The Power of Choice
A guide to Aging and Long-Term Support Administration's strategic plan for the 2023-2025 planning cycle.
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The Strategic Objective: Sets the goal that we are striving to achieve.
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The Action Plan: Our action steps to get there.
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The Success Measure: The outcome that would let us know we have achieved that goal by 2025.
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ALTSA will engage with clients and families to develop person-centered planning options that support individuals to live in a setting of their choice with services and supports that address their unique needs. ALTSA will inform specialized populations and individuals with multiple care needs and their providers about developing services.
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ALTSA will work with regional leadership teams to identify and plan improvements aimed at streamlining processes and assisting staff in addressing needs of clients including use of enabling technology and assistive devices.
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ALTSA will identify and address workforce shortages for direct care workers to build and support a more robust network of providers – as outlined in Strategic Objective #4 action plans.
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ALTSA will partner with Area Agencies on Aging (AAA) to develop system and policy enhancements, person-centered planning, staff and provider training and data analysis to increase outreach activities on identification, enrollment, and support of dyads (caregiver and care recipient enrolled in MAC/TSOA).
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Implement the utilization of individual providers through Consumer Direct Care Washington for Medicaid Alternative Care (MAC)/ Tailored Supports for Older Adults TSOA programs.
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As directed by the Washington State Legislature in 2023, establish wraparound services and housing supports for individuals who have been deemed incompetent to stand trial by the criminal justice system due to an intellectual/developmental disability, dementia disorder, or traumatic brain injury.
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ALTSA will work with the Long-Term Services and Supports Trust Commission to develop and implement outreach and community relations strategies.
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ALTSA will work with the Employment Security Department, Health Care Authority, and the Office of the State Actuary to design and implement the IT and programmatic components for the WA Cares Fund.
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ALTSA will work with the Long-Term Services and Supports Trust Commission to draft and finalize annual recommendation reports to improve operation of the program.
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ALTSA will implement a Home Care Aide navigator in each region to provide person-centered support to prospective Home Care Aides to help identify solutions to potential barriers for training, certification, and employment from the point of initial interest through employment.
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ALTSA will engage with the State Workforce Training and Education Coordinating Board in development of recommendations designed to make long term care a destination sector for the health care workforce.
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ALTSA will develop and deploy recruitment marketing materials intended for various streaming services and share information with others responsible for marketing and outreach activities.
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ALTSA will provide ongoing outreach to High School staff and to the Office of Native Education related to implementation and technical assistance support of the High School Home Care Aide Program, including deploying High School Home Care Aide Resource Guides.
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Increase the number of high schools, skills centers, tribal and compact schools delivering Home Care Aide certification training to students, summer programs, community programs by June 2025.
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Increase the number of students who earn a certificate of completion of the High School Home Care Aide program.
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ALTSA will retain a Long-Term care workforce by encouraging employers to utilize the newly released Retention Toolkit that supports Supervisors of direct care staff in recruiting, hiring, training and retention of long-term care staff. Additionally, ALTSA will track participant’s access to and use of the toolkit.
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ALTSA will evaluate the retention toolkit for accessibility and efficacy in addressing turnover by administering a survey and subsequently making recommendations to leadership on improvements.
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ALTSA will develop and deploy materials for presentations to state and national workforce boards, workforce development professionals and health care provider organizations to educate and elevate understanding of the value and contributions of the direct care workforce.
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ALTSA will serve on steering committees and workgroups convened by long-term care and workforce development organizations to create entry points into the direct care workforce.
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Increase the visibility of direct care workforce by educating workforce boards, centers and health care providers about competencies and values of the work by June 2025.
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ALTSA workforce development staff will attend a minimum of twenty-four outreach events each year
ALTSA S.O. #5: Support people to transition from acute care hospitals to services in their homes or communities.
5.1 HCS Action Plan:
- ALTSA will provide expertise and support to the “Difficult to Discharge” taskforce facilitated by the Governor’s office.
- ALTSA will hold weekly statewide meetings to review cases of individuals with complex needs and to increase care coordination efforts with cross system partners.
