Transcript Board Meeting: 11/01/2018 Secretary of Aging, Theresa Osborne

We have our first guest of the morning and I would like you to introduce you all to our

Secretary of Aging. Theresa Osborne.

Good morning.

>> SECRETARY OSBORNE:  I’ll try to use — good morning.   I’ll try to use my outdoor voice. I have a cold so — bear with me as I journey through a cold don’t infect anyone in this room.

It is always good for I know Terry Barley our deputy to be here with you, I had — contacted Matt the other day to say any item in particular that the SILC board wants me to touch on, Matt said not particularly a general aging overview and questions would be great.

So I’m happen toy do that.

I asked Terry the same question and he gave the same answer so I felt incredibly affirmed, so if they were wrong, you have to yell at Matt and Terry that will be great.

But for me, a few things I want to touch on I know Kathleen Kleinmann is joining your meeting by phone, Kathleen I single out she is appointed a member of the Pennsylvania long-term care council that is one item I was touched on, to talk about what the long term council is, I’m assuming you may be aware of and proper particularly what their working on now.

So I’ll speak briefly in terms of context so you have the same baseline of what the Pennsylvania long-term care council is.

The long-term care council was established believe it or not 3 years ago.   Time flies here we sit four years into this administration it was Act 64, Act 64, 2015, that created the Pennsylvania long-term care council.

The long-term care council in essence, replaced the long standing Pennsylvania intergovernmental on long-term care.

We wanted the General Assembly when they created the piece of legislation, originated in the house, they really wanted to expand the scope of what long-term care meant and, wanted I guess a better Verbiage to fully describe it.   It is the broader long-term care continuum the long-term care council is charged with several responsibilities.

Above all, making recommendations on all types of things that touch long-term care.

Long-term care can be institutional care, or home and community based services care.   That’s the full gamete of long-term care things such as regulations, licensure, financing or any other responsibilities, this is key for me, that I really want to stress, any other responsibilities that lie with the Commonwealth’s agencies that serve the long-term care continuum.

So that is not just the Pennsylvania Department of Aging.   As you all, well know.

The Pennsylvania Department of Health, the department of human services, the Department of Labor and Industry, department of military affairs, Department of Transportation, and anyone else I might have just missed but it is any of the agencies that touch the long-term care continuum, and more importantly the folks who need the services in that continuum to they can do what we all desire to do and live and every day life.   Fry from all types of abuse and neglect with the dignity and respect that we all deserve. That is the crux of the Long-Term Care Council the secretary of the Department of Aging I currently have the privilege of serve understanding that post, charged to serve as the council. The council itself has 35 members. And those members are appointed by the Governor. And some of them are specifically spotted what do I mean by that?  Slotted positions such as the secretary of aging serving as the chair of the council. Such as my sister state agencies have specific slots on the board. Such as the secretaries of health, human services, insurance commissioner, adjunct general of the department of veterans fairs. And transportation all the executive director of the Pennsylvania Housing Finance Agency, also two members of the house that are appointed and two members of the Senate, minority and majority members.   There’s also a member who needs to represent the area agencies on aging.

There’s also, six members appointed who represent, consumer advocacy groups and at least two of those six have to be consumers of long-term care services.   One member from the elder law section of the Pennsylvania bar association, one member who is a licensed insurance broker who has to have ten years of experience as a licensed insurance broker in long-term care.

Also 7 members who represent long-term care continuum providers one has to be a skilled nursing facility non-profit, one has to be skilled nursing facility for profit.   One assisted living or personal care representative, one home care hospice representative, one adult day center one senior community centers and one long-term care managed Karen at this timity.   So that, comprises the 35 folks who are appointed. The executive director ever the Pennsylvania long-term care council is chuck Gweinett, the first issue they decided to take up after a survey was done and discussions were held was the creation they decided to look at and analyze and give a recommendation back to the Governor, on the creation of the unified Department of Health and Human Services.   If we think back a few budgets ago, two budgets ago, Governor Wolf proposed creating a new Pennsylvania Department of Health and human services.

That would comprise what is currently known as the Department of Aging, the department of drug and alcohol programs the Department of Health and the Department of Human Services and put them into one brand new umbrella agency as I look around the room, I know that, many of you expressed your opinion on that proposal.   Some were for and some were against I’m not hear to take a poll. To me when the Governor said, Teresa as my secretary of aging I’ll let you know what my next budget a address will entail. That will be the creation of the new department.

As a former human services director, in my home county of Lackawanna I can get my head around that model pretty quickly.

I did not however think I was coming to Harrisburg to be the last secretary of aging however, that is irrelevant.   Because in these positions you serve at the pleasure of the governor. This was the — the Governor’s desire that he felt, that this new model is going to best serve Pennsylvanians, who need to access those services.

So I was excited at the opportunity to create something new.   Something new would be sustainable. Most importantly something new that would continue to serve the people had entrusted to our care regardless of the services they need.   To me the human services is the most noble work of the government, regardless stages of life. We have a duty within that roll journey we did, in that journey there were six hearings held four in the Senate, two in the house, a lot of other conversations that occurred, ultimately the General Assembly did not approve the Governor’s proposal.   Because that had to be by the General Assembly legislating saying yes we’ll create this new entity. As we all sit here today, in October — November, November now, of 2018 we know that didn’t happen. A lot of other thing have happened in the meantime in terms of how we across those human service agencies actually work together. How we coordinate, how we communicate.   How we ensure we’re better leveraging our services, leveraging the dollars had entrusted to our care in order to serve Pennsylvanians that need access to that long-term care. Whether it’s at home or in institutions, and hopefully transition is — that’s the goal from our particular lens of life I cannot stress enough, regardless of age or stages of life. For the Department of Aging we’re required under the older Americans act to serve, as visible effective advocates for older Americans for us, that’s 3 million Pennsylvanians who are age 60 years of age and old they’re is always the lens upon which we work in terms of undertaking our work.

