Is this “Community Inclusion?”

Seven months of trauma/crisis care and the crisis continues.

Kevin on a rid

Kevin is 26 years old and autistic.  He had been living in a supported living group home for 4 years after living at Fircrest for several years.  He started to have some behaviour issues develop in August 2018.  His psychiatrist attempted to adjust his medications but there were no positive results.  It was discovered that Kevin had elevated ammonia levels due to medication and this is what instigated the behaviour changes.

These behavior changes caused Kevin to assault his caregivers and a housemate.  The police were called, Kevin was handcuffed and taken to the hospital ER several times in the first 3 months of these changes. In November 2018, Kevin was hospitalized for 5 days due to self-injurious behaviors.  He then returned to his group home.

Two month later, on January 7, 2019, Kevin became anxious, hit a caregiver and a housemate – police were called and again Kevin was handcuffed and taken to the Secure Emergency Care Unit (SECU) .  Kevin was in a room with 4 other patients in the SECU – a unit that is critically important for the healthcare of our community but not the place to hospitalize an anxious person with autism. Kevin was very, very upset, cried and wanted to go home.  The group home stated that he was not allowed to return.

Kevin’s family took him to their family home but within 2 days Kevin became more and more upset because he wanted to go to HIS HOME.  His parents were unable to calm Kevin down and they were forced to call 911 for assistance.  Kevin again went back to the SECU for a night before he was transferred to a medical unit where he stayed from January 10, 2019 through February 20, 2019 when Kevin’s family was so devastated by the trauma he was experienced by being restrained chemically and physically in the hospital they attempted to take him home.

The home visit started out well but within a couple of days, Kevin became more and more anxious, wanting to go back to HIS HOME.

“The owners of the group home came yesterday and I think he was thinking he was going to his group home yesterday or today and that took him to the breaking point. No big changes, he just doesn’t want to be here anymore. He asked for his favorite caregiver all the time.

We just don’t know what else to do. It is such a sad situation. The group home owners told us they don’t want Kevin back until he gets his medications and behaviors fixed by the Fircrest team. DDA people are telling us there are no beds. Kevin is trapped in this mess and his father and I don’t know how to help him anymore!! 😢

Kevin again was admitted to the SECU about February 27, 2019 where he remains today.

The plan that DDA has come up with now is to find a place to have a respite bed and Kevin will be able to stay there from March 11 – March 28, while DDA helps the group home look for a house.  If Kevin does not have any behavior issues during this time he will be able to go to the new house if it is ready – if not, well – let’s not go there and let’s assume DDA will be able to provide the community supports that Kevin needs.
Kevin mowing the lawn

Please put pressure on our legislators to fund community supports – years of cuts in addition to understaffing and underpaying caregivers in addition to greatly underestimating the necessary funding for services and supports has led our state (and others) on a rapid downward spiral.

It’s time to pull ourselves out of this mess, understand the choices and needs of those we support and be realistic with funds and services.

 

Kevin – 34 days trapped, restrained, drugged and traumatized in a hospital

Why is traumatizing an autistic man allowed to happen?

How is Kevin going to heal from this abuse?

drug addiction

Kevin’s 33rd day in a hospital room. (Now it’s 34 days as of Feb 13, 2019)

The last 4 days Kevin has become increasingly desperate. The nursing staff at the Medical Care Unit where he is are such a great group of professionals. They have tried to keep him occupied, even taking him on wheel chair rides around the floor, but each day that passes he grows more restless. Kevin is a 5 year old (6’2” tall) that wants to go back to his safe/familiar room, surrounded by his things. He also wants to go for hikes, to the store, the movie theater, and the library. Now he is hitting himself in the stomach and legs with such force that his legs and abdomen are completely covered with purple and black bruises. This is the only way that he can deal with this overwhelming stress. He is limping because he hurt his left leg during the self-injuring actions that now are happening continuously throughout the day. Yesterday he became increasingly anxious with each passing hour, pleading for his “Bellingham house”. He began to scream, hit his room door and window and security was called. Kevin hit his RN and one of the security guard during the incident when they attempted to keep him safe in his room. Throughout the day he was heavily medicated with no success. At night, he managed to escape from his room and run downstairs to the hospital lobby and then outside where he was wrestled by security until Bellingham police arrived.
After he was guided back to his room by the police he was finally medicated with an IM injection of B52 (Benadryl/Haldol/Lorazepam). He has been asleep since then, in a way I feel this is better for him to stop his mental anguish and physical self-inflicted pain.

This situation is a disgrace, my child deserves better from our system. He will severely injure hospital staff or will be gravely injured by medication administration and/or being restrained.

Please contact legislator:
Sharon Showmake at 360 7867854
Luann Van Werner at 360 7867980
Doug Erickson at 360 7867682

Plead for my son to be able to go to a respite bed where he can have physical activity outside of his room, He is unable to comprehend what or why this is happening to him. He needs a less restrictive environment where he can feel free and safe.
please feel free to share!

