2015 ASSET LIASON REPORT

Mainstream Living, Inc.

Date of Visit: October 16, 2015

Report Written By: Melonie Stall

Need for Program. In 2015, Mainstream Living, Inc. (Mainstream or Agency) celebrated its 40th year of providing services to more than 530 individuals with disabilities daily, employing 600 workers in four counties – Story, Polk, Dallas and Boone – and operating with an annual budget of $17 million (per Mainstream’s Summer 2015 Newsletter). Their mission is to provide services for persons with disabilities which are designed to enhance opportunities, create success and fulfill dreams, with a vision to be the agency of choice for consumer services and the premier human service employer.

Mainstream serves an increasing targeted population of adults with intellectual disabilities, mental health diagnosis and substance abuse issues througha variety of programs, all of which maintain a waiting list. Mainstream is requesting ASSET funding for three services under their Mainstream Living Employment and Learning Centerumbrella- Ames Day Habilitation Services,Enclave Services and The Snoezelen Program as well as their Supported Community Living (SCL) programs - all in Story County, so that they can continue to serve persons who utilize these services but do not qualify for Medicaid funding. An abbreviated description of these four services is as follows:

1.Ames Day Habilitation Program [Service Code 1.3j] provides a variety of activities for individuals who want to broaden their community involvementby participating in several activities includingdelivering Meals on Wheels, preparing meals for Food at First, stocking shelves at the food pantryand providing assistance at the Ames Public Library. Consumers also have an opportunity to participate in a number of leisure and recreational activities or community outings that provide for socialization and self-advocacy.

2.Enclave Services [Service Code 1.3l] consist of a small group of people with disabilities (generally 5-8) who are trained and supervised among employees who are not disabled at the host company's work site.The Centercurrently hasenclave groups at Sauer Danfoss and Hach Chemicals in Ames.

3.The Snoezelen Program[Service Code 1.3j] is a multi-sensory, therapeutic environment designed for individuals with severe intellectual disabilities and intensive support needs. Opened in June of 2011, the Snoezelen Center at Mainstream Living is the first of its kind in the State of Iowa.

  1. Daily andHourly Supported Community Living (SCL) Services [Service Code 1.3a] support persons with an Intellectual Disabilities waiver (HSBC/ID) or Brain Injury Waiver (HCBS/BI) to live as independently as possible. Services are provided in the individual's home or in a home managed by Mainstream and can range from a few hours per week to 24 hours per day.

Mainstream also conducts an Advocacy, Connections and Empowerment (ACE) Program in Ames geared towards individuals with higher levels of independence, operates three Homes for the Medically Fragile who live with a serious ongoing illness or chronic health condition, operates Supported Living Apartments, provides Supporting Community Living, operates an eleven-bed Residential Care Facility for Persons with Mental Illness, operates a Transition Age Youth (TAY) program for persons aged 18 to 25 and operates a Unity Home for low-income single women, with about one-third of their overall operations occurringin Story County.

If the services ceased to exist, the needs of the individuals with disabilities could fall back onto the family or could cause the individuals to be placed in a more restrictive, higher level of care environment.

There are several other providers of services to individuals with intellectual disabilities in Story County, including Friendship Ark, Inc., Lutheran Services in Iowa, Mosaic of Central Iowa and Optimae LifeServices. Mainstream is similar to Friendship Ark, Inc., a non-profit organization, in that Friendship Ark offers Daily and Hourly SCL Services and a Day Habilitation Program, but differs in that Friendship Ark is faith-based andMainstream offers a wider spectrum of service offerings. Lutheran Services in Iowa, also a non-profit organization, offersbothHourly and Daily SCL Services in Story County, but does not have a Day Habilitation Program.

Mosaic of Central Iowa is a non-profit, faith-based organization with locations in Nevada and Des Moines, IA, offeringa full spectrum of services, similar to Mainstream. Optimae LifeServices is a for profit provider that began offering services in Story County in early 2015. They offer similar services to Mainstream as well.

