Annual Report Rowan County Department of Social Services Fiscal Year 2010 July 1, 2009 – June 30, 2010

Introduction Rowan County Department of Social Services (DSS) is committed to improving the lives of our citizens, helping them to overcome lifes challenges, while at the same time promoting their personal responsibility in order to build a stronger community. Current societal issues make the provision of quality human services more important than ever. Many in our community face unemployment, homelessness, addictions, lack of medical care, abuse, neglect, domestic violence, and hunger. Reacting to these issues in an appropriate, healthy, and positive way is challenging for anyone but impossible for some citizens, unless they have assistance and support. Many people find themselves with no place to turn except to government agencies such as DSS. Complex human needs must be met, even when government resources are scarce.

Introduction Continued DSS serves economically disadvantaged children, families, and adults, helping them to become self- sufficient. Every month, an average of 20,000 Rowan County citizens depend on the Food and Nutrition Services program so that they will have enough food to eat. And, through Medicaid and NC Health Choice, more than 24,000 individuals receive needed health services, including physician care, medicine, hospital and nursing home care. The Work First program provides a small monthly, temporary payment to 412 families, so unemployed parents can provide for their families while they are looking for work. Child care subsidies help pay for quality child care for almost 1100 children each month, while their parents work or complete their education. Children from single-parent homes benefit when DSS child support staff are able to establish paternity, develop child support orders, and enforce those orders with the help of law enforcement and the court. More than $830,000 in monthly child support payments are issued to Rowan County families who are working through DSS child support program.

Introduction Continued DSS focuses on enabling at-risk children to be safe and healthy in stable environments and on helping children in agency custody to become successful adults. An average of 236 reports of child abuse and neglect are made each month by concerned citizens, teachers, doctors, family members, and anonymous callers. Each report is carefully assessed by DSS child protective services staff. In the past year, 105 children were removed from their parents home because of abuse or neglect and were placed in foster care. There are 33 families licensed by DSS to serve as foster homes. Victims of abuse and neglect suffer physical and psychological harm, and many need specialized foster care in therapeutic or group homes. DSS social workers provide parents with resources and internal tools so they can make positive choices and changes in their lives. Many parents successfully regain custody of their children. However, 29 children were placed in adoptive homes this past year, because they could not be reunited with their birth parents.

Introduction Continued DSS helps aging and disabled adults to be safe and healthy and to live in the most stable and least restrictive settings as possible. DSS adult protective services staff assess hundreds of reports from the public about citizens who are victims of abuse, neglect, and exploitation. As a result, those in need are connected with services such as adult day care, in-home aide, and guardian appointment. When needs cannot be met at home even with support services, DSS works with the family for placement in a care facility where the adult can live safely and with dignity.

Introduction Continued The Board of Social Services and DSS work together to establish and maintain effective community partnerships to understand social issues and to prevent social problems. The DSS Board regularly convenes Community Roundtables to bring attention to issues affecting our citizens. DSS partners with law enforcement, the school system, medical care providers, the faith community, and service organizations to understand issues and find solutions to common problems. Two issues under review at this time are parenting practices that put infants at risk and teen abuse of prescription drugs.

Introduction Continued DSS is accountable to the community. The cost to administer the programs is just over $11.8 million. DSS uses a system of checks and balances and practices daily oversight to maximize revenues and to maintain the highest fiscal accountability and transparency. I am grateful for our community partners, our Board of Directors, and our 196 employees for the work that they do. Working together is the key to addressing the communitys urgent and compelling needs. Sandra M. Wilkes, Director Rowan County Department of Social Services

Assistance Issued in FY 2010 (1 of 3) Medicaid for Rowan Citizens $160,311,782 Food and Nutrition Benefits, USDA30,966,106 Child Support Collections10,410,041 Child Day Care Subsidy4,613,671 Foster Care/Adoption Assistance4,315,801 Special Assistance – Adult Care Home 2,304,249 Emergency and Seasonal Assistance1,580,080 Work First Benefits975,306

Assistance Issued in FY 2010 (2 of 3) Medicaid Transportation530,349 In-Home Aide Services101,300 Donated Funds78,126 Adult Day Care67,414 LINKS Purchases for Foster Children Leaving the System 16,722 Food/Nutrition Employment and Training Program 4,615 TOTAL ASSISTANCE ISSUED$216,275,562

Assistance Issued in FY 2010 (3 of 3)

Medicaid Program 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. 22,742 individuals were authorized for Medicaid (16% of Rowan County population) as of June 2010; average value of medical services received was $7,049 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.

