KATHIE KNOBLE-IVERSON: um, I'm going to talk a little bit about, we are in the middle of some wonderful opportunities that sort of fell in our lap. And it's an expansion of mental health services contract or a pilot program was let, two of them in Wisconsin and our local, one of our local counties that we have a really good relationship with got an expansion grant and they are expanding mental health services into two rural counties and they're going to be the lead administrative person site and they're going to expand comprehensive community services, which is skill training for people with mental illness, crisis management, a whole bunch of alternative services that don't exist right now in those two counties. I got asked to be on the advisory board. So, this is the one I said I just know so much more about what's going on because I'm on that committee than the competitors in our region. I have to keep my mouth shut when I'm at the meetings and not get real excited when I hear something that's going, we can do that. I have been able to plan so much better at our agency about expansion. We set up some goals for a branch office. I told you we've been trying to develop a branch office, a third one, for ten years. And something always got in the way. This is going to give us our branch office finally. We need several branch offices, but this is a real accomplishment for us. We did write $150,000 expansion grant to the Otto Bremer foundation. They've done two site reviews at coming in like what happened yesterday. The funder, the buyer or the foundation came in and would not tell us why, they said it's a site review. They wouldn't give us the questions. So, three of us sat in the room and got grilled for an hour about what our plans were, even though it was all in the application. We had to answer lots of questions about what we plan to do with this money. They came back the second time and wanted to know why we asked for so much. That was the only question they asked us. And then went on to talk about the fact that wouldn't it be nice if we had our own building? We would love to have our own building. This woman that showed up said, we would love to do a capital campaign with you folks. Just remember, we do capital campaigns. And we love what you do and we would love to help you get your own building. And that just fell in our laps. So we're really excited about that. We are looking for free, actually we just secured, I just found out yesterday, we secured free space for an office for a year in that area. And we will be providing comprehensive community services in the two counties. They're very low population. So this office we're setting up is an IL office and we also serve about 15 or 20 people in those two counties with personal care. So we're going to be cross training a staff person that's going to go there. They're going to know how to do personal care intake. So part of their wages will come out of our personal care program, and part will come out of IL. Probably about 90-10. 90 will be IL, ten percent personal care. We're also going to put a community-based skill trainer there to respond to the referrals then for skill training. So we'll be training a peer specialist and will be training an IL specialist. We also found out just the same week that we were doing this that two other counties that are very far away from us, they're the farthest counties away from our offices are going to do the same thing. They're going to expand. And called us and said, this is what we're going to do and we really want somebody from your agency at the table because we don't know what we're doing. And the county that likes it said, you need to have Kathie or somebody else at the table because they can help you get where you need to go. So that's, we're going to, again, up there and do a training specific to those counties so that they have some people who are trained peer specialists and they've also offered us office space. We don't know how much that's going cost yet, but that's down the road. I know we don't have the funds to, on a long-term basis, to maintain a fourth office at this point. Some of our expansion goals is that we would really like to have our own building. Our current landlord has sort of priced us out of the market and we're out of space. So at some point, we're going to need to do a capital campaign. We also need to develop staff to provide specialty services. We have such a demand for the 504s and the benefits specialists, work-related benefit specialists that, it's a load. If one of those staff would get sick or quit, we'd have some trouble responding to the demand. So over the next two years, we're training another benefits specialists and two ATPs. And those are the Assistive Technology Professionals. Because they also do the 504 assessments. And I have the ATPs in there and the benefits specialists. And we've been asked if we would develop two more drop-in centers. One in each of the counties. Probably won't be open full-time, but we've been asked to do those. And that will be based on how much funds are available. And then we'll go to work trying to supplement those funds through foundations and other things in those counties. You really need to use your strategic plan. Visit it. Change it. Our strategic plan is very fluid. If things change, and you all know, things change. Budgets change, politics change, people leave positions where you've had really good relationships and somebody you don't know comes in. So visit that plan and change it based on what's going on around you. I think ahead. Don't get bogged down in what's going on right now. This is one of the things I always tell everybody is that I typically am thinking at least two years out about how a decision is going to affect the agency in the future. I would really encourage you to do some sort of review of your agency