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Please begin with an informative title:

Family foster care may be legislated out of existence in Minnesota. Thousands of mental ill and/or handicapped people would have to find other arrangements. This issue hits very close to home.

My step brother has schizophrenia and autism spectrum disorder. He currently lives with a family in their home. He really likes his current setup and is doing really well. This all would come to an end if HF1586 and SF1400 become law.

HF1586 and SF1400 would force these family-run care providers to buy an expensive instruction manual, pay large licensing fees, hire a business manager, a coordinator and keep a registered nurse onsite (i.e., at their home). For corporate group homes this makes sense, but family home care is a small business alternative and far more personalized.

Most family foster care providers would quit if this bill becomes law.

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The legislative effects on this nucleus family, including the vulnerable adult, results in the unintended consequence of distracting the primary caregiver from focusing on direct care. The focus now perhaps becomes interpreting and following an expensive policy manual that cannot possibly document the many circumstances that may arise in this very personal day to day home life. A cookie cutter approach that works for large institutions removes the most valuable asset of Family Foster Care, “the flexibility to accommodate the needs of the individual client and family”.

The burden of expensive manuals, excessive dues, and confusing billing policies could hasten a collapse of Family Foster Care.  These homes are not large corporations that service 100’s of clients with one license; these are individuals within their family home who have opened their doors to provide very personalized care. This loss of alternative care need not happen.  I am appealing to you as a servant of the people of Minnesota to consider and reconsider some of the shortcomings in HF1448/HF1586 as it relates to Family Foster Care.  Namely, please reverse the requirement to purchase a policy and procedure manual, along with reversing the necessity of hiring a coordinator, a manager, and a registered nurse that serves only to duplicate or micro-manage work already being performed.  Furthermore, the elimination of the unfair licensing fee of $1,125 and $84 a month per client for Adult Family Foster Care is necessary to maintain the financial viability of these homes.  

Perhaps one of the most devastating components within these bills is the change in rate or pay structures for Family Foster Care.  Leaving the very difficult wording and ambiguity to remain “as is” could level the final blow.  Having worked as a CFO for many years I’m not sure what small business owner could continue to operate with NO understanding of how they will derive their revenue from the service they provide.  It is of the utmost importance that this element of the legislation is not left to chance so that the Family Foster Care Providers can continue with confidence that they will receive fair compensation without complicated billing procedures.
(excerpt from Laurie Vlach's letter to Rep. Diana McCann, published with permission)

In family foster care, the person is incorporated into a family. Obviously, the people who enter into this arrangement don't typically need 24-7 monitoring by an RN. My step brother, as an example, is relatively low maintenance. The care provided by this family is structured enough for him to live comfortably and as happily as he'll ever be considering his mental illness.

These foster home care families will forced to pay $1,185 per month plus $84 per person in their home. These bills also add a level of complexity to their paperwork and they really would need a manager to figure it out and keep them in good standing with the state.

Here's the entire letter from two concerned family foster care providers (published with permission):

FAMILY ADULT FOSTER CARE
DHS is pushing the Governor’s budget for Health and Human Services that will not save the state money but destroy the budget in long term care for decades to come. Many Family Foster Care Providers intend to quit if they are treated this unfairly and thousands of waiver clients will be returned to the counties therefore destroying any hope for a balanced budget in long term care.

The discussion group talking about new rates for Family Adult Foster Care keeps forgetting that when the year 2014 comes, the only difference between a corporate home and a family home, as far as requirements for waiver providers is that the licensor holder sleeps there.  In 2014, all foster homes providing services for clients on a waiver of any kind will have to follow the245D rule requirements.  Therefore, many family homes  that have waiver clients now,( and as a former licensor let me tell you that number of clients is in the thousands not hundreds) will absolutely have to add both professional staff and line staff to accomplish what 245D requires of them by law in the year 2014.  You can not expect family homes to do even more work than they are already doing now, add on licensing fees, add  on fines for any citations, add on more training  requirements that cost money and at the same time, tell these providers you will pay them less.  The providers will drive the clients to the reception rooms of every county social service office in the state and drop those clients off in a heartbeat.  Many of these providers have worked in an underpaid status for many years.  To tell them now that you are adding all these extra requirements and costs, while at the same time cutting their pay is a slap in the face only because the family providers are not represented by an organization like the corporates have.