Medicaid Services Provided (1 of 3) HMO Premiums for Mental Health$28,705,371 Long-Term Care-Nursing Home 24,995,602 Physician 20,014,799 Prescription Drugs 19,471,350 Hospital-Inpatient 14,827,777 Hospital-Outpatient 14,612,966 Home Health/CAP/Personal Care 14,204,983 Medicare Premiums 6,470,569 Dental 6,058,915 Adult Care Homes 3,105,170 Clinics 1,818,239 Practitioner, Non-Physician1,406,578

Health Check/Education1,128,124 Lab/X-Ray 1,028,670 Family Planning 766,149 Hospice576,507 Ambulance 473,334 Optical 440,156 Podiatry 83,841 Case Management 69,822 Chiropractic 40,715 Hearing Aids 7,630 High Risk Intervention4,515 TOTAL MEDICAID PROVIDED$160,311,782 Medicaid Services Provided (2 of 3)

Medicaid Services Provided (3 of 3)

Medicaid Eligibility Categories (1 of 2) Disabled $65,229,242 Aged 34,743,761 Infant/Children 25,174,936 Work First Over 21 17,654,941 Work First Under 21 9,306,425 Pregnant Women 4,044,795 Medicare Qualified Beneficiaries 1,398,697 NC Health Choice 1,255,237 State Foster Home Children 585,646 Illegal Aliens 533,348 Blind 413,006 Legal Aliens 110,491 Refugees 6,177 Claims Adjustments (144,921) TOTAL MEDICAID PROVIDED $160,311,782

Medicaid Eligibility Categories (2 of 2)

Long-Term Care - Nursing Home$ 25,193,833 Prescription Drugs17,675,733 Hospital13,239,151 Physician11,320,013 Dental5,851,258 Community Alternatives Program2,754,263 Personal Care Services2,584,220 Residential Child Care2,572,781 Adult Care Homes2,211,891 Private Duty Nurse2,096,013 Health Check/Education1,301,241 Home Health780,522 Practitioner-Non-Physician656,426 Rowan County Provider Earnings (1 of 3)

Dialysis398,702 Durable Medical Equipment388,161 Optical371,612 Ambulance284,799 Hospice266,822 Community Intervention Services183,004 Mental Health Providers128,889 Case Management39,483 Podiatry21,164 Chiropractic11,223 Hearing Aids2,225 TOTAL REVENUE TO ROWAN PROVIDERS $90,333,429 Rowan County Provider Earnings (2 of 3)

Rowan County Provider Earnings (3 of 3)

Food and Nutrition Benefits 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. $30,787,690 was issued to an average of 8,568 Rowan County households per month in FY 2010 (16% of households in county). $178,416 was dispensed in USDA surplus commodities.

Child Support Enforcement 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.

Child Support Enforcement $9,910,026 was collected on behalf of Rowan County children in FY 2010 Paternity was established for 4,606 children $500,015 was saved in medical costs, paid by absent parents or insurance rather than Medicaid

Child 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.

Child Day Care Subsidy $4,613,671 was issued in Fiscal Year 2010 An average of 1,164 children were served each month; 2,007 children served in FY child care providers in Rowan County received subsidy

Foster Care Placement Services 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.

Foster Care Placement Services $2,639,775 spent in FY 2010 $1,923,324 paid to Rowan County providers; $716,451 out of county 270 children served 30 licensed foster homes in Rowan County

Adoption Assistance Program 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.

Adoption Assistance Payments $1,599,183 was issued in FY 2010 in Cash Assistance and Vendor Payments $76,843 more was reinvested in the program from incentives earned for success in number of adoptions 234 children served 52 children adopted (including 23 step- parent adoptions)

Special Assistance Programs State-County Special Assistance for Adults (SA) provides 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. Aged and disabled adults in adult care homes receive their supplement from State/County Special Assistance. Adults and children who are visually impaired receive their supplement from Special Assistance for the Blind.

Special Assistance Programs Personal Care Services : Provides for the verification of the need 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. SA In-Home : 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.

Special Assistance (Adult Care Home Payments) Payments for Disabled Adults in FY $1,141,376 Payments for Elderly Adults in FY 2010 – $1,084,052 Payments for In-Home SA Care $74,923 for 28 clients Assistance for Blind - $3, Adult Care Home Providers in Rowan County serving up to 732 residents

Low Income Energy Assistance Program 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. $856,905 issued in FY 2010; 4,425 households received assistance (8.1% of county)

Crisis Intervention and Share the Warmth Programs 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. 2,572 households and 6,633 individuals were served in FY 2010 (4.7% of county population) $577,889 was paid to 24 businesses in Rowan County

Work First 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. $133,616 paid for emergencies to ensure that 402 families with children had shelter and utilities

General Assistance $11,670 in assistance provided for multiple needs not covered by other programs 89 individuals assisted 26 businesses or vendors paid

Work First Benefits and Work First Employment Services Provides services focusing on employment and self- sufficiency 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.