to stay on track. Whether it's a peer review, an internal review. I don't know how many of you know what SCORE is. It's a national association of retired business people. There's all sorts of folks out there who are willing to take their time to come in and give you some feedback about what you're doing. The thing about a peer review is it's nice because people get IL. And if you bring a business person in and it takes them a really long time to go, what do you guys do again? It's helpful. But if it's about becoming more of a business, sometimes that's refreshing that they come in and go, oh wow, you really need to change this. This is not a sound business practice. I would encourage you to somehow get some feedback about how you're doing. It also helps you stay on track. Back in the back? AUDIENCE MEMBER: With your grants for programs, are you able to establish those for numerous years or are the funding periods just for a year or a couple years? KATHIE KNOBLE-IVERSON: Are you talking about contracts? AUDIENCE MEMBER: I'm actually talking about a grant to a foundation, KATHIE KNOBLE-IVERSON: Depends on the foundation. The Bremer grant will give us two years to spend the money. Our local foundations want everything spent on their fiscal year. So if you get something in July, they'll give you to next June. If you get something in September, you got to spend it in nine months. AUDIENCE MEMBER: Yeah. Generally, each grant gives you a year to spend it, but do they allow you to reapply numerous years or is it just, KATHIE KNOBLE-IVERSON: It depends on the foundation. That's one of the things. They should have a website that tells you all that. If you get in and start to research, our La Crosse community foundation does not want you to apply if you currently are spending some of their money. So you have to wait until it's spent. They're one of the easiest foundations we've ever worked with because if we had a hard time getting some start up going or something change, we just have to send them a letter and say we'd like to extend this money three months into the next year because we've had a difficult time spending it. Now, that locks us out from applying for the next year. And we knew that. If we're spending any of their money in that year, you can't apply. That's about the only rule they have. The reporting is so simple. They want to know if you spent it based on what you said you'd spend it and they want to know if you met your outcomes and how that affects the community. AUDIENCE MEMBER: My concern with some of the program grants is that, yeah, we'll assist you guys for a year, you can apply again up to three years, but after that, we want you to find other funding. KATHIE KNOBLE-IVERSON: Yeah. Foundations aren't typically going to fund something forever. Most foundations are really excited to purchase bricks and mortar, to do start up, to do something like a one-time thing. If you wanted to do a community needs assessment because your United Way doesn't do one, they might fund something like that. We never count on foundation funds. DENNIS FITZGIBBONS: No. And in recent years, many foundations have gone into sustainability. If they're giving you money, they want you to develop a program that is going to then be sustainable without their funding and it may be in one year, may be in two years. But I don't think you'll see much beyond that. They want to see immediate results. AUDIENCE MEMBER: And one more question. So how do you guys, with your expertise then build in the sustainability after that money goes away? KATHIE KNOBLE-IVERSON: That's sort of what we're talking about here. We apply for grants to help us with start up for things that are fee-for-service. Typically. Or we ran into an issue. We wrote a grant to get six new computers because we didn't have them in our budget. And we got a virus that wreaked chaos on our agency. We had to have them. So using foundation money is for unexpected things. We try to plan how to use that foundation money. And the whole idea is when we apply, we put our sustainability plan right in that ask. So that they know we're going to sustain that program. We're just using their money to get staff trained or to get into a building or to purchase a car or whatever it is to help us get that program. It's a kick start. AUDIENCE MEMBER: Thank you. That's really helpful. Thank you. KATHIE KNOBLE-IVERSON: Okay. In your organization, to add planning is a routine part of your culture. Sometimes you get really busy. I know it's happened to us. I'm going, oh, goodness. It's been three years. We need to have our plan renewed. And it takes time to do a good plan. And I really encourage you folks to have agency dreams. We want to own our own building. We want to have at least two more regional offices and if you don't dream, you're not going to go anywhere. We do something really fun every year. We do some really fun things with our staff. We rent a bus and, out of our own money. Not federal money. Or state money. And we've only be able to do this since we've put a little money in the bank and we know it's clean money. And load people up into a bus and we go to a local lake and spend the day there. But we spend the first two hours in the morning coming up with really wonderful wild ideas that people would really like to see happen for people with disabilities in our region. DENNIS FITZGIBBONS: Interesting. We do similar things. We have cookouts, we've gone on lobster bakes, taking the ferry out to one of the islands in the harbor and things like that with all of the staff together, sometimes along with the board and use it as both the brainstorming event but also a time to sort of celebrate about who we are and what we've done over the course of a year. KATHIE KNOBLE-IVERSON: It's really hard in a center when you're super, super busy and you don't have a lot of money, you