Organization Name: Catholic Charities Maine

Program Name: Independent Support Services Program

Program Contact: Don Harden, Director of Aging Services
Email:     Phone: (207) 523-1162

UWMM has funded this program for 14 years.

Amount Requested: $11000.00
Is this an increase from what your program received for the current funding cycle? 

Received: $9000.00 Requesting increase because:Although this is an increase for ISS, it is a decrease for CCM. In the prior funding cycle we received $9,000 for ISS and $2,500 for SEARCH. This year we are submitting a single request for ISS.

Twenty-five word summary of this program’s purpose:

Catholic Charities Maine Independent Services Program (ISS) provides homemaking services to low income, socially isolated seniors and adults with disability throughout all of Mid-Maine.

How your program is uniquely important to the community:

The challenge to senior well-being. Maine is the oldest state in the country. The counties of Kennebec, Somerset and Waldo, portions of which comprise the UWMM service area, will soon see 27-30% of area residents at or above 65 years of age. Some will need physical assistance to perform the most basic of in-home tasks essential to independence and health and wellness: housekeeping, laundry, grocery shopping, meal preparation and personal care. Almost two-thirds of area seniors live alone with little or no means of support. Many live in “stressed” housing and have chronic health problems. Often, they rely on local public safety resources for wellness checks from local police, intervention and transportation from local emergency response, and assistance from local municipal offices to address food insecurity and emergency fuel needs. This taxes local resources which were designed for emergency, not ongoing needs. A high percentage of area seniors living on fixed income are unable to purchase needed in-home services privately. Many of those who do purchase private in-home help are forced to sacrifice other essential goods and services such as medications, food or fuel.
Unique capability of ISS. ISS makes low-cost services available to keep eligible seniors safe at home and enables them to help preserve scarce income for other needs. Catholic Charities Maine’s ISS program is the only publicly funded program the State of Maine contracts with to provide this subsidized service. ISS is a low cost, effective service that provides needed in-home assistance, and provides a consistent “eyes on” for those seniors without family supports. Often the ISS homemaker is the only person with whom a senior client has contact. While ISS is “uniquely important” as the only subsidized homemaker service in the UWMM area, ISS does not “go it alone”. We partner with the local area agency on aging and other important community agencies to access complementary community supports needed by the consumer. To address challenges finding direct care workers (a state-wide challenge), ISS supplements our direct employee workforce with a robust network of sub-vendors to assure we can meet client needs. These business collaborative relationships have helped us serve clients living in “hard to staff” areas and ensure that we can spread our thin administrative infrastructure over a large client census, thereby bringing down management costs.

Program Updates

Since last report (or in past two years):

Since last report to UWMM:

As referenced in the 12- and 18-month updates, the ISS Program leadership worked in coalition with other long-term care advocates in Maine to present legislation that would increase reimbursement rates for senior services, in order to address the direct care worker shortage through increased compensation for direct care workers.

In July 2018, the Maine legislature incorporated 10% rate increases in the FY 2019 State Budget. Because of this, in late fall 2018, ISS received $284,000 in supplemental funds statewide. During the final six months of the current UWMM allocation period the Program is using these funds to address staffing challenges by: (1) increasing homemaker wages to $11.50; (2) increasing sub-contractor reimbursement to $18.70/hour; and (3) increasing self-direct care reimbursement to $12/hour. Homemakers working 20 hours or more will receive paid time off and other financial incentives are being implemented to reward extra productivity with client services. The self-direct care option is key for seniors who we have not been able to serve due to worker shortages. It enables consumers on the wait and unstaffed lists to recruit and hire family members, neighbors or friends to serve as their own homecare worker. ISS has been successful in expanding participation in self-directed care. These steps are instrumental in being able to recruit and deploy adequate quality direct care workforce and being able to respond to consumers who are referred for services and have immediate needs.

Program Leadership, Don Harden, is part of a coalition of home and community-based agency administrators that have developed and submitted to the new DHHS Commissioner a list of “reforms” in how long-term services and supports (LTSS) are financed and delivered. Among the recommendations are some specific to ISS. This includes extending MaineCare (I.e. Medicaid) reimbursement so they fund ISS homemaker services (currently we are not able to bill MaineCare for ISS). It also includes a proposal to reimburse for “enhanced care coordination.” Enhanced care coordination (aka case management) would enable the ISS Program to better assist consumers with needs that exceed the scope of the ISS program, yet are still essential to help them remain independent in the home. (E.g. complementary supports such as Meals on Wheels, advocacy for fuel or intervention to avoid eviction.)

