Personal Independence Commission |
September 13, 2004 Hearing Room 3 Capitol
Building
Lt. Governor Joe Maxwell called the meeting to order. Co-Chair Reports: Lt. Governor Maxwell – Encouraged everybody to interview the candidates and to be sure and vote. Will be working on the Annual Report, which is due the end of October. Will also stay focused on the work of the PIC. Kirsten Dunham – The Missouri Disability Vote Coalition has identified 200,000 names of people with disabilities or family members who have an interest in disability related issues and they have identified who is not registered to vote. Voter registration cards were sent out to 90,000 people. The Olmstead Stakeholders Group will be holding has sent out candidate surveys to those running for statewide office. These included questions concerning commitment to the PIC. There will be a candidate forum Sunday, October 10th in St. Louis. Lt. Governor Maxwell announced that Senator Bill Foster has resigned from the PIC. Martha Hicks made a motion that the Co-Chairs send him a letter thanking him for his service. Neva Thurston seconded the motion. Motion carried. A quorum was established for the vote. Roll call was taken. PIC members present were: Lt. Governor Maxwell, Kirsten Dunham, Kelly Flaugher (for Jeanne Loyd), Kay Green (for Anne Deaton), Sandra Levels, Roya Hough (for Nancie McAnaugh), Anne Jackson, Neva Thurston, Wendy Hayes, Roger Garlich, Martha Hicks and Bobette Figler. Public Comment: Susan Pritchard-Green, Missouri Planning Council for Developmental Disabilities – Presented the Planning Council’s public statement regarding the recent death of a resident of Bellefontaine Habilitation Center and allegations of abuse and neglect made by other residents and family members. In part the statement reads: “It is the Council’s position that the State should aggressively investigate and incidents of abuse and ensure prosecution to the maximum extent of the law. Any suspected incident of abuse or neglect must immediately and thoroughly be investigated and reported to families, Missouri Protection & Advocacy Services, law enforcement and the public. Any perception that these incidents are not thoroughly investigated by all parties responsible must be eliminated. We fear that a culture has evolved that shows too much tolerance and leniency for abusive behavior at habilitation centers by staff, and that this attitude has extended into local law enforcement and adjudicative systems. The Department of Mental Health, Division of Mental Retardation and Developmental Disabilities, is charged with protecting the health and safety of individuals with developmental disabilities served in any setting, but these allegations lead to suspicion that abuse occurs, and occurs repeatedly, without being investigated or prosecuted. In addition, we feel it is vitally important that families, guardians, and advocates have access, without prior notice, to visit individuals for whom they are responsible to check on health and safety.” The entire public statement can be read on the Planning Council’s web site at www.mpcdd.com Linda Steinshouer, The ARC of the United States, Missouri Chapter – The ARC of the US, MO Chapter also has a position statement concerning Bellefontaine. In part it is as follows: “The ARC of the United States, Missouri Chapter is gravely concerned about the residents at Bellefontaine Habilitation Center. Every person has the right to be safe and free of abuse and neglect. It is obvious from recent reports that this has not happened at Bellefontaine Habilitation Center. This situation is unacceptable and must be changed immediately. It is, therefore, our position that every allegation of abuse and neglect at the center must be independently investigated and prosecuted to the maximum extent of the law. We must also address the fact that residents of Bellefontaine would be better supported in their own neighborhoods and communities.” They also expressed support for Anne Deaton and the Five Year Plan for Hab Centers. Wayne Lee, advocate – Worked at a Habilitation center. There was abuse by staff. Unless abuse is observed and reported by other staff nothing will be done about it. The legislature needs to be made aware that funding is needed to provide more options for people. Vicky Davidson, Missouri Planning Council for Developmental Disabilities – It is important when transitioning people out of institutions not to transition them into mini-institutions. Should give people a chance to see what options are available before they leave an institution. Also need to be sure that the money does follow the person. Lt. Governor Maxwell – The PIC does not have the authority to make changes. Groups need to direct advocacy toward proper agencies that can make changes. Abuse occurs in all situations including home care settings. Abuse needs to be stopped regardless of where it occurs. Kay Green, Division of MR/DD – Anne Deaton, Director of the Division of MR/DD and Dorn Schuffman, Director of the Department of Mental Health, are very alarmed about the allegations. DMH appointed a team to do a review on August 24th. They presented their first report on August 27th. Some of the recommendations made include staffing and professional support changes; requiring a psychologist to be present on the campus all day; refine the restraint policy, who responds to a restraint situation and follow-up documentation and follow-up. There will also be reviews of all behavioral service plans. In addition, reporting of allegations of abuse and neglect