Marcia Alspaugh

Recovered Wages for Caregivers

The Seattle Office of Labor Standards recovers more than $120,000 in minimum wage violations for Seattle home care providers

Below is the press release from Seattle Office of Labor Standards.  I do think the headline is misleading – it is not Seattle home care providers but only the caregivers who were employed by Aacres, WA, LLC – a for-profit supported living agency.  

you work for peanuts.jpeg

There has been a history of violations with this company – many coming from not paying their employees appropriately and understaffing with a high staff turnover rate and lack of nurse delegation services.

Aacres,, WA LLC had at least $40,200.00 in civil fines for several violations of care between June 11, 2018 and October 17, 2018.  Many of these violations repeat violations cited in previous investigations in the past year.

 

Seattle – (January 25, 2019) – The Seattle Office of Labor Standards (“OLS”) announces a $120,050 settlement with Aacres WA, LLC, a company that provides supportive living services to people with developmental disabilities. The OLS investigation found that Aacres failed to pay the correct minimum wage for 377 employees who worked or attended trainings in Seattle throughout 2017.

Alexander Njuguna is one of the workers benefiting from the settlement. “I am excited that we will get the money that is owed to us. There are so many workers over the years who complained about the injustice we faced. Being compensated will be good for all of us and reminds us that if someone does you wrong, and the law is in your favor, there can be justice. I would like to emphasize that all employees have rights and an employee should not be afraid to raise concerns in fear of retaliation by the employer.”

SEIU 775 represents more than 45,000 long-term and home healthcare workers in Washington State and Montana. “Thousands of SEIU 775 caregivers working in Seattle care for individuals with developmental disabilities in home care and supported living. Our Union works closely with employers and advocates to ensure that caregivers are treated with dignity and respect. Yet, in some cases, caregivers like other workers, aren’t treated fairly and aren’t paid what they are owed,” said Sterling Harders, SEIU 775 President. “OLS’ work to hold Aacres accountable and their fight to ensure no employer gets away with wage theft has a positive impact not just on our city’s workers, but on the level of care received by people with disabilities.”

Aacres recently announced that it was closing its King County operations after the Washington State Department of Social and Health Services cited them for serious deficiencies in care standards. A sister company, SL Start & Associates, was also shut down for violations of care standards. Aacres is a subsidiary of Spokane-based Embassy Management which is owned by a nationwide company, U.S. Community Behavioral, and New York-based private equity firm, Bregal Partners.

Please visit the OLS website for more information on Seattle’s Minimum Wage Ordinance and other labor standards.

Below is an excerpt regarding the recent (April 2018) de-certification and closure of SL Start Supported Living Services:

SL Start and Aacres are both owned by the same company—Spokane-based Embassy Management. According to business filings in Washington and Delaware and news reports, Embassy Management is a subsidiary of U.S. Community Behavioral, which in turn is owned by Bregal Partners, a New York private equity firm.

Don Clintsman, the deputy assistant secretary of the Developmental Disabilities Administration, said he understood the concern about moving clients to a sister organization, but said the two entities are different.

“The expertise that Embassy has shown and that Aacres has shown in running a supported living program give us confidence the SL Start residents will get the right service,” Clintsman said.

Excuse me – what EXPERTISE did Aacres have in running a supported living program?

Were the violations that had been accumulating mean anything to DDA?

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.

 

 

Appreciating Diversity at Home

Thomas with his map of where staff are from

Thomas had a terrific time on this outing and is really happy with his new map.  One of the reasons he likes it so much is because it’s the same map we had on our wall at home while he and his siblings were all there growing up.

He emailed me many times telling me that he was going to take the bus downtown to Pike Place Market, go out to lunch and the map store with Craig.

About as soon as he got home he sent me the following email:

“Dear mommimahd a great time on the bus with creg today “

I love the emails that Thomas sends me – many times it takes quite a bit of deciphering but it’s really worth it.  Being able to use an iPad has greatly benefited him and provided him with several ways to communicate and interact with his community.

Appreciating Diversity contributed by Craig

I just happened to find this post on the Alpha Supported Living Services Website.  It made me feel really happy to see this written up and shared with others.

Spinning (a tale)

Drop Spindle

I am a hand spinner and greatly enjoy the various fibers in my hands, spinning onto a drop spindle to make yarn.  From the spindle, the yarn is wound onto a device from which a skein is made.  The yarn becomes a bit stretched on the device and when removed, the yarn shrinks to its final length.  The skeins are labeled by their yardage and so this natural shrinkage needs to be taken into consideration.   The spinner needs to know how much the yarn will shrink in order to accurately label the yardage so that the knitter knows how much to purchase in order to make and finish the project.

There are some agencies, advocates, and legislators who spin a story regarding the support, care needs, costs of care, residential setting choice and person-centered planning for many in our community who live with intellectual and developmental disabilities.

