Pat McManaman, DHS Director, on the Next Jordan's Journal

On the next episode of Jordan’s Journal, Rep. Jordan is joined by Pat McManaman, Director of the State Department of Human Services. Director McManaman provides an overview of the Department and then delves into the background and significance of a current piece of legislation, HB868.

Last year, Rep. Jordan submitted a resolution that led to the Department conducting a study which focused on developing methods to help families reliant upon public assistance to attain financial independence. The study resulted in the introduction of HB868, which would eliminate the asset limit for the Temporary Assistance for Needy Families program.

This episode is an excellent way to learn about the Department of Human Services and serves as a prime example of the Legislature cooperating with a State Department to better serve the people of Hawaii.

The show will air on Channel 54 on Sunday, February 17^th at 8:30 p.m. and be rebroadcast on February 18^th and 25^th at 1:00 p.m. You can also view the episode on Rep. Jordan’s Vimeo channel, which has been embedded below.

Episode 24 - State Dept of Human Services from Jo Jordan on Vimeo.

DHS Confidentiality Policy

Pat McManaman, Director of Human Services, testifies before House Human Services Committee Chair, Rep. John Mizuno

Yesterday, Human Services Director Pat McManaman testified before the House Committee on Human Services on the department's confidentiality policy related to child welfare. At issue was the recent case of an unexplained death of a 9-month-old Hau'ula boy while in state custody.

The child, Jayvid Waa-Ili, was taken from a relative into state custody on August 10, 2011 and then died on August 26th.

Director McManaman defended the current policy to not release information in fatal cases. A full story appeared in today's Honolulu Star-Advertiser. Read here.

Chair John Mizuno has been critical of the previous administration's director Lillian Koller for releasing information on the state's website on fatal cases after seeing first hand how families and friends of the victims are impacted. Yesterday, he said that he liked where the current director is heading, noting that the confidentiality policy allows for flexibility when warranted.

Never shake a keiki

House and Senate Committees on Human Services today held an informational briefing to take a closer look at what the state can do to better address elder and child abuse.

In 2009, three major cases have made headlines in the news. One involves a former nursing aide who was charged in June with fondling three elderly women at a Kahala nursing home. Another, a man who allegedly beat his 7-month-old daughter in 2007, was recently found guilty of attempted manslaughter. The final case involves a woman charged with the murder of her 7-month-old nephew. Doctors found signs of shaken baby syndrome, including internal bleeding in the skull and semi-detached retinas.

Rep. John Mizuno, chairman of the House Human Services Committee, invited government and community agencies to brief lawmakers, including the Honolulu Police Department, the Hawaii Coalition of Caregivers Association, Adult Residential Care Homes Association, and Community Care Foster Homes Association.

Dr. Philip Hyden, the Medical Director for Kapiolani Child Protection Center and expert on shaken baby syndrome, or abusive head trauma, explained that major head injuries, which defines shaken baby syndrome, can only be caused by excessive force. Injuries to an infant caused by an accident, such as falling off a 2-feet couch, are usually minor. Shaken baby syndrome occurs when the brain rebounds against the skull of the baby causing bruising, swelling, pressure, and bleeding in the brain and damage to retinas.

Abuse prevention was the main focus of today's meeting. Dr. Hyden said that many shaken baby syndrome cases happen because parents or caretakers become frustrated with a crying child or lose control of their anger during a stressful day. Pediatricians must be more adamant in reminding parents of the dangers of shaking a child, he added, no matter their socio-economical status.

Advocates of elder care, including care home and foster home caregivers and case managers, also shared concerns over the lack of oversight of the people hired to care for senior citizens in nursing home institutions.

Photo: Dr. Philip Hyden talks about what can happen to a child when vigorously shaken causing a form of inflicted head trauma.

Strengthening long term care

In a recent tragic incident on the Big Island, an elderly foster home care client who was suddenly separated from his wife in Hilo and moved to another foster home in Honokaa died within a week of his transfer. Honokaa is about 45 minutes away from Hilo.

The man allegedly did not want to leave his wife, asked care providers to move him back, and called his spouse daily. Although the man received a waiver from the Department of Human Services (DHS) to remain with his wife in a community care foster home in 2007, that waiver was recently rescinded. The case is currently under investigation and cannot be discussed, but it seems that the man's status as a private client and not a Medicaid client was the reason he had to be separated from his wife. Community care foster homes only allow one private patient and two Medicaid patients.

Representative John Mizuno, chairman of the House Human Services committee, today held an informational briefing to discuss ways to prevent another tragic incident like this from occurring.

Lawmakers passed a bill this year which the governor signed into law that would allow two private-pay individuals to live in the same community care foster home under specified conditions. One of those conditions is that one member of the private-pay couple must have lived in the same care home for 5 consecutive years.

Caregivers, community care foster family homes, case managers, the Community Ties of America (CTA) and DHS met with lawmakers to share their concerns about transfer trauma and the need for stronger regulations and oversight of Hawaii's foster care program and its case managers to ensure the best quality care for the aging.

Donna Schmidt, the President of Case Management, Inc., testified in support of drafting a bill the next legislative session to create stronger regulations for case managers.

In her testimony she says, "the case management agency's role in providing oversight and supervision to the foster home is weakened when primary caregivers are unequivocally given the right to transfer clients to new agencies without cause and in particular when they are being openly recruited by case managers who interfere with established relationships between caregivers, clients and their case management agency."

