Is this how the Attorney General investigates reported fraud? If so, we are in trouble.

Is this how our Attorney General’s Office typically investigates concerns of fraud?

If so, I’m rather concerned about the competency level of the investigators.  This information was retrieved from Public Records.  I have left out the names of the agency, reporter and Attorney General Investigator’s name.  If you are interested in learning more, please contact me.

Reported to Attorney General Fraud Unit:

A provider in a supported living home listed herself for two positions:

Licensed nurse = – worked 53,505 hours in 2010 (most likely a typo) – Washington State paid her $123,063 or this position

Aid – worked 1,195 hours in 2010 – Washington State paid her $15,705 for this position

This person was paid a total of $138,768 in 2010 for her combined positions

(8760 hours in one year)

ATG Response:

Thanks for this referral. Do you know what the financial impact of reporting the overlap hours? If she didn’t report the aid hours, how would that affected the group home rate?

Reporter response:

I’m not quite sure what you are asking and why – what I can tell you is that I’m concerned about the number our hours that his one person stated she worked and was paid for.  It’s not the rate that I’m concerned about.

This one person stated that she worked 53,505 (obviously a typo, I think that she meant 5,350) as a licensed nurse and 1195 as an aide – that makes 6545 hours that this one person worked in a year.  Given that there is 8760 hours in a year, that means that she only had 6 hours a day every day of the year to sleep and attend to the other aspects of her life.  Is this doaable?  Does the state allow people to legally work that much?

That’s what I’m concerned about.  To me this seems obvious what the issue is but maybe I’m missing something – please let me know.

ATG Response:

In order for my office to prove fraud charges, specifically, theft we need to determine amount of loss to the State of Washington relating to Person’s inaccurate reporting of hours.  If she inflated hours worked on a cost report, I’m assuming that could possible impact the rate she is paid in subsequent years?  I’m trying to determine financial impact.

Reporter Response:

Wouldn’t it be fairly easy to determine the financial impact?  How many hours can one person work – subtract that from what was reported and the difference is the number of hours that was overreported.    A normal 40 hour a week job is 2160 hours a year.  This person claimed to work 6545 hours.  That means that she worked 4385 hours of overtime?  Is that even legal.

I’m sorry that this appears so difficult to figure out.  From my perspective it’s very easy.  I don’t understand what your difficulty is.

 

Why is the ATG Investigator asking these odd questions of the reporter?  What am I missing in this scenario?

Stop thisTrainwreck waiting to happen!

Please stop SSB 5459 – There is so much wrong with this bill that it will be hard to sum up in a concise and effective letter.  The critical issue is to stop this now and think about what the ramifications of such drastic changes will be if this bill is passed.

  1.  This bill is based on regurgitated false information from years past.  Senator Adam Kline continues to talk about “the 1970’s” with regards to our facilities today.  He is correct about the changes that needed to take place in 1970 but he’s far removed from the realities of the situation today and the recommendations from the experts of TODAY
  2. There are many in the community who are eligible and have requested admission to an RHC.  DDD has continually denied admission.  This is the only reason for a declining census in our RHCS.  There needs to be a survey sent out to all in the community who are eligible to inquire about their choice.  I believe you will find many who have chosen the RHC but their choice has been denied.  It is time that DDD actually supported and adhered to the Olmstead decision and respected people’s civil right to have a choice in where they want to live.  This is the very first thing that should be done before any or our RHCS are consolidated or closed.
  3. The reports that are generated by DDD are based on false information.  These need to be scrutinized.  I have researched the data and have found so many errors and flaws in the analysis of that data.  It is incredible that these reports are continued to be passed around as “fact” without anyone in the department questioning the concerns that I have raised.
  4. Rather than answering my letters regarding the fact that the “key points” are not supported by the data, DDD ignores the questions; Executives from The Arc accuse me of being “abusive” for questioning these reports.  As any person who has done research would know, it is expected to have people question your work.  When they question you, it is an opportunity to prove your point – not to call the questioner ABUSIVE.
  5. DDD reports that they have a Quality Assurance program which is up to date.  I will be sending  a synopsis of the issues I have had in researching the QA reports that should have been done, that DDD says they do, and the lack of knowledge about where they are, if they were even done and the multitude of players involved who do not communicate or know who has what report.  It’s a huge issue of “passing the buck” and nothing is getting done.  This NEEDS to be addressed before anything else can move on.  How can DDD say they have quality assurance when they don’t even have reports done, completed or available or even know who does them? DDD has not even complied with the requirements of The Roads to Community Living grant by completing the necessary surveys of the people who have participated.  The whole grant could be in danger without DDD following through with the requirements.
  6. People contacted regarding QA – still no data available – these people just keep sending emails around saying the next person has the data.  No one has it.  Players involved in this game:  (12 names which I won’t post here but sent to our House Ways and Means Committee members)  You would think that one of these people would be able to give a straight answer.  It’s time that DDD and the DDC are held accountable for their actions and lack thereof.
  7. DSHS is focusing their efforts on closing the RHCs.  The RHCS are about the only safe place for our citizens with DD.  The community homes which DDD so proudly talks about are a shambles – no safety or QA oversight, poorly trained staff with a high turnover, inadequate staffing levels and this is just the beginning.
  8. We hear about how wonderful the homes are in the community.  Just this past month I have been told by family members who have a grown brother and a 17 year old son in an Alpha Supported Living home and a SL Start home respectfully that they are not allowed to bring a visitor to the house.  What type of home is it in which as a sister or mother (or other family member) cannot even drop in to see their loved one or to bring a visitor to meet with them?  Why would they have these policies?  This is certainly not a home in which I would place my loved one. At the RHC, I can visit whenever I want, I don’t have to pre-arrange a visit, I can bring whoever I want to visit with my son.  There are no restrictions on my visitation with my own son.
  9. Rather than embarking on projects that are experimental and also on successful programs with people who are happy with those programs, it is time for DSHS and DDD to fix and bring up to standard the issues in the community.  This is where the energy and money needs to go.  These advocates talk about how they support those in the community yet their actions are contrary to that.  The problems with abuse, lack of oversight, lack of trained caregivers, and lack of services in the community will only be compounded by passing SSB 5459.

