Personal Independence Commission

February 14, 2005

Hearing Room 3, State Capitol Building
MINUTES

Kirsten Dunham called the meeting to order. She introduced Bill Fix from the Lt. Governor's Office. A quorum was not present so approval of the minutes was postponed.

Co-Chair Reports:

Ms. Dunham talked about proposals that would affect the work of the PIC. These include expansive cuts to the Medicaid program, eligibility reductions, elimination of the Medical Assistance for Workers with Disabilities program (MAWD), elimination of Medicaid coverage for durable medical equipment (DME), elimination of Medicaid coverage for a number of other health care services (dental, optometric, and therapies, among others.) She also talked about the transfer of the Personal Assistant Services program from the Division of Vocational Rehabilitation to the Department of Health and Senior Services.

Report on Bellefontaine:

Kay Green reported that there is an impact statement posted on the DMH web site relating to the closing of Bellefontaine Habilitation Center. The focus will be on the health and safety of the individuals and transitioning them to the community. The Five Year Plan calls for a total of 225 persons living at habilitation centers to be transitioned to community living arrangements. The closing of Bellefontaine is consistent with the Five Year Plan. The first concern is for the health and safety of the individuals who live at Bellefontaine. There are several issues:

• Keeping certification for the facility so the residents can continue to receive the type of care they need
• Screening of residents to see who can be transferred to a community placement and who would be better served in an institutional setting such as another habilitation center
• Working with community providers in the St. Louis area and other areas of the State
• Concerns for staff, keeping people there to care for residents, and helping staff find other job placements
• Upkeep of facility while it is still open

Sen. Dougherty requested information on the providers in the St. Louis area and their capacity to handle the residents from Bellefontaine. He also requested information concerning placement of those individuals who cannot be placed with community providers.

It was decided that the PIC would inform the Governor's Office of their support of the Five Year Plan.

At this point a quorum was established. PIC members present were; Kirsten Dunham, Jeanne Loyd, Kay Green (for Dr. Tony Casey), Sandra Levels, Nancie McAnaugh, Sen. Patrick Dougherty, Rep. Charles Portwood, Anne Jackson, Neva Thurston, Wendy Hayes, Roger Garlich and Martha Hicks.

Real Choice Systems Change Grant Update and Other Updates:

The purpose of the RCSC Grant is explore issues and activities that could enhance the lives of consumers with disabilities and long term care illnesses to live in the most integrated community setting and to exercise meaningful choices about their lives. The grant is currently in a no cost extension that will end in September 2005.

Objective 1 - Assure that the infrastructure and processes reflect consumer choice and consumer input. Under this objective the Department of Health and Senior Services and the University of Missouri Kansas City are working to expand the Information and Access database housed within the Area Agencies on Aging. A public awareness campaign will be conducted and individuals will be surveyed as to how well the database meets their needs in identifying community support services. A final report on this will be presented at the August PIC meeting.

Objective 2 - Identify perceptions of consumers and providers, service coordinators and agency staff.

Objective 3 - Conduct interagency coordination and collaboration to address Olmstead Stakeholders and Commission recommendations.

Objective 4 - To assure informed choice at all stages of care so that consumers can make good decisions.

Objective 5 - Enhance linkages at critical points to assure successful transition to community living. Working on two activities in relation to this. One relates to transitioning back into the community after a short-term hospital or institutional stay and what barriers there are to that person returning to the community at the end of that short-term stay. The second activity deals with school based health care services. A survey will be going out to schools to determine what types of services are provided and how these services can be improved.

Objective 6 - Conduct research on small demonstration projects to identify best practices and projects that should be duplicated and on data that would impact the system. There were two projects under this objective. The first one was the four pilot demonstration projects to demonstrate alternative methods for delivery of health related services within the community. The second project is a Personal Assistance Service pilot conducted by the Department of Mental Health. This project relates to transitioning people from hab centers back into the community and to work.

Objective 7 - Establish a quality assurance mechanism that relies on consumer input and is data driven.

Another project is the Best Practices Guide, a booklet of community programs that are using funds other than state funds to support their programs. The booklet is divided by region.

The final project is The Missouri Guide to Housing Assistance Programs. The Housing Work Group, a subcommittee of the PIC, requested PIC approval to print 10,000 regular print copies of the Guide, 1,000 large print copies, and 500 copies on CD-ROM. Distribution would be as follows:

• DHSS Office of Community Independence - 6200 copies
• Department of Mental Health - 3500 copies
• Department of Social Services - 200 copies
• Division of Vocational Rehabilitation - 50 copies

There was some discussion concerning needed changes to the guide. The Guide will also be available on the Governor's Council on Disability, DMH, DHSS and the Lt. Governor's Office web sites. Ms. Levels made a motion to print 10,000 copies of the Housing Assistance Programs booklet. The motion was amended to include 500 large print copies and some CD ROM copies. Neva Thurston seconded the motion. Motion passed.

Dr. Chris Rinck gave a follow-up report on the projects under the Real Choice Systems Change Grant.

Clinical Outcomes of Aging in Place - A comparison study of two groups of individuals, one group of 78 received Home and Community Based Services while the other group of 78 was in nursing homes. Comparisons were made at six, twelve, eighteen and thirty-six months. Those receiving services at home had better cognitive skills, less depression; ADL's were better, and showed less incontinence than those in nursing homes.

Demonstration Grants - There were four of these:

• Paraquad: Developed a transition manual and had community peers talk with those wanting to transition out into the community. This communication helped those transitioning back into the community feel more a part of the community.
• People First: Provided training for both individuals with developmental disabilities and service providers. Those trained to be self-advocates were much more effective because they could talk about what they did and how to do it.
• Willows Way: Trained on Individualized Person Centered Planning. Had individuals and their partners come to training. Some if those participating did get jobs.
• Creider Center for Mental Health: Had two projects. One was a support group and the other was meeting with employers. The support group was fairly successful but the meetings with employers were not very successful in changing attitudes.

Office of Community Independence Report:

Andy Petti. Office falls into two categories, education and identifying and assisting individuals out of long term care.

• Education - Distribution of the Home and Community-Based Services Guide to all long-term care facilities in the state on a monthly basis. The booklets are also being distributed to hospitals around the state. Also the posters advertising the guides are being distributed around the state. The Guide to Housing Assistance Programs will also fall under education
• Informed Choice - Are continuing the Informed Choice Trainings. The MOAIDD Board received the Informed Choice Training. Two additional trainings are scheduled in April and May, one in Hannibal and one in Springfield. They are also working on identifying individuals and assisting them out of long term care. Are also working with those people who have a difficult time transitioning back into the community to help them identify and overcome barriers.

Public Comment:

Wayne Lee - Had comments about the budget, the proposed cuts to Medicaid and the legislature.

Eydie Young - Wanted to know the position of the PIC concerning the transfer of the Personal Attendant Services (PAS) Program from Vocational Rehabilitation to Health and Senior Services. She also expressed concerns about the proposed Medicaid and budget cuts and requested the PIC write a letter to the Governor concerning these issues.

After some discussion it was decided to wait until there was more information available before the PIC as a group took any action.

Approval of Minutes:

Not everyone had the copy of the minutes from the November 8, 2004 PIC meeting so it was decided to wait until the April PIC meeting to approve the November minutes.

The next PIC meeting is scheduled for Monday, April 11, 2005.

The meeting adjourned.