With the long-term care council though, as the chair of the council I have to broaden that list in terms of not just advocating for one agency of the State government but the totality of the long-term care system in the Commonwealth of Pennsylvania.   That’s what I strive to do.

I’m sure some days I’m successful at it and sometime sure some days I fail at it and those failures are going to be brought to my attention not by myself and others but we strive to always do our best in terms of responsibilities had entrusted to our care and how we’re going to ensure Pennsylvanians can age in place with the dignity and respect they deserve.   That’s the first opportunity the council really under the new creation, creative body had a chance to work together.

After that recommendation was given to the Governor to not fully support creating new entity, but to be supportive whatever the General Assembly ultimately came up with.

Moving forward then the council regrouped and said what’s our next issue of priority?  Because they want to work on these issues together across four committees and the issue that they’re currently working on is the retention recruitment of direct careworkers.

Matt was kind enough if not all of the meetings majority of them.   Kathleen as I mentioned is an appointed member, anyone can come to the meetings they’re open to the public.

We have four committees that function we welcome anyone serving on any of those four committees, to help move the work forward of where are we?  In Pennsylvania with direct care workers?

We talk a lot about aging in place but we know we can’t age in place unless we have a direct care work force available and ready and able to care for folks who need assistance in that space of long-term care.

I give credit to all those both appointed members, committee members for the last several months that have been really analyzing prior reports, some of you may remember, when Governor Rendell was Governor there was a report commission on direct careworkers always the fear that we have, I felt this fear even prior to landing in state government is that, are those recommendations actually going to go away?  Or is it just a great exercise and those recommendations are sitting on a shelf somewhere.

So, that is the concern because that has been the reality.

So, we did ask all of the folks who were engaged in that process I shouldn’t say the folks.   All of the entities engaged in that prior process, so like Labor and Industry, education, state, health, human services transportation.   All of those agencies that were involved in that 2007 report as I imagine in your own agencies there’s a lot of turn over both direct line staff as well as leadership staff.

We asked them to look at it now, 11 years later, were any of the recommendations implemented?

If not, why not?

Or if they were, how successful, were they?

Not many as you can imagine recommendations were implemented which is say reality, you realize that, a lot of them are still viable.   Looking at the recommendations with current leadership, in terms how can we move across the State agencies in order to address retention recruitment of the direct careworkers.   In the midst of the reality we have a lot of changing environments. One is community HealthChoices I know I think later on your agenda Kevin Hancock is going to be here from the department of services long term living?  No?

>> MATT SEELEY:  No he dropped off.

>> SECRETARY OSBORNE:  If he was here he could speak to — community HealthChoices but with community HealthChoices as we know rule of now, live in the 14 counties in southwestern Pennsylvania, preparing are for two months from today, to go live in south Eastern Pennsylvania and January 1, 2020 the rest of the state we have now 3 managed care organizations we the Commonwealth is working with.

Granted it is say Medicaid program.

So our sister state agency at the Department of Human Services is obviously the lead.   I’m the State unit on aging they have a state Medicaid agency.

But those 3 managed care organizations, are really critical.

Because in order for them, to successfully serve folks in the community and the managed care environment, of community HealthChoices they too need direct care workers.   So representatives from each of those managed care organizations came to a recent long-term care council meeting talked to the long-term care council members about how they’re approaching their relationships with providers how they’re approaching their relationships with consumers in the consumer employee model.

And, how they’re approaching overall recruitment of the direct careworkers we had a panel not too long ago of direct care workers talking about their experience.   Some were on the consumer employee model and the provider agency, the agency model. So trying the long-term care rather council members trying get a full scope, regardless of the seat they represent, the full scope what is going on there in the Commonwealth of Pennsylvania.   From the lenses of the people that are actually doing the work, providers that pay for that work and the consumers that are being impacted by that work.

So, the long-term care council members are diligently going through the exercise for the recommendations they want to make to the Governor’s office, regarding retention and recruitment in the Commonwealth for the direct care workers.

I get to watch the process unfold and the executive director chuck is the one working most closely with the council members and chairs of the four committees.   But watching it unfold has been really an awesome experience for me.

I learned a lot through the process.

I anticipate, at the next meeting in December is really whether the council members will be doing the bulk of their work trying to flush out the recommendations and put form to the substance what they want to recommend that’s my anticipation of the next meeting.

That’s where we’re at with the long-term care council at the given moment.

I flow Kathleen is son the phone, Matt you’ve been at the meetings if you want to add anything or if you have any questions on the work of the long-term care council or another topic or Kathleen?

>> MATTHEW SEELEY:  You more adequately answered that.

>> SECRETARY OSBORNE:  You’ve come do some meetings I did not want to recognize that Theo, I mentioned meetings were open to the public, we’ve also had consumers and their attendants come to many of the meetings.   And they wanted to talk too, so the open public forum of I think at least 3 meetings I have little concept, I don’t know if you’re like me everything melds together I don’t remember often day-to-day, in terms of concepts of time.   But it wasn’t meetings all that long ago we did have a full host of folks come consumers of services as well as their attendants and that is incredibly eye opening as well, especially folks journeying through southwest Pennsylvania, launch of community HealthChoices what is working, what isn’t, what are the fears what are the concerns?  That’s all, important stuff for us to know and to be responsive and responsible too.

I was grateful for those sessions as well, Kathleen anything from your lens you wanted to add on that as a member of the council?

>> ROB OLIVER:  That must be — do you have something to say?


Somehow you’re muted.


>> MATT SEELEY:  It’s there, it’s not muted.

I think Rob has the right attitude.


>> SECRETARY OSBORNE:  We can come back once she gets that worked out.   Okay.