Mainstream’s programs address the following priorities established by ASSET Funders for fiscal year 2016-17:

  1. City of Ames – Meet mental health and chemical dependency needs by providing access to non-emergency services.
  2. Story County – [1] Services are available and accessible county-wide, [2] Services that help individuals develop and maintain self-sufficiency and allow them to obtain affordable housing and transportation, [3] safety, health and well-being of adults, and [4] accessible medical services to avoid out-of-home placement and institutional care.
  3. Central Iowa Community Services - Core Service Domains - [1] Treatment designed to improve a person’s condition, [2] Support for employment, [3] Recovery services and Core-Plus Service Domains – [1] Comprehensive facility and community-based crisis services, [2] Sub acute services provided in a facility or community-based setting, [3] Services supported by evidence-based practices.
  4. United Way of Story County – Income: Individuals and families have basic and emergency needs met and move toward self-sufficiency.
  5. ISU Government of the Student Body – [1] Services that provide prevention and treatment for mental health, both group and individual care and [2] Services that provide prevention and treatment for substance abuse, both group and individual care(both currently only in Polk County, however).

Program Strengths. Mainstream received another three-year accreditation from the Commission on Accreditation of Rehabilitative Facilities (CARF) in March 2015. The program strengths include its flexibility in providing services on an hourly or daily increment to persons of high-functioning disabilities or to persons that are medically fragile and need 24-hour supervision. Per Mainstream leadership, staff turnover is around 30%, about half of the state and national averages, with many key staff positions serving in excess of 20 years. The CARF report included the following comments about Bill Vaugh, Mainstream’s President/CEO for the past two years, and 35-year employee - “…a dynamic and visionary leader…widely recognized for his innovation, leadership skills, and administrative prowess…” and that “the leadership always puts the persons served first.” The report also comments on the staff’s “…outstanding services to people served…”,” …demonstrated a true sense of person-centered planning…”and“…that each of the family members express a high level of satisfaction and noted that their family member has made significant progress since being placed with Mainstream…”

Program Weaknesses. With the upcoming change to a managed care organization system as part of Governor Branstad’s Medicaid Modernization initiative, Mainstream in not currently adding new clients in every program. With four new providers to work with and a tight time-schedule for implementation, there are concerns over cash flow and ifthe new providers will completely cover services currently fully reimbursed under Medicaid. Mainstream is continually monitoring the changes and adapting its practices accordingly.

Financial Outlook. Mainstream is projecting $20 million in gross revenues for the next fiscal year. The amount of services requested for ASSET funding of $67,500 is less than 1% of this amount, but quite necessary as no other funding is readily available for these services for persons not covered by Medicaid. The Agency’s main source of income is Medicaid at approximately 93%. Mainstream does have a few private pay clients. The Agency is looking to expand counseling, therapy and substance abuse services in Polk County, which would provide a revenue stream outside of the Medicare or ASSET funding arenas.

Internal Management Practices. Mainstream’s Board of Directors (Board) will be adding three new members in November. The Agency has a good Board representation from the counties it serves and includes persons with family members utilizing Mainstream services for many years. Per Bill Vaughn, the external auditors meet with the Board to discuss the findings of the annual audit without Mainstream leadership present. This is another example of the transparency the Agency operates within, which was also commented on in the CARF reportand can be observed on the Agency’s website which has virtual tours of their many homes.

Agency Suggestions/Comments. Mainstream has requested funding for daily Supported Community Living Services even though no dollars were expended in this program in the current and prior fiscal years. These funds are requested for persons not covered by Medicaid and management stressed that this is a situational service and at a cost of $150 per day would add up quickly for a person needing to utilize this service.

General Assessment. Mainstream is one of the major service providersin Story County of persons with disabilities effectively offering a full spectrum of services to many individuals and, thus, their families. Mainstream is also one of the top 40 employers in Ames (per the Ames Economic Development Commission’s website) with stable, seasoned management and staff and a diverse Board.