ADAPT Alerts: Fw: [dpcnet] Mass. plans reform; etc..

ADAPT Alerts: Fw: [dpcnet] Mass. plans reform; etc..
Fw: [dpcnet] Mass. plans reform
Date:  Fri, 12 Dec 2008 15:26:29 -0500
> "Community First" Agenda includes closure of four developmental centers
> over four years
> BOSTON – As part of its "Community First" Agenda and commitment to
> offering community-based living opportunities for people with
> intellectual disabilities, the Executive Office of Health and Human
> Services and the Department of Mental Retardation (DMR) announced today
> plans to close four of the state’s six institutions over the next four
> years. Current residents will transition to community settings or one of
> the two remaining facilities, based on each individual’s needs,
> abilities and wishes.
> Reconfiguring DMR’s facilities system will improve community integration
> and quality of life for people with disabilities.  As plans move
> forward, DMR will engage residents, their family members and guardians
> in a thorough, person-centered planning process to ensure each
> individual’s smooth transition to a new community-based setting or
> another facility with the appropriate mix of services and supports.
> The newly re-established Governor’s Commission on Mental Retardation,
> which includes family members, professionals and clinicians, will also
> play a key advisory role as the state moves forward in its transition
> planning to ensure that the rights of people served by the Department
> are fully protected.
> "This expansion will create real choice for many people with
> developmental disabilities for whom the community has never been an
> option-all while providing equal or better care for the residents in a
> community setting," said Health and Human Services Secretary Dr. JudyAnn
> Bigby. "As we have seen many times, individuals previously living in
> facilities have benefited from a community setting with the services and
> supports they need to live in dignity and independence."
> New England currently has seven institutions for individuals with
> intellectual disabilities, with six in Massachusetts.  Currently,
> approximately 900 individuals live in the Commonwealth’s institutions,
> while more than 32,000 receive community-based services and supports.
> DMR anticipates that approximately 316 individuals will transition to
> community-based settings over the next four years.
> "This exciting transformation offers new opportunities for people
> currently residing in developmental centers and secure more community
> capacity for others in the future," said Assistant Secretary for
> Disability Policy and Programs Dr. Jean McGuire. "A crucial part of the
> proposal is the assurance that families and guardians who wish for their
> loved one to remain in an institutional setting will continue to have
> that choice."
> Elin Howe, Commissioner of the Department of Mental Retardation, added,
> "We look forward to working in partnership with individuals, families,
> guardians, employees, unions, private sector providers and advocacy
> organizations to further develop quality supports and services for
> individuals with intellectual disabilities as we move forward to
> successfully implement this plan."
> "As a longtime supporter of deinstitutionalization, I am encouraged to
> see the administration making these strides to increase community based
> care," said State Senator Frederick E. Berry. "I thank Secretary Bigby
> and Commissioner Howe for their leadership on this proposal.  I also
> extend my sincere appreciation to the staff at these facilities, many of
> whom have provided tireless care to individuals for decades.  I look
> forward to working with the administration to ensure that new job
> opportunities will be available to facility and support staff."
> "The Patrick Administration is moving in the right direction," said
> State Representative Tom Sannicandro, an active member of the Joint
> Committee on Children, Families and Persons with Disabilities. "People
> of all abilities deserve the same opportunities that each of us
> receives.  This significant expansion of community-based services and
> programs will give the men and women who live at Fernald and our other
> state institutions a better life, while still offering families a
> similar option if they choose."
> "This decision is a tremendous step forward in the state’s ‘Community
> First’ agenda," said Leo Sarkissian, Executive Director of The Arc of
> Massachusetts. "For those now in institutions, they will have the
> opportunity for the same supports and services in the community.  This
> initiative also strengthens the foundation of community options and
> supports for thousands of people and allows Massachusetts to move
> forward in disability policy."
> Association of Developmental Disabilities Providers (ADDP) Executive
> Director Gary Blumenthal, whose brother lived in an institution from the
> age of nine to the age of 38, added, "I understand the anxiety that many
> families may feel in moving their loved ones into a community setting,
> because my family went through it personally.  My family and so many
> others have found that living in the community offers so many benefits
> for people with disabilities, including opportunities for them to
> contribute fully to their communities."
> Facilities identified for closure include the Fernald Developmental
> Center in Waltham; Glavin Regional Center in Shrewsbury; Monson
> Developmental Center in Palmer; and Templeton Developmental Center in
> Baldwinville.  The Wrentham Developmental Center and the Hogan Regional
> Center in Hathorne will remain operational.
> In addition to advancing the Governor’s "Community First" agenda, this
> plan will also provide the Commonwealth with an investment of up to $45
> million to support the placement of individuals from the four DMR
> facilities into the community.  DMR is partnering with the state’s
> Division of Capital Asset Management and other state agencies to develop
> new community-based housing for DMR consumers.  The state will also work
> collaboratively with local community leaders to develop plans for
> property reuse.