Expected in the coming year:

The state of Maine advised that they will issue a Request for Proposals to re-compete the ISS contract, this is tentatively scheduled for the summer of 2019. It is normal state practice to re-compete state contracts valued over $1 million every 6 years. CCM has twice, consecutively won the ISS RFP and is well positioned to continue with the contract should it be put out to bid. In the last bid cycle, CCM was the only agency to bid on this contract.

Outcome your program most contributes to:
Health: All individuals in Mid-Maine are in safe and healthy environments with access to health supports and services.

How program contributes:
Provides a direct service in behavioral and/or physical health areas, Increases access/reduces barriers to direct services, Increases capacity/resources for direct services, Advocates for behavioral and/or physical health, Collaborates with other programs/services in behavioral and/or physical health

Define your year: July 1 – June 30

How much did we do? 248 (Total number served)

How well did we do it?

Performance measure: Percent of clients rating quality of services as good or better
Most recent year’s data: 94%
Previous year’s data: 93%

What was the difference made?

Performance measure: Percent of individuals who improve their functioning or self-sufficiency as measured by an assessment
Most recent year’s data: 0%
Previous year’s data: 0%

Action Plan

Objectives for current year:

1) Achieve our performance measures:
a) Increase # of UWMM consumers served to 248.
b) Attain satisfaction level with “how will we did it”; 95%
c) For “what was the difference made” 75% of consumers assessed on a self-sufficiency index will move from crisis/vulnerable to stable. (The assessment tool being used is the Well-Being Assessment Tool adapted by an Area Agency on aging specifically for seniors. The tool uses ten assessment indices; food security, health care, health insurance, housing, in-home care, medications, money management, safety/falls risk, support network and transportation. Consumers are assessed as in-crisis, vulnerable, safe, stable, or thriving.)
2) Attain funding for enhanced care coordination services.
a) Highlighted under #10, “Program Updates.” In addition to advocacy through the DHHS Offices of Aging and MaineCare Services, ISS is a partner with other aging advocates in representing legislation for the 2019 session; LD 653 Resolve, To Establish the Task Force To Study Opportunities for Improving Home and Community-based Services. A major recommendation is to “support delivery of enhanced care coordination as part of the homemaker program.” The recommendation proposes that reimbursement of care coordination in ISS be covered under MaineCare. Approximately two-thirds of ISS consumers are MaineCare eligible. This would be a vehicle to sustain and expand provision of care coordination.
3) Advocate for supplemental funds; eliminate wait time for access to services:
a) Also under LD 653 is a recommendation to provide access to MaineCare reimbursement for ISS homemaker services. This would enable the ISS program to better keep pace with increasing demand.
4) Address the shortage of direct care workers; recruit and retain adequate workers to ensure that no UWMM consumer goes unstaffed:
a) Highlighted under #10, “Program Updates.” Continue to advocate for competitive rates of reimbursement that provide for market competitive rates of pay for workers and reimbursement for sub-contractors.
b) Utilize effective recruitment and retention strategies for direct care workforce.
c) Utilize effective marketing strategies to recruit UWMM area sub-contractors to staff hard to staff areas.
d) Continue to market the Self Direct Care Option to consumers on the wait and unstaffed lists as an effective approach to accessing services by recruiting family members, neighbors or friends as their own worker.
5) Meet our business plan objectives to ensure financial viability.
a) Negotiate a cost competitive rate methodology for FY 19-20 contracts.
b) Utilize effective rescheduling strategies to maximize delivery of all authorized service units.

Objectives and results from last year: (2) Advocate for supplemental funds; eliminate wait time for access to services: The Program received a significant reduction in contract funds for FY 2018. The Agency successfully advocated for a restoration of funds to sustain services to existing consumers but was not able to take new consumers off the wait list. The wait list for UWMM consumers increased from (15) at time of original development of the action plan to 88 at the end of FY 2018.
(3) Address the shortage of direct care workers; recruit and retain adequate workers to ensure that no UWMM consumer goes unstaffed: CCM ISS took a leadership role during the 2017 legislative session in crafting and advancing through the Legislature a bill for supplemental funding to increase compensation for direct care workers across long term care continuum. Unfortunately, the Bill was not funded by the Legislature in 2017; however, CCM ISS partnered with other providers and succeeded in seeing the Bill successfully funded during the final negotiations of the 2018 session. Supplemental funds can be specifically used for worker recruitment and retention and the Bill requires DHHS to review rates of reimbursement annually to ensure that funding keeps pace with competitive wage pressures.
(4) Meet our business plan objectives to ensure financial viability. Financial viability is largely driven by the Program’s success at ensuring the available authorized “units” of service are provided and billed for. The ISS program more intensively monitored consumers receiving lower units (hours of service) and actively managed scheduling/rescheduling to ensure each consumer received a minimum of seven hours of service. During the FY 2018 contract negotiations we negotiated a higher rate of reimbursement with DHHS Office of Aging and Disability Services. This contributed toward delivering more units of service and improved the programs financial position.

