Sign Nebraska Profit Sharing Agreement Template Safe

Document type sign profit sharing agreement template nebraska safe

anyways jill if you would like to go ahead and start and then we'll begin with the content of the webinar we'll remind everyone to put your phones on mute or star we will actually put everybody on mute so jill if you'd like to start thank you thank you sharon uh welcome everyone uh as you know i'm jim kagan with the arch national respite networking resource center and we are really pleased and excited today to be able to share with you a special demonstration from the nebraska respite network on our e-lifespan respite system uh which is an online information and referral service as well as a secure online data and workspace system i know that many of you who are lifespan respite grantees and your partnering organizations are working on your own or through partnerships you may have with your state respite coalition or your adrcs to develop online respite registries and perhaps even a greater online capacity for streamlining your efforts to build the infrastructure for your coordinated lifespan rested system in your state um you should know that the nebraska arrested network was established in 1999 through state legislation so they have been at this uh for a bit longer than most of the other lifespan respite grantees and they have a lot of experience and insight that they're willing to share so we're really grateful for that i'm going to get right to it we have with us today sharon johnson who's with the medicaid long-term care division in the nebraska department of health and human services she is the administrator of the nebraska respite network and the federal lifespan respite grant and she's joined today by her partner in this effort charlie lewis who is the project director for the answers for families project and i'm going to just turn it right over to them and i'll let them introduce themselves a little bit further and get on with the demonstration so thank you very much again sharon and charlie thanks jill we're okay so that for recording purposes we have muted everyone and then there will be opportunities as indicated earlier um that you'll be able to ask questions and we'll open up the phone lines and in the meantime we encourage you as you're listening or hearing information please use the chat box at the bottom of the right hand of your screen if you still have that open otherwise it's full screen but do use this as an interactive uh opportunity this afternoon as much as we can in addition to charlie as jill had mentioned as the answers for families project director i also want to acknowledge jessica cook who has been instrumental in developing the e-life span respite services without the i.t partners we certainly wouldn't have gotten as far as we have with the evolving system so um thanks to both of these fine colleagues for the the hard work that they do on a very regular basis and with the overview we felt that although many of you have known about nebraska's respite network infrastructure or statewide respite infrastructure we decided that an update and an overview might be helpful for some of you who are less familiar one of the goals for this afternoon is more than sharing the insight about our own system and what it looks like based upon nebraska needs but we're hoping that it inspires you to some degree to be able to consider the possibilities for your own state respite requirements there may be elements or you may want to visit with the answers for family staff at some point to gather more detailed information but with the overview i'm going to highlight some of the key features of nebraska's infrastructure as you can imagine those of you who are familiar with their geography classes like many of the state large land mass and again as most know and as your states also experience considerable rural uh features to it however nebraska is unique in that the furthest most eastern part of the state tends to be the urban areas and so the need to improve access to respite resources and develop an improved consistency of reporting and sharing information resources mentoring one another etc etc taking advantage of current technology was an absolutely logical step for us so that's part of the reason where the e-life span evolved a number of months back again just another highlight to visualize the state of nebraska in comparison to some of the eastern states within our united states the population of nebraska is growing and as many states experience the increase in uh various uh aging populations as well as a multitude of refugee and and ethnic populations is expanding the opportunities for respite and what respite resources might need to look like the centers for medicaid and medicare medicare and medicaid services as well as the administration on aging have invested considerable effort and finances in developing adequate supportive services to remain at home and and being able to accomplish that requires supporting our caregivers and and without spending much time on that whole philosophy we understand the challenges with a diverse and widespread population can create for a system so again e-lifespan is instrumental in being able to address some of those challenges i want to visit briefly in jill opened her comments by indicating that nebraska respite services itself have been in place in the state by statute since 1999 originally creating a statewide respite network as well as a respite coalition and much of the coalition effort was surrounded around advocacy work that resulted in among other things in 2002 a statute being passed by our single house having established a lifespan respite subsidy program and so there is a difference and as we talked this afternoon it i want you to understand the different facets of nebraska's infrastructure and i use the term infrastructure to mean a variety of resources related to respite some of which directly impact the network or the coalition efforts and others