1. Fiscal Year 2011 July 1, 2010 – June 30, 2011

2. In today’s fragile economic climate, we see our family members, our friends, and our neighbors facing the worst of times. Businesses are downsizing and closing, leaving many Rowan County citizens out of work and without adequate resources to take care of their basic need for food, clothing, and shelter. In life’s most difficult times, some people do not have a family, a church, or a circle of friends to turn to for support. For these people, the poor economy can have very serious and long-lasting affects and can lead to homelessness, illness, addictions, abuse, neglect, and domestic violence.

3. In times such as these, it is more important than ever to have community resources to help hold people up until times get better. Rowan County Department of Social Services is committed to being part of a network of community organizations that help people overcome life’s challenges in the hardest of times. In fact, almost half the households in Rowan County are being helped through Medicaid, Food Assistance, and Work First benefits. These programs are helping people to receive needed medical care, to obtain food for their children, and to pay their rent and utility bills.

4. In addition to financial help, DSS provides services to those in need. Many of our disabled residents and those who are aged are getting good care in an adult day program or care in assisted living facilities, if their needs warrant such care. Single parents are getting help for their children through child support services, offered for free or for a very small cost. Parents who are working or who are full-time students may qualify for help with day care costs, giving them the assurance that their children are well cared for while parents work to earning a living.

5. Even with financial assistance and social services to fill the gaps, some parents are unable to provide a safe and nurturing home for their children. Sometimes, these children are victims of abuse and neglect, and they become DSS foster children. With the birth parents, foster parents, and DSS working in partnership, most foster children return home when it is safe for them to do so.

6. I am grateful for our community partners, our Board of Directors, and our 200 employees for the service they provide to Rowan County residents. Working together is the key to addressing the community’s urgent and compelling needs. After you have reviewed the Rowan County DSS Annual Report, please do not hesitate to call on us for more information. Located at 1813 East Innes Street in Salisbury, next door to the Rowan County Health Department, DSS is open Monday through Friday, from 7:30 a.m. until 5:00 p.m. We are honored to serve you. Sandra M. Wilkes, Director Rowan County Department of Social Services

7. $223,755,881 in benefits and services impacted our County’s economy in FY2010-2011. The vast majority is Federal and State funding, with the total County share for these benefits $2,531,460 (1.1%). 26,000 households and 48,249 individuals in Rowan County received assistance in FY 2011 in Medicaid, Food and Nutrition, and/or Work First Benefits. This means 49% of Rowan County households received one or more of these basic kinds of assistance last year.

8. 2010 census shows population of Rowan County was 138,428. 2009 estimated number of households was 53,249. 16.7% of our citizens were below the poverty rate in 2009 Median household income in 2010 was $46,292 Unemployment Rate was 11.5% for June 2011 From Charlotte Regional Partnership, US Census Bureau, and Employment Security Commission

9. Medicaid for Rowan Citizens $163,049,159 Food and Nutrition Benefits, USDA36,117,804 Child Support Collections10,238,405 Child Day Care Subsidy4,602,557 Foster Care/Adoption Assistance3,928,200 Special Assistance – Adult Care Home2,202,018 Emergency and Seasonal Assistance1,826,916 Work First Benefits877,077

10. Medicaid Transportation661,872 In-Home Aide Services86,419 Donated Funds85,730 Adult Day Care67,348 LINKS Transitional Services15,706 Food/Nutrition Employment and Training Program 2,670 TOTAL ASSISTANCE ISSUED$223,755,881

