RI's Wood Confident that DD Agency Can Clear Backlog of Applications by September's End

By Gina Macris  

A backlog of about 230 Rhode Islanders waiting to hear whether they are eligible for adult developmental disability services should be eliminated by the end of September, according to Jennifer Wood, Deputy Director of Health and Human Services. 

She commented in a telephone interview July 13, elaborating on information previously released about the eligibility waiting list. 

“If at the end of the summer, the needle isn’t moving, we will recalibrate,” she said. If additional staff are needed, they will be added, Wood said. 

There are three social workers, a supervisor, and support staff in the eligibility unit of the Division of Disabilities in the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH). 

“We’re taking a lot of extraneous requirements out of the (application) review process,” Wood said, expanding on previous statements made by the state to the U.S. District Court as part of the requirements of a judge’s order. 

Instead of the eligibility workers tracking down medical records and the like from their original sources, they will first ask families to provide them. Families are often the best record keepers, Wood said. 

Rather than taking valuable time to write “referral narratives” on applicants to give to prospective service providers, the providers will get the applicants’ actual records, as long as the applicants or their parents sign the required release forms, Wood said. 

The providers will need to see those records anyway to put together services for new clients, she said. 

The eligibility staff will be able to dedicate their time to the pending applications during the summer because their other duties are at a minimum at this time of year, Wood said. 

For example, they don’t have to attend annual meetings for individual teenagers who are special education students planning a transition to adult life, she said. Those meetings usually are held during the academic year. 

Elements of an efficiency exercise undertaken in the eligibility unit during the month of June were included in a 16-page communication plan submitted to Judge John J. McConnell, Jr. on July 1. 

McConnell has set deadlines during July and August for numerous tasks intended to move the state toward compliance with a 2014 consent decree intended to correct violations of the Americans With  Disabilities Act. (Click here for related articles) 

Jane Gallivan Settling In as Interim Director of Developmental Disability Services in RI

Jane Gallivan  Photo by Anne pETERS

By Gina Macris

Six days into her new role as an acting director of developmental disabilities in Rhode Island, Jane Gallivan said she has met an “extremely welcoming staff” who are “ready to improve what they’re doing.” 

“It’s a staff that has had a rough time. Underneath all the workload issues, trying to get the work done, they have some good values,” she said. 

“They are kind of desperate for leadership,” she said, from “someone with depth of experience with developmental disabilities.”

“I am very impressed with the staff, but they need a vision,” she said. 

Gallivan, who has great breadth and depth of experience in developmental disability issues elsewhere, said she’s “not sure that the focus has been what it needs to be” in Rhode Island. Some people are “nervous” about change, she said. 

Gallivan spoke July 12 at the monthly meeting of the Employment First Task Force, a committee representative of community agencies and parents that is intended to serve as a bridge between state government and individuals with developmental or intellectual disabilities and their families. 

The Employment First Task Force was created by a 2014 federal consent decree in which Rhode Island agreed to correct violations of the Americans with Disabilities Act by moving away from sheltered workshops toward integrated, community-based employment and other activities. 

 In its 2014 findings in the sheltered workshop investigation, the U.S. Department of Justice said, among other things, that developmental disability social workers at the state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) were small in number and lacked the training and specialization needed to work with their clients, particularly in the area of job supports and community integration. 

Charles Williams, the soon-to-retire director of developmental disabilities, says the average caseload for each of the 20 social workers in case management is about 190 clients. 

Gallivan, who has more than three decades’ experience as a state-level developmental disabilities director in Maine and Delaware, will help  select someone to fill that role in Rhode Island, according to Jennifer Wood, Deputy Secretary of Health and Human Services. 

“We are very grateful to have her,” said Wood. 

Kevin Nerney, chairman of the Employment First Task Force, asked if the group could be represented on the search committee for the new developmental disabilities director. 

Wood, who is leading an interdepartmental team charged with turning around developmental disability services and complying with the consent decree, said, “I can’t make any firm commitments today.” (Click here for article on Wood and her team.)