might be specific to the subsidy and i'll make every effort to help you understand which one that i'm referring to and in nebraska with the coalition um because i know some states the coalition effort is the predominant means by which respite services are carried out and that's something unique in nebraska because the coalition um has a more of a supportive role and it includes our respite network coordinators but it doesn't have some volunteers and at the present time we are um looking at the need for strategic planning um envisioning what our next uh direction needs to be how we reach out and recruit additional partners because once some of the early work was completed it was understood by many of the volunteers that their work was done and after a number of years we've come to realize no there is in fact much more need for input not only by family members but certainly by volunteers and professionals in the health you know in the human services arena as well as caregivers who are using the services to make sure that we're meeting their needs with the funding available to us we are fortunate in that we have state funds allocated both for respite network activities which is separate from as i indicated earlier the lifespan respite subsidy program so there are separate fundings and some of you may be using tobacco settlement funds um in your states as well and certainly in nebraska these tobacco settlement funds um provide support to a significant number of programs so we're fortunate that the need is present and we're able to communicate to the decision makers for the continuing funding in addition nebraska clearly is a participant within the administration on aging grant we are ending our current cycle in august of 2013 and a number of initiatives have been able to come to be as a result of this funding notwithstanding the e-lifespan respite resource that we're focusing on this afternoon but certainly crisis respite has had the opportunity to be tested and and as we'll continue to talk briefly um crisis respite is now because of the success and the utilization while there are there remains kinks to be worked out any new program and funding source um doesn't just happen overnight we all wish that it were that simple it's not but certainly the aoa grant has has been a an important part in allowing us to use these funds for that purpose and then we also have an annual grant through the department of education which utilizes the idea part c funding and with that um focusing on services for children and so there are some direct obligations that we have agreed to through the department of education but um all of the funding sources complement one another and so we're able to meet many of our efforts through the variety of fundings that are available to us and then i did not of course list a whole myriad of funds that any of the contracted organizations may also be accessing to support respite activities now specific for federal funding streams for resvit we all probably are familiar with these and i'm hoping that many of you on the line this afternoon are accessing or have available in your state that your state have given priority to including respite resources medicaid waivers every state is unique we have respite available through our aged and disabled medicaid waiver we also have specific respite requirements within our developmental disability waivers and within the developmental disability systems there are multiple waivers but certainly respite is available to them the block grant has respite although not utilized to anywhere close to the extent where it needs to be title three older americans act we work closely with our administration on aging maternal and child health another partner active partner in taking advantage of respite resources we have foster care child protective services and within the foster care and cps systems we've identified significant growing need and and in our state we're under tremendous um work to improve our system and folks are in within the system both within the health and human services arena as well as our state partner our state and private partners are working diligently to improve system but a great number of calls from both foster families as well as children at risk of moving into the system are there adult protective services access and have funds available through the social services um block grant for adults and then we also have in the state um out in nebraska our subsidized adoption agreement does include respite and if a family does have a child or children with significant needs they have the ability to have an increase in the amount of respite dollars available to them because on almost a a daily if at a minimum a weekly basis i received through the respite subsidy program referrals or requests for respite services through sub adopt agreement so i'm regularly referring them to their local worker or to the state manager and then of course through our medicaid paid systems um as you can see the the variety of programs that have federal funding available as well and with through all that we have the ongoing goal to be able to improve our data collection for the respite utilization for all these programs because at the current time hall we're actively partnering with them for both being a receiver of referrals and sending folks based on eligibility criteria back and forth we have a goal to be able to capture the number so we have a better idea beyond the lifespan respite network and the lifespan respite subsidy program what kind of numbers that we're impacting because now we're only able to track referrals out and i i do certainly want to mention um when we're talking about the funding issue that because i mentioned uh and if any of you were listening carefully you might have caught and the question being well what happens to the e lifespan respite service or system once the aoa grant is ended well the fact is the ongoing commitment by using state dollars has been made so there is not