This process of redefining the payment systems has gone on since the year 2004 and will not be concluded until 2017.  The entire time corporates have increased their rates while families are constantly being cut.  Department of Human Services absolutely must look at not only what the homes are doing now, but what the requirements are under 245D as you are adding new requirements.  You plan on adding a licensing fee, citation fees, need for a supervisor to write “Policy and Procedure Manuals” and write annual goals and outcomes for the clients.  Than you give corporates 15% administrative costs for doing these very exact duties, while you want 3% for families to complete the exact same thing.  This is setting up the framework for a large lawsuit.  You are also setting yourself up to more than double your costs in caring for these clients as the families quit and drop them off at the social service waiting rooms, (I was a licensor for 12 years I worked in Aitkin County, Wright County, and Hennepin County) the agencies panic and place the client in a corporate home for twice what they were paying the families.  After a period of time when enough families quit, the ONLY option you will have in the counties is the higher cost corporates.  At that time you may as well throw out any type of rating tool since the corporates will simply tell you what their price is and you will have to take it.  The other option is to reopen the Regional State Hospitals for over $600.00 per client per day.  Which to remind you that during the 1990’s  we virtually emptied the state hospitals into foster care and saved the state, hundreds of millions of dollars.  Paying corporates over $9.00 an hour for asleep staff while paying families only $2.03 an hour is another extremely unfair situation.  What if the family home providers (who work 24 hours a day, 7 days a week, all year long, should desire a week off for vacation.  Who would even sleep at your home and watch these clients, for $2.03 an hour.  Not to mention it costs hundreds of dollars to do everything you must do to qualify that person to watch your clients.  Background checks, book training, one on one training on the floor, bonding, are just some of the items corporates have always gotten paid for in their rates and families got nothing.  In the new rate system, the families are left out again without these DHS requirements being paid for by the state.  The providers will not continue to provide services to 3 or more clients 24 hours a day, seven days a week if you do not give them the respect they deserve.  They will quit.  It will be no small impact on the state when they do as they number in the thousands across the state and in 80% of those homes they have at least 3 clients.  If half of those providers quit, at an average of 3 clients per home, and those clients went into corporate homes, the entire state budget in this area would raise extremely high.  

If you want to review the state budget in this area, create DHS state raters that would go throughout the state and rate each client out   there based on the needs of the clients.  When we closed the state hospitals, the corporates were first in line to take in clients.  The supervisors in the county offices had no experience with rate setting and negotations.  The corporates received many very easy clients for the highest possible dollar amount.  The only way this can be fixed now is for DHS state raters using a client based tool to rate these clients correctly and place them according to the client needs.  Many of these clients would be okay for independent living.  The county staff have a day to day working relationship with these corporates and are not able to do what must be done as the next step since the state hospitals closed.  If you allow the new changes to drive family adult foster care
out of the business, you will only give the corporates a monopoly in residential care and rates will sky rocket.  I am not saying ALL corporates are bad, but anyone in this business knows some corporates took advantage of the lack of skills by DD supervisors primarily in deciding rates for these clients.  These supervisors come from a social work background of helping people, not business debaters.  The corporates sometimes had staff trained in these areas.  Occasionally, you had corporates show up with attorneys from their home office.

The supervisors were just not up to the task as one more item on their overcrowded workload, and this is what you get.  Many easy clients at max rates in high care residential throughout the state.   The legislators and DHS must now address this not as a social service issue, but a business issue.  Create highly trained DHS state raters who owe nothing to these corporations, do the re-rating of everyone out there and all new clients in the future.  Once the client is rated, that determines if they need corporate care, family care, SILS, or independent living.  Do not get me wrong, we need a very strong group of corporate homes to provide the services needed for high needs clients.  And when you consider just 20 years ago, most clients were in state hospitals or other large facilities.  The corporates rose to the occasion in designing new homes for aggressive clients, prader willy clients, medically fragile clients, etc. etc..   We just need to take the next step to sort out the clients who do not need that higher level of care and get  them into the much cheaper forms of care. Otherwise, we could make this worse and not better.

Steven Adair (Former Social Worker)(Current Foster Provider)
Bruce Napper (Foster Provider)

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