“I think it is appropriate, and I will keep it firmly in mind as that search committee is selected,” she added. 

Gallivan, who said she values the stakeholder group, suggested that task force members make a list of the characteristics they believe the next developmental disabilities director should have and send them to her. Change cannot occur without a strong community advocacy group, Gallivan said.  

Gallivan worked for 28 years as developmental disabilities director in Maine, where she oversaw implementation of a federal consent decree focused on de-institutionalization. Besides her consent decree experience, she also has dealt with issues like those Rhode Island faces, including the need for supported employment, shared living arrangements, and the introduction of electronic records. 

She said she worked for 7 or 8 governors in Maine, before “the current governor and I parted ways.”  Gallivan moved into the same position in Delaware, intending to stay two years, and remained for four. 

Gallivan, who is spending two to three days a week in Rhode Island, said, “I love the work,” but “my family is not happy” with her decision to accept a temporary stint here. Her responsibilities include her 101-year-old mother, Gaillivan said, so she’ll “not be coming out of retirement,”

General Assembly Approves $15.4 Million Increase For DD; Worker Raises Are Assured

By Gina Macris 

Rhode Island’s developmental disability budget for the next fiscal year includes assurances that aa total of $9.1 million in Medicaid money will be spent to raise pay for direct support workers and to begin transforming the state’s system of services for those with intellectual challenges.

Shortly after 1:30 am on Saturday, June 18, The Senate approved total developmental disability funding of $246.2 million beginning July 1 in concurrence with the House vote taken Wednesday. That total, almost all of it state and federal Medicaid funds, is nearly $15.4 million more than the General Assembly approved last year at this time for the current budget, which closes on June 30.

New budget language ensures that $4.5 million in state revenue earmarked for worker raises and performance-based contracts can’t be used for anything else in the overall appropriation of the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) in the fiscal year that begins July 1.

The language is significant. In the recent past, as much $9 million has been budgeted in a single year to raise the wages of some 4,000 workers who provide direct support services, but the money has gone instead to help close deficits in the BHDDH budget.

The workers make an average of about $11.50 an hour, often less than the clients they support in jobs in fast food restaurants. Many of the direct support staff receive public assistance,  according to testimony presented to the House and Senate finance committees during the current legislative session.

The big difference between this year and past legislative sessions has been a federal court case aimed at enforcing a 2014 consent decree in which Rhode Island agreed to transform sheltered workshops and segregated day programs into a community-based system of services over a 10-year period. The decree settled a U.S. Department of Justice investigation that found the sheltered workshops violated the integration mandate of the Americans with Disabilities Act and the 1999 so-called Olmstead decision of the U.S. Supreme Court which clarified that requirement.

In late January of this year, Judge John J. McConnell, Jr. of U.S. District Court became actively involved in monitoring the state’s compliance with the consent decree. In May, he issued an order putting the state at risk for contempt if it does not meet any one of nearly two dozen specific goals.

One of the requirements in the order is that the state adopt increased funding sought by Governor Gina Raimondo for developmental disabilities in the next fiscal year “in order to fund compliance with the Consent Decree.” The order does not mention a specific dollar amount.

Several other requirements in the order collectively set an August 1 deadline for implementing appropriate raises for direct support staff, regular supervision of workers, and a pilot group of performance-based contracts for supported employment services.

It’s not yet clear how much money the raises will add to the workers’ pay, or what the incentives will be in the performance-based contracts.

Initially, Raimondo’s budget proposal included a little more than $5 million for raises of 45 cents an hour, but that sum was not considered enough to provide performance initiatives to the private agencies that provide most of the developmental disability services in Rhode Island. .

After improved state revenue projections in May, Raimondo added another $4 million to wages and other increases to providers. .  

Raimondo sought protective language to segregate state revenue budgeted for pay increases for developmental disability workers, but that wording was eliminated in the budget passed by the House Finance Committee.

