“He’s 13 years old, autistic” – Austin Jenkins

Thank you, Austin Jenkins, for writing your article “He’s 13 years old, autistic and stuck in the hospital for the holidays. He’s not the only one. (KUOW.org, December 15, 2021).

This issue has been developing for many years and it should come as no surprise to those who have been involved with Developmental Disabilities and the limited resources, tangled opinions, and even more tangled politics that are the driving forces behind decisions and reports provided to our legislators to make changes to our state’s laws.

The passage of Senate Bill 5459 in 2011 was one such bill that directly affected supports for our youth (21 and under). This bill essentially eliminated in-state options for those with very high and crisis level support needs – necessitating the need to send these children out of state – far away from the natural supports of their family and local community members.

The final bill report can be found at this link but the summary is quoted below.

Summary: Persons under the age of 16 may not be admitted to a Residential Habilitation
Center. Persons between ages 16 and 21 may be admitted for short-term crisis or respite
care.

KUOW asks for feedback on their stories.  Today, I submitted the letter below. There is much more that I could add but I hope this prompts Austin Jenkins to ask a few more questions, speak to a few more people and reach out to individuals – not the agencies which helped to create this crisis – as to possible solutions that we believe would be beneficial, not only to our family members but for our community as a whole. 

 To KUOW:
 

“A move to one of the state’s four Residential Habilitation Centers for people with developmental disabilities has also been ruled out. They won’t take a 13-year-old”  Why not?  This would be a great question to ask and may be a very viable solution to start to address this growing crisis.   answer to this whole problem.

It’s more than shameful how our state is unable to live up to our constitution and provide appropriate supports for this population  Washington State passed a law in 2011 which prohibits those 21 and under from receiving these supports in our community.  This bill, highly promoted by The Arc is one of the major reasons why families are forced to “choose” supports far away, separating their child from their families and communities.

By removing the choice of utilizing the intermediate care facility option (Residential Habilitation Centers) which have physical space and are currently open in our state, this bill clearly discriminated against our youth who could have greatly benefited by the supports and services at one of these campus settings which have specially trained staff to help habilitate the person so they may return to their community and a less restrictive environment.  This legislation was highly promoted by The Arc and the Developmental Disabilities Council, agencies which are given public funds to advocate on the behalf of our community.

Robin Tatsuda, with The Arc of King County misses the point of how she and others trace the growing problem of youth stuck in the hospitals too.  Unfortunately, without addressing the history of the crisis, we will continue to make the situation worse.  This can be witnessed today as these organizations continue to vehemently advocate for closure of any type of support they define as “institutional” – regardless of the choices of those utilizing these supports and finding them beneficial.

At the time when this bill was in legislation, I was in strong opposition to it.  I addressed this very issue of age discrimination with the Secretary of DSHS at the time (Susan Dreyfus) and she looked me straight in the eye and said, “parents still have choice, they can send their child to another state if they want these services.”    I guess she really meant that because that is what has happened quietly over the past 10 years.

That cruel statement brought me to tears – and still does. While I fully understand an ICF may not be the choice a family would choose, it is a much better choice than what is currently “offered” by our state -that of being confined, restrained (physically and medically) in an isolation room in a critical-care hospital, having a food tray slide through a hole in the door 3 times a day with minimal human interaction.

As a parent of a youth needing these supports, I would be forced to choose an out-of-state option too.  But I was lucky – my son needed this level of support before the discriminatory law was passed. 

Living on a campus setting, being allowed to go outside, interact with others as one is able to, go to the local public school, have vocational training, interact with the community at large and stay connected with one’s family and have other appropriate supports at an ICF can be beneficial to the person and their family.  It can provide time for healing, supports for building new skills and supports to maintain those skills.  It can buy time in a more integrated setting than a hospital isolation room, until an even less restrictive but appropriate community home or pocket neighborhood can be developed.

I know that allowing our families to choose a local, in-state option (which does not need to be built from the ground up – it already exists) can save lives and prevent extreme trauma that these individuals and their families are now experiencing – trauma that they will need to live with the rest of their lives. 

With this crisis only getting worse and with the information now coming forth about what has happened to our youth the past 10 years, I am hopeful that our legislators will be able to see what is happening to our youth, families, and community.  “Shut Them Down” is far from the answer we need – yet this is what The Arc and Self-Advocates in Leadership, People First and the Developmental Disabilities Council will be pushing for this upcoming legislative session.

