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Monty Veazey discusses raising awareness on rural health care
ATLANTA — College-bound Halle Mickel gave state lawmakers on Tuesday a compelling glimpse into Georgia’s foster care system.
The 19-year-old who has seven siblings in five different homes told the Senate Foster Care and Adoption Study Committee how her family’s life has been “turned upside down” ever since they were separated last April. She sees her siblings once a week. Sometimes, those visits are canceled because child welfare workers aren’t prepared, she said.
“The pain it caused not only my mom but me felt horrible,” she said. “Watching them cry as they have to leave my mom and go home to a stranger. Seeing my siblings not getting the proper hygiene care they need and so much more. Like many others, my family has been torn to pieces by the child welfare system due to struggling with poverty and being in need of immediate help. Parents aren’t always at fault when DFCS is involved.”
Mickel’s story was included among more than four hours of testimony from advocates and experts in the foster care, child welfare and family court fields. Tuesday’s session focused primarily on finding solutions for Georgia’s taxed foster care system.
Georgia has about 11,000 children in foster care, committee chair Sen. Kay Kirkpatrick told State Affairs in a post-hearing interview Tuesday. Many are in the system due to abuse, neglect, family drug addiction, violence and other hardships.
Georgia’s foster care system is stretched so thin that children in foster care in Georgia spend about two years in the system — nearly three months longer than the national average of 21.7 months, according to The Council of State Governments Southern Office.
Often there aren’t enough families to take in children so many end up in hotels or offices as a result, Candice Broce, head of Georgia Family and Children Services, recently told the committee.
Broce was back before the committee Tuesday with good news. The foster care system reached a milestone on Sept. 8, when no foster children were reported staying in hotels or offices, she said. Since then, the agency has only used hoteling in a few emergency cases, she noted.
Still, Tuesday’s testimonies showed Georgia is spending more money troubleshooting and intervening rather than preventing children from having to go into the foster care system.
About $538 million in state and federal money is spent on Georgia’s foster care system. The bulk of that — $498.5 million — goes to intervention and late intervention programs, according to Voices for Georgia’s Children, a nonprofit child policy and advocacy group.
“In Georgia, we allocate around 20% of Title IV funding towards prevention while the majority of resources are funneled into the foster care and adoption industry,” said Sarah Winograd of Together With Families, an advocacy group for families in the child welfare system.
“While the majority of the resources are funneled into the foster care and adoption industry,” Winograd told the committee. “It’s an industry. Consider the numbers: a staggering $32,000 per year to keep one child separated from their family and in foster care.”
It costs her organization “a mere $500 to $1,500 per child in assistance and resources at Together with Families to prevent foster care and help families improve their own lives,”she said.
Why It Matters
The committee heard suggestions to help Georgia focus more on prevention rather than intervention. Among the suggestions:
- Issue state identification cards to foster children. Often kids are removed from their homes during chaotic situations leaving birth certificates and other import documents unavailable to them. Children would be issued a state ID within 90 days of entering the foster care system, displaying information such as the child’s Medicaid number. It would enable older children in the system to get jobs and perform other vital daily tasks. The cost would run about $5 a child. “That should be something that’s not too difficult to achieve,” Kirkpatrick said.
- Use the Safe Babies approach in Georgia courts. Between 2011 and 2018, Georgia saw a 44% increase in infants and toddlers entering foster care, more than any other Southern state. As a result, it needs a more collaborative, family-based approach to dealing with the youngest children in foster care, such as the Safe Babies approach used in Iowa. Iowa’s infant courts are adorned with quilts, diapers, toys and books, to help alleviate the trauma experienced by toddlers and infants in the court system. In a recent visit, Georgia officials saw how one Iowa judge, his court staff and attorneys dealt with a mother who became distraught during the hearing. The judge stopped the hearing, allowing attorneys and other staff to embrace the woman. The DFCS case manager and defense attorney told the woman they were there to help her figure out ways to keep her baby. “That’s super important. It’s been successful in other states,” Kirkpatrick said.
- Use opioid settlement money to finance foster care needs. Kirkpatrick called it a good idea but “it might not be that easy to accomplish. It’s not really under the legislature’s control.”
Kirkpatrick, a Republican and retired orthopedic surgeon who practiced in metro Atlanta for over 30 years, called Tuesday’s hearing extremely productive.
