Caseload Forecasting for Disabilities

Silhouette of people with sunset.

Senator Emily Randall (D- 26th Leg. District, WA) has introduced SB 6056 – Concerning the budgeting process for services for individuals with developmental disabilities

This is a hopeful beginning to the generation of appropriate funding for the needed supports to allow the people in this vulnerable population to be included in their communities as they would desire, improve their quality of life and help provide a more meaningful life as they would choose.

In our opinion, this means more choices and less restrictions, appropriate assessments of needs and supports and increased stability in all areas of life – home, work and community.

This bill will help address the issue of the mysterious people who live in the world of “the  no-paid services caseload” withing DDA.  No one knows who these people are, if they are even in our state or alive or what their support needs may be.  It will at least provide case managers for this population in hopes of being able to provide supports if these people are in need.

But, caseload forecasting is not just counting heads.  We need to understand what the range of support needs is and how many people are in each acuity level in each setting to better assess appropriate funding for these supports.

The Joint Legislative Executive Committee on Planning for Aging and Disability Issues (JLEC) had a work session on January 9, 2020.  A link to the session is highlighted.

 

JLEC – January 9, 2020   (Olympic Neighbors presentation begins at 48.00)

Olympic Neighbors, Father’s Group of Jefferson County, Developmental Disabilities Funding Crisis Task Force (DDFTF) members provided much information to the committee.  The chart below is taken from their information.

State Funding for Supports - Jefferson County Father's Group

Regarding residential supports – in theory the SOLA and Supported Living are essentially the same supports – the difference is that the SOLA is state operated and Supported Living is typically private-non-profit/profit agencies providing the support.

There is a significant difference in the wages for the caregivers in these residential settings – that of the state employee versus agency employees – but does that alone account for the difference in cost for these residential settings?

I think there may also be differences in acuity levels of the residents in these settings.  There may be higher percentage of higher acuity residents in the SOLAS which also could be reflected in the higher cost.

This is an issue that hopefully can be addressed in Caseload Forecasting.  We cannot base our funding on the “Average” for the whole population.  We must break out acuity levels and look at the average for that level.  This method will provide a much better understanding of the necessary funds for appropriate supports.

 

Groupthink and The Seattle Times

Once again, The Seattle Times has disappointed advocates for those with intellectual and developmental disabilities.  Is Groupthink so powerful that people totally lose their sense of justice?  Does it prevent people from asking critical questions?

Groupthink results in defective decision making and large amounts of waste in human and material resources.  This is clearly evident in the past couple of decades with over 38 “work groups” that have been formed in our state to tackle the issues of supports for those with developmental disabilities – 38+ reports which have amounted to no decisions or progress.  WASTE of time, money and talents – is this due to groupthink?

Knowledge is power and we are becoming less powerful because knowledge is being kept from us.  Our media has let us down and The Seattle Times no exception.  Many people have written to the editors to try to educate them on the issue but since the knowledge does not agree with the groupthink.  We need to have a devil’s advocate to challenge and alleviate the ongoing groupthink but will this ever be allowed?

Not at the rate we are going!

DD Task Force – Updates and Concerns

The Developmental Disabilities Task Force met and had a very informative meeting.  It appears there is a consensus supporting a continuum of care and a consensus that we are all concerned with those who do not have access to any paid services.  I want to thank the participants for their willingness to look thoroughly at these issues and issues and willingness to think of innovative approaches to the problem.

Link to audio of meeting  The slides and written information may not be up on the DD Task Force Website for a week or so.

Below is my letter to the task force regarding the presentations and comments:

September 7, 2012

Dear Task Force Members,

Thank you for the very informative discussion from the September 6, 2012 meeting. I have listened to it and look forward to seeing the slides that were presented once they are posted on the website. I do have some comments to make regarding the presentation and public testimonies which were heard.