Sometime before the June 15 vote on the House floor, however, new and more detailed language was inserted, a House spokesman confirmed Friday night. 

The new language says that $4.5 million of general revenue “shall be expended on private provider direct support staff raises and associated payroll costs to include targeted increases associated with performance-based contracting and system transformation incentives” authorized by BHDDH.

Because funding for developmental disability services is part of the state’s Medicaid program, the $4.5 million in state revenue set aside for raises would be matched by federal funds, for a total of slightly more than $9 million..

Raises also must be approved by the Office of Management and Budget and the Executive Office of Human Services, according to the budget language. Changes in reimbursement methods must be approved by the Governor’s office and OMB.

RI House Passes DD Budget Unchanged From Finance Committee Recommendation

By Gina Macris

(Correction: While the House did not change the appropriation recommended by the House Finance Committee, language was inserted prior to the floor debate that makes sure $5 million in state revenue cannot be used for anything else other than wage increases for direct support workers and performance incentives for the private agencies that employ them.) 

Rhode Island's developmental disability budget passed the House unchanged from the last week's finance committee recommendation in a floor vote shortly before midnight June 15. The House sent the entire $8.9 billion state budget to the Senate.

In developmental disability spending, the bottom line would be $246.2 million, part of $1.4 billion in human services expenses for the fiscal year beginning July 1.

 In June, 2015, the General Assembly authorized $230.9 million in developmental disability spending for the current fiscal year, which ends in two weeks.  As part of its action late Wednesday night, the House added nearly $9.6 million to that figure as a supplemental appropriation. 

The bottom line difference between the start of Fiscal Year 2016 and Fiscal Year 2017, which takes effect July 1, is nearly $15.4 million.

The new budget would include $9.1 million to raise the pay of staff of private providers who work directly with adults having developmental disabilities and to change the way the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) reimburses service providers.

These steps are necessary to satisfy some of the requirements of a federal court order issued in May to enforce a 2014 consent decree requiring a shift from sheltered workshops and segregated day programs to supported employment and community-based activities that comply with the Americans With Disabilities Act.

Pay increases would be coupled with yet-to-be negotiated performance-based contracts between the state and private agencies that help their clients get regular jobs and enjoy integrated leisure activities. 
 
Governor Gina Raimondo had proposed language that would specifically allocate $2.5 million in state funds for the raises. Each of those dollars would be matched by roughly an equal amount of federal Medicaid funding, for a total of about $5.1 million.

The House Finance Committee, however, removed the protective language around the $2.5 million in state funding, meaning that if BHDDH runs a deficit – as it has for the last eight years – the money set aside for raises could be used to help close the gap. (See correction at top of story.) 

Raimondo originally sought to pay for requirements of the consent decree in both the current fiscal year and the new fiscal year by using savings that would result from encouraging group home residents to move to less expensive shared living arrangements in private homes, but that initiative fell far short of its goal.

Her initial budget figured on saving $3.1 million in the current budget and $16.6 million in the next budget, by making as many as 500 new shared living arrangements.

However, the slow pace of these transfers led the governor to ask the General Assembly to put back all $3.1 million in group home costs in the existing fiscal year, and to reduce savings by $10.2 million in group home costs in the budget beginning July 1. The House agreed.  As a result, BHDDH is expected to save $6.4 million in group home costs in Fiscal Year 2017.

The House refused Raimondo’s request to add $5.8 million to the next budget for a caseload increase, with the finance committee recommendation saying the caseload has been stable at about 4,000 persons.

The House budget language adds extensive reporting requirements intended to keep the General Assembly abreast of BHDDH compliance with the federal consent decree, Rep. Eileen Naughton, D-Warwick, said on the House floor.

BHDDH is already required to provide key fiscal officials in the General Assembly and the governor’s office monthly reports on the developmental disability caseload and expenditures.