- ALTSA will hold weekly statewide acute care hospital meetings with regional staff to collaborate and share problem-solving strategies, medical records, policy changes, and best practices that improve discharge planning activities.
- ALTSA will evaluate current referral practices and make recommendations to create process efficiencies.
- ALTSA will carry out quality assurance actions and give reports to staff about acute hospital referrals and discharges to help manage transitions, analyze trends, and identify barriers and use of resources.
ALTSA S.O. #6: Mental Health Transformation – Provide Long-Term services and supports for individuals transitioning or diverting from state psychiatric hospitals.
6.1 HCS Action Plans:
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ALTSA will work with providers to improve their skills and their capacity to serve specialized populations.
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ALTSA will coordinate across systems to successfully transition individuals with complex needs by using an individualized, person-centered approach and care coordination to achieve and maintain community stability.
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ALTSA will continue to offer consultation services for providers serving clients with complex behavioral health needs.
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ALTSA staff will continue monitoring specialty contracts.
ALTSA S.O. #7: Support people to transition from nursing homes to care in their homes or communities.
7.1 HCS Action Plan:
- ALTSA will support community living by offering temporary or long-term services, providing staff and contracted providers with ongoing technical assistance, education, tools, and resources on at least a quarterly basis to help with the changing needs of clients.
- ALTSA will collaborate with nursing facilities, providers, residents, and families as well as expand resources, services, and strategies to support residents transitioning to their preferred community setting.
- ALTSA will implement the rental subsidies funded by the Legislature, and matched by federal grant, to support individuals transitioning from nursing facilities to independent housing with the support of Long-Term community services.
ALTSA S.O. #8: Process financial applications, complete new Comprehensive Assessment Reporting Evaluation (CARE) assessments and reassessments and develop service plans in a timely way so that individuals can be supported in the setting of their choice.
8.1 HCS Action Plan:
- ALTSA will work with the Centers for Medicare and Medicaid Services to expand the use of presumptive eligibility for long-term services and supports.
- ALTSA staff will coordinate training tools and policy for case management and nursing staff.
- ALTSA will hold quarterly statewide and regional performance metrics reviews at statewide meetings to identify best practices, barriers, and accurate reason coding to determine action steps for the division.
- ALTSA is providing employee time, project management, and funding to address barriers surrounding the hiring of individual providers by Consumer Direct Washington (CDWA) and to alleviate impacts on workload of Home and Community Services and the operating budgets to the Area Agencies on Aging (AAA).
9.1: ODHH Action Plan
- ALTSA will increase awareness about ODHH’s consultation services by sending ODHH representatives to meetings and events hosted by state agencies and divisions that serve clients by June 2025.
- ALTSA will increase opportunities for trainings in rural and other underserved areas by developing on-demand webinars and live virtual trainings.
- ALTSA will increase the number of service providers who receive virtual or in-person trainings and consultation by improving outreach and public relations strategies.
Success Measure 9.1.1/DH1.8: Provide education and training upon request to at least 50 service providers in communication access modalities (communication methods for people who are Deaf, DeafBlind, Deaf and Disabled, Hard of Hearing, Late Deafened and Speech Disabled) per year by June 2024 and 100 requests by June 2025
ALTSA S.O. #10: Expand the number of case management services offered for clients who are Deaf, DeafBlind, Deaf and Disabled, Hard of Hearing, Late Deafened, and Speech Disabled.
10.1: ODHH Action Plan:
- ALTSA will monitor the caseload and contract performance at the Regional Service Centers and implement corrective actions, when necessary, through June 2024.
- ALTSA will increase opportunities for virtual and in-person case management services in rural and diverse areas – including extension of in-house case management services in Vancouver/Clark County.
- ALTSA will increase the number of clients who receive virtual or in-person services by improving outreach and public relations strategies.
Success Measure 10.1.1/DH2.1: Provide case management services to at least 700 clients through June 2024 and to at least 500 clients through June 2025.
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ALTSA will continue to work with the Human Resource Division to make improvements for recruitment, onboarding, and retention processes. ALTSA will build position descriptions, job postings, and hiring aids that will align with newly established investigator core competencies for Adult Protective Services field staff. Retention efforts will be supported with the continuation of Communities of Practice, for staff at all levels of the organization, to provide opportunities for feedback on recruitment and retention efforts.
