List of Audio Sections for ILRU Online Course 2: Consumer Direction and Living in the Community

• [No audio for Session 1)
• Course 2, Session 2: “What is Consumer Direction?”-- Suzanne Crisp
• [No audio for session 3]
• [No audio for session 4]
• [No audio for session 5]
• Course 2, Session 6: Myths of Consumer Direction-- Suzanne Crisp
• [No audio for session 7]
• Course 2, Session 8: “A day in the Life”-- Tony Records
• Course 2, Session 9: “On Community”-- Bob Kafka
• Course 2, Session 10: “One Person at a Time”-- Bob Kafka & Mike Oxford
• Course 2, Session 11: “Nursing Home = Safe? Community = Dangerous?”-- Mike Oxford
• Course 2, Session 12: “Low Cost Resources”-- Mike Oxford
• [No audio for sessions 13, 14 or 15]

COURSE 2, SESSION 2
“What is Consumer Direction?”
Suzanne Crisp
It’s a pleasure to (speak with you). I appreciate everybody's (participation). It’s kind of a pleasure to be isn’t it. It’s also a pleasure to be here to talk about what we are going to talk about today, and that is quality of life issues, how we can enhance quality of life. We are going to talk about consumer direction and for the purposes of today’s discussion, self-determination and consumer direction we are going to say it’s the same thing but lets talk a little bit about what that is. I like this definition of consumer direction the very very best. Some of you might know Judy Heumann, she is a National Advocate for the disability community. "It’s not doing things by yourself but being in charge of how things are done". I love that quote, I just love it. What it means is that a consumer, a person receiving services, is in control of who, when, how they receive those services. It’s a pretty simple concept and it’s one that state government and federal government has really never been keen on. They haven’t gotten it but they are getting it. There is hope. Lets talk about consumer direction just a little bit more in detail. We think, under consumer direction, that consumers are the best judge of what their needs are and the approach to meet those needs. Don’t you know what’s best for you or does it take a stranger or a case manager to know what is best for you? I think everybody in this room would probably say,"omm, I think I am the expert on me". We think that a person should be able, as a God given right, to choose services and who provides those services, and by services we are talking about personal care, all the activities of daily living, bathing, dressing, eating, meal preparation, running errands, everything it takes all of us to do to get through the day. We are talking about personal care. We are not talking about skilled care. We are not talking about invasive procedures, we are not talking about even strong medication management. We are talking about personal care. We think that personal care, because it is such an intimate service, should be tailored to meet individual needs. You know, imagine yourself sitting in your home, needing a bath, wondering who’s going to come in, if they are going to come in, who is going to come in to give you that bath. A bath is a very intimate thing, and I definitely want to know the person that is going to be bathing me. It also crosses disability. You all know what a cross-dresser is? Well I am not a cross-dresser, I might look like it. Hush Mike. I am a cross advocate. I have got one foot in the aging community, actually it’s about a foot and a half, and then I have got a half a foot in the disability community, and a lot of people think that those are separate communities and while I think I am in the minority usually, I maintain that there is a lot of commonality between those two communities. Now let’s talk about the stereotype, the profile of a person with a disability. They are young, they are assertive, they are demanding, they want to change public policy, they know what they want, and they have an assistant or an attendant to help them. Whereas our stereotype of an aged person, a person who is elderly, is that they need to be cared for, they are so grateful for anything they can get, they are quiet. They are and another person can well know what they want. It’s OK to be a mind reader for a person who is elderly and instead of an attendant or assistant, they have a caregiver. Well, I am here to say that all of that can be thrown out and we have the program here that pretty much proves that. So, consumer direction is not confined to mental health or developmental disabilities, or aged or persons with physical disabilities, younger persons with physical disabilities. You can consumer direct a little or you can consumer direct a lot. You can say I want to wear this color dress today or I don’t want to bath today or you can take cash and arrange your own services. It’s a full spectrum of what you can do with consumer direction. It’s not a cultural thing. It’s actually not a funding thing either. In the past many of our programs have been state funded because Medicaid, a public funding, has not recognized the value of consumer direction but as I said when I started, they are beginning to get it and it certainly is not confined to any particular age, children, adults, elderly.
END OF SESSION 2 AUDIO