have to be creative about how to let your staff know that you appreciate what they do. And I was raised in a family where no news was good news. If you're doing, I didn't get a lot of kudos and that's probably one of my biggest flaws. And this past eight or 10 years, I've had to figure out how to express my appreciation for people and how to change, I didn't like turnover in our agency. And I want people to be there because they want to be there. And so we've really changed our environment there. And I've had to learn to how to say, you guys did a great job. People don't care if they're making $60,000 a year if they're really happy with what they're doing. DENNIS FITZGIBBONS: Yeah. Got to find ways to reward people and make it fun. KATHIE KNOBLE-IVERSON: Is this one yours or mine? One other thing we'll talk about is that you need to maintain awareness of the market changes. DENNIS FITZGIBBONS: Doesn't look like mine. KATHIE KNOBLE-IVERSON: Okay. Make sure your staff continue to participate in community groups. You've heard it, heard it, relationships, relationships, relationships. Keep people and if somebody leaves or gets tired or going on a, having lots of babies at our center, so people are gone for 90 days. Make sure somebody else goes to those meetings and you maintain that relationship. Stay connected with your vendors. And that's really important. And we talked a lot about this outside of our presentations is, you need to sort of decide how much you can tolerate when a vendor is sort of pushing back or a collaborator is pushing back. You need to just try to find what you have in common. And work on that. And sometimes you can make great changes in other organizations if you have a nice relationship with people. We have some vendors, some of our, we just go back to our agency and we're just so upset with some of the changes we're making or some of the demands we're making and I tell people, okay, you can do that here. That cannot show when you go to a meeting. You have to go there and you have to say, okay. I understand you have to do this. What can we do to help solve this problem? What can we do to change at our organization so that this is easier for you to respond to the people that are pushing you to get this done? We did that with our local VR and this has changed our relationship immensely. Doesn't mean we don't complain about them once in a while back at the office, but that's done in private. And everything else, our relationships with them are great. Now they do all their staff meetings at our agency. Have a great big conference room. They come there. Every time they come, we get to go in and have an hour and do a presentation about what the coolest thing is that we're doing at the organization or services that they could provide to their consumers. If you don't have a state association, try to see if you can't get together with other centers a couple times a year and talk about the things that you have in common or that another center might be doing well and share that. And things you're doing well. We share everything in Wisconsin. Forms, curriculums, anything that, and it's just automatic. It just happens. And that has been, we're the newest center in Wisconsin and I couldn't have done it without my seven peers. They were wonderful. Every time I ran into a problem, I was able to call somebody and they helped me through whatever problem I was going through and that's endeared them to me. It doesn't mean that we always agree. But our agreement is that if we disagree, it's just like complaining about VR. It stays in our group. And once we leave, we're all smiles and happy and we agree about everything to the public. And that has taken us a long way in Wisconsin. And to maintain your relationships with DHS and your state DHS and vocational rehab. Go to purchaser meetings, buyer meetings, even if, if you're curious, our county has every quarter, I didn't know this until we started having contracts. They have a meeting every four months for anybody that has a contract with them or the general public. You can go in and you can find out what's going on with their budgets, services that they're interested in developing and it's a really nice opportunity to go in there and, we could do that. And lots of times all you have to do is say, I'd like to be your vendor. And they'll send you their requirements and you can start providing services as soon as you do a contract. If information is public, ask for it. Once an RFP is done, everything is public in Wisconsin. I don't know if it Is in all your other counties. You can get a copy of anybody's RFP. And with computers and everything, it's just so easy to get. The last time we did an RFP that we didn't get, I asked for all the copies and I needed to figure out why. Next go around, we got the contract. So it was really helpful to figure that out. Cross train with your competitors. We invite our competitors to our agency all the time because we want to know what's going on with them in their organization. We get their newsletters, they get ours. We monitor, if they have a website, Facebook, Twitter, we stay connected with what's going on with them that way. DENNIS FITZGIBBONS: Okay. Interesting, listening to Kathie's presentation and watching the slides here and thinking, our presentations are very similar. So to begin, I would say we want to continue, or you might want to create a culture of engagement, where everyone in the organization is engaged in analysis and generating ideas. And Kathie's talked about that. It's very important to us at Alpha One that it's sort of an open door type of thing, and there's always that process where someone's got an idea or they see a solution to something that's been bugging them that they can take it somewhere and it can go and we can try to use it as a means of creating a program or improving a program