4. Sub-Group Activity
Each of the sub-groups met for one hour to discuss their priority areas.

A. Services Sub-Group
(Members present: Kathryn Kazenski, Margaret Forbes, Chandra Murphy, Helen Bailey. Staff: Donna Lerman, Eileen Griffin)

The Services Sub-Group focused on two objectives:

• direct funding
• advocacy, self-advocacy, and self-monitoring

Direct Funding. The group agreed that direct funding should target people, not services, allowing people to individualize services to meet their needs.

The sub-group agreed that they would like to include all services and supports, including housing and transportation, in the individual budget, so that an individual has maximum control over how the money is spent. Members agreed that:

• some standards for accountability and quality should be set;
• people should be given the option of purchasing the services of a fiscal intermediary to manage payroll, tax withholding, and other administrative details;
• people should be given the option of purchasing the services of a broker who could link people to services. Members talked about finding a less confusing term than "broker;" they also discussed whether the broker should be independent of the providers providing services.
• ways of using surrogate decision-makers needed to be identified so that people who can not make their own decisions about purchasing their own services are not excluded.
• eligibility for direct funding should be based on a combination of medical need and financial criteria.

Advocacy, self-advocacy and self-monitoring. Members did not have time to completely address this area. Margaret shared some of her materials on self-advocacy and rights. The group discussed the difference between an information sharing network and developing a coalition of groups around common interests.

B. Workforce Sub-Group
(Members present: Lora Perry, Cynthia Sudheimer. This sub-group was staffed by Stuart Bratesman.)

Problem definition. The sub-group agreed that it is not good enough just to fill all the direct care work force vacancies and reduce high turnover rates. It matters how the vacancies are filled and who fills them. The problem is not only that agencies, providers, and consumers can't find enough persons to fill existing positions and meet rapidly growing demand. The problem is that many of the people who currently do get hired lack the appropriate education, trained skills, trustworthiness, career dedication, and attitude to do the job properly, and that the situation won't change until the job itself is fundamentally redefined from a semi-skilled to a professional occupation commensurate with teaching or social work. This would entail:

• increasing the educational and training requirements to two or four years of college-level classes;
• providing more direct hands-on experience during training;
• providing more supervision and mentoring support during the first year of employment;
• increasing the range and level of responsibility for direct care staff; and more than doubling the current provision of wages and benefits

The sub-group agreed to shift its focus from private-sector philanthropic, to state-funded solutions, in light of the Work Group’s mission of identifying state responsibility and state action. The sub-group agreed to look upon state action as a first-step toward a broader and more fundamental privately funded solution.

The sub-group agreed that the portion of the Working Plan that addresses direct care work force issues should address:

• the need to transform the fundamental nature of direct care jobs;
• the need to change public attitudes and prospective employee attitudes about the nature of direct care work and direct care staff through public service announcements and other public relations methods;
• the need to change service agency management attitudes toward direct care staff through conferences, workshop meetings, and videos for service agency managers;
• the need to expand and improve upon direct care staff training, using Maine's behavioral health specialist training program as a model;
• the exploration of deferred loan incentive concept that would defer payment of direct-care related education and training so long as training graduates remained in the direct care field; and
• the need to increase annual wages for direct staff from below the poverty level for the family of four, to the $25,000-$32,000 – closer to the level of teachers and other socially valued occupations.

The sub-group also discussed the possibility of reducing the demand for community-based direct care staff by exploring measures to reduce staff travel time. This might be accomplished by creating incentives for persons with disabilities to live nearer each other in more central locations instead of remote locations.

The members agreed that Lora Perry and Stuart Bratesman would meet in the next two weeks to draft the sub-group's portion of the Effectively Working Plan.

C. Coordination Sub-Group
(Three new members joined the Coordination Sub-Group: Tom Bancroft, Jonathan Connick, and Peter Driscoll.)

The group reviewed the components of the plan discussed in previous meetings including:

• development of a website to provide access to information about services;
• development of a single entry system;
• development of a service matrix to examine gaps and overlaps in services.

The group discussed case management, noting that this system was originally established to improve the coordination of services to consumers who utilize services from multiple agencies. This position has become more specialized and less autonomous and has developed differently in different agencies. It was suggested that the plan include a review of current case management types in order to develop a new model.

The group was reminded that the focus of the coordination part of the plan should be on Olmstead applicability, with a goal of harmonizing existing programs that are working effectively and eliminating those that are redundant or ineffective. It was also noted that Dennis Tan’s data integration work would complement the coordination plan.

Topics to be discussed at the next meeting include:

• discussion of a work group to oversee the implementation of the coordination plan;
• institutions;
• transition.

5. Core Data Set
Dennis Tan led the discussion on the Core Data Set. He explained that the core data set is a project funded by the Center for Health Care Strategies. He asked Work Group members to assume that they did not have to worry about confidentiality, or how to integrate the data, or to think the data as an integrated case management system. He asked Work Group members to identify:

• what questions they would ask to help determine whether Maine is meeting the requirements of Olmstead.
• why they want to know the answers to those questions (the relevancy to Olmstead)
• why their questions could only be answered using data linked across departments.

Work Group members identified the types of information they would be interested in, including:

• Waiting list data. The number of people on waiting lists, by geographic region, service; identify patterns based on who is on, what services they are receiving/what services they are waiting for, where they are receiving services, waiting for services, and where are the services they are waiting for, who is coming off waiting lists. It would be important to know if there are differences across departments/funding streams in the rate at which waiting lists move.
• Provider workforce. Commonalities and divergences across departments in the staff turnover rates, recruitment and retention rates, wages, competency requirements, portability limitations. It would be important to know where the departments can work together to improve provider workforce, including standardized training, parity of wages, recruit and retain, otherwise improve efficiency and effectiveness of provider workforce development.
• Revolving door. How many people transition back and forth from institutional to community setting (e.g., correctional facility or jail and home or community), plan for services, how many services provided, effectiveness of the services.
• Transportation. How many people have a need or unmet need for transportation services (work, doctor’s appointments, recreation, etc.)
• Barriers to services. Communication barriers, physical accessibility, funding, cognitive barriers.

6. Timeline for Developing Plan
Eileen reviewed the timeline for the next several months. The Work Group agreed to the proposal to use the Wednesdays following Work Group meetings for drafting sessions. Eileen distributed draft outlines for discussion next Wednesday and a sign-up sheet for next Wednesday’s meeting. The Work Group also discussed the fact that some members would like to invite Barbara Donovan from the Department of Transportation, and someone from Maine State Housing Authority to a meeting. However, there was no consensus on when it would be possible to fit that into the Work Group’s timeline. 

7. Announcements
Members requested the Work Group to revisit the Universal Access Group’s list of accommodations needed for an inclusive Work Group process. Eileen announced, on behalf of Alice Conway, the Hospice and End-of-Life Conference to take place June 6 at the Augusta Civic Center. (Contact the Maine Hospice Council 626-0651.)

8. Next Meeting
Agenda items for the May 23 meeting include: Real Choices grant application and sub-group activities. The May meeting is scheduled for Wednesday, June 27^th from 1:00-to-4:00pm at the Cohen Center. Stephanie Crystal is the chair of this meeting.