> DMR leadership and staff will bring to this process extensive knowledge
> and experience gained from more than 30 years of community transitions,
> including the closures the Belchertown State School in 1992; the Dever
> Developmental Center in 2002; and the J.T. Berry Campus of the Hogan
> Regional Center.  Consumer, advocate, and family responses to transition
> surveys have been overwhelmingly positive, reporting high satisfaction
> even when not initially supportive of community services.
> As the facility consolidation plan moves forward, the state intends to
> retain skilled and talented state employees and will work hard to
> mitigate the impact on DMR employees. DMR will also work with other
> state agencies and providers to identify employment opportunities for
> DMR staff as needed.
> Finally, the important issue of campus and facility re-use will be
> guided by local planning processes that will be set up under the
> auspices of the state’s Division of Capital Asset Management and the
> Department of Housing and Community Development.  A facility re-use
> group is already in place for the Fernald Center.
> DMR Community Services Expansion and Facilities Restructuring Plan
> Consistent with Massachusetts’ "Community First" long-term care policy,
> the successful appeal of the Ricci case, and the Governor’s recently
> launched Olmstead Plan, the Executive Office of Health and Human
> Services and the Department of Mental Retardation (DMR) are announcing a
> major expansion of DMR community living services and plans to close four
> of its existing six institutions over the next four years.
> The plan will create real choice for many people with developmental
> disabilities for whom community living has never been an option, while
> also assuring an enduring institutional placement choice for those
> currently living in the developmental centers. Most importantly, the
> plan will adhere to the central Ricci case requirement that people be
> provided with equal or better care.
> Currently, there are approximately 900 people living in the state’s six
> developmental centers; Massachusetts has six of the seven remaining
> institutions in New England. Connecticut has the other.
> Plan Summary
> The restructuring plan anticipates a broad array of client support and
> program development efforts including:
> *        Significant expansion of community services for people with
> mental retardation who current live in developmental centers;
> *        Closure of four of six existing facilities, beginning with
> Fernald in FY10; closure of Monson, Templeton and Glavin occur the end
> of FY13;
> *        Provision of individual service planning and placement choices
> for residents and their families/guardians that permits placement in a
> state operated or vendor operated community residences, placement in
> Wrentham Developmental Center or, on a limited basis, into Hogan;
> *        Assurance of long-term institutional placement at Wrentham
> Developmental Center for those residents who choose to remain in an
> institutional setting. Wrentham was strategically selected to remain
> open over the long-term, because it is best situated to accommodate
> additional residents;
> *        Deferral of future planning regarding the Hogan Development
> Center until after completion of the current four-year plan;
> *        Development of new state and vendor operated community settings
> in areas proximate to the existing centers;
> *        Anticipated overall reduction of approximately 50% of the
> institutionalized population by the end of FY13 as a result of over 300
> expected community placements, transfers to Wrentham Developmental
> Center and Hogan Regional Center;
> *        Projected investment of over $40M to support the placement of
> individuals from the four DMR facilities into the community; a reduction
> of current institutional spending by approximately 50%; and
> *        Facilitation of new economic and strategic local development
> options through collaborative facility re-use planning.
> Plan Development and Oversight Mechanisms
> The Plan will have an ongoing collaborative development process as well
> as several oversight mechanisms to assure diverse input and
> transparency. These efforts will include:
> *        Immediate establishment of departmental and facility level
> planning groups involving consumers, family members, Center employees,
> advocacy and provider groups,  as well other interested stakeholders;
> *        Plan review and advisory meetings with the newly re-established
> Governor’s Commission on Mental Retardation; and
> *        Ongoing review of DMR program planning and practices by the
> Statewide Advisory Council.
> Facility & Campus Re-use Planning
> EOHHS, DMR and other agencies are committed to assuring the successful
> and collaborative planning of campus re-use. This will occur through the
> establishment of local Facility Re-use Planning Committees, led jointly
> by the Department of Housing and Community Development and the Division
> of Capital Asset Management, and including representation from DMR,
> legislators, local communities, and other appropriate stakeholders.
> Workforce Strategies
> The 1,596 direct care, operations, clinical and management staff at all
> of the Centers are critical to the ongoing quality of care and support
> residents receive and will be crucial partners in the transition
> process.  Plans to support workers through this process include:
> *        Facility staff involvement in all phases of Center and
> departmental plan development and implementation;
> *        Creation of new job opportunities as downsizing occurs, through
> community residence development and placement options at other
> developmental centers, elsewhere in the Department, and across EOHHS and
> other state agencies;
> *        Provision of re-training and other job development and
> placement support;
> *        Development of appropriate incentives to assure adequate
> quality staffing throughout the closure process; and
> *        Commitment by the Department to minimizing the impact of
> facility reconfiguration through close collaboration with unions and
> other facility staff.