or whatever it might be. A recent example was in Maine, we've had a brain injury association for many, many years and they've been funded through the Department of Health and Human Services but their funding has shrunk completely to the point it disappeared in the last six months. No longer any funding whatsoever for the brain injury association and network. And they were trying to cobble together information and referral and other resources for people and their families who have brain injury. And they need to find a home for this particular function and they came to Alpha One and said, would you be willing to take over brain injury information and even though there was no money attached to it, we said yes, because it fits like a glove within our mission. It's a disability. Why wouldn't we be doing that? So we agreed to do that. Right away, I didn't realize we had hired someone maybe six months before that who has a deep affinity for brain injury. And I'm not sure where it comes from, but he was so excited that we were now doing this that within a month, he said, we should be doing a podcast. So now we have a podcast called Brain Matters, which you could access through our website, which is really nice because I wouldn't know where to start a podcast if I fell over one. But now we've got a young person coming on and that's exactly what they want to do. And so there's people tuning into this thing and that type of thing that goes on that's exciting. Again, someone who's stepping forward and said they want today do that over and above his regular job description of things he's already doing. The marketplace is constantly changing and evolving. I don't have to tell you that. So that means there are always opportunities as a result so we're always seeking new solutions. A great example of that right now is the Affordable Health Care Act. You could look at it as a threat in how it's going to impact health or you can look at it as an opportunity for independent living. And I believe it is an opportunity for us. The government and private sector roles and rules are constantly being revised. Been a lot of talk about managed care here these three days. Had a big impact and other things will continue to do so. Cost effectiveness creates opportunities. And I think that's one thing independent living is fantastic at, being cost effective. We know how to deliver services for as low a cost as we can do it without giving it away. And I compared this for those of you old enough to remember the old Miller Lite beer commercials, tastes great, less filling? That's independent living. Tastes great's our philosophy, less filling's the cost effectiveness. And I think that's what we continue to excel at. And the market's always looking for cost effective solutions. The changing market, the Affordable Care Act is fundamentally transforming health care in America. So what are the lessons that IL knows and has that can be applied here? I believe that they're there. Our experience and Self-direction fits like a glove with ACA. The expectation of ACA is that the individual receiving health care is going to be deeply involved now in making the decisions around services of, from their doctors and other affiliated sources because they want that involvement so that you take personal responsibility for your health care. You got more skin in the game. The old model was, you went to the doctor and did whatever they said to do. Or you saw a commercial on TV about some pill that looked good and you want it, so you tell your doctor you want it. That's going to end with ACA. There's much more accountability there. And we know personal responsibility and accountability. So we got something to offer ACA. Advanced technology is when within almost every person's grasp and reach now. How can we use it to continue to promote independent living? I can't show you directly because it's a cell phone. But if you go to our website, you'll see that there is an Alpha One app. So we decided to experiment and create an app. It's free. It's available either through Apple or what's the other thing? Android. Sorry. I'm so hip. Anyway, we have an app. It has our website on there, news stories, that would be from our website. I think you can get our podcast through there. And various things that would be on our website. And it's just another good tool to use, people can use it to stay in touch with things with us and we can use it to promote things. And far many other things like Twitter and all those things I know nothing about. But I also know there are many, many apps now that you can use for your self-care management things, about being well and staying well. And those things, the market is wide open for us to develop things that may apply to disability. And I think you can develop an app with the investment of just a few thousand dollars if you got a person who knows how do that. We developed this in-house. We didn't go anywhere to do it. Just had a couple geeks on staff who knew how to find out how to do it. KATHIE KNOBLE-IVERSON: And there's apps out there for everything already. That's one of the things, new services we're going to sell is we're training transition-age kids how to use apps effectively to help them be more self-sufficient. And that was an I&E project that we worked out, innovation and expansion project we just worked out this year with our local VR office. And so we wrote a grant and went out and bought a bunch of tablets and we're working with three schools and said you need to get your tablets and get those ready and find us some kids so they're sending us all their seniors to start working with these apps and we're hoping that we can start with kids that are younger in the future. But eventually, we will get paid $65 an hour to do that. DENNIS FITZGIBBONS: And it's also a great tool for, go ahead, question? AUDIENCE