a risk of losing um what has has been found to be extremely beneficial for our efforts so sustainability is always a key need and then continuing i wanted to mention um nebraska does contract or we refer to as sub grants with six organizations in the state multiple counties including the university of nebraska to provide respite network services and these contracted entities did not have an administrative role with the lifespan respite program because it does have separate funding but certainly that is yet another goal to be able to better merge the efforts and being able to identify what the impact of our work beyond other means but in terms of specific families that are able to benefit from directly from the respite subsidy program when in fact they are eligible for that and as i had indicated a couple of moments ago the respite coalition is separate and yet it is a part of our network activities okay just to give you an idea again um within the six regions um where people are at and then in the next slide um without going through all the detail for the sake of time i wanted to give you some insight as to a sprinkling of the activities or responsibilities of our respite network so within the next couple of slides you'll see that some of those issues now for just a moment i wanted to focus on the lifespan respite subsidy because that's the one of the two key pieces of funding available to us in nebraska but for the subsidy folks do need to meet financial criteria and i wanted to help have you understand that this is a program that is much higher than many of our programs available within the state for public funds because it is at 312 percent of the federal poverty level which allows a lot of folks who might not otherwise if it were a a strictly low-income needs-based eligibility program and the caregiver must reside with the client or with the care recipient and cannot be paid and we sometimes you know find it a real challenge because someone may be receiving money for another program to assist their care recipient but if the um the care recipient or the care giver is receiving money we're not able to have them take advantage of the respite subsidy program um so that's i think just enough i i wanted to give you a basic idea it is a life spans which means we do have an active caseload that spans throughout the lifespan and into that fiscal year state fiscal year which of course is july 1 to june 30 of each year we did serve specifically through the respite subsidy program 744 persons and out of that number 165 were children and as you can probably imagine this particular program does have a substantial turnover rate because oftentimes people are not either willing to use respite resources until late in the need of caregiving or we do have people that then go into institutional care specifically the nursing home in most cases or perhaps the number of deaths that we encounter so um we we have uh the 744 number could could be even much higher than that so and another aspect of the network coordinator responsibility is to assist with provider recruitment not only for our program but for other medicaid programs some of which i had listed earlier within the federal funding streams to give you an idea and that's one area that in my involvement i have made every attempt to have our network coordinators become acquainted with the family providers specifically through the respite subsidy because the respite coordinator for anyone that we use and that we send out to our partners or to families the coordinator completes the following registries we have within our department an adult protective services registry as well as a child abuse and neglect registry to distinct registries we access and identify any concerns through the nebraska sex offender website as well as obtain a criminal history on the person and while the respite subsidy participants or caregivers are encouraged to use a provider through the network or at least participate in terms of having the provider checked by no means does everyone do that because many times respite subsidy families might be using a family member and they don't see the need for that and so that's another area that we're working to improve the collaboration between the two um entities between the network and the respite subsidy program and fortunately in my capacity i'm able to identify those issu s when they arise and then develop plans in order to address the concerns we do list what we refer to as public providers on our nebraska resource and referral system and we're coordinating with our aging and disability resource center website which continues to be in development it's not yet live and i wanted to point out that a public provider is one who has agreed that their name might be posted in the public place so that others might be able to con call on them for respite resources many family members for instance or a friend who is providing respite specific to an individual family may not be interested in having their name posted in a public way so we make reference to a public or a private provider okay so with that i want to turn it over to uh charlie who will now um introduce us and and actually demonstrate how what i have taken how we are using our technology to improve what we have but before she starts i don't want to neglect asking if anyone has questions and we will unmute if anyone has a question to ask any questions that with the information provided so far and again you can always include it in the chat box i know sometimes on my own participation on national calls i may not always be as comfortable speaking up but um you can certainly type your question in and we'll see that and and incorporate it into our presentation so we'll go ahead and mute again and then charlie will continue with the presentation thank you sharon um the e-life span respite system is really based on a couple of things one is to be able to view uh well you well let me back up a little bit looking at the respite regions