We’ll come back to that.

Excuse me the next topic I wanted to take a moment to talk about is Pennsylvania’s opioid crisis from the lens now with — not my long-term care council, chairperson’s hat, very specifically to the Department of Aging in this space just a few items that I just want to touch on.   As I trust that we’re all aware just as Pennsylvanians 13 million of us who call Pennsylvania home, knowing that this crisis impacts doesn’t discriminate it’s not discriminatory in the reach or devastation.

And, if your family is like mine from a personal perspective, my family has been impacted by this crisis I’m sure if I went around the room, many of yours probably has been as well.   If not your personal family but, friends or neighbors or so and so forth.

So it really is a crisis in Pennsylvania.   So, the Governor’s disaster declaration did a lot of things I’m not here to speak about all those things but we have answered questions about it, it is really awesome, the steps the Governor has taken obviously I serve at his pleasure of course I support the effort.

The opiodid command center gives us an opportunity to come together every Monday, state agencies working together in terms what our response is as I spoke about the Department of Aging.

I actually have been paying close attention to your national council’s efforts in this space.   So your national council on independent living as I’m sure you’re aware, their chronic pain and opiodid task force I’ve been trying to pay close attention to that that’s consumer oriented across the spectrum of over and overage 60 they put out a lot of good documents and Blogs I’m thrilled to be able to tap into it, in the month of October, there was a Federal piece of legislation called the support act.   We need another acronym the substance use disorder prevention that promotes opiodd recovery act. It was just signed in October at the Federal government the desire is very akin to what we’re doing here in Pennsylvania that is to stem the addiction and over doses in communities and increase access to treatment. Our concern from the Department of Aging’s lens my state state agencies share the concerns your input is incredibly important to us.   The Bill’s provision like the work we’re doing in Pennsylvania, rightly and rightfully so, pivots prescribing opioid prescribing uses and the drugs, it is not necessarily addressing how people, who are legitimately prescribed opioids and under supervised treatment for chronic pain how they’re fairing in this space.

So I see a lot —

>> SUSAN TOMASIC:  Not well.

>> SECRETARY OSBORNE:  I see a lot of heads nodding I’m not alone I live in Scranton I’m in Harrisburg Monday through Friday when I go loam to my hometown, in Scranton whether I’m leaving church, the grocery store, I’ve been getting stopped, by older Pennsylvanian who I know in my little community, saying Teresa told me they won’t describe anymore do you want them to go on heroin.   Well no, I really don’t want them to go on heroin. I’ve been talking to Dr. Levine and secretary Smith in particular about the need, about this — this concern about this fear, quite frankly. It is a fear that’s bubbling up not just from folks living in the community, but also folks in institutions and long term settings. We are talking right now, about everyone likes to be empowered everyone likes to be engaged, everyone likes to use their own voice whether they can for folks who can’t speak for themselves thankfully there’s good advocates like you willing to do that, how would those folks be impacted by this, the tools they need to talk to their doctor themselves, if they can and how do we also continue to further education physician ins this space.   So we are, working on that.

It is real concern.

So thoughts that you have on how we can work together in that space, again, I can’t stress enough, I would love to work with Matt and the SILC on that.   In addition to that, advocacy effort that empowerment, that enablement for folks who are being told by the physicians this, we have a part-time Geritrician, a physician in our office that Terry gets to — I talk to him, Terry meets with him on a regular basis I hop in and say hey Doc, what’s going on?  I don’t do that, but fully way. He is in our office office every Wednesday he is trouble to us Dr. Galinski, a part-time retired physician in the Philadelphia area.

He came on board with us probably about five years ago at the department — four years ago he started right when I started actually.

I share that with you because he is really instrumental working with Dr. Levine and her approach on the prescribing guidelines for Geritricians, we have a doctor from the Department of Aging working closely in that space he is also talking to other physicians about kind of how I — to best describe it perhaps the pendulum swinging too far.   He is also working with us in that space as well.

In addition to that, from our lens of life you know there’s 67 counties across the Commonwealth, 52 local area agencies on aging that cover those 67 counties and we’re really working closely with them at the local level, so that they can engage in better relationships or enhance relationships with their local area agencies.   We’ve been talking to the area agencies on aging that has to be done at the local level, although secretary Smith from the drug and alcohol programs overseas the single county authorities that I oversee the area agencies on aging we want to set a tempo, in that, we’re striving to do that in our space, we’re encouraging our agencies senior center partners in particular to talk about the proper use storage and disposal of prescription drugs especially for pain medications.

I think that you all would agree that this crisis doesn’t necessarily start on the streets.   It is starting in you’re medicine cabinet. And if you grew up in my house my dad was a pharmacist we did not have a medicine cabinet.   We had a medicine closet.


And you never knew what was in it.   Because he was the one that knew everything in there, no one could read his handwriting I think he thought he was a doctor they weren’t always labeled medications he he is deceased.   He cannot get arrested I would say to him, I come from a family of enablers you’re such an enabler. A lot of interesting discussions in our house, with this medicine closet.

I shared with you that the disease of addiction hit my family and in particular, the opioid over dose space I often think, my dad didn’t mean for that to happen I’m not implying that at all, but is it where it started?  Just being able to get a pain medication being able to use it and knowing where to get more, so — any way. Those are the crazy thoughts that go through my head, in terms of if that happened in my family we’re not unique, we are not unique, when it comes to, what folks deal with.

So how many other families are dealing with this?  So that proper use storage and disposal of prescription medications is critically important because you guys know it, our seniors, folks like to Hoard pain medications I didn’t use it all I might need it.