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Tell him about CCA!!!
MFP so far – A CMS Perspective
The following is an article on the CMS Survey of the MFP Projects so far…
In fact, in the opening months of MFP, 48 percent of
individuals transitioned from a nursing home to the
community were patients with mental retardation or
developmental disabilities (MR/DD). Another 26
percent of patients transitioned were individuals with
physical disabilities and 21 percent were elderly, Appold
The community infrastructure already exists for
transitioning more MR/DD individuals, Appold said, which
is why she suspects that population has had more success
in MFP.
Use of technology is another factor that contributes to
an individuals success in MFP. People with disabilities
have generally been more receptive [than elderly patients]
to technological solutions to everyday problems, said
William Ditto, director of the New Jersey Division of
An individual is also more likely to succeed if he or
she has family or close friends teaming up with them as
they can help find or maintain housing while the patient is
in a nursing home as well as determine what modifications
are needed in a housing setting to provide for the patients
medical needs, Ditto said.
While actual execution of the MFP program is still
in its infancy, its on the chopping block in some states
as they consider budget restraints. To me its a little
hard to understand because it is drawing more money into
the states, Appold said, although the money brought in
goes specifically to MFP uses. An economic downturn is
having its effect.
States could receive more MFP money than previously
expected if the Federal Medical Assistance Percentages
(FMAP) rate is increased as has been proposed in multiple
economic stimulus packages proposed by Congress in
recent months.
Changes to MFP under a new administration are also
uncertain, Appold told state Medicaid directors.
Preliminary data on CMS Money Follows the Person
(MFP) program show one-third of patients assessed for
potential participation did not transition from a nursing
home back into the community, an agency official said
Nov. 13 at a state Medicaid directors conference. The
official cautioned the data is an early snapshot, as most
of the 31 states with startup programs only recently began
offering the service.
Availability and suitability of housing for qualified
residents are the primary setbacks of MFP, a demonstration
program providing federal money to states that
develop new strategies in providing long-term care
support. Startup for the program has been slow in terms of
[states] meeting their benchmarks for transitions, said
Carey Appold, CMS technical director for MFP. Basic
reasons for that: housing, housing, housing.
The preliminary numbers arent too surprising, Appold
said, since states are only beginning to assist patients who
have been in nursing homes more than six months transition
back into the community. Infrastructure for the MFP
program  such as community programs and housing
suited for the patients needs  is still being developed,
which contributes to the slow startup, Appold said.
States have various outreach approaches used for
MFP, ranging from systematic to grassroots, Appold said.
Based on the limited data collected thus far, she said the
grassroots efforts seem to be most successful. Missouri,
using a voluntary network to identify possible patients for
the program, has become the only state to surpass its
transition benchmarks, the CMS official said.
The snapshot of data CMS collected but is not yet
publishing also revealed that states are not transitioning the
large percentage of elderly patients they initially predicted
they would. Appold said states originally estimated elderly
patients would make up half of the 35,000 people nationwide
expected to transition into a community through MFP
TX State "Schools" slammed by DOJ
Texas state schools don’t protect residents, investigation finds
In the past year, at least 114 residents died, 53 from preventable conditions such as respiratory failure that are ‘often the result of lapses in care,’ according to the findings.
By Corrie MacLaggan, Andrea Ball
Wednesday, December 03, 2008
Texas’ institutions for people with mental retardation fail to provide adequate care and protect residents from harm – failures that have been fatal in dozens of cases, a U.S. Department of Justice investigation has found.
In the past year statewide, at least 114 residents of state schools died, 53 from preventable conditions such as respiratory failure that are "often the result of lapses in care," according to the findings. Federal officials documented incidents that included residents’ swallowing Swiss Army knives and a delay of days in the reporting of a resident’s rape allegation.
"We have concluded that numerous conditions and practices at the Facilities violate the constitutional and federal statutory rights of their residents," said a letter sent to Gov. Rick Perry this week by Grace Chung Becker, an acting assistant U.S. attorney general. "While specific findings vary among the Facilities, we find that there are systemic deficiencies throughout the Facilities."
The findings come after federal officials documented grim conditions at the Lubbock State School two years ago and later expanded their investigation.
Nearly 5,000 Texans live in 13 state schools, including Austin State School.
Allison Castle, a spokeswoman for Perry, said the governor expects the Department of Aging and Disability Services "to continue to ensure that corrective actions and improvements are implemented to provide appropriate and quality care for state school residents."
Despite the name, state schools – whose budgets total $458 million a year – are not actually schools, but homes for adults with mental retardation. Some are nursing-home settings; others are on-campus houses that resemble ordinary homes and are staffed 24 hours a day.