Schmidt adds, the "role of oversight and supervision has been undermined as a result of case management agencies openly soliciting foster homes and encouraging them to transfer clients from one agency to their own. This trend while clearly unethical has become an accepted practice in the industry lowering the standards for all."

Lawmakers, stakeholders and government agencies will work together during the interim to develop solutions through higher case management standards in order to strengthen long term care in Hawaii.

Riding backseat

Hundreds of social service advocates today gathered at the Rotunda of the Hawaii State Capitol in response to the Lingle administration's budget proposal to eliminate the Healthy Start program. The cut would save the state $23.2 million dollars over the next two fiscal years. The rally began immediately after the Governor's State of the State address.

Former State Rep. Alex Santiago, chief executive officer of PHOCUSED, an advocacy group for health and human services, took issue with what Governor Linda Lingle said about social-services programs in her address to the people of Hawaii.

After praising the Dept. of Human Services and its community partners for their substantial progress in child welfare services, Lingle pointed out that, because of recent reductions in revenue, balancing the state budget will take precedence over anything else, even notable services and programs.

"…they and other worthy programs will take a back seat to our more immediate need to balance the budget. Today's struggling economy has created a deep hole in our budget that we need to dig out of this session," Lingle said.

Santiago kicked off the human services rally under the volcanic opening of the state capitol with a bold statement firing back at the governor's comments and igniting cheers and applause from a swarm of social service advocates clad in neon green t-shirts.

"We take a backseat to no one," he announced. "You [Lingle administration and Legislature] will not balance the budget on the most vulnerable people of this state."

Rep. Ryan Yamane, chairman of the House Health Committee, has been quoted in a recent Honolulu Advertiser article saying that lawmakers will try to find money for the program. However, he did also relate the difficulties that this will entail.

"We're going to try," said Yamane, a social worker. "The difficult part is, when we give one dollar to one place, it means somebody else is not going to get that dollar. So the question comes down to looking at what are the core services of state government in the health area and looking at ways to help support valuable programs."

Housing the Homeless

Committees on Housing and Human Services, chaired by Reps. Rida Cabanilla and John Mizuno, held an informational briefing on the state of homelessness in Hawaii and the challenges we face today.

Below are some of my notes on the issues that many of the human service and housing providers in attendance touched on. Agencies, organizations and homeless shelters who gave testimony include the Institute for Human Services (IHS); the Department of Human Services; Hawaii Habitat for Humanity Association; Lighthouse Outreach Center; Weinberg Village Waimanalo; Family Promise; Waikiki Health Center; Gregory House Programs; H5 Hawaii; Safe Haven; Kalihi Palama Health Center; and the Hawaii Public Housing Authority.

Out-of-State Homeless
Darlene Hein, a homeless advocate who works at the Waikiki Health Center's homeless outreach program, talked about the need for a Return Home Program in Hawaii:
· People come to Hawaii because they think that "the hula girl's going to bring them a maitai on the beach".
· Most vagabond visitors realize within 3 months that it's not like that once they get here and want to return home but cannot afford it.
· If they stay longer, past 6 months, they get used to the homeless lifestyle in Hawaii and no longer want to go home.
· Goal of project would be to help send out-of-state homeless who cannot afford plane tickets back to the state they came from, where they are familiar with services provided, have family and friends residing there, and better access to resources.
· IHS has addressed vagabond visitors who seek to establish themselves in Hawaii through the welfare system by actively encouraging them to return home if they simply do not have the resources to survive in Hawaii.
· Creating public-private partnerships with travel and visitor industries could help fund the program.

Access to Affordable Housing
· More affordable housing is needed.
· Transitional and permanent shelters can only do so much. Where do families and individuals go if there is no affordable housing or if they simply can't afford what is supposed to be "affordable housing"?
· Wait list for public housing totals 11,800.
· How do you define affordable housing? According to some of the service providers at the briefing, affordable housing prices are still out of reach of many of their clients, especially the elderly, disabled and mentally ill living on supplemental security income ($556/mo). In Honolulu a resident would have to spend 130.4% of benefits. The neediest in Hawaii are priced out.

Job Training and Securing Employment
· Biggest problem at Next Step is getting people jobs.
· Homeless who have been arrested or convicted of a crime have a tougher time getting employment.

Overrepresentation of Micronesians in Homeless Shelters
· IHS recommends that the state push for dialogue between the U.S. government and Micronesian governments to address the migration of citizens who are unable to support themselves when arriving in Hawaii.
· Many Micronesians have migrated to Hawaii seeking a better life under the Compacts of Free Association (COFA).
· IHS is concerned that too much space in public housing, transitional and permanent shelters are being occupied by Micronesian immigrants. "It would seem unfair for a huge preponderance of public housing to be occupied by COFA families when so many of our local residents are also in need as indicated by the very long waitlist to enter public housing," said Connie Mitchell in testimony. Mitchell is the executive director of IHS.
· Although not advocating for deportation, Mitchell emphasizes that COFA clearly states that "those who cannot show sufficient means of support in the US are deportable."
· Main point: Immigrants must have sufficient funds to relocate and/or jobs secured in advance before entering the state in order to avoid an increase in the homeless immigrant population.