Or, at a senior center, if I had a nickel for the number of times not just in this privileged post even before I landed here working in the aging network, sit at a table of seniors at a senior center, Martha has pain in her back, Mary said I have something great, my doctor gave me I’ll give you some.   We have to better educate about it, we didn’t use your full prescription, throw it out. Don’t flush it down the toilet, bring to a drug take back box, so that box is greatly important too in that space. That’s what we’re focused on on that proper use storage and disposal. Tied to that we’ve also been getting some stories brought to our attention, real attorneys brought to our attention senior high rise communities it happened in a couple of Northeastern Pennsylvania and happening there and other places too, I’m sure.   Where senior high rise they have usually a common area where folks live in the high rise group together get to know enjoy socialization so on and so forth. One particular high rise the story was described to me there was a gentleman who started, not living there he didn’t live there but there was during the summer months when they would sit outside in the outside area, beautiful you know, engaging in conversation and, enjoying each other’s company, enjoying beautiful northeast community weather the gentleman started stopping by sitting with the folks and became friends with them sure enough the conversation lead to, Mary saying hey you know I’m having a hard time paying my bills you know I am struggling to make ends meet the trusting guy has become friends with the folks are gathered outside, said you know — I can you know, what do you have you could sell to me, do you have any, prescription drugs, you can sell to me.   Well I’m sure the — I’m condensing the story.

Bottom line is, this gentleman, making friends with folks in the senior high rise in Northeastern Pennsylvania this woman, said you know what?  I have this bottle of prescription drugs it’s pain medications I’m never going to use them Oxy you can buy them from me I can make some money off help me pay my bills great.

So she did.

He then you can imagine, he sold them for triple the amount she told them to her, probably — someone who didn’t need them I’m sure.

But why do I share that with you?  Because when it was brought to employee attention we talked about it with drug and alcohol, also talked to the district attorney’s office in that particular area the district attorney said, look we have a problem.   You guys, meaning aging and drug and alcohol you have to go back in educate the seniors in this high rise they’re committing a felony.

The might have been they sold that prescription drug to someone else who then sold to someone else, if I go after the guy who bought it I have to go after the person who sold it.

So before we do anything, go in and educate those folks on do not sell your pain medications.   So we did.

We did do that.   The local area agency on aging did go with the single county authority did go in and educate those folks.   That gentleman I’m sure is, you know, looking to other senior places where he can gain access to trust trusting seniors struggling to make ends meet and, get their prescription drugs.   So, that’s another area that we have been working on as well. The conversations we can’t a be afraid to discuss with seniors what is going on in the space. We had several opioid round tables few senior settings I’m happy to do more.   To facilitate that conversation.

With seniors and with providers of services with our centers for excellence.

In this space as well.   The one opioid round table we did do was a senior who shared with us at 63 years of age, she hurt her back nurse aid, in a personal care home all of us know nurse aid, regardless of setting they do a lot of work and they’re — you guys know as well as I do, not paying a lot, don’t get a lot of respect and this person care home setting I’m sure she is working really hard for a lot of years as an aid she hurt her back went to her doctor which is what she was required to do, the doctor prescribed pain medication she was able to keep working, worked like a germ, she builds up tolerance over time, needs more and more drug to get through the day.   And, eventually she over dosed accidentally, accident tally over dose.

It was brought by back employee Norcare, it was in the lobby of the high rise building where she lived the second time was brought back by Narcan, she was mortified she brought to the emergency room.

How could she go back to that living environment, if folks think she is say drug abuser?

She was brought back by Narcan, what’s that stigma?  What are people going to think of me I applaud her she courage usely shared her story with us, in particular for the providers, drug and alcohol services that were in that room, at the round table conversation that we had.

She courageously went to treatment.

She found other means with a team of health care professionals that were supporting her she could go back to work.

And she was relieved of the addiction of needing more and more of the drug every day.   What she said, in order to continue her program she was listening to what she was being advised you could imagine that was to join AA program.

And she went to an AA meeting then she said you know, AA wasn’t for me.

Well imagine saying that to a drug and alcohol providers that’s not for me there is a big gasp for me, no one was there my age.   I’m 63. If I wanted to take up smoking that would have been a great place for me to do it. No offense to these folks that are smoking while they’re at the AA meeting but she said, there was no one there I could relate to, I could relate to their story but no one experiencing what I’m experiencing as a 63 year old.

So, those providers then said we need a peer group for folks in this space, that is more age appropriate.   It did get the providers a space to work in. That’s a community we need to engage in across all 67 counties so seniors have the access to the support.   The other piece I want to mention in terms of, accessing the support and treatment, you know, many of the disease of addiction for the baby boomers is critical for us to address we’re talking about that now.

Across the country I’m sure you know statistic, 10,000 Americans every day, turn 65.

That trend will continue for the next 13 years.   So it is critical that, those who are bringing the disease of addiction into the golden years have access to support and services in an understanding of other chronic medical conditions.   So that is one group. The other group is late onset folks that are falling into the disease and addiction. This is not always disease and prescription, but alcoholism the highest rate of alcoholism in the country, is women overage 65, there’s recent studies that came out that said there’s more opt hospital admissions due to alcoholism for seniors as there is for other conditions.   It is critical we continue to work with our sister state agencies at the state level suchs the Department of Health in particular, this space and the department of drug and alcohol programs, in order to ensure that we’re addressing this space for seniors as well as for the other populations. The last space in term of the drug and alcohol and opioid crisis I want to talk about, grandparents raising their grandchildren.

I don’t know how many of you in the room are, grandparents.

Some of you are nodding your heads you are.

But, we have more and more grandparents raising their grandchildren specifically due to the opioid crisis than ever before, there could always be a grandparent raising a grandchild that’s not new it could be for military service or death due to cancer but their numbers are swelling because of the opioid crisis.   Currently in Pennsylvania, we have 89,000 grandparents raising their grandchildren. That’s just the one that’s we know about.