“I thought it was another great meeting,” she said. “We work pretty hard to get input from all the different groups. We won’t make our decisions about which things to tackle until we finish [all of] our meetings. We have one more where we’ll be getting some testimony.”
The senate committee’s next meeting is in Columbus on Oct. 26. It will focus on adoption.
“After that, we’ll get together and figure out what our legislative priorities are going to be,” Kirkpatrick said.
Want to know how many foster children have been placed in foster homes outside of your county? Go to seetheneed.org to find out. See The Need was created by Alpharetta-based FaithBridge Foster Care to raise awareness about foster care in America.
Header image: The Senate Study Committee on Foster Care and Adoption held their second meeting at the Capitol to hear testimony from citizens, nonprofits and state agency representatives. (Credit: Georgia Senate)
The House Human Relations & Aging Committee explored several legislative and regulatory solutions to address the long-term care needs of Georgia’s rapidly expanding elderly population last week. A big focus was on how to best use Medicaid funds to provide more care for seniors who don’t yet need to be in a nursing home, and are trying to stay in their homes, assisted living facilities or personal care homes.
Lawmakers, leaders of state health and welfare agencies and a variety of long-term senior care facilities and associations spent four hours discussing how to provide better care for the growing population of low- and middle-income Georgia seniors who have a range of medical, housing and social service needs.
Some need modest support that can be provided in their homes by relatives or other paid caregivers, while others, including people with dementia, need ready access to medical services and constant oversight, but not the more intensive, expensive and skilled care that’s provided in nursing homes.
Much of the discussion centered around HB 582, a bill introduced in the last legislative session by House Public Health Committee Chair Rep. Sharon Cooper, R-Marietta. It would allow assisted living communities, personal care homes and other providers of home- and community-based services to enroll as Medicaid providers and receive Medicaid funds, which is currently prohibited by state law.
Access to Medicaid funds would help Georgians who need these services, but can’t afford them, “to age in place without moving to a skilled nursing facility,” according to the bill.
Nursing homes are currently funded by state-managed Medicaid dollars, comprised of about two-thirds federal funds and one-third state funds. And some personal care homes that have up to 24 beds serving elderly people who are frail are also allowed to receive Medicaid funding in Georgia through waivers granted by the federal Centers for Medicare and Medicaid Services.
Meanwhile, some larger assisted living providers want much wider access to Medicaid funds to meet the ever-increasing demand for affordable housing and supportive care that aging residents need.
Among them is Wesley Woods Senior Living, which provides apartment homes and care to about 1,800 older adults in Georgia, ranging from seniors with extremely low incomes to the affluent. CEO Terry Barcroft told the aging committee that she has 172 beds categorized as assisted living or personal care homes, where staff provide daily living support services to residents.
Many of their units are occupied by seniors on fixed incomes who depend on subsidized housing assistance, she said, and can’t afford to pay for supportive services. Wesley Woods provides more than $1 million in charitable care to make sure such people can stay in their homes,” said Barcroft.
But there are many more seniors in Georgia who need assisted living care but who don’t qualify for Medicaid waivers. The passage of HB 582 would create more accessible options within long-term care programs for thousands of people “who don’t need 24-hour skilled nursing but do need 24-hour watchful, protective oversight,” Barcroft said.
Why It Matters
The state’s senior population is rapidly growing. Georgians aged 60 or older currently represent more than 15% of the total state population of 11 million, said Debra Stokes, executive director of the Georgia Council on Aging. Numbering 1.7 million in 2020, the senior population will expand by more than 500,000 people by 2030, when they’ll outnumber the under-20 population. By 2040, older Georgians will number 2.8 million, with the greatest rate of growth among those 80 and older.
Meanwhile, the number of Georgians age 65 or older living with Alzheimer’s disease and dementia is also expected to climb to 190,000 people in 2025 from 150,000 in 2020, a 27% increase, said Nancy Pitra, government relations director for the Alzheimer’s Association of Georgia. At the same time Georgia’s Medicaid costs to care for seniors with Alzheimer’s, $1.2 billion in 2020, are expected to increase 26% by 2025, she said.
People with moderate to severe dementia need constant oversight, Pitra noted, and allowing them to access Medicaid-funded services in assisted living facilities would mean living and receiving care in more affordable, less isolated, home-like environments.
