Green Mountain Support Services: Elder care agency gets last minute reprieve

Sister organization Champlain Community Services has temporarily taken over operational control of the Morrisville agency, which provides developmental services, adult family care and brain injury services for more than 120 people.

“The intent at this point is this is an interim temporary arrangement while processes and procedures are put in place, overhauled and improved as necessary so that GMSS is on stronger footing moving forward,” Monica White, commissioner for the Department of Disabilities, Aging and Independent Living, said this week.

The department oversees 15 such agencies in Vermont and White said it is rare for an agency to be in danger of losing its designation.

Green Mountain Support Services had been placed on “provisional designation” status since October 2021 and both the state and local entities have been at loggerheads, despite Green Mountain making what White called “intermittent progress” with the state’s mandates. But that was not satisfactory for White, and on Feb. 27, the department issued a notice of de-designation for the local agency.

White relaxed that status this week, following the recent resignation of executive director Josh Smith and board president Steve Peterson.

White said in an announcement Monday she was grateful that the Colchester-based agency was “willing and able to step in and stabilize their fellow” agency, calling it “the best possible outcome” for Green Mountain’s clients.

She said she did not take lightly the decision to de-designate the agency, knowing it would have a significant impact on people Green Mountain served. She was happier reversing that decision and bringing in Colchester to help.

“I am delighted that CCS stepped up and offered to step in and help,” she said.

Questionable conduct?

In a Dec. 21 letter to the Morrisville agency obtained Tuesday through a public records request, White expressed “continued concerns” with Green Mountain’s senior leadership team that had come to her attention throughout the “extended” re-designation process.

Those included a lack of appropriate financial management and oversight; and a lack of communication with the state agency related to “issues and challenges.”

White asserted in her Dec. 21 letter that Green Mountain Support Services in late 2021 formed a quality assurance department that was “poorly conceived and misguided” and headed up by two unnamed staffers who had “histories of non-responsiveness and failures to follow” Department of Disabilities, Aging and Independent Living guidance.

White also pointed to the hiring of a new program manager despite the opposition of the organization’s own hiring committee, calling the move a “poor personnel choice for a key leadership position.” That employee, also unnamed, only lasted a few months.

“However, during his tenure, he was often unhelpful to the point of prolonging or making situations worse,” White wrote.

Tuesday, White added that the Department of Labor had claimed Green Mountain was misclassifying some of its staff as contractors rather than employees.

Finally, White said her department had been notified that Green Mountain was in a “precarious financial situation” and, as of December, was roughly $500,000 in debt and would need access to cash reserves to make payroll.

In a Feb. 27 letter, White again referred to “significant concerns related to senior leadership,” as well as Green Mountain’s “financial situation.”

In that letter White also refers to an investigation into Medicaid fraud by the state attorney general’s office. However, she said she could not comment on the attorney general’s investigation. Details of that investigation were not available as of press deadline.

Former executive director Smith, who resigned March 2, denied any wrongdoing, and instead blamed the state for dragging its feet in communicating with his agency during an extended probe into Green Mountain’s processes and financials that began in late 2021.

“They kept moving the goalposts down further and further,” Smith said of the department’s stated benchmarks for Green Mountain. “It was basically completely unattainable from the beginning.”

He said Green Mountain did have financial difficulty last summer, partly because of his executive decision to house some elderly clients who were in danger of becoming homeless in an agency-owned respite house when there were no immediate resources available for them. He said the agency “basically paid someone $30 an hour,” which is where the contractor-versus-employee question was raised.

However, Smith said allegations of financial difficulty by the state are laughable since the state hamstrung Green Mountain by placing a moratorium on bringing on new clients, which could have resulted in more revenue. He said being $500,000 in debt may seem big, but it was overblown.

“At the end of the day, we’re a $14 million organization,” Smith said. “We were fine, because we still had 130 days of cash on hand from our investments and our money markets that I created.”

According to the agency’s most recent tax form on its website, Green Mountain had an operating budget close to $12 million.

Smith said allegations of Medicaid fraud are false, and the state conducted scores of Medicaid fraud investigations last year and only a handful of them had merit.

“They investigate the intent behind it. Did they intentionally try to steal money from the government?” he said. “And 90 percent of the time it is not.”

White said agencies had billing flexibility during the COVID-19 state of emergency, so there should not have been any cash flow problems.

“They had the ability to draw down funds,” she said.

Smith was quick to point out that the state’s complaints were not about actual client care, and said Green Mountain maintained an 89 percent rating from client surveys.

“We still have an extremely happy staff,” he said. “We were doing amazingly well.”

White said she could not comment on further specifics due to patient confidentiality and privacy concerns, but she said things were not as rosy as Smith suggests.

“I think it’s fair to say that clients’ experience has been a mixed bag,” White said. She was quick to point out that, for the most part, Green Mountain does a good job. “It’s important to recognize that there is some great stuff happening in terms of some of the really dedicated and talented staff who have been doing great work and will continue to do great work.”

Smith said he takes issue with the de-designation process for elder care agencies, saying there should be a committee or some oversight body involved.

“Literally, we had one woman who was able to make a decision to disrupt over 150 people’s lives,” Smith said.

‘Long, bright future’

Had the state gone through and pulled the plug on Green Mountain, the de-designation would have been made official on May 27. A form letter that would have gone out to clients was dire in nature, but ultimately was scrapped at the last minute.

According to that form letter, clients would have had to seek developmental services, adult family care or brain injury services elsewhere. Ramifications could have included working with a different local agency — there are 15 in Vermont, White said — moving to another service provider, taking care of things themselves or with family, or moving into a residential care home.

Now, all those things are off the table, thanks to Champlain Community Services stepping in, much to the relief of the new leadership team in place at Green Mountain.

“This means the people who receive services from us will not experience any disruption to their services or caregiving teams,” Elizabeth Walters, the new interim executive director, said in an email this week, adding the agreement will “stabilize and strengthen” the organization.

Walters said the sister agencies “have a long-standing, collaborative relationship and we are profoundly grateful for their willingness to step in in this way.”

Under the arrangement, she said, Champlain Community Services will help Green Mountain assess strengths and deficits and plan for improvements, but also provide immediate support where needed.

“Sarah Henshaw has stepped capably and energetically into the role of board president and is already taking concrete steps to strengthen the board’s functions and oversight of the agency,” Walters said in an email Tuesday.

Green Mountain’s board named Walters the new interim director immediately after Smith resigned March 2, and Henshaw was named president of the board of directors after former board president Steve Peterson resigned that same day.

Henshaw echoed the gratitude for the state reinstating Green Mountain’s status and Champlain Community Services.

“CCS is a trusted partner that will help us assess, plan and implement improvements, and ensure our operations are effective and compliant,” Henshaw said in an email Tuesday. “Our joint goal is to ensure that GMSS has a long, bright future as an important and valued specialized service agency.”

Walters added, “Together we intend to do the work that is needed to ensure GMSS is again recognized as a provider of high-quality supports to Vermonters with disabilities.”