Empowering Independence Episode 1

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CDChoices is proud to bring you episode 1 of the new podcast Empowering Independence! Join Blaise, CDChoices’ Communication and Outreach Associate, as he sits down with CDChoices staff Denise (Communication & Outreach Specialist), Carol (Program Director), and Elizabeth (CEO) to discuss Consumer Directed Personal Assistance. Click on the player to listen. A full transcript follows below.

Empowering Independence Transcript:

Empowering independence 1.pdf

Empowering Independence

Episode 1

Blaise Bryant: “Welcome to the first episode of the Empowering Independence podcast here from Consumer Directed Choices in Albany New York. I’m Blaise Briant.”

Denise DiNoto: “And I’m Denise DiNoto.”

Blaise: “Denise, this is exciting,”

Denise: “Very exciting, starting something brand-new. Something that’s not been done before by another fiscal intermediary. I’m happy to be a part of it with you.”

Blaise: “Well, I’m glad that you were receptive to the idea of doing a podcast.”

Denise: “But maybe we should tell the folks a little bit about ourselves.”

Blaise: “Yeah, lets do that. We are Consumer Directed Choices and I figure since you are a Consumer and I am not, let’s give them the Consumer skinny on things, and what we do, and all that.”

Denise: “Sure. So, we live in the great state of New York, which has a program called Consumer Directed Personal Assistance or CDPA. CDPA lets people with disabilities, like myself or senior citizens who need home care self-direct their own care. What that means is we are empowered to recruit, train, supervise, and manage our own home care staff, But we need agencies called Fiscal Intermediaries to help us with our pay role and benefits administration. So, Consumer Directed Choices, who is sponsoring and representing this podcast, is what’s known as a fiscal intermediary. We administer payroll and benefits for people who use Consumer Directed Personal Assistance. and you’re going to learn more about that today with our first guest.”

Blaise: “Our first two guests, Carol Durante, who’s our corporate compliance officer and Elizabeth Martin who is our CEO. We’ll hear from them in a few minutes to talk about what they do and how they got here. The reason we’re going to do that is because it’s very important I think for people to know how we got here. How did we get to this place?”

Denise: “So, Consumer Directed Choices helps people with disabilities and senior citizens live independently in their own homes instead of an institutional setting. And when we talk about Consumer direction, we often hear well, what is Consumer direction, why does it matter? What does a fiscal intermediary do? We allow people to live with the maximum amount of independence as they can or as they want to. And we recognize that this isn’t the right choice for everybody. Not everybody wants to be empowered to self-direct their own care, but for the people that choose to do it, this is a way to help them remain a vital part of their community, where they belong, where they want to be. And let’s face it, a lot of people want to stay at home rather than face a nursing home. And we are happy to help promote that idea and saw the podcast as a way to spread information about what it is that we do, share Consumer stories, and share different perspectives related to CDPA and its role in the community.”

Blaise: “Why do you think some people wouldn’t want to self-direct their own home and personal care, and be in charge?”

Denise: “Well, it is a lot of work. As a Consumer, I can tell you it is a lot of responsibility to employ your own home care staff. And if you think about the work that an employer does, recruiting, training, supervising, managing, that means that if somebody is sick and they call in sick for one of my shifts, I now have to find somebody to cover that shift for them. If one my personal assistants sends me a text and says, “Surprise, my water broke two weeks early and I’m in the hospital having my baby now instead of two weeks from now,” that happened to me the other day. Then I have to then adjust my schedule so I have coverage for all of the shifts that she would’ve worked until her maternity leave. And some people don’t want that responsibility. I can understand that – it is a lot of work. But I also want the responsibility of who’s coming in to my house and when. I don’t want a stranger touching my body. Personal care is is personal tasks. Its bathing. Its dressing. Its grooming. And I want to have a say over who is touching my body, who is helping me with those tasks, and at the end of the day, it’s my house. I want control over who is coming in to my house, and who has access to me, and my body.”

Blaise: “Which is an extremely important thing. And Consumer Directed Choices was founded by a person with a disability, someone I know you considered a dear friend, Constance Laymon.”

Denise: “Absolutely. And Constance and a group of Consumers and people who had family members with disabilities, they knew that Consumer direction would be an option. In fact, I know we are going to play a clip of Constance in her own words talking about Consumer Directed Choices and how she founded it, and why it was important. And she tells it better than I ever could.”

Blaise: “You did the lead in. I’m just going to do do the attribution, its courtesy of a show here in the area that she was on several years ago called The Subject Matters. Here’s Constance Laymon talking about how CDChoices was founded.”