This swelling of the aging population will elevate the demand for affordable housing that is already tough to come by in Georgia. It will also exacerbate the existing shortage of skilled nurses, nursing assistants, memory care providers and other caregivers that serve seniors.
Finding new ways to finance the cost of long-term care for seniors is crucial, said MaryLea Boatwright Quinn, assistant deputy commissioner of the Division of Aging Services in the Department of Human Services. She leads the agency’s home- and community-based services program for vulnerable adults, which has a budget of $114 million, and allocates state and federal funds to aging-related agencies in Georgia.
Home- and community-based services positively impact seniors’ health and reduce health care costs by reducing hospitalizations and getting people to be more compliant with disease management, said Quinn, a licensed medical social worker.
“We’re trying to help people … stay in their home of choice and avoid institutionalization as long as possible,” she said.
One of the newer models relying on Medicaid, and Medicare, to provide long-term, community-based care for seniors is PACE, or Programs of All-Inclusive Care for the Elderly, which provides, often at an adult day health center, comprehensive medical and wraparound services to medically frail elderly people through an interdisciplinary team of caregivers.
Most patients enrolled in PACE programs live at home. Costs for their care are capped at a flat per diem rate, instead of being paid per service, and providers are required to deliver all the medical, social, transportation, food, physical therapy, memory care and other services that seniors in the program require.
The FY 2024 state appropriations bill mandated that the Department of Community Health conduct a needs assessment on the establishment of one or more PACE programs.
Brian Dowd, deputy commissioner of the department, told lawmakers that his team has been studying some of the PACE programs operating in 32 states for several months, and determined that the model could be viable in several Georgia counties they looked at, including Fulton, Dekalb, Cobb, Bibb, Chatham, Richmond, Gwinnett and Muscogee.
Because “they’re essentially on the hook for everything” that patients need, Dowd said, providers are also incentivized to use case management and other efficiencies to keep costs down.
Adopting PACE wouldn’t rely on a Medicaid waiver, which typically lasts five years, he said. It would more likely involve amending the state Medicaid plan. Dowd said the Department of Community Health is examining the need for legislation to authorize PACE programs in Georgia, and also developing cost projections for the program.
Kathleen Benton, CEO of Savannah Hospice, told lawmakers that she had spent two years researching PACE programs, and hopes the state will fund a pilot program.
She estimated the per person cost of a PACE program in Georgia would be $4,700 per month. “That’s much different than the $6,100 spent on nursing homes right now,” she said, adding that with PACE, patients and providers are more satisfied, attrition for both groups is low, and the supportive family members of patients aren’t overwhelmed with trying to provide or coordinate all of their care.
“We’re in a perfect storm in Georgia,” she said. “Beyond the aging population, we have a labor shortage,” and no good solutions on the horizon to solve it, Benton said. “We must look for inherent caregivers in the home. We have to support them and provide them respite.”
Rep. John LaHood, R-Valdosta, who manages several assisted living and senior care centers in Georgia, told State Affairs he sees pros and cons in the PACE model.
“In one way it makes it more predictable for the state to put a price tag on one person and say, ‘Alright, they’ve been taken care of at this price, no matter what they need,’ ” he said. “I think my concern would be that a PACE provider might be incentivized to be so efficient, to mitigate the risks of overspending, that they might avoid necessary care and getting that person engaged with the necessary providers. We would need some accountability, some kind of backstop for that.”
While all lawmakers and others who spoke at the committee meeting agreed that providing more independent living situations, medical care and social supports for seniors is important to pursue, not everyone was sure that using Medicaid funding to do it would work.
Some were not clear if repealing the state prohibition on funding assisted living and large personal care homes with Medicaid monies is permitted by the federal Medicaid agency. Others pointed out that 45 states are already using Medicaid funds for assisted living and a variety of home- and community-based services, with no regulatory backlash.
Catie Ramp, CEO of the Georgia Senior Living Association, a nonprofit trade association representing private pay senior living facilities, said her association is concerned about the potential negative consequences of allowing more Medicaid spending in the senior living market.
She said Medicaid’s low reimbursement rates might lead providers to “minimize quality of care and care options” in order to avoid passing on costs to residents. Otherwise, their labor costs will rise significantly, she said.