11. Assistance Issued in FY2011 (3 of 3) Medicaid Food and Nutrition

12. ProgramSFY2006SFY2007SFY2008SFY2009SFY2010SFY2011 Medicaid Benefits for Rowan County Citizens 136,546,353 131,023,854 135,980,808 149,763,354 160,311,782 163,049,159 Food & Nutrition Benefits 12,528,052 13,621,754 15,665,695 21,914,764 30,966,106 36,117,804 Child Support Collections 8,400,586 8,946,054 9,687,106 10,275,552 10,410,041 10,238,405 Child Day Care Subsidy 4,849,590 4,881,310 4,692,805 4,271,602 4,613,671 4,602,557 Foster Care 1,066,444 1,028,695 1,165,545 1,998,492 2,639,775 2,364,717 Adoption Assistance 1,124,050 1,177,468 1,259,664 1,473,883 1,676,026 1,563,484 Low Income Energy Assistance 383,909 233,253 253,485 740,083 856,905 1,119,876 Special Assistance Blind and Disabled 1,239,476 1,186,150 1,235,222 1,231,932 1,145,274 1,108,570 Special Assistance Aged 1,374,294 1,356,665 1,331,233 1,230,958 1,084,052 1,093,447 Work First Benefits and Employment Services 1,238,572 1,185,948 1,209,949 1,078,819 964,038 854,438 Crisis Intervention and Share the Warmth 269,203 263,847 349,631 643,951 577,889 672,283 Medicaid Transportation 297,175 297,187 339,657 388,460 530,349 661,872 In-Home Aide Services 93,407 98,853 97,327 99,353 101,300 86,419 Donated Funds 71,130 68,779 66,672 106,918 78,126 85,730 Adult Day Care 59,861 69,825 70,664 71,035 67,414 67,348 Special Assistance In-Home (notation only; included above) - - - 92,760 74,923 51,923 Work First Emergency Assistance 138,547 133,539 127,971 133,738 133,616 23,630 Assistance for Domestic Violence Victims 11,075 22,028 25,558 23,916 11,268 16,639 LINKS Purchases for Foster Children Leaving System 4,949 5,547 6,465 9,464 16,722 15,706 General Assistance 22,306 28,626 12,009 9,760 11,670 11,127 FNS Employment & Training 14,450 18,475 22,475 19,825 4,615 2,670 Total Assistance Provided 169,733,429 165,647,858 173,599,941 195,485,858 216,200,639 223,755,881

13. 32% Increase in 5 years

16. Pat Spears, Program Administrator Programs Medicaid for Families and Children Medicaid for Adults Medicaid Transportation Special Assistance Food and Nutrition Services FNS Employment and Training Low Income Energy Assistance Crisis Intervention Share the Warmth

17. Medicaid is a health insurance program for low-income individuals and families who cannot afford health care costs. Medicaid serves low-income parents, children, seniors, and people with disabilities. 23,725 individuals were authorized for Medicaid (17% of Rowan County population) as of June 2011; average value of medical services received was $6,872 per person for the year. Expenditures are shown by type of service received, individual recipient categories, and type of providers in Rowan County, based on reports from the Division of Medical Assistance.

18. HMO Premiums for Mental Health$31,172,113 Long-Term Care-Nursing Home23,853,812 Physician21,154,913 Prescription Drugs20,182,541 Hospital-Inpatient14,678,085 Hospital-Outpatient14,363,780 Home Health/CAP/Personal Care12,223,885 Medicare Premiums7,038,301 Dental6,249,584 Adult Care Homes3,395,853 Health Check/Education1,513,584 Practitioner, Non-Physician1,480,956

19. Clinics1,458,651 Lab/X-Ray1,202,536 Hospice977,652 Family Planning927,946 Ambulance487,189 Optical476,276 Podiatry86,240 Case Management74,025 Chiropractic37,742 Hearing Aids13,495 TOTAL MEDICAID PROVIDED$163,049,159

20. Medicaid Services Provided (3 of 3) Mental Health HMO Premiums Nursing Home Doctor RX Hospital

21. Disabled $66,973,337 Aged 33,657,090 Infant/Children 26,129,066 Work First Over 21 (Includes Medicaid for Families) 19,097,068 Work First Under 21 (Includes Medicaid for Families) 9,197,467 Pregnant Women 3,764,262 Medicare Qualified Beneficiaries 1,734,392 NC Health Choice 1,109,684 State Foster Home Children 531,954 Blind 445,552 Illegal Aliens 424,641 Legal Aliens 145,335 Refugees 1,145 Claims Adjustments -161,834 TOTAL MEDICAID PROVIDED $163,049,159

22. Medicaid Eligibility Categories (2 of 2)

23. Nursing Home, Skilled & ICF$24,964,008 Pharmacy21,041,218 Hospital13,915,434 Physician11,896,585 Dentist5,814,910 Adult Care Homes2,335,095 Community Alternatives Program2,235,156 Residential Child Care1,923,137 Personal Care Services1,547,627 Private Duty Nurse1,433,183 Health Department938,322 Home Health and Infusion Therapy733,153 Nurse Practitioner, Speech/Audio/OT706,131

24. Hospice657,585 Optometrist401,321 Medical Equipment363,113 Community Intervention Agency270,005 Ambulance266,935 Dialysis Treatment262,957 Local Education196,887 Mental Health147,596 Case Management54,786 Podiatrist25,611 Chiropractor13,108 Hearing Aid Dealer1,955 TOTAL PAID TO ROWAN PROVIDERS $92,145,818