COURSE 2, SESSION 6
"Myths of Consumer Direction"
Suzanne Crisp

Lets talk about some consumer myths here and maybe some of these have already floated around in your head. You know if you give people money, they will misuse it. They will spend it on things, probably sins. They won’t use it for what they are suppose to. If you give people money, someone, maybe even a member of their family, will come in and they will take that from them. They will abuse them. They will exploit them. They will take that money from them. People who have a chronic condition are not interested in the stress of managing their own care. They are just not interested. They want to be cared for and they lack the ability. Because they have a chronic condition, they seem to not be quite as organized, quite as strong to manage their own care. If you give a person the right to manage their own care, then their health will decline and that will just create medical conditions that will be more complex and more costly to public funding. People who have a chronic illness are vulnerable, they don’t need the stress, again, of self directing, and these are the two that I like the best, case managers know best. These people have gone to school. They understand all the resources out there. They can put a whole, a person, they can make them whole after they have been separated, and agency services are superior. They have rules, they have regulations, they are monitored by the state and federal government, I love that one.
END OF SESSION 6 AUDIO

COURSE 2. SESSION 8
“A day in the Life”
Tony Records

Over the past couple of years I have been trying to understand the plight of people with disabilities in nursing homes: public nursing homes, private nursing homes, large nursing homes, small nursing homes, publicly funded nursing homes, corporate nursing homes, and non-profit nursing homes, rural nursing homes, and center city nursing homes. I have found there is one common denominator within nursing homes - - the looks on the faces of lonely and disconnected people. Not many self-generated smiles are seen. Sleep is the avoidance mechanism of choice. Recently, I spent an entire day on an unannounced observation visit of a 40-year-old gentleman with a developmental disability in the nursing home. I carefully maintained a log of what I observed. With the exception of mealtime, in an 11-hour period, there were a total of 21 minutes of interaction with others, including paid staff - - no nurses, no doctors, no licensed therapists of any kind, no volunteers, family members, or friends. The only phone call was a wrong number. In fact, the most engaging interaction of the day came from a seven-minute, one-sided conversation with the housekeeping staff. In reading his chart, it revealed that he required “24 hour nursing care.” His record also indicated that he was eligible for nursing home care because he required “constant monitoring, repositioning, and nurturing.” A nursing assistant that came in at the end of that day documented in the progress notes that he “had a good day.” When I asked her what that meant, she said they write this in when there were no reported problems. My visit was cut short because they told me that everyone must go to bed at 8:30 and lights out at 9 o’clock. The next day I checked with the state on the quality review documents of this nursing home and learned that it had a 96% consumer satisfaction rating. When I asked someone in the state, who seemed to be the person who would know, she told me that the nursing home I had visited is “one of the better ones.” My first challenge to you today is that you not believe my story but rather go out and find out for yourself. Seek out someone in a nursing home, any nursing home, and visit him or her unannounced. Don’t observe everyone, just this person, not for 10 minutes but for a day. I know that this may be asking you to turn off your cell phones, beepers, palm pilots, and fax machines for that long, but it just may be one of the most productive and motivational days you have spent in a long time. If you can’t carve this out of your busy schedule, try it on a weekend, they never close.
END OF SESSION 8 AUDIO

COURSE 2, SESSION 9
“On Community”
Bob Kafka

After you get your state to put in the waiver, personal care or home health, after you get your state to start acknowledging that community first is the policy, then the difficult issue of building what the bureaucrats call the infrastructure, which is, you know, the support system that is necessary to do that. Again, we have done it through a VISTA Volunteer Project. I personally do not believe that is the most efficient way to do it nationwide, obviously. I am very aware to community based organizations being in there, doing the hands-on identification and service coordination, and so, you know, even though we are not an independent living center in Austin, and we are not an area agency on aging, we basically said, you know, we have to do something and so what we did is we basically got a VISTA Volunteer Program. We have five VISTAs that we have. We have a project called Access Texas, and Access Texas is a combination of all those things that we saw would be necessary to sort of get people out of nursing homes. We have people, one VISTA organizing people, volunteers, to go in, start identifying, meeting people, starting to do this sort of just, you know, are you in the least bit interested in the service package. You know, then we have a housing VISTA that basically is working to coordinate the sort of housing stuff out there. We have a person working on benefits in terms of, you know, what are the basic benefits in switching and getting people out. We have an ADA Coordinator, to basically talk about the issues of, you know, public access, transportation, and things, and then we have somebody that is doing, like, attendant recruitment and sort of in keeping because we sort those into pieces and they work, sort of work as a team. What we are in right now, with Olmstead implementation, is the transition period where we have to start building that, so that when the bureaucrats and the politicians say well, where are you going to find this or that, that we have some answers for them so that we can truly get people out.
END OF SESSION 9 AUDIO

