“Never Events”

Dangerous situation on city roads

As previously reported, PeaceHealth St. Joseph Medical Center in Bellingham, Washington was found to be out of compliance regarding the use of restraints, seclusion, isolation, patient care and emergency services in an investigation by the Washington State Department of Health.

One critical issue that this investigation missed was the issue of elopement of a vulnerable adult who ran out of the hospital, barefoot and in scrubs, and was later found over 2 miles away.  This event is called a “Never Event” by the Patient Safety Network of the US Department of Health and Human Services.

Patient protection events
Discharge or release of a patient/resident of any age, who is unable to make decisions, to other than an authorized person
Patient death or serious disability associated with patient elopement (disappearance)
Patient suicide, attempted suicide, or self-harm resulting in serious disability, while being cared for in a health care facility

It is clear from the medical record, investigation, reports from local police and family/guardian that the hospital was well aware that this patient was a vulnerable adult under a guardianship yet when this person left the hospital and the hospital staff was well aware that he ran out of the exit while being escorted to the restroom,  the hospital did not notify anyone.  Does this hospital have a policy regarding missing patients such as a special code called?  That is the standard of care and apparently this hospital does not practice up to the standard of care.

I have contacted the DOH team which did this investigation asking questions why this critical event was missed and not addressed in the investigation.  I am still awaiting a response.

I am so thankful that the outcome was not what we see in the photo below – but given the circumstances, this was a real possibility by the “Never Event”

Body of a young child covered by a sheet“.

Centers of Excellence – change from the bottom up

We often hear about Centers of Excellence but what does this mean?

I think it should be fairly obvious but apparently it’s not.  For parents, family members, people with intellectual/developmental disabilities (IDD), advocates, community members, healthcare providers, vocational and recreational support people, it generally means a community which interacts and supports those with IDD in all aspects of their life in a manner which provides the best quality of life for that person.  It is a collaborative effort from all angles.

This can be done but for some reason, even though we hear about needing centers of excellence, they are being broken down rather than built up by the very agencies which should be supporting them.

Here in Washington State the Developmental Disabilities Administration recently proposed a “feasibility study” at the cost of $601,000 to actually dismantle much needed Nursing Facility for those with IDD which also provides respite for many across the state, evicting the current residents from their home to create a “Center of Excellence” which has a totally different definition than one would expect. There are so many things wrong with this proposal which was most likely generated by a recent court decisions regarding people with mental health issues and the fact that federal reimbursement for care is better in the Developmental Disabilities Arena than in the Mental Health Arena.

This proposal needs to be stopped before it goes any further, wasting our valuable funds on things when those critical funds could be used for so much better, actually providing services and supports utilizing existing resources and building up what we have rather than tearing down, dismantling and rebuilding programs which would actually provide less than what we currently have.  This makes no sense.

Our state has a history of doing just that.  In 2012 Frances Haddon Morgan Center was closed, a Residential Habilitation Center  (RHC)which was home to over 50 residents and provided much needed respite care.  FHMC was also situated on the western side of the state providing an alternative which was closer to many people’s homes of origin.  This was a huge political mess with much misinformation provided and believed by those who made the decision but the decision was made which The Arc, the Developmental Disabilities Council and others celebrated as a victory.

At least one young man’s life was lost as a direct result of this closure and many others were displaced more than once from one home to another.  This alone is inexcusable.  The other issue is the misinformation regarding “cost savings” and the fact that many now are being denied services which could have been provided if FHMC was still operational.  FHMC is currently just a building, empty, sitting unused for many reason – it is a shame to walk through the campus and know what good use it could if only it would be allowed to be utilized.  Families and communities are hurting due to this decision.

What did happen was that there was no cost savings at all – in fact, just the opposite.  Rather than building several crisis care centers located strategically around the state, there has been one center for youth which has can serve up to 3 youth at a time.

The program which was built to “replace” FHMC has been open since December 2012.  To date they have served 12 children, only one of whom returned to their family home (which was one goal of this program). The current cost of this program is $1,165 per day.

This is the program for which FHMC was shut down for – how many people are now going without help, are suffering in crisis due to this huge error on the part of some so-called advocates?