So we realize that there’s a concern of the grandparents that they’re expressing to is they have no support.

And, they have no standing and they have no rights with all of the responsibilities.

That’s their verbiage they’re helping me express their concerns.   We’re really good at talking a lot, as state officials, sometimes we’re not so good at listen.Ing.   So we needed to listen to grandparents over the over the course of 99 months we’ve set up a series of listening forums we can actually sit down and listen to grandparents share with us, not just the crux of their story, but where there are barriers, what they’re facing where they need help, where they need support so everything, from enrolling a child in school, to taking him or her to the doctor to getting medical records to accessing CHIP and medical assistance, so accessing so and so forth.   So what we’re trying to do is to categorize what their concerns are and put them in the right bucket.

And then determine okay, I was with the governor at one of these forums he said — I’ve done two forums with him, the other ones I’ve done have been with my cabinet colleagues from health, human services, drug and alcohol programs and education.   So that’s kind of the, we’re kind of the big agencies so to speak, not to diminish any other agencies we all have a role in this, but it it’s been me and my cabinet colleagues who have sat down with grandparents who have curagously shared their stories and pointed out what is not working for them.   At one particular session in Luzerne County, a few months ago, was a group of grandparent that is the Governor, met with those, happy to facilitate the conversation and — I ended with the session by saying Governor is here with you.

Fill in the sentence for me — Pennsylvania can — and fill in the blank.

And, grandparents all had you know, great responses one in particular response was rose to the top simply Pennsylvania can do better.

When we left the room the Governor said to me, Teresa, the law, Governor you need to change it, what law is it.

I had to look at him, and say Governor I’m not sure, I’m not the expert of the child assistance care I’m an — no, I am a want to be attorney with no license or education to practice law.   When I hear a law needs to be changed I need someone else to help me Federal law or state law.

Is it Federal regulation or state regulars?  Federal policy or state policy?

For example, whether it comes to income, for WIC or income for CHIP or income for TANFF it’s part Federal and part state, how do we unweld that, whether it comes to standing child services, working or have worked in it, trying to navigate through, custody, dependency, trancy, guardianship, family court versus orphans court, you need several to walk through that the grandparents were bringing up these issues that were like okay we have to categorize it, put things in the right bucket list, get the right people around the table, to say, here’s what we can pull from.   Here’s what the State can change, either regulation policy or legislation, here’s what we need to talk to our Federal partners about. Same thing.

Federal regulation, legislation, policy, and here’s where the legislatures need to know about, here’s what the Governor’s office needs to be informed we just finished our listening sessions and listening about two weeks ago, we’re going to be regrouping next week as you imagine all that information, talking to total about 15-16 grandparents, all with different stories, the same end result in terms of they’re grandparents I’m sensitive about the fact that not every grandparent is over the age 60, the youngest grandparent I met was 49 it was a 5 year old grandparent who said to us, I feel like I’m 85.   Because, I — I don’t have the energy I don’t have the stamina I need support I need RESPIT access to day.

>> TERESA CARAWAY:  , I need affordable day care.   It’s under the Department of Human Services and office of which children youth and families, office of departmental disabilities and Long-Term Living, grandparents need support too, if they can be successful, the children are raise the properly.   Many grandparent also adopting their grandchildren in order to be able to be the sole decision maker and now you can imagine is a process that changes the family dynamic.

The children are suffering.   They’re asking for access to trauma therapy, asking for grief counseling.

And I’ve been talking to my cabinet colleagues about warm hand offs so we’ve heard a lot in our communities I hope you’ve heard a lot about the warm opioid hand off if someone in my family over doses tonight on, heroin or — opioids and they go to the emergency room, brought back employee Narcan the protocol for hospital as cross the Commonwealth they will be talked with and in terms of encouragement to go right into treatment.

That’s the warm hand off so right from the emergency room, warmly hand them off into treatment that’s great.

I hope that happens.   It is better than the life being lost and it is a pathway to recovery.

However if that doesn’t happen at the — in the midst of both these situations there’s a child if the person goes into treatment, that child, then if the mom or the dad is going into the treatment the other partner isn’t engaged in the picture, more often than not, the child is being handed warmly to the grandparent.   Often right into the emergency room setting.

We’ve had grandparents share with us that, often law enforcement is not asking for identification.

Are you really the grandparent?  There’s a lot assumptions — that’s not a criticism, it’s the reality of situations, that we’re dealing with, in these hospital settings and emergency room settings.

And — the grandparent is getting the grandchild, and no follow-up the next day.   No call from children and youth services.

No call from the area agency on aging there’s no call from the hospital social worker saying how are you doing?   Did you get through the night are you okay? that trauma, that is all now been experienced the worst cases, that I — the worse in my opinion is the child is the one who found the parent deceased and then that child is now going home with the grandparent.   Not with the parent. That’s trauma, that’s grief not just for the child but also the grandparent, whose child just passed. All of those moving parts impacting Pennsylvania’s families need to be better addressed.

There have been in the past two weeks two bills the Governor signed that is going to help in this space, we certainly a lot proper work to do.

One actually both bills came out of the house, one was, supported by representative Shinsky, that was for guardianship, that mechanism is now — takes effect in 60 days we’re trying to get our heads around how that will work and the area agencies agencies on aging will know what this is.   They have legal services they provide they’re trying to see if there’s a natural connection there.

But guardianship, for the grandparents specifically due to the opioid crisis treatment requirement in there, while a lot of folks are applauding that effort and I am there’s a lot of folks saying that now we’re shifting from family court to orphan’s court.   So we need, we need the legislative body involved in this as well.