 

Regarding 1:1 care

 

There is a huge difference between 24 hour 1:1 care in the RHC and in the community. Mark Eliason used this number in comparing acuities but what needs to be considered is that there are many in the RHC who do not need 1:1 due to the fact of living in an RHC. They do not need 1:1 in the RHC because there is available staff to keep them within eye sight or to respond to needs.

 
This would not be the case if this very same client with the very same support needs lived in a community setting. My son is one of these very people. While he was living at home we had to have a lock on his bedroom door to keep him safe. We were reported to and investigated by CPS for this. The response from DDD was that we would need to install an alarm system on his bedroom door. All an alarm would do would keep waking us up every time he left the room to wander the house or neighborhood or destroy things. An alarm would only add more crises to a situation which was well controlled by the lock we used.

 
I know that many, many families use methods such as this to keep their children safe but are afraid to say anything for fear of CPS taking their child away. I can tell you that my husband and I had many conversations regarding telling people what we had to do in our home to keep our son safe. My belief is that people need to know and I never had a problem telling people because I knew that the way in which we used the lock was for safety only. Our son never even used his room or went in there except to sleep – he much preferred to interact with people. This was never punitive or restrictive for him but a safety feature which allowed our family to sleep and allowed him to stay in a safe place for the night and sleep when he would sleep.

 
The CPS charges were “unfounded” and the issue they were most concerned about was if Thomas could get out of the house if there was a fire. I explained that if there was a fire and every door of the house was open, Thomas would still need help getting out of the house. In fact, this lock ensured that we would know where he was and could actually save time by going were we knew he would be and getting him to safety.

 
I think a much better way to look at comparing costs, and this was also suggested to me by Don Clintsman in correspondence which we had, is to look at the direct/indirect care costs. These figures are available and I have already sent in data which reflects these costs. Please ask Don Clintsman or Mark Eliason to gather the data on the most costly community clients and you will see the high cost of these clients in the community. When they retrieve this data though, it is important to remember that this is only the DDD cost and not a comprehensive cost which you will see with regards to the daily cost of a resident in the RHC.

 

 

Denial of Admission to RHC by the Admissions Review Team

 

Don Clintsman presented information on this and I believe he stated that there were only 2 people who were denied and these may have been cases in which other residents would have been at risk.
As a parent of a child who was denied services and as an advocate for others, I must agree with Julianne Moore’s testimony. I, too, have witnessed and know of many instances in which the families were denied services by the case manager or regional director. In these instances the process never even got to the Admission Review Team because a Request for Admission was never done. The denial for admission was done long before a request would have reached the team and the team does not even know about these many, many families.

 

I can also say that in our son’s case and with a family who I am working with at this time, both of our sons were already in the RHC prior to the Request for Admission was ever sent to the Admissions Review Team.
Julianne is very correct in her testimony and one cannot look at the Admissions Review Team data for accurate information regarding how many people are denied these services and how many families’ choices and requests for services were not considered.

 

Crisis Care

 

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.

 

 

Statewide Crisis Care Team

 

Again, while this seems like a great concept, as a parent I do not understand how this would work. When a team is sent to a home, where will the team stay while the child is being stabilized? Are hotel costs and travel costs all added in with the operational costs of this program?

 
Why, when we already have two facilities in Eastern Washington which have experts at working with DD clients in crisis, would a family opt to send their child across the mountains to Lakewood for care? This is not only an issue for those on the east side of the mountains but also on the west side. Doesn’t this only add to the crisis? Where is the family going to stay to be close to their child? Families are already at financial breaking points and the cost of travel and lodging could just add to the crisis – not to mention loss of employment and other issues that may come into this scenario such as child care for other children.

 
Crisis care needs to be in one’s community – we need to utilize the services we have and enhance them rather than reinventing the wheel with a program which is untested and unknown.

 

Choice of care and community

 

I hear over and over again that people have more choice in community settings – what they want to eat, who their roommates are, where they want to go and where they want to work as if those in the RHC do not have these choices.

