through CDDO Transfers – 10 ( four of these were handled in crisis mode) ; Making choices to change providers for their services-13; New access choice- 4; Crisis access -2 TA transfer- 1, accessing through wait list- 0 ; Moving out of county - 4

c.  COMPLEX NEEDS: 4-19-17 email defers this to tracking only the #’s that meet the definition identified or having 1 or more behavioral health diagnosis.

In Cowley County the number of individuals identified in KAMIS as meeting the definitions is : Interfering Behaviors 167; High Medical Needs - 149.

d.  PROVIDER WORKFORCE:

Hourly rate for DSP‘s range from 8.13 to 9.50 per hour which is an average of 9.04 per hour.. Three agencies paying 9.00 or more and one 8.13.One agency reports 16.50 per hour which is believed to be for an SMC services who hire only nurses.

Recruitment activities reported in the survey include: hiring events, job fairs, career boards, flyers, website, newspaper, radio, Cowley County Works web site, Facebook, ADP system that feeds into other career based sites, Career Builder Newspaper. Though not reported providers utilize volunteers and make presentations to various organizations, sponsor and get involved in events for public relations building as well.

Average DSP turnover rate reported of the nine respondents: 2 at 0%; 1 at10%; 2 at 30%; 1 at 35%; 1at 50%; 1 at 60%; 1 at 70%. The average turnover rate for Cowley County CDDO providers is 31.67%.

Average monthly number of open direct support positions at each agency: The numbers reported are questionable ranging from 0 to 3.16 to 70. I am unable to interpret or accurately report this data. It appears the Limited License reports 0 which is accurate; and the SMC and FMS self-direct providers likely reporting 0 as they do not hire DSP or are not responsible for the hiring as they noted. Excluding these numbers and recalculating the two large numbers it would appear the average for the major providers might be 3.6. This should be considered questionable.

Reasons for vacancies in order: 1) lack of qualified applicants 2) other which included * failed background checks, *some leave before they start as background check process takes so long, *not enough pay 3) voluntary termination/resignation 4) recruiting 5) one listed involuntary termination/ resignation

Average time to fill a DSP : Responses ranged from 14 to 120 days with an average of 45 to 49 days for all Cowley providers responding.