Please listen to our families – you may not see or hear them – they are too busy trying to deal with the trauma in their lives.  We do have options that can be looked at – options and choices brought up by those who need or have used these supports and have found them to be extremely beneficial.  We may have to dig deep to find them and learn because they are purposely excluded from conversations and decisions by those who claim to be advocates and speak for “our families”

With that being said – as a person with current lived experience of this problem, I support Enhanced Behavior Support Home legislation currently being developed with WAA in addition to removing the discriminatory law passed in 2011 which prohibits those 21 and under from choosing one very viable option which is available in our state.

More to come on this critical issue.

I’ve been quiet this past year due to critical health issues and was going to shut this blog down since I did not have the time, energy or ability to even think about advocacy. But the fact that several people reached out to me in the past couple of months asking me for advice, seeking help for their own advocacy, or asking me to join them in other efforts, has prompted me to keep the blog up for historical references and information that may be difficult to find elsewhere. My hope is to continue to participate and we’ll see how it all transpires as time moves along.

Abuse and Neglect in the Hospital

I am beside myself with anger, frustration and helplessness regarding the situation with our friend, Kevin.
Kevin has not been “on hold” in the ER at PeaceHealth St. Joseph Medical Center in Bellingham, Washington since April 24, 2019 (for this episode)

PeaceHealth

Below are messages that I received from Kevin’s mom and legal guardian last night and this afternoon.  Kevin is a 26 year old young adult.  Kevin is autistic and is a vulnerable adult with a legal guardian.

“Cheryl, the hospital let Kevin leave the hospital and he was on scrubs and no shoes running down one of the busiest streets in town. He made it to the respite bed where he was a couple of weeks ago. He ran in the middle of cars for 2 miles. They called me and let me know he was there, the hospital called me after the respite bed told them he was there. He had blood blisters in his feet. Then they had the audacity to tell Tom (respite care administrator) that Kevin checked himself out of the hospital. The police came later and took him.

“The police took him back to the hospital and told the ER manager that Kevin is gravely disabled and should not be let go in streets like this.

I have asked for a DMHP assessment, but they are giving me the run around

He has blisters on his feet and sticks stuck in his skin – the doctor is supposed to see him sometime today.

They just called me and said they will let him leave again. I guess the DMHP assessment was not done because it was done when he first got to the ER.

It’s a never-ending mess.”

I went to the Bellingham police station and they said that when they drop him off at the ER they let the hospital know that he is a danger to himself and others and needs to be in involuntary confinement.  The hospital disagrees.  I hope he does not escape again tonight – it was a miracle that he didn’t get hit by a car yesterday.

This ongoing nightmare has been reported to the DD Ombudsman, Adult Protective Services, the Department of Health and Developmental Disabilities Administration yet no action is taking place and the hospital is continuing to neglect Kevin and put his life at risk.

As a mother, nurse and advocate I am totally appalled and sickened by the lack of attention and concern that these state agencies, which are there to provide protection and care and the hospital which is to provide safe, appropriate healthcare continue with this neglect.

This is more than insane – is anyone listening?  Does anyone have any solutions?

Kevin’s mother has requested over and over again to allow Kevin to return to Fircrest Residential Habilitation Center (one of our States’ Intermediate Care Facilities) but DDA has continued to refuse saying there are no beds.  If this is an entitlement and there is “no refusal” how can DDA say there are no beds?

Is the only choice to let the hospital and state agencies continue to neglect their duties until Kevin runs into the street and gets killed by a car?  Then what?

Susannah Frame – King 5 Investigator – Please read this and help!

 

Critical Access Hospital used as “residence” – Abuse by DDA

This practice is finally being addressed.  Most recently, the case of using a bed in a Critical Access Hospital  as a “residence” for a man with a developmental disabilities. The man, a client of Washington State Developmental Disabilities Administration (DDA) developed some behavior issues.  A crisis evaluator responded and law enforcement transported the man to the local hospital for a medical evaluation.  The man was cleared medically to be released but the licensed home refused to take him back.

That means that without a safe and appropriate place to be released to, the hospital cannot release the man even though he is not in need of medical support services.

Read the Blog “Stuck in the Hospital – Mason’s Story”

My name is John Short and I am an Emergency Medicine Physician at Mason General Hospital in Shelton, Washington. The following is my first-hand account of an ongoing injustice perpetrated by the WA state government against a disabled person:

Since DSHS/DDA has failed to find housing for Mason, we are now in a position of providing it for him. These state agencies are well aware of the laws and are using them to force hospitals to become part of the housing “crisis plan”. Where does that leave hospitals such as ours that don’t have large facilities that can absorb the needs of such clients? “Housing” is not a reimbursable diagnosis and so it is very likely that MGH will receive no funds to cover Mason’s stay. Anyone who has received a hospital bill knows how much this means. This is not to mention the 24/7 security that has been hired by MGH which would not be covered even if there was a medical condition that we were treating.