sometimes you know that providers might live in the other region but might you know cross over you might say and and provide care for the caregiver in another region that was a big challenge in the old system and so that's where we kind of started there were several meetings with the coordinators as to what was working with the old system what wasn't what would they like to see and so over several months a wish list was developed and then we started programming and the e-lifespan respite system is really online information and referral system it's real time so that if i'm on the phone with a caregiver or a caseworker i can put in their information and provide some providers that will will will come up the system itself is really based on needs of the care recipient and the caregiver looking at a whole host of different areas around you know adls are there any behavioral emotional needs any medical needs location of service time of service needed are there any funding types that they are tied to so that looking at those needs then will match with the skills of the provider and so how we did that is we asked the same set of questions that we do with the care recipient to the provider so then we can come up with a a definite match and so it provides needs with skills of the provider i'm just whipping right through here it comes back in a list and as you'll notice you get a whole list here and if they were previously referred to the caregiver it does show that in on what date but it also shows by distance um as well so that it's you know based on needs and then looking at the distance from the provider to the care recipient it also identifies those that will also transport you get the list you can email the list and you can talk to them over the phone or you can print out a list and hand it to them there are several different ways you know that that you can provide a list to the caregiver or caseworker that is working with a caregiver after a provider then is referred to a caregiver and we asked a set of questions about 30 days later to see if they used the provider if they did not we asked them why why not you know and you can see here if they said no you know they didn't meet the needs i'm not ready to use respite used another provider so it gives us some sense of you know why a provider was not used but if they did use it then we ask quality questions around you know did they show up on time does what they uh are supposed to do they respect you do they have the skills needed follows your instructions and would you recommend these set of questions match other programs that then we can get a sense of overall services in nebraska respite being one of them to help with the 30-day follow-up we have a have a host of reports that can that are generated um to then be able to follow up with caregivers so that we know um you know we need to contact them to to follow up with them other reports that we helped generate sharon spoke about the different background checks that we do in nebraska and it allows um you know to say are they accurate are they current you can upload the actual release form you can take notes and i should say that if a provider does not have updated background checks they will not come back in a search so just so you know that other reports that we have of course is around the provider so that you can see across the state at a glance what type of skills that the providers have the length of time that they have been a provider and then you can match that then with the caregiver report to then say okay i have these needs for caregivers and care recipients but it looks like we're short in the in this particular area so you can do like a matching to to make sure that you can identify gaps and barriers and then have a plan to address those um this is just a screenshot of what the background check looks like um you know of course red is is out of date um that sort of thing and the contact report and this identifies you know the number of contacts number of unique contacts um and then um to highlight the utilization of fund of respite funding we have we asked the caregiver um you know how have they applied for this uh possible funding source um if they haven't are they receiving it they're not eligible or they're not interested and this will help identify us in targeting certain programs so that we can identify you know the the needed areas by caregivers um one thing that we'll be adding is you know did the did the coordinator refer them to any of these so so that helps you know utilize respite funding sources in a way that we weren't able to do before provider report you know pretty general stuff we have more stuff but we also keep track of how many were deep deactivated and the reason why did they request to be removed um was it for health reasons was it that you know that they um did not get any referrals um so that we can then um try to provide strategic planning around provider recruitments and then one thing that was added was the ability to put in your fiscal year budget and then sharon at the state can then pay off of the invoice each month from the budget um so how that works is that um you know i put in the my expenses for the month and then i close each category and once it's closed then the coordinators can no longer open that but if there's a mistake or something there is that ability by the state to reopen that certain category but then sharon can take that as their final submitted report and then make payment to the particular regions agency activity logs we do um it's you know there is an expectation that there will be some outreach there will be training as discussed a little bit earlier and this is a way that coordinators can really put down what exactly they're doing and then when they are ready to do strategic planning they can see um at a glance you know you can do a search for like i want to see all of the training in that was done in um january through april um they'll be able to search for that and