Cecilia Fedorov, a spokeswoman for the Department of Aging and Disability Services, said her agency is reviewing the 62-page letter and will work with federal officials on an agreement on the state schools’ operations. That could take years. State and federal officials have yet to reach an agreement on the federal investigation on the Lubbock State School, the findings of which were reported to Perry in December 2006.
That report found that the Lubbock facility failed to provide adequate behavioral services, medical care and oversight. After inspecting the Denton State School and combing through state documents on the other state schools, federal officials determined that the "serious problems and deficiencies in care" found in Lubbock exist throughout the state.
According to the new letter, federal officials found that statewide, school residents ingested latex gloves, suffered preventable injuries from seizures and falls, and received inadequate preventive health care. State schools had liberally used restraints such as straitjackets, which are not generally recommended, the letter said.
The report included sweeping recommendations, including improving emergency-response training, better documenting medical care and immediately stopping the use of straitjackets.
State Rep. Patrick Rose, D-Dripping Springs, chairman of the House Committee on Human Services, said that the report "is disturbing, and it underscores the necessity that we reform the way we deliver these services."
He said he’s planning to file a bill for the legislative session that begins in January that would require the consolidation and closure of several state schools.
Examples of problems found
The latest federal investigation found that:
. Psychiatrists do not adequately consider residents’ medical issues. Earlier this year, a state school resident was praised by her psychiatric medication review team for losing weight. What the team did not seem to know was that direct-care workers had observed the resident purging.
. State school residents are denied opportunities to learn about ways they can live in their communities.
. Detecting, reporting and investigating abuse is a problem. In February , a 17-year-old girl with mild mental retardation told a staff member that she was raped by another worker. But it was not reported until days later, and the sheriff’s office was not notified until after that. By the time tests for sexual activity were performed, they were negative. State officials said the allegations of sexual abuse were "inconclusive."
Fedorov declined to comment on that incident, saying state officials are still reviewing the letter.
The federal investigation found that the state schools fail to provide "basic oversight of resident care and treatment critical to ensuring reasonable safety of their residents."
That’s true in Austin, said Carl Mcafee, who worked at Austin State School for six years before quitting last month for another job. Staffers are often forced to work 16-hour shifts that leave them exhausted and unable to adequately care for the residents, he said in an interview last month. Those long hours leave some staffers so tired that they fall asleep on the job, he said.
State officials say exhaustion is no excuse for employees to abuse or neglect residents. Anyone found to be hurting clients will be fired, Fedorov said.
Statewide, more than 800 state school employees have been suspended or fired for abusing residents since the 2004 budget year, the federal letter says.
Meanwhile, Austin State School is severely understaffed, Mcafee said. Staffers are so busy that they don’t see residents falling down or hurting each other, he said. Some residents wander out when staffers aren’t looking, he said. Employees are sometimes injured because they don’t have help controlling clients when they become violent, Mcafee added.
Jim Branson, an organizer with the Texas State Employees Union, which represents more than 11,000 state workers, said that across the state, these employees are extremely overworked.
"One lady worked 24 hours in a row," he said. "Another worked 33 hours with two hours of sleep."
Austin records suggest neglect
According to the Justice Department report, state schools fail to provide adequate psychological services to meet the needs of the residents. It also said that "facility residents are injured on a regular basis by another resident’s aggressive behaviors."
In December 2007, a female resident at Austin State School – who was supposed to receive regular psychological counseling but did not – attacked her sleeping roommate and tore her eyelid, according to documents provided by the Department of Aging and Disability Services before the federal report was issued.
In its investigation into the incident, the state agency reported that the attacker had been hospitalized for 17 instances of aggression, seven instances of property destruction and one attempt to hurt herself at a group home.
The Department of Justice letter said that "a significant number of residents’ injuries are discovered as opposed to being witnessed by staff, strongly suggesting that residents are being neglected."
Investigation records from Austin State School show that staffers did not know that residents had fallen or been injured until days after the incident.
In one case, employees did not know a female resident had fractured her pelvis until two days after the injury.
The Justice letter says that many of the problems stem from a high staff attrition rate and staff vacancies.
"Until the facilities can successfully retain, train and supervise their staff, they will face enormous difficulties," the letter says.
In the 2007 budget year, 36 percent of state school workers across Texas left their jobs, Fedorov said. But she said agency officials are "well on our way" to hiring the 1,690 new state school workers mandated by the Legislature in 2007.
The new Justice report triggered a strong response from Advocacy Inc., a federally funded organization that has the legal authority to investigate abuse and neglect cases at state schools.
Beth Mitchell, a lawyer at the Austin-based group, said it will hire its own experts to investigate problems at the schools.
It will then make recommendations to the state. The group has no regulatory power over Aging and Disability Services, but it has legal standing to file lawsuits on behalf of state school residents.
"What yells and screams out in that report is that people are at risk right now of imminent harm," Mitchell said.; 912-2506; 445-3548

About reality

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