{"Short_Answer__76":"201900883","Date__77":"05\/16\/2019","Multiple_Choice__78":"Marilee Bengtson","Multiple_Choice__79":"Scott Schifsky","Short_Answer__80":"Residential Transitions","Short_Answer__81":"Chrysa Reichel","Multiple_Choice__84":"Elopement","Multiple_Choice__85":"Hennepin County","Date__86":"02\/02\/2019","Free_Text__87":"Individual is a 25 year old woman who lives in a 1 bedroom 245D group home in a residential area in Maple Grove.  It was reported in the CEP Intake Form that the individual was agitated around 12:00 am due to being told she could not call friends as it was too late.  An on call staff was called to help support the individual to understand it was too late to call friends.  The individual went to bed around 1:30 and locked her bedroom door.\r\n\r\nMorning staff arrived at 8:00 and knocked on individual\u2019s door as medications needed to be administered.  Staff heard no response.  Being the door was locked, the staff obtained the key and it was then discovered the individual was not in her room.  Staff followed elopement protocol and notified on-call staff and non-emergency police.  Staff and police searched local area and found individual walking near the home and she was taken back home.\r\n\r\nIndividual stated she waited until overnight staff were in bathroom and then left the home.  She reported she walked to local Walmart, called a friend and then walked to his apartment as he was going call her an Uber.  Her friend came down to meet her, called her an Uber, she instructed the driver to drop her off at park near her group home vs her group home as she wanted to swing.  Originally the individual stated she left at 12:30 am but then stated she wasn\u2019t sure when she left the home.\r\n\r\nIndividual complained of back and foot pain but refused to go to Urgent Care but opted to sleep.  The next morning she was willing to go and was diagnosed with First Degree Frostbite.  Doctor prescribed over the counter medication for blistering and pain.","Multiple_Choice__96":"1","Short_Answer__91":"The individual\u2019s plan was to have one awake and one asleep staff on overnight shift. There was no asleep staff.","True_or_False__94":"Yes","Date__97":"06\/10\/2019","Free_Text__98":"orning staff arrived at 8:00 and knocked on individual\u2019s door as medications needed to be administered.  Staff heard no response.  Being the door was locked, the staff obtained the key and it was then discovered the individual was not in her room.  Staff followed elopement protocol and notified on-call staff and non-emergency police.  Staff and police searched local area and found individual walking near the home and she was taken back home.\r\n\r\nIndividual stated she waited until overnight staff were in bathroom and then left the home.  She reported she walked to local Walmart, called friend and then walked to his apartment as he was going call her an Uber.  Her friend came down to meet her, called her an Uber, she instructed the driver to drop her off at park near her group home vs her group home as she wanted to swing.  Originally the individual stated she left at 12:30 am but then stated she wasn\u2019t sure when she left the home.\r\n\r\nIndividual complained of back and foot pain but refused to go to Urgent Care but opted to sleep.  The next morning she was willing to go and was diagnosed with First Degree Frostbite.  Doctor prescribed over the counter medication for blistering and pain.","Free_Text__100":"No asleep staff for the overnight shift was influenced by the staff who was scheduled being ill and no one else available to cover the shift. Other staff were unwilling to cover this shift because the home is further away than most of the provider\u2019s other homes. Also, the asleep shift was likely to be awake because the person was known for having challenging behaviors.  Further supporting staff\u2019s unwillingness to cover this shift was that they would only receive $10\/hour.\r\n\r\nAn additional factor that influenced the shift to go unfilled was that the provider didn\u2019t feel pressure to fill the shift. The individual\u2019s team, including the case manager at Hennepin County, had previously agreed that due to known staffing shortages with the provider, when an overnight asleep was not available the individual\u2019s plan would allow for only the one awake overnight staff.\r\n\r\nMinnesota\u2019s Rate Management System (RMS) determines a reimbursement rate for an individuals required supports (staffing pattern), which is agreed upon by the provider and case manager at the county per the DHS 6790 form.  This RMS rate then affects the provider determining they could pay overnight staff $10\/hour for asleep shifts.  \r\n\r\nAnother influence was the Minnesota State Legislature, who creates laws governing provider rates, enforcing a 7% decrease in reimbursement rates to providers in July of 2018.  This impacted the provider\u2019s ability to give an annual raises to staff and in turn influenced the provider having a staff shortage.  This was influenced by Federal (CMS) action determining Minnesota\u2019s reimbursement rates were increased too much in recent years, and the Minnesota Department of Human Services\u2019 decision to determine which rates needed to be cut and by how much to come into compliance with the CMS decision.","Multiple_Choice__101":"0","Multiple_Choice__103":"3","Free_Text__104":"Other staff were unwilling to cover this shift because the home is further away than most of the provider\u2019s other homes. Also, the asleep shift was likely to be awake because the person was known for having challenging behaviors.  Further supporting staff\u2019s unwillingness to cover this shift was that they would only receive $10\/hour.\r\n\r\nThis RMS rate then affects the provider determining they could pay overnight staff $10\/hour for asleep shifts.  \r\n\r\nAnother influence was the Minnesota State Legislature, who creates laws governing provider rates, enforcing a 7% decrease in reimbursement rates to providers in July of 2018.  This impacted the provider\u2019s ability to give an annual raises to staff and in turn influenced the provider having a staff shortage.","Multiple_Choice__105":"0","Multiple_Choice__107":"0","Multiple_Choice__109":"0","Multiple_Choice__111":"0","Multiple_Choice__113":"0","Multiple_Choice__115":"3","Free_Text__116":"An additional factor that influenced the shift to go unfilled was that the provider didn\u2019t feel pressure to fill the shift. The individual\u2019s team, including the case manager at Hennepin County, had previously agreed that due to known staffing shortages with the provider, when an overnight asleep was not available the individual\u2019s plan would allow for only the one awake overnight staff.","Multiple_Choice__117":"0","Multiple_Choice__119":"0","Multiple_Choice__121":"0","Multiple_Choice__123":"0","Multiple_Choice__125":"0","Yes_or_No__432":"Yes"}