MEMBER: Are you guys teaching the classes living and working well with disability and used that in a for-profit stream? DENNIS FITZGIBBONS: We haven't done that for maybe ten years, but we're looking at going back to it and trying to work that into some of our ACA ideas that we have. I don't know about you, KATHIE. KATHIE KNOBLE-IVERSON: No, we are working on that, a couple of the centers in Wisconsin are doing that. They haven't had, again, it's one of the ideas we tried to get all the centers to do and it just died in some centers. You get into rural centers and it's so hard to get groups together outside a community. Unless it happens at school, right afterwards and then you have transportation issues, so it didn't work very well for us. Once we got outside of La Crosse. But in Milwaukee, it's fantastic. They serve like 600 kids a year through that process. AUDIENCE MEMBER: And they were able to access schools and stuff to teach the living and working well? KATHIE KNOBLE-IVERSON: Actually, the kids come to the center. AUDIENCE MEMBER: Right. Thank you. DENNIS FITZGIBBONS: Again, so it could be a great advocacy tool. We know some of you are already using Facebook and things like that. We have seen the Arab Spring last year or the year before, and how social media really changed governments across northern Africa. So the power of these tools is amazing and if we can capture that with the IL movement, imagine the kind of systems change we can accomplish in our own states or around the country. We have likely seen the high water mark for direct government funding for independent living activities. How are we going to respond to that? And something I think, Kathie talks about looking years ahead, a few years ahead. I think independent living needs to look ahead to a future where there may not be any federal funding for independent living. And what does that mean for us going forward? Because no one seems to be writing a lot of extra checks these days from government resources for anything that we do and we need to become better and better at looking for the means to pay for what we do for consumers and our communities. The competitive environment, I have convergence as the emerging paradigm. What a big word. I would say collaboration is the emerging paradigm. And we want to be creating new partnerships and new approaches. The last few years, we've been working closer and closer with many organizations. Two in particular would be the Area Agencies on Aging and their Aging and Disability Resource Centers. For many, many years, we've all sort of led parallel lives, but not really worked closely together in the last year plus with money follows the person and other opportunities like that. We've started to partner quite a bit. We're doing cross training, we're actually working with one of the ADRCs to look for a way we can apply for a grant together and partner on things. It's a lot of partnering going on in that community, which ties in great to the aging of Maine, which now has the highest per capita age of any state in the nation. We're a very old state, truly. And we're only getting older. Makes sense to be looking at how what we do in independent living can be applied to that population. A lot of that was talked about yesterday by many of you. Another thing that we haven't done and we are doing more of in the past year is reestablished a close relationship with our protection and advocacy organization in this state and I don't know if any of you guys have good partnerships that way, but, again, we sort of led parallel lives and because they're sort of in the protection and advocacy and sometimes one of our consumers may be going to them because they've got an issue with us, so we now sort of had a distant relationship. We've gotten beyond that and we want to work closely together and collaborate where we can and that's really paying some immediate dividends that we've had referrals for, access design services and communities and that the P & A have had complaints from and they've been able to refer us to go and work with, say, a school system or someone else to help them get themselves in line with what the rules and regulations are around access. KATHIE KNOBLE-IVERSON: We have always had a really wonderful relationship with our P & A office centers. They've been like our ninth partner with all the centers. But something interesting is happening in Wisconsin. All the complaints about managed care start out at the centers. And our P & A will take the systems, things that are more systemic or are looking more towards a class action suit and so we had a meeting with them. They have a new director, they had some turnover and he came to our state association meeting and said that he really wants us, they don't get to count all the advocacy we do for family care to help people maintain their services or get more services or go through their appeal process. They only count what gets to them. And 90 percent of what happens in the state happens in the centers and it never gets counted as advocacy happening. So the new director said, I want to ask a favor. And he wants us to document that. Because he's going to go after more money saying, here's what's happening on the ground. And that money's going to come to the centers, not to them. Because he feels awful that you feel they can't pay us for all the work we're doing. And so, it's those kinds of partnerships, probably going to take a couple years. It's that kind of thing that can just happen and it took a different director than was there before. But the director that was there for 30 years had that same attitude, that you're our partner and if we can bring in money to support what you're doing, we'll do it. DENNIS FITZGIBBONS: Also, differentiation between the public sector and the private sector providers is diminishing, creating new competitors and new