Barcroft said that labor shortages since the pandemic have led Wesley Woods to raise its base pay to $15 an hour, costs which “can only be passed on to residents and their families,” she said, adding that she hoped the state would continue to promote medical career pathways “to help students understand what CNAs [certified nursing assistants] and med techs do,” and draw more people into the field.
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Header photo: A nurse assists a resident at Fellowship Home at Brookside, an assisted living center in Valdosta. (Credit: The Fellowship Family)
If anyone knows the inner workings of Georgia’s top law enforcement agency, it’s Chris Hosey.
In his 36 years with the Georgia Bureau of Investigation, the Georgia native has worked under five GBI directors and held every sworn supervisor rank in the bureau’s investigative division.
On Aug. 1, he assumed the helm of the 86-year-old bureau, succeeding Michael Register who returned to Cobb County where he is public safety director. Hosey is the third director of the bureau in the last four years. Register’s predecessor, Vic Reynolds, was appointed by the governor to be Superior Court judge in Cobb County.
Hosey takes on a bureau with a staff of about 850 and a budget that topped $147 million in FY 2023. The bureau has investigated 65 officer-involved shootings since January, according to its latest monthly statistical report released this month.
State Affairs spoke with Hosey about his nearly four-decade tenure with the bureau, his plans for moving the agency forward, the case of the headless goats, and Will Trent, television’s quirky, fictional GBI special agent.
The conversation has been edited for clarity and length.
Q. What inspired you to go into law enforcement?
A. While I was in college, I had the opportunity to meet GBI agents and learn about the agency a little bit. I liked the professionalism that I saw in the agents that I met. I liked the fact that it was a statewide agency. And I had the ability to travel throughout the state to investigate crime and that sort of thing.
I don’t mean this to sound bad but violent crime interested me. Just the ability to investigate and solve a complex situation intrigued me.
Q. You’re a career GBI employee. What unique attributes do you bring to the bureau?
A. Knowledge of the agency. There was still a learning curve obviously going into the director position. But I think I brought a lot of knowledge of the agency and the operations of the agency from just being around it for 36 years. I’ve served in literally every capacity the GBI has, beginning in the investigative division and then as deputy director over investigations. DirectorRegister made me assistant director last year. So I got a lot of exposure to what the director does, prior to his leaving.
Q. You’ve been with the GBI a long time, what do you love about the job?
A. I enjoy the work. I enjoy the people. I enjoy the partnerships in working with our state partners, our sheriff’s office, our local partners in our sheriff’s office and police departments. I’m just big on relationships like that because I don’t believe one agency can do the job by itself. It takes everybody working together with a common goal in mind, set egos aside and work together and get the job done.
When you find yourself a part of a great team, that makes you not want to leave. It makes you want to stay. It makes you want to see that team develop. It makes you want to see new players come, watch them grow and be successful as well.
Q. The GBI has had three directors in the last four years? Has that created disruption within the organization and its goals?
A. As I’ve said before, the success of this agency doesn’t depend on who’s sitting in the director’s chair. It’s dependent upon the men and women that are out there doing the job everyday. The director provides guidance, oversight, sets goals, whatever. Every one of the directors I’ve worked for were … very, very good leaders. Very good vision for the agency. They did great jobs.
Q. How does your leadership style differ from your predecessor?
A. I don’t know that there’s a lot of difference. One thing that I recognized when he came was, in a lot of ways, we were a lot alike in our leadership styles. We believe there’s a mission out there. We set our goals and we give our people within the agency the ability to do their job, and we support them in that. He taught me a great deal in the time that he was here. He exposed me to a lot.
I think one thing important about leadership is … once you get in a leadership position, it is not about you anymore, it’s about taking care of your people.
Q. What are the biggest challenges facing the bureau?
A. We have to make sure that we’re staying current with the times. The world is changing around us as a law enforcement agency; we’ve got to change with it. That involves technology, additional resources, equipment, personnel, whatever the case may be. We’ve got to be forward thinkers. We’ve got to be dealing with a day in front of us, but we’ve also got to be looking down the road trying to predict what could change next that we can be ready for and prepared for and not trying to catch up.