generate and then take a look at the gaps and barriers and what was the outcome and how many people were impacted by that so it's really a way to be able to not only gather the information but then really use it in your strategic planning for the following year um one thing that sharon had mentioned is that uh you know this is since we are a huge state we may be in answers for families have uh built a little little collect well we call it a cult answers for families collab but it's really a space if any of you have used some some project management type things you can you know create your group and then in that group you can review uh any documents this happens to be rules you can view all of them um you can have discussions you can have upload documents and then you can also upload events that are coming so that the whole um agencies that provide respite coordination um are able to really collaborate um what we're adding to this particular thing is to have an online chat so that if there's any questions they can just instead of shooting an email they can just type in you know what about this kind of thing and have it taken care of right then and that um will kind of open it back up um i do see that there is a question so let me go ahead and unmute everybody jane this is sharon thank you for your question and to respond to that um dedicated employees i work i am an employee of the state of nebraska department of health and human services and with the respite subsidy we have some shared responsibilities by another staff person but no there's not through the program in a formal sense um it's me and i not only um i'm currently involved in and we we're missing we're down a couple of staff so hopefully at some point um we will be able to get back up full staff but it i am doing uh case management work as well as i manage the network and manage the contracts and and as charlie was demonstrating with this being a secure system it means just that it's only open to authorized persons and that is one key means that i'm able to manage the workload because i'm able to before i can pay an invoice on a monthly basis i need to be able to see the reporting that's been done by the activities and and other means because we've incorporated into this e-lifespan system all the areas that are required within a statement of work of the contract itself in addition we have incorporated in one way or the other adopted standards that are not only an attachment to the contract for the six regional respite coordinators and their agency staff but it takes in all of the legal commitments by one means or another so those individuals that are working under a contractual relationship out in the area um some of the six regional sub sub grantees will have breastfed assistance in their offices but otherwise it's going to be on a volunteer basis through everyone every one of the six regions are required to have an advisory board and we all know that advisory board is a voluntary commitment that is being made and then with other partners so it's it's predominantly either contract and as answers for families working under contract or voluntary thank you of course other questions please sharon this is jill um as a follow-up to that um in your six regions that are part of the respite network um through these sub contracts um there is a respite coordinator though who oh yes that's that's right absolutely that's the element um within their budget that they they may have an assistant not all due because of the volume and and what their agency um had proposed that they're capable of being able to meet the statement of work obligations of the contract but yes they are um paid persons but not um and they're not an employee of the state nor are providers employees um a provider is considered um an employee of the caregiver in a sense it's a it's a different relationship but we're very very careful that providers are never perceived as being um under any obligation to the state of nebraska or specifically health and human could you very briefly give us just some of the basic funding sources for supporting funding for those coordinators where does that what is well that comes out of our tobacco dollars what we refer to as state dollars and we'll go back to the specific here we go we have state funds with tobacco settlement dollars and then some of the monies that were available through the aoa or administration on aging grant have funded the network coordinating subgrants as well as a small department of education grant i know one time you were using medicaid administrative dollars for supporting your infrastructure are you still doing that not so much i mean they're there that's where it gets complicated and i was trying to keep this um fairly straightforward this afternoon um but no but um no we're they're all within the tobacco settlement funds there's different categories one are admin dollars and then there are service dollars and funds that monies are taken from each but it's it's been made clear in recently how we're paying for respite services um it's not med medicaid admin dollars at this time because these are not medicaid funds that we're using right okay thank you for that adrian and katie recruit that is i'm can you provide just a bit more detail for your commenter question please oh the question was do you proactively recruit i just would correct oh okay i read the last one and not the ones before my apologies he mentioned something about um tracking why somebody would deactivate themselves sure provider network and then you alluded to recruiting right so we just wondered what your recruiting process was absolutely and if i would have read your question in order it would not have been a challenge see how that works oh you read from right to left oh i thought it was left right um i guess it is left to right therefore i have issues um the recruiting process in our logo um we include a 188 respite number that is a toll-free number that providers are able to call into