I am fully aware of the views of Disability Rights Washington and Advocacy Agencies such as The Arc which push for deinstitutionalization – consolidation and closure of RHCs.  With policies such as those we end up with trans-institutionalization such as what is happening at Mason General Hospital in Shelton, WA.

This practice is abuse by DSHS/DDA – not only of Mason but of everyone in our state.  It is wasting time, money and resources while DSHS/DDA does nothing and forces others to do their job and a much higher cost – both money and human cost.

According to the reports, Mason had been in foster care and “aged out.”  It’s not as if the issues suddenly appeared – there should have been a transition plan in place and the new group home should have been well-staffed and knowledgeable on Mason’s care and support.  DDA clearly did not do their job before Mason ended up at the hospital.  He had only been at the new home 2 days before he was carted off by the Crisis Response and law enforcement to the hospital.

 

KOMO News report

How to create a crisis – deny services

Way back in 2011 and 2012 when Washington State was “researching” issues related to caring for our DD population, there was a DD Task Force which met several times.  The goal was to discuss the future of DD Care in our state with emphasis on the consolidation and closure of the close the Intermediate Care Centers.

Several of the predictions I had and tried to communicate to other DD Advocates and legislators have come to fruition.  Please listen to the families who are the real experts and survivors.  Advocacy Agencies such as The Arc, Disability Rights Washington and other similar agencies which receive public funds to provide advocacy must abide by their  policies – policies which may not be in the best interest of those actually involved.

  •  SL Start and client neglect/abuse – I reported issues in August 2012 to the legislature.  Senator Adam Kline only provided ridicule and sarcasm in his response to me –

“But I suspect this won’t happen.  I could be wrong, but I suspect that this story’s real value to the RHC advocates is in its expected political effect.  It portrays the RHC families—even the residents—as pawns in a game in which the malevolent community advocates are the operators.  SL Start is the villain in this instance, maybe the Arc the next time, maybe the Governor.  And you are “silenced” by these conspirators.  The victims are rendered mute, while only the conspirators may speak.  The conspirators “manipulate some of our community members.”   Oh, please!”

Obviously, this Senator believes this situation is fabricated to make an issue.  I wish it was but it’s not. This Senator goes on to berate me for being an advocate for safe and appropriate care and categorizes me into the “pro RHC” side.  When will he and others realize that it’s not about sides – it’s about safe and appropriate care for each individual.

April 2018 Headline – Apparently I had some real information that needed some attention.  If only people had taken the time to listen, trauma could have been alleviated.

Washington Shuts Down Care Provider For Disabled Adults, Now Families Face Tough Decisions

Below is an excerpt from the blog post dated September 8, 2012.  I address the issue that DDA did not even consider the issue of DD clients using the hospital and ER as crisis care.

That comes from a different budget so it’s not a factor to DDA.  Well it should be because it greatly affects the PEOPLE involved in addition to adding overall cost to our state’s budget.

While the concept of the crisis team is good, why not use the facilities and services we already have in place to run this program out of? We have the space and expertise to do this already and it seems ridiculous to start a whole new program for something that we have which already works very well.

I believe this was also part of Julianne’s testimony and she is 100% correct in her assessments of the situation.

As a parent who has survived crisis after crisis, I can also tell you that you should look to the hospital emergency room data on how many people are taken there for crisis. I believe you will find a lot more information regarding where folks with developmental disabilities go when they have a crisis. I also know this is the case from working with other families and hearing their stories. Talk to the ER nurses at Seattle Children’s and ask them how many families bring their kids with DD (particularly autism) there for crisis intervention. Talk to the Inpatient Psychiatric Unit doctors, nurses, and staff and Seattle Children’s. I believe you will find staggering numbers. You will see a much different picture than one you may hear from DDD. DDD is not aware of many of these crisis admissions to the hospitals because they are not notified.

What about connecting the crisis care team with the local hospitals and emergency medical response systems? What about connecting with the Crisis Line? I know that not only in our family’s case but in many, many others, these are the systems which we accessed in times of crisis. These are the places in which we will be able to realize the extent of the crisis situation with people with DD.