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ALTSA will continue to make enhancements to the APS Training Academy by utilizing training developed through the National Adult Protective Services Training Center (NTAC) to increase staff knowledge and skills. ALTSA will continue to implement staff feedback, gleaned through lean events, to enhance the APS training academy, enhance staff knowledge, skills and understanding, clarify policies and procedures, create efficiencies within case management application (TIVA).
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ALTSA will continue in-training units of Social Service Specialists 1 and 2 to provide case aid support to investigative staff to further build workforce capacity and allow investigators to focus less on administrative tasks.
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ALTSA will continue to hire staff, increase retention, and reduce turnover by cross-training staff for all facility types and hire on-call staff to respond to changing complaint volumes.
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ALTSA will continue to conduct trainings to ensure quality and consistency of investigations and modernize the Residential Care Services investigation, documentation, and record storage systems.
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ALTSA will return to timely re-inspections, which were delayed by the COVID-19 pandemic waivers.
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ALTSA will continue to cross-train licensors for different settings and improve recruitment and retention strategies.
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ALTSA will continue to modernize the Residential Care Services inspection, licensing, documentation, and record storage systems.
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ALTSA will continue to use continuous quality improvement internal controls to track timeliness of oversight and compliance activities.
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ALTSA will return to timely Nursing Home Statements of Deficiency processing, which were delayed by the COVID-19 pandemic.
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ALTSA will continue to expand and retain Residential Care Services staffing for Certified Community Residential Services and Supports to allow for program-specific quality recertification and enforcement.
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ALTSA will continue to modernize the Residential Care Services inspection, licensing, documentation, and record storage systems.
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ALTSA will return to timely quality assurance activities, which were delayed by the COVID-19 pandemic.
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ALTSA will utilize learnings from lean workshops conducted with front line staff to evaluate and prioritize areas for improvement. ALTSA will create processes for consistent intake decisions and timely assignment of investigations.
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ALTSA will continue assessing national voluntary consensus guidelines and assess changes to current response times to provide further clarity.
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ALTSA will take recommendations from the policy workgroup focused on policy and procedure improvements to include: separation and clarification of policy from procedure, continuation of all staff training webinars, staff engagement in policy changes through communities of practice.
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ALTSA will engage tribes and tribal organizations to expand information and identify opportunities for the delivery of Long-Term Services and Supports to American Indians and Alaska Natives.
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ALTSA will build state agency partnerships to identify complementary funding resources and opportunities for tribal contracting that support elders and individuals with disabilities and provide comprehensive, evolving Long-Term Services and Supports.
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ALTSA will build strong relationships with Long-Term Service providers to increase statewide capacity to serve American Indian and Alaska Native older adults and individuals with disabilities during the COVID-19 pandemic and throughout the recovery period.
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ALTSA will engage tribes to identify long-term services and supports that meet the requirements for increased federal financial participation.
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ALTSA will help tribal social and health service departments bill for Medicaid-reimbursed Long-Term Services and Supports by sharing federal requirements for updating Indian Health Service contracts.
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ALTSA, in coordination with the Health Care Authority, will develop and implement billing guidelines and systems for Medicaid-reimbursed long-term services and supports provided by tribal governments/enterprises.
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ALTSA will conduct quality assurance reviews to help ALTSA divisions to identify barriers and develop interventions through proficiency improvement plans.
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ALTSA will provide consultation and technical assistance in the following areas:
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Divisions will develop proficiency improvement plans in consultation with QA team.
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Divisions will complete annual risk assessments and build a monitoring schedule to ensure program and fiscal contract compliance.
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Create and distribute monitoring tools for use by Area Agencies on Aging (AAA).
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Address areas where proficiency standards are not met and develop corrective action plans.
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Analyze statewide trends and adopt training, technical assistance, policy revisions or other actions, as necessary.
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ALTSA will encourage participation in Connection Cafés and Focal Point offerings supporting connection and wellbeing.
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ALTSA will share a monthly Wellness message providing education and links to health and safety resources.