investigations conducted locally for all facilities have been changed. There is also a group conducting a quality and safety review at the Marshall Habilitation Center. The Division of MR/DD has implemented informed choice for individuals living in hab centers. During the annual Person Centered Planning process persons are informed of their rights under Title II of the Americans with Disabilities Act to receive services in the most integrated setting. Those who receive services in the community are informed of their right to receive services in the community. Under the Five Year Plan for the hab centers residents are being informed of their right to live in the community and the community options available to them. Many are choosing to stay in the institutions. There are efforts to divert people from entering the hab centers but sometimes the hab center is the only place they can receive the level of services and supports needed. Lt. Governor Maxwell said he felt the PIC should make a statement that abuse of any kind in any setting should be quickly investigated and stopped and the firmest measures necessary should be made in order to make changes to protect and prevent future abuse. The PIC should also adopt a statement that indicates they support and encourage continued, speedy implementation of Olmstead in the full spirit of the law. Wendy Hays made this motion. Bobette Figler seconded the motion. Motion passed. Lt. Governor requested it be typed up, signed by the Co-Chairs, and sent to the leadership of the House and Senate, the Governor’s Office and all state department heads. Data Dictionary Presentation: Jerry Worthington, Office of Administration – Are working on the Data Dictionary Project. Are working with the Departments of Mental Health, Social Services, Health and Senior Services and Elementary & Secondary Education, Vocational Rehabilitation. They are setting up a data system to collect standard information, such as name, address, etc., only one time. Thin information will then be available for other agencies providing services. They are also including non-state entities such as federal and county agencies. The data collection system is ready and will be presented to the state’s Architecture Review Committee for approval. State agencies will then be obligated to use this standard for collecting information. The contract is being funded through the E-government Initiative. This funding will end soon and they will have to ask the Legislature for another round of E-Government funding. If that funding is not provided then the departments using the data services will have to pay for them. He requested that the PIC take a position of support to help in these efforts. Lt. Governor Maxwell proposed that the PIC take the position of supporting the continuation of E funding so this project might continue without jeopardizing program dollars. Neva Thurston made the motion. Wendy Hayes seconded. The motion passed. The funding would be for $3.4 million dollars. Transportation Presentation: Steve Billings, MO Department of Transportation – Public transportation is defined as transportation by conveyance. It should be regular and consistent and includes buses, subways, light rail, commuter rail, monorail, passenger ferryboats, trolleys and inclined railways. MoDOT provides financial assistance to public and specialized transit agencies such as Missouri Elderly, Handicapped Transportation Assistance Program (MEHTAP). This receives 2.7 to 2.8 million in funding. About 3.75 million goes to State Funded Transit Operations Assistance for urban and rural public transit providers. The Section 5309 receives 18 to 20 million a year. 5310 Vehicle Program receives about 1.6 to 1.7 million. This program provides vehicles to agencies serving seniors and persons with disabilities. The FTA Section 5311 Rural Transit Program is where funding for the OATS Program comes from. OATS receives 20 to 30% of the funding. Services for people with disabilities include; fixed route scheduled service (largely in urban areas). Complementary Para-transit service also must be provided where fixed route services are provided. These must meet the ADA accessibility guidelines. There is also demand response participant service (this is in Joplin only). There are about 50 Specialized Transit Services Programs designed to serve a specific population, such as elderly or veterans. Associated Mobility Services are those that are associated with a specific agency, such as sheltered workshop or an agency providing meals. Most urban transportation is fixed route while most rural transportation is demand. There are three types of services offered. These are: curb-to-curb, as required by the ADA; door-to-door; and through door to through door. Most providers just provide curb-to-curb service. Special Projects Team Report and Agency Updates: Kelly Flaugher, Division of Vocational Rehabilitation – Had no new information to report. Kay Green, Department of Mental Health – Distributed copies of the DMH budget request. The MR/DD Comprehensive Waiver was amended to include a transition service. This will assist individuals with start up costs when moving out of an institution. The Division of MR/DD and the Housing Unit within DMH in partnership with the Division of Senior Services have applied for a housing grant with CMS. The grant is for $250,000 over three years. Money would be used to continue Informed Choice and to put another housing specialist for southwest Missouri area and one in the Office of Community Independence. Should hear if