Please read the report the DD Ombuds   published and consider the tasks outlined to address this critical problem.

Provide appropriate funding to community residential providers and support the ICF to provide appropriate care for DD clients in crisis.

Hospitals are not Community Living

The DD Ombudsman’s Office published the report “Stuck in the Hospital”

This report discusses the crisis situation that we have gotten ourselves into by not listening to the families, caregivers and people involved.   It has been known for some time that people are boarding in the emergency rooms and hospitals because there are no safe community options for them.

With the mindset and policy that refuses to acknowledge that the Intermediate Care Facility has a place in the continuum of care and admission to these potentially life saving communities is prohibited by the administration, we have developed a situation that is much worse.

Has DDA and the legislature willingly been closing their eyes to this situation?  The fact that there has been no tracking of this by DDA or by the hospitals is neglectful when trying to understand the needs of the population.

The trauma and cost that is wasted is horrendous.  Reading these stories makes me very angry and very sad.  I cannot imagine the trauma that these people have endured while “living” in the emergency room or hospital.

As a parent of a disabled child who also experienced some of this (but nowhere near the extent described in the report) I remember times of crisis when there was no place to go.

Extreme mania and psychosis caused medical complications which necessitated a medical hospitalization.   My son was loud, did not sleep, was hallucinating and would not stay in one place.  He paced the hospital halls with family or caregivers (not enough nurses to provide his care).  At one point, we were told that we needed to keep him in his room since he was scaring the other patients.  Clearly, they did not understand that confining him to his room would only agitate him more and cause more noise and activity that would be even more disruptive.

The inpatient psychiatric unit was not much better – while they were able to manage his mania/psychosis, they were not prepared to manage medical issues or understand his intellectual/developmental disability.

The option that was suggested by the discharge team from the psych unit was “call the police” for the next crisis – meaning that my son, at age 14, would be taken to jail.

Jails and hospitals should not even be a consideration for this population in crisis.

The only place that would have been appropriate to provide both the comprehensive care needed to stabilize my son was the ICF/IID – unfortunately, he was denied admission for at least one year after a request was made and consequently had several lengthy hospitalization before this was finally approved.

Thank you to the DD Ombuds for addressing this crisis situation and developing a plan for correction.  Now that it is acknowledged, a solution can be addressed.

 

 

Save Fircrest – Essential Supports

A bill has been passed to the Senate Floor to vote on closure of Fircrest School – one of our states Residential Habilitation Centers (RHCs).  The RHC houses two critical communities of care – a Skilled Nursing Facility (SNF) and an Intermediate Care Facility (ICF).

It is a fact that there does need to be some capital improvement to the facilities to provide a safe environment for the residents and this is why we support the Fircrest Master Plan Fircrest Master Plan A-2

The campus has been neglected in the capital budgets for years and this is one reason why there is a large dollar sign to this project.  When buildings are neglected, they deteriorate and become unsafe for residents.  This is the situation we face now.

This does not mean that the land should be sold and the residents forced from their homes and community.  It does provide opportunity to change and to make needed improvements and to re-access the needs.

These are the opportunities that we support:

Fircrest Master Plan Alternative A-2

Federally Qualified Healthcare Center with oversight provided by the Department of Health for Fircrest residents and adult residents in the state who live with intellectual and developmental disabilities.

Collaboration with the University of Washington, Center on Human Development and Disabilities to provide specialized and comprehensive healthcare to community members.  This collaboration would also provide training for students in the healthcare professions.

Opportunities for improvement are not an option if 2SSB 5594 passes.  This bill seeks to close Fircrest and deny current and future residents access to the necessary supports.

We need to defeat 2SSB 5594 to protect out most vulnerable citizens.  Tell your Senator to Vote NO on 2SSB 5594.

 

Preserve and build Respite and Crisis Stabilization

Time is running out – we need a YES Vote on SB 5243

 

save respite part 4 Please read and understand why a YES vote is critical to our families who need support. This bill helps to maintain and build respite and crisis stabilization services – how can an advocate be against this bill?

According to the Action Alert sent out by The Arc – Washington State they oppose this effort to preserve respite and crisis stabilization.  This bill is only aimed at preserving and building – not shutting down and limiting the few choices that our families have for respite and crisis stabilization.

It is time to question the motives of The Arc – Washington State and ask why they want to tear apart services.  Tearing down will only hurt those we are trying to help.

Please call the toll-free hotline at 1-800-562-6000 and ask your Senator to vote YES on SB 5243 – it is for the sake of our families!