opportunities to compete. Think we heard here in the last day or two that for-profit entities are now competing in what has been historically an arena that we've had to our ourselves or at least to other non-profits. That works both ways. If that can happen to us, why can't it happen that we can compete in the arena where for-profits are competing. And it's not impossible and it can be done because as the next one says, successful ventures do not stand still. We need to always be looking for the next opportunity and be ready to move and adjust as we go forward. Technology can give you the edge or unmake your organization. If you can't access the data and information you need to control your costs, to know what your outcomes are, et cetera, then you're going to be in big trouble. If you can do that, then you can be ahead of your competitors and always stay a step or two ahead of them. The road ahead for Alpha One looks like this: we're committed to engagement with the health care system being transformed by ACA. We are encouraging ACA organizations to utilize the principles of self-direction to maintain quality and cost effectiveness. They want active consumer participation. We know active consumer participation in independent living. So we have something to bring to the table there. Supporting the emerging network of primary care, that is going to drive health care practices will guarantee equal access to facilities and services for all consumers. Here's an opportunity for access consulting services. The health care system, most hospitals are great in terms of access. I don't know about where you live, but we've still got a lot of rural centers, a lot of rural dental offices, doctor's offices, whatever it might be. And many of them are not fully accessible. Many of them are not accessible at all. But this is really one more opportunity because of the changes in health care to take advantage of that and get out there and drive for full accessibility. Promoting technologies that increase consumer control and informed decision making about health care options and alternatives. Again, it's that repeat of using technology, whether it's apps, telemedicine, Skype, for direct communication with providers and I think, again, there's a great fit here for wellness and prevention in that program you were talking about over here earlier. Things I didn't write on when I created this were a couple other things. We see aging opportunities. I've mentioned we actually have already taken some first steps in diving deeper in serving the autism community. That's a growing population of people as well. Young people in particular with autism are struggling with that transition from school to work or college, et cetera. And we get more and more feedback about the gaps in services that are out there. So we've actually started to apply for funding on that. We've hired a young man part-time to actually create a virtual community for us, again, using the new technologies because we believe that that's a better fit for people with autism. They'd rather communicate using these tools than face to face often. And because of the distances in Maine, that's going to overcome that in terms of travel. KATHIE KNOBLE-IVERSON: One of the things I would encourage all of you to do is go back to your state and find out if there's been a change with the children's waivers. I believe it was a federal change. I don't believe it was just in Wisconsin. So I would see if you can go back and find that out because that could open doors for you for all sorts of things. Whether it's services for a particular population or accessibility surveys or whatever. But then you got to find out that it's out there. And then you have to go in and develop that relationship with your local DHS if you're able. You don't have to be Medicaid certified. The counties typically would bill for that. They would pay you and recoup the funds. In Wisconsin, we have to bill WPS. But that's just a real new thing. That just happened in Wisconsin in the last six months. DENNIS FITZGIBBONS: Good suggestion. Another one, this is where we diverge. You want a building, we want to sell ours. We've had our building. We bought it around 1990, '91 and 1 of the things we learned during the economic downturn was that money became really tight. And all other resource were tied up in a building that we couldn't use. We could use the building, obviously, but while we had money on the books, the actual money was the building and the property that we owned there. So we couldn't use that money and resource to invest in services, invest in people. Whatever we wanted to do. It was too tied up to get to. And we couldn't sell it because it had lost value during the recession, so we didn't want to take that approach either. My goal before I retire in the next few years is to sell the building and move from where we are in South Portland, which is a medium sized town by Maine standards and move to Portland, which is the largest community in the state, just across the river. That's where we ought to be so that consumers can access us easier. We're very hard to get to now. We want to be on the bus routes and public transportation so we can do things more actively with the consumers in the city and have it become more a showplace of what we do. We're too remote where we are. So that's a goal that we have. Not that you shouldn't get a building, but you might want to think twice. Further down the road, we believe we'll continue to look at the private disability insurance market because they are facing increasing performance pressures and I think they're looking for a differentiator in the market. I still think that what we've been successful with in the past with Prudential and others is a way for them to differentiate themselves from their competitors. Unfortunately, it waxes and wanes with these