Or I’m sorry, judiciary, all of the branches involved, in particular, justice Todd overseeing the council on — elder abuse within the Supreme Court we have a meeting coming up.   They asked if I would speak about the issue. We had them at one of our listening sessions they can kind of soak it in, the Judge presiding over the cases need to be informed and educated about what is standing the grandparents don’t have.   They’re saying okay grandparent you can take the child home, after think made all the decisions for you. So fully way, that is what we’re, working on, in that space.

The other bill, that was just signed into law is riptive Kathy Watson, the kin ship navigator bill, to provide information and resources and supports for grandparents also some Federal money tied to that.   That is going to be going to the Department of Human Services as the State medical agency and also, overseeing the office of children youth and families we’re working with our sister state agency in terms of how that is going to form itself.   There’s also Federal legislation.

That just got passed we are incredibly, I think, fortunate, right now in the United States Senate there is a special Senate committee on aging but they actually do look at from a totality of aging and disabilities.   But that committee right now is chaired by senator Collins from Maine and senator Casey is the ranking member of the minority chair, from Pennsylvania obviously.

That’s a good thing for Pennsylvania.

It’s not, this is not a political statement it’s a selfish one on my part to have a Pennsylvania representative or senator rather being the ranking member of that, gives Pennsylvania a lot of opportunity, to communicate directly with the leaders of that committee.   Know what policy they’re looking at, for opportunity for having laws and voice at the Federal level how Pennsylvanians are being impacted by things, Senators Casey and Collins had a hearing on grandparents there were two grandparents from Pennsylvania, testified in Washington, they were the voice, of other Pennsylvanians in terms what they’re struggling with and what Federal laws need to be changed that U.S. special Senate committee, on aging is incredibly important to us.   Not just in this space but in other spaces as well.

Including Alzheimers disease, housing transportation, you know we name it, pivot to the long-term care system, that committee in the Senate that has access to it, they also just passed a piece of Federal legislation — that will, provide a kinship navigator program at the Federal level as well and also, will, also will — require advisory council to be formed the advisory council formation is just under way, taking these solicitations for folks who want to be part of it, Pennsylvania certainly wants to be apart of that, we also want the folks on the advisory council to come to Pennsylvania, one of the requirement they need to talk to state that is are working with the space.   So we’re excited about that.

I am going pause that, on the opioid piece see if anyone has any questions on that.

I could have timed that better.

>> ROBERT OLIVER:  You mentioned that — the impact.

>> SECRETARY OSBORNE:  I’m going to repeat it, to make sure I captured two to make sure everyone else heard it, the question is, drug take back boxes, not being familiar with what the concept is and where they are.

Great question, thank you for it.   Sometimes I assume everybody knows what I’m talking about.

Drug take back boxes so we need safe spaces that folks can take their opioid prescription drugs as well as other drugs it could be any drug, any prescribed drug and they can take their prescribed drug to a safe place usually drug take back boxes are located in a — police station or district attorney’s office or in a courthouse.   So it varies. There is a web site I don’t have the address, I’m embarrassed to say with me I will get to Matt who can get to all of the members of the council. There’s an interactive map on the Pennsylvania web site that folks can go to click on your county and it will show you where your drug take back box is and in your county.

Also, I encourage you to get your law makers and your local representative, or senators web sites or call their services officen times they will sponsor drug take back activities and locations can you go to.

So a lot of partnerships to make drug take back days or drug take back months you know available for folks the encouragement is to have a drug take back site in your community.   You can take your unused opioid prescription drugs or any other prescribed drug that you have not used the full prescription for as we normally don’t do.

Take to the location where you put them in a — they look like mailboxes actually just put them in there a lot of folks have said to us well if they’re in a you know a police station, you know aren’t you going to get in trouble.   There are no questions asked. They just want you to — bring the drugs in. They don’t care what you are and what you’re doing. If you’re going in trying to take drugs out that’s a problem. Putting drugs in, you’re okay.

So, that’s the concept of the drug take back boxes.

The Commonwealth is through the opioid command center working really closely with the Attorney General’s office so thanks to technology, there’s now bags you can get, you can pour the unused medications in, seal it, shake it and they — they dissolve naturally.

So we’re trying to make through the Attorney General’s Office, trying to make more of those bags available.

The other piece that the opioid command center advocated for you know obviously the Governor and other members of the general assembly was, um, just about two months ago, it was a piece of legislation, passed, if any of you journeyed through hospice before, there used to be a law that said if my mom journeyed through hospice she had a lot of pain medication for the pain she was in, when she passed we had a lot of pain medications left.   So the law used to be, those hospice nurses could not take my mother’s unused drugs they had to leave them behind. That’s not always a good suggestion.

Because you never know who those drugs whose hands they will fall into.   The law just changed is now hospice nurses can take all those drugs away, at the time of the death of the person which is a lot safer and those drugs are not falling into the wrong lands because you — don’t talk to your protective service folks they have if not one, multiple situations prior to this law being passed that adult children or grandchildren or carrying neighbors all swooping in not just for money but for their drugs.

And then — lock boxes needed to be used and so on and so forth.   That law is a really good thing for Pennsylvania.

So that’s a great question look at the web site you can go right on it.

>> SPEAKER:  This is Shona I have a question.

Does that also apply to nurses that may work in home care agencies when, for example, consumers we serve pass away use the law I just spoke of, to my knowledge it is specific to hospice I’ll double check on that for you.

>> SHONA EAKIN:  Thank you.

>> SECRETARY OSBORNE:  You’re welcome.

>> SUSAN TOMASIC:  I’m member of the NCIL, task force on opioids you’ve obviously seen the reams of information on the task force has sent out.   What I would like to stress, this is what we talk about in our meetings ever single time, is that while we’re aware there is a crisis it’s those of us who experience chronic pain on a daily basis and we’re being forced into the situation of our doctors being told they can not prescribe needed medication.   Or that, our doctors are told, we have to be weaned off of them and, using techniques that have not been proven to be effective or safe or reliable.