Read the bill here and decide for yourself what is in the best interest of our families and community members in need of services.

(1)(a) The Yakima Valley School shall continue to operate as a residential habilitation

The Yakima Valley School must operate crisis stabilization beds and respite service beds as the capacity of the school allows and as the needs of the community require, subject to the availability of amounts appropriated for this specific purpose.
(b) As of the effective date of this section, no new long-term admissions are permitted.
(2) The department, within available funds:
(a) Shall establish state-operated living alternatives, within funds specifically provided in the omnibus appropriations act, to provide community residential services to residential habilitation center residents transitioning to the community under chapter 30, Laws of 2011 1st sp. sess. who prefer a state-operated living alternative. The department shall offer residential habilitation center employees opportunities to work in state-operated living alternatives as they are established;
(b) May use existing supported living program capacity in the community for former residential habilitation center residents who prefer and choose a supported living program;
(c) Shall establish up to eight state-staffed crisis stabilization beds and up to eight state-staffed respite beds based upon funding provided in the omnibus appropriations act and the geographic areas with the greatest need for those services;
(d) Shall establish regional or mobile specialty services evenly distributed throughout the state, such as dental care, physical therapy, occupational therapy, and specialized nursing care, which can be made available to former residents of residential habilitation centers and, within available funds, other individuals with developmental disabilities residing in the community; and
(e) Shall continue to provide respite services in residential habilitation centers and continue to develop respite care in the community.”

This is how 2SSB 5243 currently reads. Please read and understand why a YES vote is critical to our families who need support. This bill helps to maintain and build respite and crisis stabilization services – how can an advocate be against this bill?
(1)(a) The Yakima Valley School shall continue to operate as a residential habilitation

The Yakima Valley School must operate crisis stabilization beds and respite service beds as the capacity of the school allows and as the needs of the community require, subject to the availability of amounts appropriated for this specific purpose.
(b) As of the effective date of this section, no new long-term admissions are permitted.
(2) The department, within available funds:
(a) Shall establish state-operated living alternatives, within funds specifically provided in the omnibus appropriations act, to provide community residential services to residential habilitation center residents transitioning to the community under chapter 30, Laws of 2011 1st sp. sess. who prefer a state-operated living alternative. The department shall offer residential habilitation center employees opportunities to work in state-operated living alternatives as they are established;
(b) May use existing supported living program capacity in the community for former residential habilitation center residents who prefer and choose a supported living program;
(c) Shall establish up to eight state-staffed crisis stabilization beds and up to eight state-staffed respite beds based upon funding provided in the omnibus appropriations act and the geographic areas with the greatest need for those services;
(d) Shall establish regional or mobile specialty services evenly distributed throughout the state, such as dental care, physical therapy, occupational therapy, and specialized nursing care, which can be made available to former residents of residential habilitation centers and, within available funds, other individuals with developmental disabilities residing in the community; and
(e) Shall continue to provide respite services in residential habilitation centers and continue to develop respite care in the community.”

This is how 2SSB 5243 currently reads. Please read and understand why a YES vote is critical to our families who need support. This bill helps to maintain and build respite and crisis stabilization services – how can an advocate be against this bill?
(1)(a) The Yakima Valley School shall continue to operate as a residential habilitation

The Yakima Valley School must operate crisis stabilization beds and respite service beds as the capacity of the school allows and as the needs of the community require, subject to the availability of amounts appropriated for this specific purpose.
(b) As of the effective date of this section, no new long-term admissions are permitted.
(2) The department, within available funds:
(a) Shall establish state-operated living alternatives, within funds specifically provided in the omnibus appropriations act, to provide community residential services to residential habilitation center residents transitioning to the community under chapter 30, Laws of 2011 1st sp. sess. who prefer a state-operated living alternative. The department shall offer residential habilitation center employees opportunities to work in state-operated living alternatives as they are established;
(b) May use existing supported living program capacity in the community for former residential habilitation center residents who prefer and choose a supported living program;
(c) Shall establish up to eight state-staffed crisis stabilization beds and up to eight state-staffed respite beds based upon funding provided in the omnibus appropriations act and the geographic areas with the greatest need for those services;
(d) Shall establish regional or mobile specialty services evenly distributed throughout the state, such as dental care, physical therapy, occupational therapy, and specialized nursing care, which can be made available to former residents of residential habilitation centers and, within available funds, other individuals with developmental disabilities residing in the community; and
(e) Shall continue to provide respite services in residential habilitation centers and continue to develop respite care in the community.”