We can’t let history repeat itself yet that is exactly what this “feasibility study” is doing.  It must be stopped before it goes any further.  Let’s look at what a “Center of Excellence” really is and build these up with the resources and available space we have – it’s all there already – it just needs to be utilized appropriately.

 

DDA CenterofExcellence

 

A Gym Membership?

Community members playing in the open field

Community members playing in the open field

 

If you cared for a young man with autism and moderate intellectual disability with the following other issues, would you consider a gym membership as an appropriate solution to his need for physical activity?

  •  significant deficits in communication, social interaction, relationship development, coping skills, long-term planning and executive function.
  • He is physically active and energetic with running, jumping and constant movement.
  • He is very high energy and needs to be constantly engaged to minimize behavior issues.
  • Communication is impaired due to his frequent need for physical activity sensory stimulation.
  • He enjoys swinging for up to 20 minutes, long walks, jumping, etc.  and sensory stimulating sounds and movement activities.
  • At times he needs staff to contact guard him due to his behavior to dart away when he sees something off in the distance which interests him or he may push and run into others.
  • He is not traffic safe

I ask this because this is a solution that has been offered to a family from the Roads to Community Living Team.  This young man currently lives in a supportive community in a campus setting.  The campus setting is ideal to benefit this young man in his physical activity needs and also for his safety.  The Developmental Disabilities Administration (DDA) wants to move this young man from the supportive community in which he is stable and safe to a dispersed home.  The family has requested he remain in the current community and their request has been denied.

The fate of this young man is now at the administrative hearing stage.  DDA has come up with some solutions under the Roads to Community Living program, to help with the transition.  One of these solutions is a gym membership (remember the RCL program only lasts for 365 days).  Do you think the gym membership is a solution to the physical needs of this young man?

If so, why?  If not, why not?

 

Fact or Fiction Part 2

cost center

“Average” Daily Rates in Washington State for residents with Developmental

Disabilities who live in 4 types of Supportive Residential Care

Regarding the cost of care, it is clear that the comprehensive cost of the care of those with the highest support needs who choose the RHC is the most cost effective care.  As revealed in the report “Assessment Findings for Persons with Developmental Disabilities Served in Residential Habilitation Centers and Community Settings” (2011) residents in RHCs had significantly higher support needs than community residents.  The RHC residents were also significantly more likely to meet both extensive behavior and extensive medical support needs than residents in community residential programs.  “Our current findings suggest very clear difference in medical support needs, with those in RHCs being more likely to have high medical support needs than those in community residential programs.” (Barbara A. Lucenko, PhD and Lijann He, PhD, 2011)

 

This report also examined the DDD Acuity Scales and found that the residents in the RHCs also  had significantly higher support needs in interpersonal support, protective supervision and Activities of Daily Living (personal care, dressing, bathing, eating) in addition to medical and behavioral support needs. 

 

 

Looking at the daily cost of care in each cost center, it is also clear that there is much cost shifting in some areas which make it appear that the cost of care is less expensive.  This is the information that is often not shared when comparing costs.  It is also critical to look at the support needs of the residents in each setting, realizing that those in the RHC have significantly higher support needs and inherently higher costs related to the higher support need.

 

One other area that is misrepresented is that the “community” ICF/IDs offer the very same services as the state run supported communities of the RHCs.  It is clear by auditing their costs that this is not the case.  Knowing the high support need of the average RHC resident, it is very clear that this average RHC resident could not be safely and cost-effectively cared for in the “Community” ICF/ID since the comprehensive services are only available in the RHC. 

Please see this link below for a description of the cost centers and more information on the data 

 Average Daily Cost of Care

Bibliography

Barbara A. Lucenko, PhD and Lijann He, PhD. (2011, February). Assessment Findings for Person with Developmental Disabilities Served in Residential Habilitation Centers and Community Settings. Retrieved from http://www.dshs.wa.gov/pdf/ms/rda/research/5/36.pdf

In Washington State the term Residential Habilitation Center (RHC) is inclusive of the ICF/ID and the specialized Nursing Facility.  The costs in these reports are only for the ICF/ID part of the RHC.