COURSE 2, SESSION 10
“One Person at a Time”
Bob Kafka & Mike Oxford

So what it comes down to is that a person in an institution or a person in jeopardy of going into an institution and they want to get out or they want to stay out, and I know that sounds very simplistic, but it really does boil down to one to one and how do you do that? What we want to try to talk a little about is really sort of the hands-on, grassroots, really hard, difficult, grubby, long, very very difficult process of getting and keeping people out of institutions, and I don’t say that to sort of scare people but to really put a little point of reality, that this stuff is not rocket science per se, but it is a lot of hard, long, difficult work, working with people that have a lot of significant needs. As people have gone into the nursing home, it’s been mostly nursing homes rather than ICF from our facilities, but it works as well on that arena but it’s been mostly nursing homes, we found out some really interesting stuff and, you know, the thing is is that somebody is not just going to wake up and say hey, you know, I want out of this nursing home today, you know or you know, I am ready to move out into an apartment living with myself or with somebody else or I want to work in some kind of shared housing kind of thing. You know, it takes sort of a real sort of building a relationship with that individual and what we have found is that we have invited them to our ADAPT meetings. They come out. They use the Para-transit. They basically get to meet people and see individuals who have had experience living out there, you know, so that they can even see what you mean by community, you know, and the other thing which, you know, Tony Record talks about it in terms of his, you know, parameters is that, you know, what does community really mean to that individual. You know, what are the things that they even could have to conceive of and, you know, and what we have found is that they are interacting with the people with disabilities. They get a sense and they are frightened, they are very frightened. It has almost nothing to do with their attendant support needs, cognitive or otherwise. It almost always has to do with other support issues, you know, in terms of that because, you know, as has been said, there isn’t an individual in an institution that there isn’t a parallel person in the community and what we have found is that there is no support network. There are no friends, families are very limited there and you actually almost are building that kind of thing. So just by coming out to our meeting, basically, has started the process of the transition. You know, regardless of their level of cognitive mental or physical needs, you know, we have had people who have significant mental health, brain injury, people with just, you know, (intelligible) spinal cord injured who have come to our meeting. In all honesty, some are risk takers and we have had a much easier time getting the few people that we have, (unintelligible) short time we have had this project, you know, to get out. Others, basically, you know, have had real fears in terms of that and the issue of, you know, backup and then dealing with the families and their concerns.