Constance: “I was hired by a um uh local nonprofit to uh coordinate a new program. And it was a few months after being hired that the organization had some financial difficulties so everyone in the place was laid off. At that point I said well I’m going to continue to volunteer. And at one point I actually kind of took the files home and ran the uh program out of my living room. So as time went on and knowing that it was such a vital home care program. All I gathered together uh a great group of people, to really start thinking about creating our own nonprofit entity to facilitate this program so that we, especially the Consumers who really knew what was broken with home care, that we could create an organization that was specifically about the disability view. And to make sure it was fiscally stable and and receptive to disability. Um we found an attorney who helped us to do the incorporation. Then I had a mentor who assisted me and writing all the internal revenue service nonprofit uh exemption pieces. And then from there I just kept meeting with people, kept uh you know developing you know all the little pieces over the next few years and we became operational. We incorporated in ‘97, and became operational December 29, 2001.”

Blaise: “Before we break here and we have Elizabeth and Carol come on, let’s just take a second to talk about what the show is going to look like for the next few episodes. And the things that we sorta have in mind. We’re going to be talking to people from throughout the country and advocates throughout the state, hear how home care is done in different parts of the country, and what the hot button disability advocacy issues are because Consumers regardless of where you are, are an integral part in advocating and being a part of society.”

Denise: “Absolutely. And it’s that Consumer perspective that’s really what we’re here for to share the Consumer’s voice. Because you know, we’re not just one unanimous community who thinks the same way, who experiences life the same way. For each person that we have on, their individual story’s gonna be a little bit different. And that is the beauty of Consumer Directed Personal Assistance. It can be individualized to meet your needs. You are in charge of your program. You are in charge of your life. You are in charge of how you are living. So, what works best for you may not work best for somebody else. But you can customize your routine, your staff, your schedule, and hearing from our Consumers in their own words is very empowering. And we’re gonna do our best to shine a light on their stories and allow them to share their stories with you so that you can hear how this program is benefiting them.”

Blaise: “And this is going to be posted all over the place. On our website, on our Facebook page, Twitter. We will also be on the Apple and Google Play App stores, Spotify. A couple of months from now we’ll be on iHeart Radio. We’re gonna be all over the place. And if you have any ideas, because this can’t be just Denise and I coming up with ideas. This is why we’re together and we want you to be a part of the show as well. Send me an email: That’s And what we’re going to do now is take a break. Denise, this has been fun as always. Elizabeth Martin, our CEO, and Carol Durante, our corporate compliance officer, will be with us here in just a minute from Consumer Directed Choices on the Empowering Independence Podcast.”

15-second Break: “Consumer Directed Personal Assistance supports seniors and people with disabilities. It gave me an opportunity to hire my own assistants, able to direct my own care, they could help me live an independent life. To learn more, visit”

Short music bed transitioning into segment two.

Blaise: “Back on the Empowering Independence podcast, I’m Blaise Bryant. And as promised after the break, because they’re gluttons for punishment and they’re very busy – Elizabeth Martin the CEO of Consumer Directed Choices is to my immediate left, and down at the far mic on our left is Carol Durante who is our Program Director and corporate compliance officer. I know both of you are extremely busy, so thank you so much for taking a few minutes here.”

Elizabeth Martin: “Absolutely, you’re welcome.”

Carol Durante: “Thank you.”

Blaise: “Sure. Elizabeth, I’ll start with you. How did you come to CDChoices?”

Elizabeth: “I came to CDChoices actually as Chief Operating Officer originally back in 2011… September ,2011. Uh and I before that I was working for Albany County Department of Social Services as their Director of Administration. And I came on board as the CEO at the time was Constance Laymon, she was the founding CEO. And she took me under her wing, and she taught me all about the program and I fell in love with it.”

Blaise: “Carol, how about you?”

Carol: “Um I came to CDChoices in 2003. Um I knew Constance prior to working here.  She, um I knew her when she fell off her cliff…uh off the cliff actually.”

Blaise: “Oh wow, really!”

Carol: “Yup, so I’ve known her for years. I… Her and I worked together, I was actually a Home Health Aid for her um after she came out of Sunnyview. And then I went on, pursued my career in nursing. She started this company and did some other things, and after a while she would call me and go, “Wanna come work with me? Wanna come work with me?” (Blaise laughs) And I kept going I don’t know what you’re talking about, cuz she would say the Consumer Directed Personal Assistance program. I said I have no idea what that means. And then she started to tell me what it was and talked me into coming over, and been here ever since.”