There’s a lot that doesn’t change in investigations. There’s the traditional investigation, talking to people, collecting evidence, whether it be physical or testimonial evidence. I believe we should always be at the top tier of doing that. But with today’s times, with the technologies out there for something as simple as cell phones we’ve got to be able to ensure that we are utilizing current technology that can assist us and complement the traditional investigative tasks that we have done for years.
Q. What will be your top priority going forward?
A. We’ve got to continue to address violent crime and gang activity across the state. We’re continuing to look at ways we can advance in that. But again, that’s an area GBI will not fix by itself. We rely heavily on those partnerships around the state as we do in every investigation that we work.
My focus is on the agency and providing the resources, manpower, and the leadership that it needs. We’re an agency that has always adapted regardless of all of the instances that have come up. We have always found a way to adapt and get the job done.
Q. What budget and policy requests will you make for the upcoming amended FY 2024 and FY 2025 budget?
A. We’re still working through that right now. We’ve not finalized anything, budget wise. I’m looking at what our needs are coming from the division directors and how that can best support the agency over the next year or the following year.
Q. Are you expecting any policy or legislative changes with regard to the GBI during the 2024 session?
A. No, hopefully. Not to my knowledge.
Q. Senate Bill 11, which enables the GBI to investigate all acts of terrorism, passed during the last session. This bill opens the door for the GBIto pursue alleged crimes that local law enforcement agencies have deemed not worth their time. Are there some cases you’d like the GBI to pursue?
A. Not that I can think of right now. We take them as they come. If they’re worthy of an investigation, then we’re going to pursue that.
Q. SB 44, which is intended to limit gang activity, appears to have some unintended consequences. Apparently, critics believe more people could face prison sentences if they miss a court date or, for example, if they get stopped for something like a broken tail light. Thoughts?
A. In general, I think we have very good gang laws in this state. It’s not hard to work across the state and realize that there are concerns when it comes to gang activity. There’s a nexus between human trafficking and gang activity at times; it just depends on where in the state you want to look. The fact that we’re seeing evidence of gangs attempting to recruit 11 year olds, 12 year olds is very uncomfortable to see and hear about. I believe we have good gang laws. I believe we’re pursuing it in the right way. And at the end of the day it’s to make Georgia safer.
Q. Have you personally sat down with gang members or alleged gang members?
A. Years back I have.
Q. Would you consider doing that again going forward?
A. Yeah, absolutely.
Q. The GBI is investigating a case involving headless goats that have been dumped in the Chattahoochee River over a number of years now. Has any progress or arrests been made in that case?
A. I’d have to go back and check on that. I’m not really familiar with the incidents.
Q. Georgia’s ban on abortion after six weeks, or the first detection of a heartbeat, took effect last year. Have you had a case where an individual had violated Georgia’s abortion law? If so, did you arrest that person?
A. I’m not familiar with any. But just like any other law that is set forth for us to enforce, if we had the need to investigate one, we will. I’m not familiar with any we’re working on right now.
Q. Aside from becoming head of the bureau, what’s your biggest accomplishment at the GBI?
A. Probably them allowing me to stay here 36 years.
Q. What’s your biggest disappointment?
A. I don’t know that I’ve had a big disappointment. There’s things that have come up through 36 years that bothered me. But you know, I live under the adage that this too shall pass.
Q. Have you seen the [ABC Friday night television show] Will Trent. It’s about a GBI special agent. Do you have a Will Trent on staff and more importantly do you recognize the TV version of the GBI?
A. I watched it the first night [it came on] and I wasn’t real sure. Then I continued to watch it. It’s entertainment. I mean, it’s Hollywood. You know, Will Trent is depicted as an excellent investigator and from that standpoint I got 300-something of him. I enjoy watching it.
I actually went to an out-of-state conference in the spring of this year. When they handed me my name tag, my name was on one side and [the name] Will Trent was on the other side. They knew I was from Georgia and that show was out. I was getting ragged about that a little bit.
Want to get a glimpse of what the GBI does? Take a look at its monthly statistical reports here.
The Christopher E. Hosey Files
Title: Director of the Georgia Bureau of Investigation
Current residence: Thomaston
Education: Bachelor of Science in Sociology from Georgia Southwestern State University and a Masters in Public Administration from Columbus State University. He is a graduate of the FBI National Academy, Class 247.