In terms of getting people out, there are basically three main things that you have to look at. First of all, you need to begin identifying people. OK, who wants out of an institution? Who is in danger of entering an institution? We gotta actually have real live people to identify. Statistics and theories, as Bob was saying, is a good place to start but in the end we are talking about individuals, one person at a time, so we gotta find the people. We gotta make sure they have the information, and their families have the information, so an informed choice can be made. A lot of people, even in states that are fairly progressive like mine, the biggest thing that we find as we move someone out is that they weren’t aware they had a community alternative. Even though everyone is suppose to be made aware of that before they enter now, it’s not happening, so identifying the people is a critical first stage. The second thing, I think, is that you gotta understand why someone went in to begin with and I found, empirically, through practical experience, that the number one thing is what Bob said is that you lose your family. You don’t have community contacts. You don’t have family. You don’t have folk around and people become isolated and that’s really what drives people into institutions. That I have found, number one is lack of community and lack of family but other things can happen too that aren’t just related to the direct services like adequate attendant services or even health care. It’s things like, and especially with elderly folks, you can’t keep your house up, so then the city or the county is issuing citations against you, condemning your property and so on, In other words, you can’t clean out your gutters, you can’t do your storm windows, you can’t paint your house, the roof starts leaking. OK, then you end up with substandard housing and then someone will come and investigate, Adult Protective Services or something and the housing is unsafe. It’s inadequate. There are no neighbors around to help you do things and off you go. It’s even true, things like mowing the lawn or shoveling snow because in Topeka, if you don’t mow your lawn, the city will do it for you. First they cite you and you get fined and they do it for you and let me tell you it’s the world’s most expensive lawn job. OK, and you’re on a fixed income and you can’t do these things for yourself and don’t have the neighbors and family to help you, you’re not going to last long like that. Someone will make you go to an environment that is perceived as more safe, OK, and may, in fact, be more safe at that level. So we find things like lack of income, can’t keep your house up, all sorts of things like that. You get confusion maybe on bill paying and these are other triggers besides the attendant services. So "why" is very important. And the other thing that is kind of sad is that family members are wonderful and there is also serious problems with it. We found a number of people, I will give you some examples. There was this guy in this nursing home and we had moved someone out of the same facility and what happens is you get a hold of one and there is 10 or 20 others like, me too, me too, can I have your card. So if you get a hold of one person, the word gets out. Well this guy wanted to move out too. His family had wanted him there to begin with. He had some pretty serious medical stuff going on as well as a physical disability and he wanted out and wanted out and the family was supportive and then it got to the very end and he said well, I just need to wait because my Dad wants me to be able to walk to the bathroom from my room, OK, and this guy ain’t walking to the bathroom ever or anywhere else for that matter. So in other words, his Father really didn’t want him at home. They didn’t want to deal with it, and so they set up this incredibly high straw hurdle that had to be gone over which wasn’t going to happen, and so the guy is still there. Again, he had a right to do this, and we were supporting that and a lot of family pressures. Another recent thing that happened was a woman that moved out. We helped her move out and she had her own home and a husband there and everything else. She didn’t know what her income was. We had to help her. In other words, all she ever saw was her 30 bucks a month and didn’t understand that Medicaid was paying for things, that she had a pension, that she had these other resources. All she knew was she got $30, OK, and so people don’t understand the resources that are available, even financially or who is paying the bill.

Let me just give you one illustration. We were working with this young guy, 31 years old, in a basically, almost like an ICF/MR facility and, you know, he was really interested in moving out and we had been going through a whole bunch of changes with it and then we got a letter from his Father basically saying, I mean, almost in these words, that the blood of his son would be on our hands if we ever think of moving him out of that facility, you know. I mean this is a letter, you know, that was sent to us, you know and, I mean this was a, wasn’t the persons guardian or anything just Dad trying to protect….