Blaise: “Fantastic. So, I guess the best way to do this is to have each of you just talk about what you do. I mean we hear Program Director, we hear CEO, we hear Corporate Compliance Officer, some one who is just coming off the street and has no clue in the world what we’re talking about here.”

Elizabeth: “Well, um as CEO I I’m obviously responsible for all the operations of the organization. I work closely with our Board of Directors, half of whom are actually people with disabilities, or Consumers, or Designated Representatives. And uh work with them to to develop a vision and a strategic direction for the organization, and then I’m responsible for moving forward with that.”

Carol: “And I oversee as the Program Department um the staff on the program side, we’re the side that goes out, meets with Consumers, uh goes over program rules and responsibilities. And then my other hat as the Compliance Officer is investigating when we get complaints in on things that could possibly be Medicaid fraud. I investigate those, um and I work with different plans to and their investigators and gather different information for them. I also have some relationships with the um Office of the Medicaid Inspector General and work with them on some of the cases as well to to um prosecute people that we find are committing fraud.”

Blaise: “How real of an issue is Medicaid fraud?”

Carol: “It’s a pretty real issue here, um, with managed care it seems a little bit more, they they have a different sense of the clients that they send over to us then the um local DSS’s , they seem to have known them a little more closely. And now with the home care shortage more and more people are being moved to Consumer Direction that maybe shouldn’t be in Consumer Direction, maybe aren’t as self-directing and in control as they should be of their services.”

Blaise: “Uhhumm.”

Elizabeth: “In general though, um there was a study done some years ago on self-direction programs nationwide and the amount of fraud and uh abuse done in self-direction programs isn’t really that much different than what you would normally see in any other kind of traditional  or licensed home care agency um situation, but it is something we have to keep an eye on.”

Blaise: “Gotcha. Elizabeth Martin, CEO, Carol Durante, Program director and Corporate Compliance Officer here with me on episode one of the Empowering Independence Podcast, which is of course our tagline here. And Elizabeth, guess we should talk a little about this thing called a budget that came out about a week and a half ago (Elizabeth and Carol laugh). As we record this in mid-April it will be up on May first. How, I guess the best way to ask this without sounding how much I know and what I don’t know is how are we… how is the program affected short term?”

Elizabeth: “Short term, um, it depends on what you mean by short term.  If you mean short term in the next next couple of months, probably nobody will notice anything.”

Blaise: “I would say within the next year or two.”

Elizabeth: “Ok, next year or two ok. So, the way the program (I hope I don’t get to wordy with this). The way the program will be uh affected is there’s two main components that affect us the most. There’s some other things that are fairly decent with it, but two main things that will affect us the most. One is that the state is going to go through a procurement process for Fiscal Intermediaries, people like CDChoices and other about 600 other Fiscal Intermediaries across the state will have to submit applications to contract with the Department of Health in order to continue operating. The understanding is that the Department of Health, or at least the impression is that the Department of Health will not be approving 600 contracts. Um so there is, we’re anticipating that there will be within the next year or so fewer Fiscal Intermediaries uh operating throughout the state. The other component to what the state is going to be doing is that they want to change how Fiscal Intermediaries are reimbursed. Currently we are reimbursed, as our operations, we’re reimbursed as a percentage of total costs for the program, that includes wages for the workers, and their benefits, and things like that. The state wants to carve out our operations and instead of giving us an hourly reimbursement, they want to change us to a per member per month, which is kinda like how premiums are done for managed care plans are the same kinda concept of a monthly premium. The they also in the process of doing that they are looking to make some fiscal cuts. So, they want to, from what I understand, the target is to get $75 million in state fund savings and that would be a hundred and fifty million total if you include the federal share of the Medicaid dollars.”

Blaise: “Phew.”

Elizabeth: “So, they’re looking for a total of a hundred fifty million dollars savings in a program um statewide. And they were trying to just do it to the administrative costs, they don’t, they’re trying not to affect services, so we’re working with them as closely as we can with the Department of Health to trying ensuring that is the case, that the services are not hurt during this process.”

Blaise: “I guess that sounds like change is comin’.”

Elizabeth: “Absolutely. (Blaise and Carol laugh) Absolutely. So. I’m I’m still confident that we’ll be here next year, CDChoices.”

Blaise: “Good.”

Elizabeth: “So. I’m feeling good about that. I just don’t know um how much of a funding cut we may experience, if we experience one. I don’t… That’s, that’s a little nerve racking and we’re trying to strategize to address that.”