Please for the sake of not only our most vulnerable citizens who are safe and healthy in their current homes but also for all those in the community who will be hurt even more by the changes  that this bill support, DO NOT PASS SSB 5459.

Very Scary article about persons with Developmental Disability being hospitalized

Journal of Intellectual & Developmental Disability – September 2010; 35(3) 155-164

  •  People with ID continue to experience a higher burden of illness than the general population and this is reflection the overrepresentation people with ID in hospital settings.
  • Needs such as toileting and nutrition, poor communication between staff and patient, oversedation, medication errors, pateint fear and anxiety, insufficeint pain management and poor discharge preparation
  •  Carers (parents and caregiving staff from residential placment) have described vigilance as necessary to ensure adequate care and safety and to minimize fear and anxiety
  • Group home staff are not trained to care for people with serious or chronic heatlh contidions, but have basic first aid training.
  • This study had 76% hospitalization rate over 2 years.  Extensive strategies used by family and caregivers to improve hospital experiences for people with ID.
  • Carers perceived staff to be generally uncomfortable with or indiffernet to the needs of people with ID Care practices that did not acknowledge their special needs were interpreted as indiffernece:  “they don’t’ wash them, they don’t even brush their hair or clean their teeth.  They don’t put their glasses on them etc.”
  • Staff don’t respond to needs – mostly toiliting and nutrition little help with food prep/eating, problems incontenence  and not being changed as needed.
  • Lack of caring or that hospital staff had little or no prior experience or understanding of people with ID  Carers wondered if hospital staff saw people with ID as having little value.  Should a treatment even be tried?  was patient worthy of it?
  • Inabiltiy to treat pain effectively = pain only managed if someone were present to “translate” and insist that the pain be treated.  Not treated if patient didn’t complain.
  • Failure to assess the specific situaiton and respond accordingly – diagnoses and treatment  option were explained to people who lacked the capacity ot understand or hospital staff incorrectly assumed that the patient was unable to understand.
  • Many misinterpretations of behavior that expressed fears, desires or preferences.
  • No care because patient doesn’t know to push button or call out for help
  • Hospital staff fail to heed carer’s advice – poor outcomes for residents.
  • Identified concerns about the lack of attention paid by hospital staff to their descriptions of residnets fears and phobias and warnings about residents reactions to certain approaches – can have catastrophic responses
  • Many challenging behaviors due to lack of structure and staff discomfort –lead to fear, confusion and increased behavior issues.
  • Discharge plans show misunderstanding of what group homes can handle – early discharge due to problems in hospital yet group homes unable to manage early discharge – staff not trained to manage illness and treatments
  •  Difficulties due to hospital staff constantly changing – maybe one shift would follow instructions but not the next.
As a parent who has had a child with ID/DD and mental Illness hospitalized, I can attest to the truth of these statements.  I can not tell you how many times, I arrived on the unit and my son had not gone to the bathroom, had his face washed, had dirty teeth, had food spilled down his shirt, among other issues.  This was all with a 1:1 aid to care for him too.  I wrote out very easy instructions on how to communicate with him, what he liked to do and how to calm him – I don’t believe anyone even looked at them even though I went over them with the staff.  Overall, I was very disappointed in the care that my son received at two of our major hospitals here in the Seattle Area.  There needs to be major improvements in this area.
  • In hospitals with clear policies, resources and systems in place to address the special needs of people with ID, much better outcomes