Work First Benefits and Work First Employment Services $925,695 cash assistance payments issued in FY is the average number of households assisted each month (75% of these payments are for the child only) $38,343 paid to assist clients in finding and keeping employment $11,268 to Family Crisis Council, assisted 7 victims of domestic violence

Medicaid Transportation $530,349 paid to vendors and family members to transport Medicaid-eligible clients for medical services 40,397 trips serving an average of 251 recipients per month

In-Home Aide Services 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. $101,300 spent in SFY 2010

Donated Funds $78,126 in contributions from the community used for the following purposes: $67,802 for Christmas Happiness $6,524 for One Church, One Child $2,023 Childrens Services $910 Adult Services $867 Food Pantry/Income Maintenance

Adult Day Care Provided to monitor adult day care centers in order to ensure program quality. Our agency may also provide limited funding and case management services to disabled adults who need this program but are unable to pay for it. $67,414 spent in SFY 2010

LINKS Purchases for Foster Children Provides financial assistance in preparing youth who have been in foster care for independent living. Foster care youth between the ages of 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. $16,722 spent in SFY 2010

Food and Nutrition Services Employment & Training 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 recipients needs and develops a plan for training activities or for job search activities based on the recipients individual needs. Persons who participate in the program are reimbursed for participation expenses. $4,615 spent in SFY 2010

Total Impact on Rowan County Citizens and Economy in FY 2010 $216,275,562 in benefits and services impacted our economy. The vast majority is Federal and State funding, with the total County share for these benefits $2,646,033 (1.2%). 24,985 households and 44,545 individuals in Rowan County received assistance in FY 2010 in Medicaid, Food and Nutrition, and/or Work First Benefits (46% of Rowan County households)

Demographic Information Estimated 2010 population of Rowan County was 142,013 (54,520 households) Median household income in 2010 was $46, % below poverty rate in 2008 May 2010 Unemployment Rate 11.8% From Charlotte Regional Partnership, NC Rural Center, and US Census Bureau, ESRI Forecasts, Employment Security Commission

Projected Growth Projected Rowan County population 2015: 149,325 Projected Number of Households 2015: 57,419 Projected Household Income 2015: $53,090 From Charlotte Regional Partnership, U.S. Census Bureau, ESRI Forecasts

Cost of Administering Benefits and Providing Services The cost for administering over $216 million in benefits was $11,804,312, or 5.5% of total benefits issued. County share of administrative costs was $5,205,244. This cost includes the provision of protective services for children and adults as mandated by law. We have included the cost of these social work services in our administrative costs rather than in benefits issued.

Childrens Protective Services 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.

Child Protection Statistics Reports Received in FY2010 – 2,833 Physical or Emotional Abuse – 103 Sexual Abuse – 119 Abuse and Neglect – 5 Neglect – 1,587 Dependency – 51 Screened Out (did not meet criteria in law) – 969

Adult Services The Division of Aging and Adult Services supports 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.

Adult Protective Services Protective Services Reports Received in FY2010 – 346 Abuse – 11 Self-Neglect – 69 Caretaker Neglect – 53 Exploitation of Assets – 23 Already receiving services – 14 Psychological Evaluations - 1 Screened Out (did not meet criteria in law) - 225

Administrative Costs by Program Area ProgramTotalFederalStateCountyPercent Economic Services 4,449,3542,300,67029,3842,119, % Childrens Services 4,078,8751,935,862442,6331,700, % Child Support 1,809,7111,193, , % Adult Services 752,159299,394106,021346,7446.4% Work First403, % Child Day Care 310,306291,269019,0372.6% Totals11,804,3126,021,030578,0385,205,244100%

Administrative Costs by Program Area 1- Economic Services $4.4 million 2- Childrens Services $4.0 million 3- Child Support$1.8 million 4- Adult Services$752 thousand 5- Work First$404 thousand 6- Child Day Care$310 thousand Economic Services Childrens Services Child Support Adult Services Work First Child Day Care

Leadership Team and Contact Information Sandra Wilkes, DirectorJane Johnson, Budget Analyst Pat Spears, Program Administrator for Economic Services (Medicaid, Food and Nutrition, Energy Assistance) Tom Brewer, Program Administrator for Childrens Services, Foster Care, and Adoptions Barbara Sharpe, Program Administrator for Childrens Protective Services Nancy Brandt, Program Administrator for Child Support, Adult Services, Child Day Care, and Work First Lillian Morgan, Chair, Social Services Board