companies so it's hard to get a real strong foothold, but I still think there's a solution there that's worth pursuing. Another one is that we really recognize that consumers experiencing memory loss and dementia are increasing at a significant rate, which calls for new approaches and resources to meet this situation. And Alpha One wants to be a part of this multifaceted solution to this emerging challenge by applying IL philosophy and models to serving people who have dementia or memory loss and some things could be things like advanced directives on how someone wants to be cared for or interacted with when that occurs. And when it does become an issue of dementia, et cetera, how do you honor choice and control for that individual going forward. And I think that there's a huge need there and I think there's a role for Alpha One in that that we'll be pursuing as well. KATHIE KNOBLE-IVERSON: Part of our assistive technology program, we spend a lot of time researching apps and assistive technology specifically for that population. Memory loss and dementia. We get lots of mates that come in, the husband or the wife, and they really want to keep them at home as long as they can. They don't want them to go into a nursing home or into the assisted living site and so a lot of what's happening is we're able to help them until it's absolutely necessary and they skip that assistive living portion of it. Because we helped them figure out how to get the assistance they need to keep them at home. And typically that's a free service that we offer. We haven't figured out how to get that paid for yet. But we help a lot of folks stay in their homes that are aging. Any questions? DENNIS FITZGIBBONS: Yes? AUDIENCE MEMBER: I'm not sure that this is really a question, but kind of a comment on your last statement. In Los Angeles County, we have about 10 million people living in our county. We're the largest county in the nation. It's like a country. But one of the things, we're in a pilot project right now with the managed care and the rest of the country's going to be getting this where they are emerging people that are on Medicare and Medicaid and we have just been offered contracts with some of the health plans to do independent living services for them. It's not a lot of money per person, they're offering us $120 per person per month. But they're assuming that that's about two hours of work a month with them and these are ongoing people. The pilot project has 200,000 people going into it, so it's a tremendous opportunity for us right now if we do it right. And I think in the future, this is going to open up for the rest of the country and there are other pilots going on across the country, but this is the largest one. And we've been involved in this for about a year and a half now, but I think that it will be hitting and I would like to encourage people to really get in tune and pay attention to what's happening with it because it's coming. KATHIE KNOBLE-IVERSON: Yeah. Managed care is going to happen, I'm convinced it's going to happen everywhere. And if you're not ready for it, you'll be left behind. Managed care has to pay for institutionalization out of their per diem that they get and they don't want to do that. This is the place we're hoping we can get paid if a person's part of the managed care entity, we can get paid to help with the assistive technology to keep them out of the nursing homes. They might be paying $600 a month for supportive home care to keep somebody home or for respite for a partner who's caring for their spouse and assisted living is going to cost 3,000, $4,000 a month. And a nursing home's going to cost six. That's the partnerships that you have to start looking for is, here, we can help you with this. We can help you avoid that kind of expense. Richard? RICHARD PETTY: I just wanted to use another name for what's going on in Los Angeles that it might, some of you might not have picked up on. It's the dual eligibles demonstration projects and HHS and CMS are working to reduce the extremely high costs that they experience with people who are eligible both for SSI and SSDI. And so yes, there are pilots and yes, look for those programs, projects in other areas of the country. There may also be an advocacy role for centers here, but definitely something that is emerging and very much on the horizon. KATHIE KNOBLE-IVERSON: There's a pilot in the Wisconsin that’s targeting dual eligibles. I hate that term, but that's what it is, that have mental health issues. And the whole outcome, the whole focus is to lower the hospitalization rate. And it's been very successful. It's up in northern Wisconsin in 13 counties I think. And it's been a very successful pilot, but we don't, nothing's happening. Typically when you get a pilot and it's successful, they replicate it or it starts to move, we haven't had anything else happen in Wisconsin. So any states aware of a dual eligible program that's targeting folks with mental illness? Yours is elderly? Or any disability? AUDIENCE MEMBER: It's anybody who's on Medicaid and Medicare. KATHIE KNOBLE-IVERSON: Anyone. AUDIENCE MEMBER: Any age. Yeah. And the services their asking us to do are not necessarily medical and not necessarily deinstitutionalization, they want to keep people out of the emergency rooms. And they're recognizing that they have to have homes and they have to have transportation, they have to have food and stuff like that in order to exist in the community and they'e starting to see us as the resource that they know nothing about how to find non-medical services. One of the real advantages for us is we got to the table early and we started saying, here's what we can do. And that's what I would encourage you to do. As soon as you hear any meeting is going on, get to those meetings and get to the table. KATHIE KNOBLE-IVERSON: Yeah. In the