caregivers call into referral sources call into that is one means that we might be able to identify a party who is interested in delivering respite services certainly that is by no means the only it's just one of many ways some of the specific responsibilities of our respite network coordinators and their agency staff include the recruitment that happens through public speaking engagements that may happen and i do this on a regular basis when i'm answering questions for example for a caregiver who is providing care for someone through the respite subsidy program and and they have questions about whatever and i might ask them if they're interested in providing care for other families and if so then i will refer them to the appropriate regional coordinator to pursue getting more information that's one way other ways folks go to health fairs again a lot of public speaking nrrs or the nebraska resource and referral system which is a component of answers for families it's a website that provides an extensive listing of categorized resources that is one way to learn more about respite the recruitment and training of respite providers can be a a webinar in and of itself there's it depends on the creativity and the resources and sharing best practices which this system has tremendously improved the ability for coordinators to understand what one another are doing and to literally mentor one another both by viewing one another's reports we have an upload feature where someone may have their news media outlet or their news release excuse me news release shared online and so that can be used in another region they may share one another's brochures we have worked very hard to provide an improved consistency from one region to another while still allowing for uniqueness based on needs of a particular part of the state we never want to lose that but at the same time we know we live in a mobile society where people are moving from one region to the other and we don't want people to be able to have access in one area to resources and then drive 10 miles to a border county and not have that available so many of our forms are now a consistent network approved form versus each region having their own so that assists with the provider recruitment but using the resources of an advisory committee to help with recruiting providers certainly there will always be the need to recruit what i'll call generic providers even though you saw that we have many ways when a call is being received or through an email i mean any number of means of net or of providers being able to reach us but when the matching happens then we get down to a greater degree of detail but we do have some that have a wide ability to work with both an elderly person one afternoon and perhaps they're working with a 10 year old with severe autism with limited communication skills to an adult who has a chronic disease and has limited physical mobility many of the providers however do have a specific population that they may be more comfortable with based on personal or professional experience as well as what training they may have received because the training of providers is also a network coordinator responsibility not always to deliver the training itself but certainly to identify what training is available and to make that information available to the providers so that they can take advantage of it beyond a basic training that includes an orientation to the process and and the different respite services that are available through the various funding sources does that give you a bit more insight to the provider recruitment adrian and katie yes absolutely thank you of course other questions please then i will ask those of you on the phone do any of you have a system that collects the kind of information that nebraska has captured through our e-lifespan online system hello this is joyce in texas hi joyce hi and um we don't collect as much information as you do but we do collect information on the type of respite that providers are willing to provide so whether it's in home or out of home or emergency or crisis respite medical non-medical sort of information okay and you mentioned the crisis respite and i spoke just very quickly about it but that has been um somewhat new and there had been planning for a great deal of time but limited decision making until a few months ago and then in january of 2013 we did with all a variety of input extensive input actually over a number of years and and a variety of means drafted um guidelines and and provided statewide pilot in using funds and and as i say that proved to have some successes as well as some areas that need additional attention but the need then to recruit providers willing to serve as a crisis provider and and making sure that first responders and a first responder definition can mean many many many different things and and identifying who those providers might be and then going out and having those one-on-one conversations working with the trade associations um the large list serves that are available for instance with firefighters across the state or or the emergency medical technician um networks themselves and and making them aware of the respite resources that are available to the child care providers who may have already been providing what i'm referring to as traditional respite but seeing if they're willing to be a crisis provider based on nebraska's definition of a crisis and that that certainly is um somewhat unique to nebraska looking at national best practices as well as what has been identified as needs within our own state from previous referrals so if additional questions do come up after you mill over the content that we shared today we have our contact information available on this screen and well as charlie indicated this will be posted and and jill i'm assuming it'll be posted on the arch website as well as our own answers for families and in other places but if you have questions or would like more information we're