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ALTSA will ensure wellbeing best practices that support work-life balance and burn-out prevention are woven into leadership and staff development workshops.
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ALTSA will encourage staff participation in continuous improvement efforts.
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ALTSA will encourage continuous process improvement by providing and expanding Lean training opportunities and application of Lean practices within staff’s sphere of control work processes.
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ALTSA will support leadership in creating the conditions for innovation through training and coaching.
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ALTSA will leverage information from surveys, focus groups, and other feedback mechanisms to use staff voice in creating a work culture with high satisfaction.
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ALTSA will support person-centered thinking, effective change management, trauma-informed leadership, and continued telework and flexibility while meeting business needs.
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ALTSA will support Employer of Choice initiatives in partnership with DSHS.
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ALTSA will provide staff and leadership development opportunities through Focal Point, Lessons in Leadership, The ALTSA Way, Lean trainings, and Connection Cafés.
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ALTSA will maximize Washington State Learning Center capabilities for ease in access and reporting.
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ALTSA will expand individual and group leadership coaching, mentoring and development workshops.
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ALTSA will provide technical assistance to providers to improve systems that support quality of care through 1:1 consultation specific to the program setting and protocol areas.
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ALTSA will conduct provider questionnaire to measure the effectiveness of the Long-Term Care Quality Improvement program technical assistance.
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ALTSA will collaboratively update Secure Tracking and Reporting System with the Facility Management System and the Records Management System.
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ALTSA will develop an integrated document management system in alignment with DSHS enterprise IT strategies to improve the efficiency and effectiveness of current data and documentation systems.
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ALTSA will utilize enabling and assistive technology to support clients and the staff’s work, including using technology to gain client signatures, and the use of BOT technology to complete repetitive tasks such as simple redeterminations for services.
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ALTSA will migrate paper-based Adult Family Home application to an electronic Web-based application.
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ALTSA will annually review and update the Continuity of Operations Plan, train staff and test the plan through exercise or real-world incidents.
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ALTSA will annually review and update the Emergency Preparedness Plan to effectively and efficiently respond to future emergencies and disasters; including public health emergencies.
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ALTSA will support an incident response team, called the Long-Term Incident Management Team, by providing ongoing training and exercises to members.
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ALTSA will continue to participate in the Washington Incident Management Team Coalition to assist in the development and implementation of statewide standards for Incident Management Teams in Washington State.
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ALTSA will maintain a risk register, perform quarterly updates, and make recommendations to ALTSA leadership to avoid or minimize future risks.
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ALTSA will maintain a risk program that is integrated with other risk elements such as tort claims, safety reports, incident reports and public disclosure requests.
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ALTSA will continue to train management and staff about Proactive Equity, Anti-Racism , Access, and Belonging principles.
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ALTSA will expand quality assurance policies and procedures to measure EDAIB success.
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ALTSA’s Executive Leadership Team will become Certified Diversity Executives/Certified Diversity Professionals by June 2025.
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ALTSA will build the capacity of current Certified Diversity Executives/Certified Diversity Professionals to maintain their certification and for professional development.
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ALTSA will increase the use of EDAIB Communities of Practice to provide tools and resources for proactive engagement in EDAIB shared knowledge and language.
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ALTSA will increase proactive engagement with community partners and stakeholders.
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ALTSA will increase partnership with women and minority owned businesses.
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ALTSA will continue to meet or exceed the Culturally and Linguistically Appropriate Services Standards by supporting a diverse workforce, creating and supporting programs to retain staff, removing any potential biases identified within policies and procedures and working with tribes to identify barriers and unintended consequences of hidden bias in current practices.
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ALTSA will continue to provide opportunities for staff and leadership to acquire shared language and practices on equity through diversity workshops, discussion opportunities and resource sharing on Equity, Diversity, Inclusion, and Belonging topics.
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ALTSA will continue to use art, videos, storytelling, and employee recognition to generate sustained personal dialogue and enterprise-wide appreciation for transformational systemic change.
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ALTSA will complete DES Path Toward Equity: Disrupting Structural Racism through Awareness and Belonging training for Agency Subject Matter Experts, Executive Leadership, Management and Supervisory staff by June 2025.