The new language encompasses not only information required by the U.S. District Court but other factors affecting the budget. It says:

“The department (BHDDH) shall also provide monthly the number of individuals in a shared living arrangement and how many may have returned to a 24-hour residential placement in that month. The department shall also report monthly any and all information for the consent decree that has been submitted to the federal court as well as the number of unduplicated individuals employed, the place of employment and the number of hours working. The department shall also provide the amount of funding allocated to individuals above the assigned resource levels, the number of individuals and the assigned resource level and the reasons for the approved additional resources.  The department shall also provide the amount of patient liability to be collected and the amount collected as well as the number of individuals who have a financial obligation.”

(This article has been updated.)

• UPDATE: The Rhode Island House passed the developmental disabilities budget unchanged June 15 and sent it to the Senate. Details to come. 

More Money for Developmental Disability Services; Is it Enough to Satisfy the Court?

By Gina Macris

The Rhode Island House Finance Committee’s recommended budget for developmental disabilities could represent a glass half full or a glass half empty. 

Neither description is likely to satisfy the U.S. District Court, which recently issued an order saying, in effect, that the state must provide developmental disabilities programs a full glass.  

The House Finance Committee would give Governor Gina Raimondo most of what she asked for in the next fiscal year, including $5.1 million to raise the pay of direct care workers making poverty wages and another $4.1 million to restructure the way private service providers are reimbursed. 

But the recommended budget also is built on two iffy assumptions – that the developmental disability agency will be able to save $6.4 million in housing costs and that the caseload will remain the same, with about 4,000 people receiving services. Raimondo’s budget asked for a $5.8 million increase for 100 new cases. 

If either assumption misses the mark, there might not be enough money in the budget to shore up the private service providers, putting at risk at least some of a total of $9.1 million set aside for the raises the service providers want and performance-based contracts the state wants in order to restructure the way it reimburses the private agencies and satisfy part of the U.S. District Court order. 

All of the Governor’s request – a total of  $16.9 million in added federal and state Medicaid revenue-  is needed to correct chronic underfunding in the budget of the Department of Behavioral Health, Developmental Disabilities and Hospitals (BHDDH), the department director, Maria Montanaro, told the House Finance Committee in a recent hearing.

 For the last eight fiscal years, including the current one, the bills BHDDH gets from service providers have exceeded budgeted amounts, Montanaro said. 

Raimondo sought to protect wage increases by specifying in her original proposal that $2.5 million of general revenue “shall be expended on private provider Direct Support Staff raises” in the next fiscal year. That sum would be matched by federal Medicaid dollars for a total of $5.1 million that would pay for 45-cent hourly wage increases.

 The protective language around the $2.5 million in state revenue has disappeared from the House Finance Committee’s recommendation. 

With the protective language gone, there could be a replay of the current budget, in which $4 million was originally set aside to boost workers’ pay but never made it into their pockets, going instead to help narrow a hole in the budget. 

Raimondo herself is counting on the first assumption, that BHDDH will save $6.4 million in the next fiscal year by convincing group home residents that they would be happier living with able-bodied housemates in private homes in the community. These are called shared living arrangements. Simply relocating people would run counter to federal law.

The $6.4 million in savings represents a fraction of Raimondo’s original estimate. In February, when she first released her budget for the 2017 fiscal year, she proposed saving $16.6 million by moving 400 group home residents to shared living in 12 months’ time. The House Finance Committee agreed with her subsequent request to restore $10.2 million of that total. 

The prospects of achieving even $6.4 million in savings are not strong if the efforts of the past six months are any indication.  What BHDDH director  Montanaro describes as a “full court press” to increase the number of shared living arrangements in the second half of the current fiscal year has yielded results that are about the same as the first half. There were 11 new shared living arrangements from July to December of 2015 and 10 new placements since January.

The governor’s budget proposal called for $3.5 million in group home savings during the current fiscal year with 100 new shared living arrangements,  but the actual savings will be more like $200,000, Montanaro told the Senate Finance Committee at the end of April.  