The problem we face is a matter of underestimating costs rather than overestimating.  Much of the problem is that the legislators use “averages” of the whole for budget forecast rather than “averages” for a specific population.

Last year I provided legislators with the costs of care for my son who resides in supported living.  He had been a resident of the intermediate care facility  (ICF) and only moved to supported living due to issues of medical/nursing care that could not be met at the ICF.  Last year, his cost in the community was higher than the cost of care in the ICF.  This year his costs will be higher still due to needing more 1:1 support and the fact that he lives in Seattle and the agency (not state funds) must pay the caregivers the Seattle minimum wage ($15.00/hour) rather than the contracted state reimbursement (wages start at roughly $11-12.00/hour)

One of our seasoned State Senators wrote ” Obviously some clients need more support than others.  Unfortunately, the numbers you are using are misleading and imply that community care services are more expensive than RHC care.  Since the state pays for both, we have significant experience with many different client and settings, and the various elements of costs.  We have used averages for our proposals because that is the most accurate way to account for a group of clients and settings.  On average, community care is much less costly than RHC care.

As follow up, this senator then wrote “The cost of community care is lower than the cost of RHC care.  That is known by our budget writers because we pay the bills.  Individuals have variances, but the OVERALL cost is lower.  We have had hundreds of RHC clients transition to community care so we have real experience and real data on this.  By providing your personal experience to Senator you have convinced her that it applies to the overall cost of care, and that is not accurate or factual.  I hope you will help me correct the record. “

I did follow up with a response as to why the costs I reported were very important to take into consideration since my son was representative of the type of resident in the ICF that may desire to move to a community home with supported living.  I wrote ” The issue of providing data for my son is extremely relevant to this issue, it is factual and accurate.  I provided the exact documents that were provided to me by DDA so if for some reason they are inaccurate, that is an issue that needs to be addressed with DDA.  I would be more than glad to provide you with the same information.”   I did not hear back from her.

With the upcoming legislative season just around the corner, this annual issue will again come to the surface.  We need not only affordable housing but trained caregivers for these people with higher support needs.  We need to look at the cost of care for this specific population – not the OVERALL AVERAGE as the senator above thinks is more accurate.  I totally disagree with her assessment and understanding of the care needed and cost to provide this care.

New Hampshire has developed a High-Cost Review Committee which looked specifically at those with higher support needs, their Support Intensity Scale score and the costs of care.  Below is a graph documenting some of the costs attributed to people in different residential settings in New Hampshire.

NH HCBS costs June 2015

The graphs below were generated by the data provided by Washington State Developmental Disabilities Administration 2017 Caseload information.

WA State HCBS costs per setting August 2017Budget from actual costs not average

If our legislators continue to use the OVERALL AVERAGE cost as the measure for cost of care, we will continue dive into deeper crisis.

In order to best serve our community members and start to crawl out this hole, we need to fund appropriately.  That means that we need to look at the different types of support needs and numbers of people in those categories.  This information is readily available through the Developmental Disabilities Administration – one just needs to ask for the right information and use it.

Developmental Disabilities Administration 2017 Caseload Information

dshs.wa.gov/…/Final 2017 DDA Statewide Caseload Information Handout_10-13-2017.pdf

Developmental Disabilities Administration 2017 Caseload and Cost Report

 

Senate Health Committee Hears Bill which looks to close ICF/IDD

Today SB 5594 was had public comments in the Senate Health Committee (Washington State)

There are actually some wonderful new ideas expressed in this bill (Federally Qualified Comprehensive Community Healthcare Clinic!!) but plans  to consolidate  from a combined campus of a skilled nursing facility and an intermediate care facility to just a skilled nursing facility is troubling.  This is  not explicitly written in the language but it is clear this is the goal.

The bill states a building at Fircrest must be remodeled and updated to serve as a skilled nursing facility.  Other steps must be taken to consolidate other buildings and ensure residents are provided the opportunity to stay at Fircrest or move into the community.

Given that Fircrest will only have a skilled nursing facility, what will happen to the residents who are not eligible for those services but choose to stay at Fircrest in an ICF/ID?  The bill does not address this population that currently resides at Fircrest.

“Former Fircrest School residents who fail to succeed in the community may, after repeated failures, remain in the community or may choose to move to another residential habilitation center; however, former Fircrest School residents may not return to Fircrest School.”

The other HUGE issue is that the community is far from ready to be able to accommodate the needs of the number of residents who may choose to live off campus.  Already there is a long waiting list for housing, staff and other services.

The critical issue that needs to be addressed before any changes can be made is that of supported living wages and supports.  These wages and supports need to be appropriately funded to provide the services.  This is the system that will provide stability, success and sustainability to community residential settings and is the issue that needs to be addressed as a first step to any issues of consolidation of the intermediate care facility.