25. Rowan County Provider Earnings (3 of 3) Note: $ 31,172,113 HMO Premiums for Mental Health for Rowan citizens does not show in this chart because the provider, Piedmont Behavioral Health, is located in Cabarrus County. Nursing Homes Pharmacies Hospitals Doctors

26. This service is provided through a contract with Rowan Transit System $661,872 was paid to vendors and family members to transport Medicaid-eligible clients for medical services 38,036 trips were provided in FY2011, serving an average of 265 recipients per month

27. State-County Special Assistance for Adults (SA) provides Medicaid coverage and a cash supplement to help low-income individuals residing in adult care homes (such as rest homes) pay for their care. Adult care homes are unlike nursing homes in that medical care is not provided by home staff. Designated staff may administer medications and provide personal care services such as assistance with bathing, eating, and dressing.

28. Special Assistance In-Home is an alternative to placement in an Adult Care Home for individuals who are able to live at home safely with additional supportive services. Slots for this program are limited and persons determined eligible for SA In-Home receive Medicaid and a monthly financial payment based on need.

29. Payments for Disabled Adults in FY 2011 - $1,108,570 Payments for Elderly Adults in FY 2011 – $1,093,447 (Includes $51,923 for SA In-Home Care)

30. Food and Nutrition Services (FNS) is a federal food assistance program that helps low-income families. Monthly allotments of FNS benefits are issued via Electronic Benefit Transfer cards (EBT cards). The purpose of Food and Nutrition Services is to end hunger and improve nutrition and health. $35,946,840 was issued to an average of 10,671 Rowan County households per month in FY 2011 (20% of households in county). $170,964.34 was dispensed in USDA surplus commodities.

31. Food and Nutrition Services (FNS) unit members ages 18 through 59 may volunteer to participate in an E&T Program. The local Employment Security Commission administers the program. FNS recipients who volunteer for the program are referred to ESC. The E&C Coordinator assesses the recipient’s needs and develops a plan for training activities or for job search activities based on the recipient’s individual needs. Persons who participate in the program are reimbursed for participation expenses. $2,670 spent in SFY 2011

32. The Low Income Energy Assistance Program (LIEAP) is a Federally-funded program that provides for a one-time cash payment to help eligible families pay their heating bills. $1,119,876 was issued in FY 2011 5,069 households received assistance (9.5% of county)

33. The Crisis Intervention Program (CIP) is Federal funding which provides assistance to low-income households that are in a heating or cooling related emergency. Share the Warmth is funded by Piedmont Natural Gas and its customers. These two programs are administered through a contract with Rowan Helping Ministries.  2,737 households and 7,069 individuals were served in FY 2011 (5.1% of county population)  $672,283 was paid to 26 vendors

34. Nancy Brandt, Program Administrator Programs Adult Protective Services Adult Day Care In-Home Aide Services Special Assistance In-Home Adult Care Homes Guardianship Work First Benefits Work First Employment Services Work First Emergency Assistance Child Support Enforcement Child Day Care Subsidy

35. Adult Services support older and disabled adults and their families through a community-based system of opportunities, services, benefits, and protections. Services administered through Rowan County DSS include protective services, case management, home management, in-home aide, adult day care, placement services, guardianship, and other services for elderly or disabled adults.

36. Protective Services Reports Received in FY2011 – 310 Abuse – 3 Self-Neglect – 70 Caretaker Neglect – 54 Exploitation of Assets – 12 Exploitation of Person – 3 Psychological Evaluations - 5 Screened Out (did not meet criteria in law) – 203 Preventive Outreach Referrals – 102 Incompetency Hearings - 24

37. Adult Day Care services are an organized program of services in a community group setting to support adults’ personal independence and to promote their social, physical, and emotional well- being. Additionally, we monitor adult day care centers in order to ensure program quality. $67,348 spent in SFY 2011

38. In-Home Aide Services are provided to assist families with attaining and maintaining self- sufficiency and improving quality of life for the elderly adult to stay in their homes as long as possible to avoid premature substitute care and unnecessary out-of-home placement. These services assist with home management tasks and personal care tasks for adults who cannot carry out the tasks essential to the activities of daily living. $86,419 spent in SFY 2011

39. Personal Care Services provide for additional personal care assistance for Medicaid eligible residents in adult care homes. A resident must meet Medicaid criteria as a heavy care resident and require extensive or total assistance in ambulation/locomotion, toileting, and/or feeding. DSS staff provided case management for 134 recipients of personal care services in FY2011. The cost of the services provided by adult care home staff is included in our Medicaid expenditures.