(Progress on the Action Plan in the current year is provided in the 18 month update.)

Success Stories

Judy is a 71-year-old resident of Winslow. In the early 1990s Judy began to gradually lose her sight. She traveled across the country 4 times to “be sure I saw it all before I lost my sight, so I could have the memories of it when I could no longer see.” Judy was a nurse and a CRMA before she started to go blind. She said she loved working in nursing facilities with the elderly and some days misses the work she did; it always reminded her that “there are people worse off than me and I have so much to be grateful for.”
She was an ISS consumer from 2005-2009 and returned for more services in 2018 when she became unable to perform household tasks independently. She is almost completely blind now and sees only some light flashes. In addition to being blind which has required 21 eye surgeries, she is a breast cancer survivor, is physically dependent on a cane to get around, has traumatic brain injury and is missing part of an ear due to a car accident. She has autoimmune disease and balance issues caused by inner eye damage and blindness.
Due to support received from ISS, Judy lives independently in her own home. She states that ISS allows her to have her home be as clean as it was when she was able to see. Her ISS homemaker is “my eyes and gets all the places that I can’t see.” The ISS Program assists her in getting groceries, enables her to go into the community, “things I would never be able to do on my own, as I can’t drive.”
Judy states that her homemaker Larry is a “Gift from Heaven, such a nice man. . . I don’t know what I would do without the workers that come into my home, I would not survive without the help I receive, they are here because they care, Catholic Charities treats you like they are taking care of family, you are not ever going to find a more giving and loving organization, they do it to give back to the aging community.”
Even with significant physical and medical challenges including blindness, with the weekly visit of a homemaker from Catholic Charities, Judith can remain independent in a place she considers “home.” That Judy has been supported successfully under ISS level care demonstrated the cost effectiveness of this service and the return on investment of United Way of Mid-Maine dollars.

Previous Year Actual Income and Expenditures

Government Funding UWMM Funding Other UWs Funding Fees/Dues Funding Other Sources Funding Total Income
401343 9000 0 16227 0 426570

Total Actual Expenditures: $390003

Current Year Budgeted Income and Expenditures

Government Funding UWMM Funding Other UWs Funding Fees/Dues Funding Other Sources Funding Total Income
499419 11000 0 20154 0 530573

Total Budgeted Expenditures: $530573

Anything remarkable about your program’s budget:

As noted in Program Updates and the Action Plan, additional funds were received from the state via the supplemental funding (received in November 2018). These were used to increase staff / workforce compensation. We expect this increased reimbursement rate to be sustained in FY 2020. Higher stable wages will contribute toward better workforce recruitment.

What else you’d like reviewers to know:

Why invest in this service?

ISS/Homemaker program provides a low-cost service that uses trained and closely supervised para-professionals. It is a cost- effective program that heavily leverages UWMM’s investment. Because ISS operates statewide and has a very lean management structure, we are able to spread administrative costs over many different geographic services areas. The result is that each service area, UWMM included, benefits from shared and centralized functions yet bears only a small portion of the costs associated with administrative staffing supporting the service area.

The service itself is low barrier. For a low cost, it provides clients eight to ten hours a month. It is preventative and thus helps clients avoid or delay the need to obtain higher cost care (nursing homes, rehab, psychiatric or assisted living facilities). As little as $177 a month keeps an elderly woman independent in her own home at a significant savings compared to what it would cost for her to be in a nursing facility. CCM has a long record of expertise serving vulnerable low-income seniors: we have been providing homemaker services to priority clients for fifty-two years. We have the capability to serve people in all towns of the UWMM catchment area. We have decades of experience with rural service delivery. We understand the importance of serving people where they live and providing them with supports that – though “basic” – are vital to their ability to remain at home successfully, safely, and with quality of life.


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