So I would stress to you, that there’s a whole other side of to this, that you cannot forget about.

>> SECRETARY OSBORNE:  Absolutely.

>> SUSAN TOMASIC:  Those of us who have been on the same prescription for years and years and we have not taken more than we’re supposed to, we’re under a doctor’s supervision and medicine that works for us, are now being treated like we’ve committed a crime.

I personally can tell you that, while I have a great relationship with my rheumatologist I’ve got a great relationship with my pharmacist, people are looking at me like why are you taking this.   It’s none of their business to start with. Those with this kind of chronic pain then if we can’t have access to the medication that works for us that the doctor has prescribed for us, we have options that include going out and buying it illegally.

Or in worse case scenario, suicide.

There’s not really anything in between there.

So, please don’t forget, that part of the population.

>> SECRETARY OSBORNE:  Absolutely I appreciate it.

I just captured some of your words so I can take them back to Dr. Levine as I mentioned earlier, we are talking about it and — obviously we’ve come up with some solutions to what you just described in terms of doctors saying the State will not let us prescribe it, is so far from the truth.   So — opioid stewardship is the word that Dr. Levine regularly drills into our brains so — I would definitely take that back and look forward to continuing the conversation, with this body about how to best educate those doctors you raised another good point about pharmacists. You know, the pharmacist in our space at aging we’ve been communicating with on this, the ten thousand pharmacist that is are — are PACE partners, the PACENET partners you raise good points to ensure how we’re talking to them about this as well.

And that culture of our — our folks at the counter treating customers you know, be nice I grew up in a family of pharmacists I can relate to what you’re describing, at the folks counter asking inappropriate questions I understand that.

>> KAY TYBERG:  I have a question, in relation to a — she was saying the doctors are prescribing less of those pain pills and also referring them to physical therapy.

Which is good management decisions, but by the same token the insurance companies are also reducing the amount of time that those individuals can receive therapy.

So I see a conflict right there that could be helpful in the long run.

>> SECRETARY OSBORNE:  That’s good insight I appreciate that.

Thank you.


>> SUSAN TOMASIC:  Kathleen do you have something?


I — I had a question on the different subject.

I know Pennsylvania health care association and some of the centers were working on a piece of legislation called presumetive eligibility.

And when I would talk to.


She indicated that the administration was not supportive of that legislation and I just wondered if you could speak to that in terms of the administration’s position, especially given that the budget office, says it would be a net effect of zero.   So if you would explain what that presumptive eligibility is and the position that would be helpful.

>> SECRETARY OSBORNE:  Sure I’m not aware of the budget’s office’s net effect of zero I have to look into that.   I’m aware of the opportunity for presumptive eligibility piece of legislation I think it was coming out of the that to be passed.   The concern has been if presumptive eligibility is passed, CMS does not like the wording of that. That being aside, there was a concern that there would be —

>> KATHLEEN KLEINMANN:  I don’t like it either.



>> KATHLEEN KLEINMANN:  I think there are better terms, some declaration —

>> SECRETARY OSBORNE:  I agree I can think back to years ago I wasn’t in administration in state government but when I was working at a local area agency on aging, when the aging waiver program was very first introduced and there was, in essence, somewhat of a presumptive eligibility process followed, without it being formally called it.   The concern is, currently there would be a woodworking effect, with regard to the cost.

The cost of presumptive eligibility implement, that is my understanding of the Department of Human Services review of the bill as proposed and in conversations that were occurring with regard to the bill it was proposed to perhaps the bill where it might actually fall prior to the end of session.   I’m not aware Kathleen of the budget office saying that’s a net effect of zero. So — I will go back and talk to my legislative affairs director, with the footnote placed on the bill and get back to you on that.

I know the session ending, it is not going can to it’s not going pass, whether or not it gets introduced next session is something they have to better prepare for.

>> KATHLEEN KLEINMANN:  It was my understanding that it passed both houses but had — go to a conference committee.

The problem where it got stalled was in the conference committee, between the two houses.

But — they were looking for a — you know even though the bills were almost identical they just could not get through the conference committee on time.   So — I expect it to be re — reinitiated but, the idea is if you go to a nursing home, and — um, not the home care, then get services immediately, is really putting people in a very bad situation.   Maybe together we can look at this in the next session, I would like you to put that on your radar, something we could talk before on the long-term care committee.

>> SECRETARY OSBORNE:  I’m sensitive to time I’m going over it.

So — the only other pieces that I just wanted to quickly mention is another piece of legislation that is the older adult productive services act in addition to this body and — as advocates and individuals engaged in the process and, no different than the — opportunity for presumptive eligibility this has a lot of impact to your folks.

You could put this on your radar screens for next session I would be incredibly grateful for.   The last piece, I swear I’ll mention we’re in Medicare open enrollment make sure we’re encouraging those to take a look at where they’re at in their Medicare realm and the difficulty of navigating that process between now and October 15th when it started and December 7th Social Security increases, obviously need to be considered as part of that.   Because the deductibles for Medicare part AB, there’s a 2 percent COLA, announced on October 12th, the premium Medicare part B is increasing I’m asking you as fellow advocates making sure we’re ensuring folks navigating that space are aware of the changes talk to APRISE coordinator making sure they’re aware of the changes make sure they make the best health care decisions for themselves for next year thank you Matt and everyone else doctor for the opportunity to be here.


This has to do with the Department of Aging funding.

The lottery funds probably a large portion.

>> SECRETARY OSBORNE:  75 percent.


So, um, if you or — anyone else in this room missed out that recently there was a 1.6 billion-dollar prize, which was won.

I recently saw a report that these large jackpots are win falls for the states that take part in Mega millions and power ball.   So for example, when a recent jackpot hit over 600 million and remember that’s for the winner.