40. The Special Assistance In-Home program provides an option for in-home care for older and disabled adults who are in need of placement in an adult care home, but who desire to live in a private living setting and can be maintained safely in that setting. A social worker develops a care plan based on client assessments and planning with the clients, family members, and others and determines how the Special Assistance In-Home payment is to be used to enable the client to live at home safely. $ 51,923 spent in FY2011 to assist 20 clients

41. Adult Services Social Workers provide licensing, monitoring, and case management services for Adult Care Homes (Assisted Living facilities). 17 Adult Care Home Providers in Rowan County served up to 729 residents in FY2011

42. Guardianship involves the provision of services to individuals who are declared incompetent by the court. DSS is given responsibility for the adult’s personal affairs, making important decisions regarding the individual’s personal welfare. The agency is Guardian of Person for 55 cases.

43. Provides services focusing on employment and self- sufficiency and monthly payments for families with children who meet income eligibility guidelines. The program promotes work, requires personal responsibility, and helps families get and keep a job. Work First Family Assistance benefits provide short-term services with families expected to work actively towards becoming self-sufficient. The program is built on the premise that all families have a responsibility to their families and community to work and provide for their children.

44. $810,561 was issued in cash assistance payments in FY 2011 334 is the average number of households assisted each month (76% of these payments are for the child only) $43,878 was paid to assist clients in finding and keeping employment $16,639 was spent on contracted services with Family Crisis Council, who assisted 27 victims of domestic violence

45. Emergency Assistance provides benefits to families with children to alleviate an emergency situation defined as an unexpected, immediate crisis that is not expected to re-occur if assistance is provided. Citizenship and residency requirements apply as well as income and resource limits. Examples of situations where services may be provided are families in immediate danger of eviction or foreclosure or where a utilities cut-off notice has been issued. $23,630 was paid for emergencies to ensure that 62 families with children had shelter and utilities

46. Child Support Enforcement works to ensure that both parents are responsible for the financial support of their children. Services are provided to the custodians of minor children, regardless of income level. County agents help locate non- custodial parents, establish paternity of the child, and petition the court to order child support payments and to enforce compliance.

47. $ 9,957,326 was collected on behalf of Rowan County children in FY 2011 An additional $281,079 was saved in medical costs, paid by absent parents or insurance rather than Medicaid Paternity was established for 249 children

48. Day Care Subsidy provides for the care, protection, and developmental experiences of children for a portion of the day or night. Services may be provided to families who demonstrate a need based on North Carolina Division of Child Development policy. Eligibility requirements also include a residency requirement in the county of North Carolina where they apply, citizenship requirements, an age requirement of the child, and income eligibility. Each type of child care arrangement must be licensed or meet all applicable Division of Child Development requirements for the type of arrangement.

49.  $4,602,557 was issued in Fiscal Year 2011  An average of 1,150 children were served each month  2,068 is the total number of children served in FY 2011  Approximately 85 child care providers in Rowan County received subsidy

50. Tom Brewer, Program Administrator Barbara Sharpe, Program Administrator for Children’s Protective Services Programs Children’s Protective Services (Intake, Investigations, In-Home Services) Foster Care Licensing and Placement Services LINKS Transitional Services Adoption Services Adoption Assistance Payments One Church, One Child Program

51. The Child Protective Services program strives to ensure safe, permanent, nurturing families for children by protecting them from abuse and neglect while attempting to preserve the family unit. Child Protective Services help prevent further harm to children from intentional physical or mental injury, sexual abuse, exploitation, or neglect by a person responsible for a child's health or welfare. Child Protective Services also help protect children who have no parent, guardian, or custodian to provide care and supervision, or whose parents or guardians or custodian is unable to provide for the care or supervision and lacks an appropriate alternative child care arrangement.

52. Reports Received in FY2011 – 2,827 Physical or Emotional Abuse – 89 Sexual Abuse – 105 Abuse and Neglect – 14 Neglect – 1,699 Dependency – 46 Screened Out (did not meet criteria in law) – 874 Second Report on Active Cases - 339

53. Foster Care is a temporary living arrangement for abused, neglected and dependent children who need a safe place to live when their parents or another relative cannot take care of them. Often their parents face issues such as illness, alcohol and drug addictions, family violence or homelessness. Length of stay in foster care varies from a few days to much longer. The foster family, the Department of Social Services, and the birth family work together to return children to their own homes when it is safe for them to return.