And so again, here is this woman. She’s got her own home. It needed some work on it but we can do home mod’s and we worked all through this stuff, straightened out the social security, figured out the income, talked about what modifications were going to be necessary to this home and basically it was a combination of access issues plus it was a really old kind of decrepit house and the floor really was questionable so the floor had to get beefed up. It needed new floor joist. So these are the kinds of things, so it wasn’t necessarily the wider bathroom door, the grab bars and things we think of. It’s that the floor wasn’t safe beyond. We kind of wondered about the rest of the family there and but never the less that was something that we looked at so what it came down to was we hit a road block that ultimately was overcome but we got this story, that they have got an adult son 34 years old living at home and the husband was saying, well junior here really wants his freedom and independence and doesn’t want to have to be taking care of Mom. It reminded me of that Jerry Jeff Walker song, you know, 34 Drinking in a Honky Tonk and Mama Made Me What I Am, but it’s like here is this guy 34, talking about independence. It’s like move out of your Mom’s house. If you are going to live in your Mom’s house and grub their food and use their bedroom, you gotta help Mom. I just, you know, I just couldn’t believe it. So again, I felt like it was a pretty flimsy excuse. Now I am sorry, I am not trying to offend anyone who lives at home or anything like that, but you know the point is, is I felt like that was a pretty flimsy thing and here is a guy 34 years old and working and his Mom can’t live in her own home because he doesn’t want to have to mess with it. Sad, OK, but family members do do this. We have had other experiences where a guy we got out of a nursing home and helped him with a divorce and everything. His wife had sent him there. He was in an accident, post-accute, got sent to the nursing home for rehab and never left. That happens a lot. It’s called a brief, in our state, a brief planned stay to kind of finish rehabbing but what happens is the brief gets dropped, OK, and you never get out of there but anyway, this guy was there and he had his own home and quite a bit of resources and stuff and a really nice house. Well, the wife wanted the house with her boyfriend in it and her new car and everything else and did not want hubby back at home. OK, so we had a very dysfunctional unloving family thing here that had nothing to do with the guy’s age or disability or anything. It was family pressure because the wife wanted the money and the boyfriend and the nice home and didn’t want to deal with it. I mean, so these other secondary things are important just beyond a plan of care and everything else. It makes no sense, OK, to send this guy back home with the wife who is going to do everything she can to get rid of him again, right? So you have to go into other areas, around division of assets, a divorce. Things like this can pop up. Other things that happen, again, I think more with elderly folks, and Rosalee hit on this. Basically what she said yesterday, is so true, is this buy in to the over medicalization and the number one thing that still gets people into nursing homes is incontinence, which is a pretty dang easy thing to deal with, OK, and, ummm, but that is still the number one thing and so you hear, I have to take a lot of medicine. This one woman we moved out, and we didn’t even know why she was there. She didn’t qualify for the waivers or the nursing home and we asked her why she was there and the answer was well I need supervision bathing. She didn’t need any assistance. She needed none. It was incredible. She is in this $35,000 a year nursing home and needed no assistance, early 40’s, so we were kinda telling her she should have charged money for the voyeurism and could have made some if that is all they are doing is watching her get naked and jump into a tub. You know, I mean, so you run into all these kinds of different situations, again, beyond the direct hands-on attendant that really needs to be looked at. So why are people here? It’s fascinating.

Let me give you an example about this urinary thing and it is really aged. I am spinal cord injured, I am “incontinent”, I wear a leg bag with an external condom. Most spinal cord injured guys do that. Women have internal catheters just because the anatomy is different. When my Dad lost his legs, he wasn’t incontinent but he couldn’t get to the bathroom at night or anything else (unintelligible) without assistance so the question was how is he going to go to the bathroom? So I just sort of logically said and for the evening an overnight bag, like most spinal cord injured, and during the day, a leg bag. Well, you would have think I was asking for an act of Congress. We can’t do that. Their answer was, well. we will put diapers on him or when he goes to the nursing home, you know, and again they said it to the wrong person, but I knew the system and I was able to divert but it was amazing to me how aged number one, but number two how there was a direct route into the nursing home or would have been when my Dad had his legs amputated. The woman, the social worker, the discharge planner, asked me which nursing home do you want to put your Dad in with not even a thought and so what it said to me is, you know, is to be able to get out or divert. Some first line players need to be very much attacked in terms of where they are at because, I mean, they would have moved him there in five minutes. I mean she had a list of nursing homes which she just handed to me. I mean it was just unbelievable. If you combine the lack of view of community but also the ageism in the difference the way they treat younger versus older people.