more than happy to respond offline as well this is jill again i i can ask one more question of those who are listening absolutely we're getting close to uh reaching our hour time limit um i think it would be helpful to get a sense from people if any of you i know you know the limited funds that you have those of you who are developing respite registries or collaborating with your state inr system or your respite coalition are primarily collecting information on providers and then putting it online for families or their case managers to access um this system i think is a little bit different and correct me if i'm wrong sharon and that it's not readily available directly to family caregivers this is for the rest of coordinators to use so that they actually have to engage in a conversation with someone who's calling that's correct this this site that we've shown is is secure only to authorized persons within um our system that have grants with us is there any other state that's doing anything similar to that whether you're doing it perhaps with your adrc and using uh adrc counselors who have been trained in options counseling um you know where you're really interacting with the person seeking the information to provide more one-on-one kinds of directions is anyone else out there looking at that kind of system it's very labor-intensive so i'm imagining that not too many of you are is my question it's probably not clear either well i just wanted to get a sense of that there was something similar to the way that you have your network system set up sharon in nebraska with your six regional respite coordinators and well and we do want to make sure people understand that the provider information is available to the public through the nrs system or the nebraska resource and referral system um that is a a public element of information but the vast majority of content that we share today is private or secure and again we are working closely um with the aging and disability resource center team and i've been actively involved in the last few months with that as well so that um some of which that we have already developed can be incorporated into the adrc site once it does go public so there will be multiple ways for families to be able to access this information yeah excellent that's great um this is joyce in texas again and actually julie you brought up a question or an issue that um we would face if we were trying to do this which is um potential viability from having a listing of people that you're effectively functioning or recommending and i'm wondering how you deal with that when you say recommending um it's just making available a list that have of individuals or organizations who have met base requirements it's not necessarily recommending it identifies um what their what they what the care excuse me the provider has indicated that they have expertise or interest in providing like a closure statement that you provide where you said we're not recommending you and they is not telling you that these are the best providers or something like that when the providers are exported to the nrs and there is a disclaimer on the system saying that you know it's it's no certain one is recommended so there is a disclosure on that however there is not really a disclosure on the list that is generated by the respite coordinators however um there are training um components that um to you know how do you hire a provider and so that um that is a area respite region's responsibility to provide training on how to hire a provider and within the the various programs that have respite resources available to them each of those programs have a variety of criteria for the use of providers depending on the funding source for example with the respite subsidy program it's within our regulations and it's on the application and it's on the letter of eligibility that the family is has the has the privilege really of identifying who their respite provider will be that we're not assigning anyone but so that i believe in a multitude of ways is how we're addressing any potential legal liability those are very important points thank you still again also aren't all your providers they're vetted through your background screenings absolutely because if they're not or if they're any concern they don't make it to the public sharing of being a qualified provider or they won't return in a search internally as well and we work closely with health and human services we have what we refer to the position as resource developers and for most of the federally funded programs that provider has a very lengthy provider agreement it's a legal document that they must sign and again specific to the programs but the we work with them on individuals that perhaps are um providing services both for some of the respite programs as well as others that are available through the department and if the person does not meet many of the same expectations they won't be used by any means and there are legal explanations on the on the provider agreement but the subsidy is unique in that we do not um have any specific role in determining who provides services we offer assistance but we don't assign a provider jill it looks like we've met the three o'clock hour thank you so much sharon and charlie for what i think it's really has been an excellent excellent presentation uh the e lifespan respite system but also just better understanding how the nebraska arrested system works and for sharing all of this information with us we're very grateful to you and as sharon said this information will be made available through them and also through the arch website and we'll send around those links as soon as they're available as well as copies of today's powerpoint slides we will make those available also with that i want to thank everyone uh for joining us today and uh thanks sharon and charlie again and uh be sure to join us for the next lifespan respite grant t call on july the 16th thank you jill for the invitation