54. $2,364,717 spent in FY 2011: $2,275,750 for room and board $88,967 for clothing and miscellaneous needs $1,819,158 paid to Rowan County providers; $545,559 out of county 249 children served in FY2011; 31 foster homes licensed and supervised by Rowan County DSS

55. Provides instructional services and financial assistance to prepare youth, who have been in foster care, for independent living. Foster care youth between the ages of 13-21 are eligible for assistance with expenses such as car insurance, furnishings for new living arrangements, employment expenses, educational expenses, and the like as they develop new skills for living outside of the foster care system. $15,706 spent in SFY 2011

56. Adoption is the legal and social process in which a child who is born to one set of parents becomes the child of another parent(s). The adoptive parents then assume all legal rights, obligations, and responsibilities of parents to the child.

57. The purpose of the adoption program at DSS is to find permanence with a family who meets the special needs of our children. The agency also completes home studies for step-parent, relative, and independent adoptions at the request of the Clerk of Court. Adoption Assistance payments are available for certain qualified children who are adopted from DSS custody. $1,534,373 was issued in FY 2011 in Cash Assistance and Vendor Payments $29,111 more was reinvested in the program from incentives earned for success in the number of adoptions finalized.  230 children were served in FY2011  13 children were adopted from DSS custody  14 step-parent/relative/independent adoptions were completed

58. The DSS has two attorneys on staff and two paralegals who assist with preparation of court documents. Children’s Services Legal staff represent the agency in matters pertaining to child abuse, neglect, dependency, custody, termination of parental rights, and adoption. Support Services Legal staff represent the agency in Adult Protective Services, Guardianship, and Child Support Enforcement cases. DSS Attorneys work with individuals and families who have an active case with DSS.

59. $11,127 in assistance provided for multiple needs not covered by other programs 104 individuals assisted 23 businesses or vendors paid

60. $85,730 in contributions from the community used for the following purposes: $72,237 - Christmas Happiness $10,929 - One Church, One Child $2,364 - Children’s Services $200 - Food Pantry

61. The Rowan County One Church One Child Program is a mission/outreach program between Rowan County Department of Social Services and local churches. Goals are:  Identifying and supporting families in congregations who are interested in becoming foster and/or adoptive parents.  Helping meet the needs of children and families that have an open or active case within Rowan County DSS Children's Services Division.  Supporting foster parents and relatives who care for Rowan County's children in foster care.  Educating church members about the needs of Rowan County children and families who need support and assistance.

62. The cost for administering $223.8 million in benefits and providing additional mandated services in FY2011 was $11,340,788, or 5.1% of total benefits issued. County share of administrative costs was $4,127,512. This cost includes the provision of services such as protective services for children and adults, as well as the cost of determining eligibility and issuing program benefits.

63. ProgramTotalFederalStateCountyPercent Economic Services 4,195,7972,473,34128,0281,694,42837.0% Children’s Services 3,974,9312,065,021396,0251,513,88535.0% Child Support 1,714,7271,461,8140252,91315.1% Adult Services 699,004309,431110,681278,8926.2% Work First 386,3291,5250384,8043.4% Child Day Care 370,001367,41002,5913.3% Totals 11,340,7886,678,541534,7354,127,512100%

64. Administrative Costs by Program Area 1- Economic Services $4.2 million 2- Children’s Services $4.0 million 3- Child Support $1.7 million 4- Adult Services $699 thousand 5- Work First $386 thousand 6- Child Day Care $370 thousand Economic Services Children’s Services Child Support Adult Services Work First Child Day Care

65. Sandra Wilkes, Director Jane Johnson, Budget Analyst 704-216-8422 704-216-8346 Sandra.Wilkes@rowancountync.gov Jane.Johnson@rowancountync.gov Sandra.Wilkes@rowancountync.govJane.Johnson@rowancountync.gov Pat Spears, Program Administrator for Economic Services 704-216-8407 Pat.Spears@rowancountync.gov Nancy Brandt, Program Administrator for Services Support 704-216-8343 Nancy.Brandt@rowancountync.gov Tom Brewer, Program Administrator for Children’s Services 704-216-8446 Tom.Brewer@rowancountync.gov Barbara Sharpe, Program Administrator for Children’s Protective Services 704-216-8479 Barbara.Sharpe@rowancountync.gov Lillian Morgan, Chair, Social Services Board lamorgan@carolina.rr.com