pilot in Wisconsin, they're getting four hours a week for each person. And it is the misuse or abuse of emergency rooms. Which, a lot of times, with folks with mental illness, then they automatically enter into the psychiatric setting. And it's really changed how people get the support they need. And they use peer specialists in that situation. DENNIS FITZGIBBONS: Question over there? AUDIENCE MEMBER: I want to be clear. Richard said SSI and SSDI. My understanding of the duals was Medicare and Medicaid. So I just, I wasn't clear if there was something I was missing. KATHIE KNOBLE-IVERSON: It's Medicare and Medicaid. AUDIENCE MEMBER: I'm sorry. It's the same? DENNIS FITZGIBBONS: Medicare and Medicaid. AUDIENCE MEMBER: So I'm glad Dennis, that you mentioned the ACA and the ADRC initiative because it's got a lot of opportunities, but it's also had a lot of headaches for the CILs. So I'll just kind of give a little bit of background to those that may not know. So Maryland is adjusting to this Aging and Disability Resource Center initiative. They're collaborating with the local Area Agencies on Aging to enforce this no wrong door approach to accessing services. And one of the concerns for the CILs is how to continue to fund these co-location arrangements and the provision of this enhanced options counseling service when federal grant funding ends. And one of the suggestions for sustainability has been private pay. So my question is, Kathie, I know that Wisconsin is one of the Part A grantee states. So how is this initiative affecting your CIL and then also for both of you, how do you perceive a private pay model as being feasible to your CILs? KATHIE KNOBLE-IVERSON: In Wisconsin, in our service area, we have 15 ADRCs. Yeah. Two in one county and, must be 14. 14 ADRCs. We have wonderful relationship with them, but when they started out, we were at the table when managed care came. That's the other thing. If managed care is coming to your state, get at the table. Because there's all kinds of options for advocacy issues in the development of managed care. In independent living centers, we applied to be the ADRCs. It didn't happen. They are housed in counties. The counties manage the ADRCs. That's the firewall that they created because the managed care entities are independent. They're not part of counties. We thought for sure we were going to go out of business. That we weren't going to get I&Rs. We responded in a small region to 5,000 I&Rs last year. We have a wonderful partnership. We were right there when they developed them. We know what their areas of expertise are and that's access to managed care. That's their expertise. They know nothing about assistive technology. They don't know that much about benefits. So they added a benefits specialist, but it's to help people apply for benefits. They know nothing about how work affects benefits. So we get referrals from them all the time. They know when people aren't eligible for managed care and they still need a service. And if it happens to be personal care, we get a referral from them. So in Wisconsin, there's not going to be an opportunity for anyone to charge because it's already mandated that it's a free service for anybody in the state. You could not be eligible, but you can still go to that door and they will do an assessment and talk to you about all the resources that are there. But it's really locked into the resources that are managed care. So we are like number one on their list as far as in the ones that we have a great relationship. There's a couple new ones that developed on our border counties that are from another area that they cover part of our county. We don't have such a great relationship with them yet. And we're going in there and saying, you need to tell people we're here. Here's what we can do for them. One said, you just provide fluff services, right? And it's like, no, once they've seen that we can do advocacy, ADRCs can do, in Wisconsin, at least, can do a little bit of advocacy and it's very limited. Once something gets beyond what they can do, we get that referral too. And of course we don't get paid for that. AUDIENCE MEMBER: So has the increase in referrals affected your funding since IL funding is finite? KATHIE KNOBLE-IVERSON: That's why we continue to try to make money on other ventures so that we can respond. We have weeks where we have to tell people it could be four or five days before we get back to you. Sometimes we get inundated. Sort of depends on what's going on in the area. The month we send out a newsletter, it takes us a month to get caught up because people think about us again and get connected. It depends on what's happening at the ADRC too. They lost their benefits specialist for a while. They were sending everybody to us. And we just had to say, you have to stop doing this. This is your job or you have to pay us for it. And they tried to recruit our benefits specialist too. And thank God he didn't go there. We have a really nice, we meet we them all the time. We have a really nice relationship. But there's no money in the game at all for us. And yes, it has increased our workload. DENNIS FITZGIBBONS: I see there's another question, but quickly in Maine, I think the ADRC network is different. The ADRC are actually in the triple As and there was no RFP put out to anyone to apply or land a triple A so it was a done deal by the Department of Human Services. So we've been fighting for a place at the table for the last two years and pushing and pushing and pushing asking the department to name us or designate us as an ADRC, which is not a welcome piece for the triple As because they want to sort of corner that market. While there is no continued funding for that, I believe there are continued opportunities that come for that type of service and that's why we want to get involved and work together on that.