they received the grant in late September or early October. Ms. Dunham asked if the PIC members had received the draft of the Housing Guide. It was decided that the Housing Guide would be emailed out again to the PIC and a deadline set for responses. Andy Petti, Department of Health and Senior Services, Office for Community Independence – Are still filling some positions. Have hired a Social Service Worker II to work with discharge planners from hospitals and nursing facilities. Are interviewing for Community Health Nurse V and Health Program Representative III. This person will be responsible for helping identify and coordinate housing resources. The office will be coordinating the Informed Choice Trainings around the state. The “Guide to Home and Community Based Services” booklet will be distributed through the OCI office. On October 30th a change in the State Code governing long-term care facilities will take effect. Those going into long term care facilities will have to be provided with a copy of the Home and Community Based Services Guide. Roya Hough, Department of Health and Senior Services – DHSS is working with Anne Deaton at DMH to identify the population of those who are aging and also have a mental illness or MR/DD. This population is often underserved. Services and waivers cross department lines. Also Washington University is conducting a study of depression among the elderly. They are using seniors in the DSS caseloads to do the study. Want to develop a screening tool with possibly two or three questions, so they can identify symptoms of depression and make referrals for counseling or other services over the phone. Department of Social Services, Division of Medical Services – Chris Rinck, UMKC, presented a report on the Real Choice Systems Change Grant. Informed Choice Training – Charge was to develop the Informed Choice Training and to conduct the training around the state. Conducted nine trainings around the state. Trained 287 participants representing 68 organizations. Purpose was to train people on Informed Choice so they could return to their communities and provide this information to others. There were five modules: Introduction; Roles and Responsibilities; Communication Skills; Exploring Options; and Responsibilities and Accountability. Have several recommendations:
Survey of agency staff and providers – Got a good response to surveys. Asked questions such as: how safe people with disabilities feel in their environment; satisfaction with support network; happiness with friendship network; satisfaction with daily activities; advocacy issues; satisfaction in finding and maintaining PCA; amount of choice in lives and awareness of choice. This was compared to a similar survey of consumers done at an earlier date. The survey results can be viewed on the PIC web site at gcd.oa.mo.gov Recommendations were:
Real Choice Systems Change Grant Public Forums – These were conducted at twelve sites and had 168 participants. People were asked what was going well. People were satisfied with their personal care attendants, their case managers, their living situation, their employment and Medicaid transportation services. They were not satisfied with transportation for non-medical reasons. People face challenges about benefits (keeping them, qualifying for them), health care, high cost of medications, and support services, There was confusion over eligibility criteria for benefits. There were concerns about funding and not enough available affordable, safe, housing; low wages and high turn over in attendants; increased wages for direct care workers, not enough Medicaid providers; employment issues; accessibility issues and waiting lists. Cash and Counseling: Sherl Taylor, Division of Medical Services – A focus group has been meeting concerning Cash and Counseling. Their objective was to develop and offer Cash and Counseling methodology for Home and Community-Based Services in Missouri. Individuals would have the option to self-direct, designate a representative to direct their care, or have a legally appointed guardian or representative to direct their care. The demonstration pilot would be implemented in both an urban and a rural area. The demonstration project will last no longer than a year. The committee suggested that the state Medicaid agency begin the process of developing a waiver for Cash and Counseling. They also recommended that there be a great deal of marketing to media resources, discharge planners, case managers and community-based organizations and development of general outreach materials such as a brochure. To qualify for Cash and Counseling an individual would need to be assessed as needing Personal Care Services. Individuals could choose between a traditional case manager or a self-directed case manager. There would need to be a grievance process in place. It was recommended that individuals would be able to hire anyone including family members. The consumer would also have choice in the selection of fiscal intermediary and counseling supports. Ms. Dunham requested that the PIC look over the report and the recommendations before the next PIC meeting and be prepared to discuss them. Ms. Taylor also reported on the status of the no-cost extension of the Real Choice Systems Change Grant. The extension would allow completion of incomplete grant activities and there would be no new activities. The Grant would be able to provide funding for the PIC for the next year. The extension request should be approved in the next couple of weeks. The meeting was adjourned. |
