Ray County Services increases workload

The state’s Division of Mental Retardation and Developmental Disabilities is shifting the case manager workload to local entities, including Ray County.
Parents of children who receive services for developmental disabilities packed the community room of the Ray County Library last Wednesday to learn how services for their children would change.
Kansas City Regional Office Director Jerry Carpenter told local consumers the only changes to their services should be positive changes.
Carpenter said the division is changing the focus of the service it provides by shifting from a case manager role to an administrative role that will focus on standards and quality of services.
The division’s focus began to change in 2006 when Gov. Matt Blunt appointed the Mental Health Task Force that was chaired by Lt. Gov. Peter Kinder. Blunt appointed the task force after a 2005 state audit and a 2006 story by the St. Louis Post Dispatch exposed serious incidents of abuse and neglect, according to the findings of the task force.
One of the task force’s 25 recommendations was to shift case manager services to local entities within counties. Those entities must be Senate Bill 40 agencies or meet certain criteria established by the federal government.
Carpenter said his case managers have loads of 70 to 80 clients on average. He said you couldn’t convince him that his department is doing a good job providing services.
“We do not do a very good job,” Carpenter told the audience. “If you can convince me that your son or daughter receives better services from one of my case managers that have 70 people on their case load, I will argue that we are not doing a very good job.”
Carpenter cited other factors that make the healthcare system not function properly. One major factor is retaining case managers. He said at one time he had about 120 case managers in the Kansas City office and is now down to 56. He said he lost 10 case managers in 2008. He said those requesting services are not slowing down either. He said about 40 to 50 new clients walk through his doors every month. In Jackson County alone he has about 1,700 clients compared to about 120 in Ray County. He said shifting those cases to local entities frees up resources for his office to implement the new procedures.
“I have to have the resources to support an ever-growing population of consumers that come through our front door,” Carpenter said. “We’re always trying to shuffle things.
We’re doing real good some days, I truly believe, to actually know where you live and I’m not trying to be facetious about it. That’s the reality we face.”
Some parents expressed concerns that a lot of services don’t even reach Ray County because no one will come. Again, Carpenter pointed to a lack of resources.
“That is a fundamental fault of our health care system,” he said.
Carpenter said federal reimbursement dollars would be shifted from the state’s general fund back to the counties where services are provided. Ray County Board of Services agreed to have a maximum of 40 clients per caseworker. Currently, the board employs three caseworkers locally. Currently, the state bills the federal government $84 an hour for services. Carpenter said 60 percent of that would come back to the county.
Carpenter anticipates the whole shift to be complete by June 30 and said he believes the board will have to hire a fourth case manager by then. He said by virtue of shifting the focus, Ray County will see an increase in consumers. He said many times families in rural areas are reluctant to come to the Kansas City Regional office.
“I see it in Cass County.I see it in Bates County,” Carpenter said. “You cannot convince me that it doesn’t exist in Ray County. That is a population we know is out there.”
Carpenter said as the focus changes, consumers should notice a change in the quality of services. He said his office eventually will stop doing case management and focus only on quality and compliance.
“Our role is going to be about compliance. We are going to hold them to standards,” he said. “We’re going to be in the provider’s agencies. We’re going to hold their hand and we’re going to help them become more compliant to federal rules.”
One father at the meeting said personal care is something that has been lacking from the services.
“They know my son,” the father said. “He’s a person, not a name, and to me that means something.”
Carpenter said it is hard to hold his case managers accountable under the constraints the current system is under. He hopes that will change.
“It’s hard to hold somebody accountable if your case load is such that the time to spend [isn’t there] to accurately make sure that everything we are doing is correct,” he said. “That’s what we’re trying to change.”
After hearing some more concerns about case managers changing, Carpenter said he understands and he hopes that will change as well.
“We try to keep a case manager with a core group of consumers for a long period of time, because we know how long it takes to form those relationships,” he said. “They’ve been instructed to make this as painless as possible for the families and consumers. We want this to be as seamless as possible.”

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