And there’s probably at least 600 million that is going into the lottery system.

This reporter, reported that Pennsylvania’s share of just that one jackpot was $68 million.

Not the normal shares that come in through these jackpots so I did a little Finegean math that’s what I call it.   When you look at 1.6 billion-dollars for the prizewinner, I estimated that Pennsylvania’s share of that jackpot was probably close to 100 million.   Okay.

Just in that supposedly, according to this reporter is just single funding.   You know single purpose lottery funding Pennsylvania good thing you’re part of the Mega millions the power ball here’s your share.

What happens to that?

>> SECRETARY OSBORNE:  Goes to the lottery fund.

>> TIMOTHY FINEGAN:  Then — does your budget increase?  As a result of that?

>> SECRETARY OSBORNE:  Depends we are blessed to live in a Commonwealth that has a lottery fund dedicated to older Pennsylvanians and — anyone that has heard me speak knows I try my best you just gave me, your Finegean math to say it I try my best every time I’m talking somewhere, good bad or indifferent I somehow weave in Pennsylvania lottery I have you have to play to win, benefits older Pennsylvanians every day, Lega millions creeped up I was reminding folks to play, you have to play to win.

To your point, I’m a proud recipient of funds from the lottery fund we do not oversee the lottery fund it is over seen by the department of revenue.

The lottery office is in embedded with them.   Perhaps, for future meeting you may want to ask the director of the Pennsylvania lottery to come talk to you more specifically about how those mechanisms work.

I can’t dispute anything you just said I read similar articles and in myselfish advocacy role I always want to say well then what’s our share going to be.


>> TIMOTHY FINEGAN:  That’s right.

>> SECRETARY OSBORNE:  I do, do that in delicate ways you know I like my job.

I like to keep it.

But, to your good point, you know the Pennsylvania lottery — there’s been a lot of talk in the last four years as I journeyed through my budget hearings I’m regularly asked well what about the solvency of the lottery fund?  What are you doing about that? Well I’m doing my part by buying lottery tickets and encouraging others to play letting them know how it benefits older Pennsylvanians I rely on the really smart folks at the department of revenue that oversee the Pennsylvania lottery to ensure that it is solvent.

So, Pennsylvania though, the concerns if you, this year already, we’ve had these, two massive buckets of prizes.   The year before, we didn’t have fully.

So when that happens, you know, what are we going to do.   So fully way, to your really good point, well my budget increase I’m going advocate all I can for it to increase.   Our conversations with the Governor’s budget office, for next year’s budget have already started I have to start with not what could happen, but where we’re at and how much money we need.

And the Department of Aging, 75, roughly 75 percent of our budget comes from the Pennsylvania lottery.   25 percent from older Americans act fund, neither have been increased in my four years of, working in the Commonwealth.   Until this year. The current budget year, we did secure 2.18 million-dollars specifically, for older adults protective services.

That space needs that money not to say that, that other services don’t.

But we’ve had a spike in the number of reports for protective services, more cases in financial exploitation and a hole host of other things that I needed to fight for that money, specifically, earmarked for that purpose.

I mentioned little bit earlier the older adults productive services act if there’s adjustment or total rewrite of that act we need money in order to implement that.

But back to your really good question I’m gobbling up someone else’s time.   We’re one.

The work we do is dependent upon the lottery as I mentioned the percentages of lottery funds we receive, primarily through the work of our local area agencies on aging the Pennsylvania Department of Transportation receives funding as well for the free and reduced shared ride program that’s another entity, that also receives lottery funds that need to be part of you’re conversation whether it comes to transportation shared ride system which I know has the challenges as well.

The department of revenue also, runs the property tax rent rebate program.   The Department of Aging also runs the PACE program. And, as you know, also just signed into law I don’t flow I shouldn’t have said that signed into the law, expansion for the first time in the 15 years PACENET guidelines that have been adjusted that is something that needs to be accounted for, within the lottery funds we receive understood to — to fund that expansion.

And then lastly the Department of Human Services, Office of Long Term Living to manage the aging waiver program and now community HealthChoices benefiting older Pennsylvanians they too, receive lottery funded dollars.   So you raise a great point in terms of advocacy this body will do collectively as well as individual advocacy for your own agencies in terms of you know, appropriations committee in the house and in the Senate, how are you looking at the lottery funds?  You know I can use all the help I can get. So — definitely you know the more we can work together on where we’re at with the provision of lottery dollars we’re blessed to have here, they’re dedicated to older Pennsylvanians how we stretch those doctors, to ensure the older Pennsylvanians can stay at home, is, going to be really important thank you for bringing that up.   I’m glad I’m not the only one that is doing some reading on it.

I have to — I have to —

>> MATT SEELEY:  Can you repeat that name for the lottery division.

>> SECRETARY OSBORNE:  Drew szvitko I had him come to the starterly meeting last December.   Last year’s expansion of lottery programs that was put in place in Pennsylvania.   Drew’s job to implement it, my job is to implement the PACENET expansion his job is to implement all things lottery I love Drew, so I like to keep him happy they do a good job, Gus bucks think of Drew and his team when you think of his — now the holidays one the Guss the ground Hog will be dressed as Santa he is great good with his time educating folks with the lottery fund as quick as I a.m. to say I’m blessed to get throws funds to be able use them well and wisely to serve older Pennsylvanians had entrusted to our care Drew is quick to say he likes to raise the revenue so others can benefit from it.   It’s the dichotomy of working together and the general assembly to say you know, we have some dollars, how do we increase budgets but we try. Thank you for your good question.

I appreciate it.


Thank you so much.

>> SECRETARY OSBORNE:  Thank you for the extra time I appreciate that too.




I appreciate it.   Take care.

>> MATT SEELEY:  Thank you.