Blaise: “Right, I mean I’m not trying to sit here and instill optimism, pessimism, fear, it’s just because the budget has been such a huge issue lately here in the state, its kinda like the elephant in the room that we’ve gotta talk about.”

Elizabeth: “Absolutely. And I don’t want to overly, I don’t want to cause fear unnecessarily, um the effort I do believe the state when they say they don’t want to hurt services.”

Blaise: “Sure.”

Elizabeth: “I absolutely believe that. I am concerned with the amount of the savings that they are trying to hit. And I am concerned with how quickly they are trying to do some things, but again that’s why we try speaking to them and and communicating with them and expressing our concerns in the hopes  that they make any changes in a way that makes sense, and that actually provides some improvements to the program, I’m totally in to providing improvements to the program. I have many of the same concerns that Department of Health had about the program, and so I do want to find solutions to that. And, and actually in the budget there were a couple of good things I think that I think were in the budget. One of them was they are establishing a work group, a statewide work group that includes representatives of Fiscal Intermediaries, Independent Living Centers, it’ll include Consumers and Consumer advocates as well as the plans and the county Departments of Social Services to talk about best practices for Fiscal Intermediaries, and to talk about um the procurement process for the Department of Health when they go through selecting Fiscal Intermediaries, you know what’s the best way to do that. And to also look at the services that are being provided and see if there’s any ways to make improvements. So that’s a good thing. I do think that will be helpful. The other good thing that they put in the budget is protections for Consumers if they want to switch FIs, whether it’s because an FI closes shop or because they just they just want to switch an FI, because that’s the Consumer’s choice. They provide some protections to allow that to happen a little more smoothly and without fear um among um any of their workers or the Consumers about any kind of ramifications from that.”

Blaise:” Sure.”

 (Elizabeth and Blaise interrupted each other.)

Blaise: “Carol, I guess we should talk about compliance now since we talked about the program and stuff. What sort of basic rules of practice, rules of thumb should people practice to be in corporate compliance and not have to worry about inadvertently committing Medicaid fraud, cuz I would imagine that’s one of those things where you could commit fraud completely accidentally and not realize it sometimes, right?”

Carol: “Absolutely. I think that Consumers um one thing that would probably be helpful for Consumers is to complete time sheets on a weekly basis, um fill them out in real time so that way you you’re not trying to recall hours after the fact. Um making sure that you’re not signing time sheets ahead of time, time, verifying hours worked on time sheets prior to submitting them to us, um and it’d be nice if Consumers took the control of that time sheet and sent it in directly. And mail, email it, fax it, whatever way that they could to us directly without it going in to another person’s hands that would be a good help for Consumers I believe.”

Blaise: “What else do you think people should know about CDChoices or what you guys do in program in general?”

Carol: “Um, we go out and we orient, orientate the Consumers on the program, so we explain to um how to send in that paperwork, how to fill out a time sheet, and we will go out and reeducate if they’re struggling, cuz we realize it’s a lot to throw at somebody in an hour and a half time possibly. And it, if they’ve never been an employer before, you’re now becoming an employer in and hour an a half. Um so we go out and we explain things to them, go over the paperwork, make sure its all completed, and uh just assist them. If they are struggling, we will go out and reeducate with them, and work with them as best as we can to, to make sure they can succeed at this.”

Blaise: “And that’s the value, the beauty of the, absolutely, the beauty of having a peer mentor on staff to, right?”

Carol: “Absolutely, yeah, Margie. We direct a lot of people to Margie if they call me to um tell me that they’ve got things going on. I’m always directing people over to Margie to find out how to have those conversations.”

Blaise: “And a peer mentor, in case you don’t know what that is, is someone who is specifically trained on staff to be able to help you with all aspects of navigating the Consumer Directed program. Well, Carol and Elizabeth, I know you guys have a lot going on, so thank you so much for taking a few minutes here on the Empowering Independence Podcast episode one. Uh its been a lot of fun, we’ll do this again.”

Elizabeth: “Thank you.”

Carol: “Thank you.”

Blaise: “Of course. And thank you so much for listening to the Empowering Independence Podcast. I’m Blaise Bryant. Special thanks to Shawna Nunziato, our transcriptionist, and to our guests, Denise DiNoto, Carol Durante, and Elizabeth Martin. And as our late founder and CEO, Constance Laymon use to say, “May self-direction rule the land.” And we will see you next month here on the Empowering Independence podcast.”

Short music bed which fades out indicating the end.

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