Yeah, and so again you identify people, you figure out why, try to figure out all the reasons why someone is there, OK, because you will be astounded some times that either just lack of knowledge about alternatives, about an alternative system at all or some pretty kind of ugly things are behind some of this, and that is just the truth of it. One of the things too that Bob touched on that I will say that we have been somewhat successful with and you got to balance it is as you meet someone and you are talking about available things, think about inviting the person, prior to actually moving out, to participate in community activities. Go around town, invite them to your agency, your senior center, or your independent living center, or whatever to participate in whatever you do. I mean we do a lot of things like rallies and marches and fliers and so we have to stuff envelopes and make signs and do things. We also have like a fishing club that people with disabilities take their attendants and go fishing. I mean I talked about this yesterday, but that is fun, go bowling, go to the movie, and kinda get use to it a little bit. I would just say the qualifier to that though is you got to be careful because it is a balance. I will jist be blunt ( unintelligible). It’s not my goal to improve the nursing homes. Lord knows they need improvement. There is lots of other good groups that work on that and it is certainly necessary but that is not my goal, OK, it’s not my agency’s goal, I think there is only so much you can improve a flawed system, and that is my philosophy. It’s a flawed system and you can guild the cage, but you’re still in the cage, OK, and so don’t really, you know, we get some of those requests, you know, can’t you get something done. We make appropriate referrals and so on but just don’t get into that and the thing about inviting people to the community is one of my concerns is that we don’t want to make it a nicer place like, oh, I can put up with living here as long as I get to come and go, and so there is a balance at some point along the way because otherwise we are getting into a service delivery system that is very long-term that we are not funded for, you know, that doesn’t meet our mission and so on. It’s just those kinds of philosophical issues but never the less, turning someone into the community before hand can be a very big help and mean more of a success to the extent that someone knows where shopping is, is familiar with the stores, knows how to use the public transit and things like that. It’s going to be easier when someone does move out and tend to be more successful because people are oriented. You know, umm, and I have got some other things I want to show you but finally the concept of independent living, we need to be really clear on, and I am as guilty of this as anyone in the world where we tend to talk philosophy and advocacy as the major point and we have to keep in mind there is all sorts of people and as Bob has said, and in spite of the woman who needed nothing, most of the folks coming out have significant needs, health needs as well as physical and cognitive kinds of supports, and you just can’t move someone out and go here is your apartment and here is the key and have a nice life. So in other words, if you go back to Judy Heumann’s definition of independent living, it doesn’t mean being by yourself or doing things by yourself. It means being in control of the decision making, and so we have to make sure that that is clear because otherwise we will be abandoning people and it won’t work, and then we will be accused of abandoning people and not having it work and it would be true, OK, so what we have found in experience is that there is a 90 day period of time when someone first moves out that you are going to be working with the person a lot – one or two or three staff people like every day and making sure that things are set up, that things are working right, that the attendants are coming, that the schedule is working right because all these things, until you’re actually moved into your own place, you don’t know really, and so you have to adjust things and keep your eye on it and frankly there is a fair amount of hand holding, OK, that people just need support, you’re coming from an environment where there is always noise and activity and in the back of your mind you always know that there’s, if you fall down or get into trouble there is someone around, OK, then if you picture you are by yourself, in an apartment, you don’t know your neighbors, you don’t know your way around town, you don’t even maybe, you haven’t really worked with your attendant a whole lot yet, you don’t know, you don’t know and it’s a very scary thing and so you’re going to have failures unless you are really willing to be in there with people. Now what is exciting is that this 90-day window is when we start getting people saying things like, I really appreciated all your help and you guys are great, etc., but do you have to keep coming over here? Well no we don’t as a matter of fact. It’s a very good sign and, so. after around 90 days is when you get the folks like, go away and take care of your own life, I got mine under control here, and so that is a very good thing, and that is just an average. It can be less or more but it’s something that you have to commit to otherwise it really won’t work.
END OF SESSION 10 AUDIO

COURSE 2, SESSION 11
“Nursing Home = Safe? Community = Dangerous?”
Mike Oxford

I mean this whole notion, this dichotomy, nursing homes say community dangerous, where did that come from? Where is the evidence? Where is the proof that abuse and neglect exploitation is any higher in the community? In fact, all I could find is it’s higher in the nursing home. OK, so where this notion ever got that you get 24 hours of anything, wrong We now know from CMS now, they did a study on averages - - less than two hours of any kind of hands-on assistance per day in a nursing facility. You get less than 20 minutes on the average of actual nursing, the rest are the…. pardon me, five minutes of actual nursing. They run down the hall with a clipboard, checking boxes. You don’t get 24 hour. You get less than two hours. You get five minutes of nursing and the rest is like aides and so on, you know, doing very minimal things. You have to look at what are the services provided? I don’t care where, I don’t care under whose roof, what are those services? Assistance getting out of bed, assistance eating, going to the bathroom - - the services are identical. You can get skilled nursing in the community. You can go to the doctor in the community. You can get therapy there. Most Medicaid programs pay for all of that. You don’t have to be in a particular four walls and a roof to get the healthcare and the nursing and the therapy and the rest of the services that you need. The actual service is identical.
END OF SESSION 11 AUDIO