Career path: Narcotics agent, local violators squad, 1987-89; special agent, Region 5 in Statesboro, 1989-90; special agent, Region 2, Thomaston/Greenville, 1990-2001; assistant special agent in charge, Region 2, Greenville, 2001-05; assistant special agent in charge, West Georgia Drug Task Force/West Metro RDEO, 2005-08; special agent in charge, Region 5, Statesboro, 2008-09; special agent in charge, Savannah RDEO, 2009-12; inspector, headquarters, investigative division, 2012-20; deputy director of investigations, HQ, investigative division, 2020-22; GBI assistant director, 2022-23.
Family: Married 34 years to Powell; two daughters.
Hobbies: “I go to the gym. I’ve been doing that for years. I enjoy golf. Working in the yard. I like woodworking. I just haven’t had time to do much of that here lately.”
If you weren’t in the field of law what would you be doing? “The first thing that popped in my mind was probably something in the medical field. I went to school for EMS [Emergency Medical Services]. The GBI actually sent me to school for that for our tactical team. Once I completed it, I actually went to work part-time with an ambulance service at home. And I did that up till last year. Then things just got so busy. I didn’t have time to do it anymore but I enjoyed it. I still have the uniforms. I still intend on going back and doing it some more when I can, when things settle in.”
The days of standing in long lines to get or renew a driver’s license may soon be in the rearview mirror for good.
Over the next month, Georgia drivers will continue to see significant updates in services as the Georgia Department of Driver Services continues its push to modernize through state-of-the-art technology and to cut back on long wait times caused by a shortage of workers and backlogs due to Covid-19.
The department will roll out about 20 kiosks in its metro Atlanta offices where motorists can get or renew driver’s licenses, replace lost or stolen ones and record address changes. The rollout is a pilot program and will be extended to the rest of the state later, department spokesperson Susan Sports told State Affairs.
At the same time, the kiosks you use at Kroger and Publix to renew your car tags “are being updated and modified to add the driver’s license [renewal services] to them,” Sports said. Initially, those kiosks will renew licenses and ID cards. More services will be added later. The grocery store kiosks are run by the state Department of Revenue.
Driver services has also taken steps to make traveling easier for Georgians.
The department now allows Georgians to add their driver’s license or state ID to Apple Wallet on iPhone and Apple Watch, making check-in at airports quick, easy and secure. It is not intended as a replacement for a physical copy of your license or ID but it can speed up the process at TSA checkpoints. Android users will soon have a similar option, Sports said. Georgians meanwhile also have the option of renewing their driver’s license online.
Despite the online presence, some people still prefer to come into the office, Sports said. Now, they’ll have the option of using a self-serve kiosk rather than having to stand in a long line.
Why It Matters
The state is spending close to $2 million to add the kiosks and update services for Georgia drivers, an initiative driven by fewer department staff and greater demand for quicker services.
“The kiosks especially should help with the agency’s workforce issues,” DDS Commissioner Spencer R. Moore said. “If you have a self-service kiosk that is handling that renewal customer coming in, not having to take a break or a lunch or take vacation, it’s going to really offset some of those staffing challenges that we have.”
The new technology isn’t just for giving short-handed staff some help. It also is intended to head off a potential rise in wait times once a round of license expirations kicks in over the next two years, Sports said.
“Having a self-service kiosk option will save wait time for customers,” she said. “In turn, the driver examiners will be able to assist those customers that cannot be served in any way but in person. It will save customers time because if they use the kiosk, they do not have to fill out the required ‘application for service’ or take a ticket number for service as is required for all customers visiting in person.”
While as many as 45 Department of Motor Vehicle agencies in the United States were using some type of self-service kiosks in 2021, there is still a large number of government agencies that have not yet taken advantage of the technology, according to Kiosk Marketplace.
Meanwhile in Georgia, the Department of Driver Services’ kiosks are currently wrapping up the test phase, Sports said, and should be rolling out over the next 30 days at the 65 DDS offices statewide and in grocery stores.
“That’s the wave of the future and our customers are on the go. They want more options,” said Sports. “In the old days, you’d go to the DDS and you would take a lounge chair and you’d take a book and you knew you were going to be there all day. So now … our service goal statewide is less than 30 minutes.”
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Header image: City of Warner Robins former Police Chief John Wagner poses with a Georgia driver’s license. (Credit: Georgia Department of Drivers Services)