 
Those in residential settings run by vendors and the state do not have choices of roommates. When looking at community residential homes, families are only given choices of homes in which there are vacancies. I have heard (please correct me if I’m wrong about this) but that the department cannot certify more homes or beds in the community until the vacancies in the current homes are filled.

 
If this is true and the current vacancies do not meet the needs of people needing residential services, how will their needs be met?

 

 
Emily Roberts testimony was wonderful and she gives a very different picture of people with developmental disabilities than the people who currently reside in the RHCs. Emily is very articulate and capable. She and others in SAIL are people who can be self advocates and I applaud them for that. They, though, do not speak for people like my son and many others who cannot make their voices heard. Emily talks about people who are able to work and go out in the community independently and she and others are great examples of why we need a continuum of care service model.

 

Waiver and allowable services

 

Don Clintsman reviewed the waiver services and referred to allowable services under each waiver. It also needs to be noted that there is a huge difference between “allowable” and “approved.” What is missing is that for the “allowable” services to be provided, they must be “approved” by a team. They also must be delivered by a contracted provider. These two conditions make these “allowable” services unattainable for many who may need them.
Trying to have the “allowable” services provided for our son was one of the issues which added to the crisis. Even with prescriptions from medical doctors and physical therapists, DDD would deny these services and say they were not necessary. With one thing in particular, the DDD Children’s manager told us to restrict fluids for our son so he would not need a specialty diaper – fluid restriction was not the problem – his neurology was the problem and he needed these specialty diapers. So, even though they were an “allowed” service, they were not “approved” and we therefore needed to purchase them ourselves. This is just one example but I have many which I could give.

 

Those without Services

 

I think it was made perfectly clear that we are all concerned about those not on a paid service. It is also clear there is a consensus that we do need a continuum of care to best meet the needs of ALL people with developmental disabilities. We also need to support the families in caring for their loved ones. They are the backbone of support and when we run them into the ground we not only send the person with DD into crisis but destroy the family.
I, too, am the face of crisis and survival, as Diane Larsen testified to you. It’s amazing what families will endure to take care of their loved one at home. The self-sacrifice is incredible and we need to support these families to enable them to care for their loved ones.
Moving our son to the RHC was not our first choice but it was the choice we had to make to keep him safe and healthy. It was the choice we had to make to save my life. It was the choice we had to make to enable our other children to heal. It was the choice we had to make to have our family together. It was the choice we had to make which would provide our son with the supports he needs to be a productive and contributing member of our community.
I miss our son. I still cry over this choice knowing that I, as his mother, am not able to care for him as I had planned. But that’s about me.

 

When I see him excited to return home to Fircrest after a “home visit”, when I see him jumping up and down with joy at Fircrest because he’s home and has to run around telling all the staff that is there “hi” without caring about telling me “bye”, when I hear a housemate of his say “Tommy’s home. Tommy is a happy boy”, when he can go into the kitchen and get a drink independently, when he can ask for a snack and his staff tells me it’s his new favorite thing, when staff tell me things that Thomas loves to do or what he has accomplished, when I walk around campus and he says “hi” to everyone he sees and calls them all by name and they return with “Hi Thomas”, I have to remember, this is about him. He is safe, healthy, and happy in his community.

Thank you,

Cheryl Felak, RN, BSN
Seattle, WA

DDC and DDD sending survey regarding “No Paid Service”

 

In early September the Informing Families Building Trust project will send a letter to individuals with developmental disabilities and their families who are on the No Paid Services caseload.  This letter will invite them to participated in a short online survey.  The survey, which is a collaborative effort of DDD and the Washington State Developmental Disabilities Council (DDC), is being conducted to understand what individuals not receiving services and their families need and to better inform advocacy for appropriated funding of services.

Please encourage families who receive the letter to complete the survey.  Survey responses are confidential but are extremely valuable in helping us better understand people’s unmet needs.  The survey will be open from September 7 to September 30, 2011.

If you have questions about the survey, contact Eva Rooks at the DDC by phone at 8—634-4473 or by email to eva.rooks@ddc.wa.gov.

Thank you.