  • This study confirms previous findings of poor supports and treatments of people with ID in

     hospitals. Need to rethink role of group homes, staff training and supports while in hospital

DDD Errors and misinformation

Due to continued reliance on the reports from DDD and DSHS, I am now writing daily reports informing our senators of the flawed data and analysis in the information they are receiving.  If anyone would like sources of the original documents and data, let me know – I have them.

The Olmstead Decision

I realize that our legislators are very busy trying to sort out the facts and many are probably not sleeping very much right now.  I certainly would not want to be in any of their shoes – but they are also not in my shoes nor have many of them lived the life of being a parent of a child with developmental disabilities.  Until you have lived it, it is very, very hard to even imagine what life would be like.  It’s easy to take a glimpse here and there and make assumptions but that cannot be generalized to what the total responsibility of caring for a family member with very intense care needs involves.

Senator Adam Kline is one such person who does not comprehend the intensity of care needs or the issues involved in supporting a continuum of care for our citizens with developmental disabilities.  Senator Kline references studies published by DSHS as reliable sources for cost comparison.  If one were to look at the original source, one would see how flawed these DSHS reports are.  Of course, that takes time and energy and our legislators need to rely on agencies to provide this information.  What do we, as citizens, do when these agencies themselves are part of the problem?

Yes, Senator Kline is correct in saying that this is not all about cost but that we need to address the issue of quality of life and the least restrictive environment.  To me, that is actually the main issue and it is for this reason that I fight so hard to maintain our continuum of care for our most profoundly affected citizens with disabilities.  Yes, there are many of our citizens with developmental disabilities that do much better in residential neighborhood communities – in fact, that is probably the best alternative for most of our citizens.  But, for some, that alternative is as if placing them in isolation, unable to interact with the outside world, at the mercy of a mostly untrained and inexperienced care staff and with little oversight to make sure that our citizens are being treated humanely.  This is the violation of human rights – not what Senator Adam Kline is talking about.

No one is disputing the issue that Senator Kline writes about with regards to “individuals ought not to be institutionalized when their needs for habilitation can be met in a less restrictive alternative.”  What he is really missing though is that for many, our state operated residential centers (RHCs) are the least restrictive alternative.  So it sounds to me as if Senator Kline is encouraging people disobey the US Supreme Court in the Olmstead decision by supporting moving our residents out of their community which is the least restrictive for them into a more restrictive community.

The Olmstead Decision

The Court based its ruling in Olmstead on sections of the ADA and federal regulations that require states to administer their services, programs and activities “in the most integrated setting appropriate to the needs of qualified individuals with disabilities.”

Under the Court’s ruling, certain principles have emerged:

  • unjustified institutionalization of people with disabilities is discrimination and violates the ADA;
  • states are required to provide community-based services for persons with disabilities otherwise entitled to institutional services when the state’s treatment professionals reasonably determine that community placement is appropriate; the person does not oppose such placement; and the placement can reasonably be accommodated, taking into account resources available to the state and the needs of others receiving state-supported disability services;
  • a person cannot be denied community services just to keep an institution at its full capacity; and,
  • there is no requirement under the ADA that community-based services be imposed on people with disabilities who do not desire it.
This is the part that Senator Kline needs to re-read.  He seems to be missing this information when citing the Olmstead Decision.
For more information and letters sent to our Washington State Legislators, they are in the links section.

Have you or anyone you know been denied services by DDD?

Do you know anyone with a developmental disability who requested residential services from DDD and was denied?

 

If they were denied admission to an Residential Habilitation Center (RHC) such as Fircrest, Frances Haddon Morgan Center, Rainier School, Lakeland Village or Yakima Valley School and were eligible, DDD cannot deny services.

If you know of someone who has experienced this denial of services, please have them contact the author of this blog.  We can help them.

This is critical and urgent in order to maintain services for our most vulnerable citizens.