COURSE 2, SESSION 12
“Low Cost Resources”
Mike Oxford

Finally, I am going to go through some things that we do and putting things in place without money. You know, we call it scrounging. We get things donated. We go garage saleing and stuff and we store it in a warehouse. People give us pianos, stair glides, shower benches, wheelchairs, beds, televisions. We have gotten a whole bunch of, this is really ironic, we have gotten a whole bunch of hospital beds and some TV’s and stereos and stuff out of the state hospital as they closed it down and it’s a very good thing because they closed it down and the stuff that is still good there goes right out into the community. So we get it. We got to pick up with a Tomy lift, one of those hydraulic tailgate things, and we go and pick up this stuff. We store it and when someone needs it, we give it to them. Another thing that we found, by accident, is hotels are always rotating out beds, furniture, televisions and so on. Ask them. A lot of times it goes to the dump. OK, but if you work for a not for profit, they can give it to you. You can write them a tax deductible receipt for the value of that donation and so they get a tax write-off. They feel good about the community. We are expanding our ideas and promoting ourselves in the community and people get good stuff for nothing and so it’s cost effective and so that is really a way to do that and help mitigate those costs because we get no money at all and no support from the state or federal government to do this and so we have had to figure out how to do this with a no or a low budget. Now then, what we do in terms of marketing and getting the word out is, I have these, they are on the front table. There is two versions, one is whatever that is, cream color, and then one is a darker brown and these are in here just to take a look at. These are the basic questions and concerns that we have gotten from people and their family members, over time, and so we looked through them, in very plain, kind of common sense, easy to understand language, and its got pictures of different people that we have assisted with moving out of institutions, - - all races, all genders, all ages, from different kinds of institutions ranging from a mental health institution to a nursing home to a state hospital, so a wide range there, and just real quickly to go through the stuff, you can read it, how much is it going to cost, who is going to pay for this. My home is gone is now, how do I find a house. I had to sell it. You know, umm, what if, what if, you know, I use a wheelchair, how am I going to find a place I can get around in? My family says I’d be safer in the nursing home. These are all the things that we have ran into and so we printed them up with pictures of some of my staff and some of the people we have helped moved out. As basic information it has been very effective for marketing and what we do is we place these with hospitals, rehab facilities, some of the nursing homes if we can, state officials, case managers, and so on and we keep these sprinkled around so people can grab them and look at them. Been pretty effective there and then it’s got our contact information on it, additionally we have developed, which is in your packets from yesterday, there is two sheets, one is just blank, a volunteer helped us do this, what it takes to help someone move out of an institution and then on the attendant side, one of my managers, Alan Jensen, called this Operation Escape and basically it’s just a checklist of basic information that people will need and basic supplies and supports that are needed - - a safe place to live with utilities on, attendant recruited and in place, you’re eligible for services or not, people have been informed of their right to self-direct their services or not - - if Adult Protective Services is involved, and often times there is, we have to coordinate with them - -and then essential supplies: you need a bed, a set of sheets, a blanket, a chair, a table, a refrigerator, a stove, basic pots and pans and stuff like that that we get in place for people, almost like a care package, if you will forgive the term, that would do the basic essentials to get started, to get someone moved out.

We only have about five minutes left, and so…
Yeah, so that is basically, you know, what we have been doing. I will tell you that last year we prevented 1,190 people from entering nursing homes and other institutions and I think we helped about 14 people move out, a little more than one a month, around one a month. It’s very slow. It seems like not enough, but one a month is actually quite a bit and finally, just I want to go back, you got to remember this, because if you look at the whole big problem - - we need 40,000 housing units, we have got 18,000 people who we think would qualify for community services - - you’ll never get started because it’s too big. It has to be one person at a time, one individual at a time with one individual plan for independent living, for services, finding one house or apartment at a time and so on, and then it’s very manageable by anyone, one person at a time. We often times get overwhelmed. Well, 40,000 housing units isn’t going to happen, I guess we can’t do this. You can find one unit. We even help people relocate within the state or outside of the state if housing or other services are an issue because some times you can’t get housing in the little town where you live but if you move to a city, you could, and we make that option available to people. It’s all about information and options for individuals.
END OF SESSION 12 AUDIO