The House Finance Committee’s recommended budget acknowledges this development by adding $3.5 million back into to the department’s supplemental appropriation for the current fiscal period, which ends June 30. 

While approving major elements of the governor’s developmental disabilities budget proposal, the House Finance Committee rejected a $5.8-million request to cover an estimated caseload increase of 100 in the coming fiscal year, saying that the developmental disability caseload has been stable at about 4,000. 

Yet there is a backlog of about 240 individuals who have applied for an eligibility determination, according to a BHDDH spokeswoman. Two thirds of them are under the age of 21, according to another BHDDH official. That would mean that roughly 80 are over 21.   

And the numbers of young adults with developmental disabilities who are turning 21 and leaving school - 74 in the current academic year alone – suggest that the caseload should be growing. 

Persons with developmental disabilities between the ages of 14 and 21, who are at risk of segregation as adults, are one of the main concerns of the U.S. Department of Justice in enforcing a 2014 consent decree requiring community-based adult services, with an emphasis on supported employment. 

The consent decree, in effect until Jan. 1, 2024, resulted from a DOJ investigation that found the state’s sheltered workshops and segregated day centers for adults with disabilities violated the integration mandate of the Americans With Disabilities Act (ADA), which was clarified in the 1999 Olmstead decision of the U.S. Supreme Court.. 

In a hearing in April in U.S. District Court, the DOJ presented evidence that BHDDH does not determine eligibility until a few months before an applicant turns 21. 

State law says that persons with developmental or intellectual disabilities are eligible for services when they turn 18. 

Newly eligible young adults and their families often have trouble finding appropriate services, according to the evidence presented in court.  

Many of the two dozen private service providers in the state are not accepting new clients because they say they are operating at a deficit.  Montanaro has confirmed that assertion, telling the House Finance Committee recently that the private agencies have opened their books to BHDDH. 

With the federal court case continuing under terms of a judge’s order, there is likely to be pressure on the state to make sure that all applicants for adult services get timely consideration and an appropriate array of supports, a factor that could push up the caseload numbers. 

In its budget recommendation, the House Finance Committee said it would reconsider its refusal of a caseload increase if the numbers do go up. 

It is possible that decision was at least partly influenced by frustration in the House leadership with a history of poor record-keeping at BHDDH, something that also has worked against the department in the U.S. District Court case. 

The House Finance budget added extensive language requiring BHDDH to report monthly on a variety of statistics, including everything submitted to the court as part of the consent decree requirements. 

After the court experienced delays in getting an accurate count of individuals protected by the consent decree, Judge John J. McConnell issued an order May 18 that requires the state “to create a live database that will allow for efficient and effective tracking of each member of each target population outlined in the Consent Decree and all related and required services and outcomes.” The order then describes all the reporting requirements in extensive detail. 

In all, the order contains 22 requirements, most of them with deadlines in July and August. In the event of a violation of any part of the order, the DOJ or an independent court monitor in the case could ask McConnell for a show-cause hearing as to why the state should not be held in contempt. Fines start at $1,000 a day and max out at a total of $1 million for the year.

The first requirement of the order is that “the State will appropriate the additional money contained in the Governor’s budget for fiscal year 2017 in order to fund compliance with the Consent Decree.” No dollar amount is cited.  

Charles Williams to Retire; Second RI Developmental Disabilities Official to Announce Departure

By Gina Macris

Williams                                          Image courtesy BHDDH

Charles Williams, Director of the Division of Disabilities of the Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH), confirmed today (June 3) that he will retire July 22.

 Williams is the second high-profile figure within BHDDH to announce his departure in two days. On June 2, the department director, Maria Montanaro, announced her resignation effective June 24. 

Williams, who joined BHDDH in 2005, said he had always planned to remain in state government for ten years, long enough to become vested in the state pension system. Williams marked his 10th anniversary in state government last October and celebrated his 71st birthday in January. 

In a telephone interview, Williams said that his retirement has nothing to do with either the federal government’s ongoing intervention in daytime programs for adults with developmental disabilities or the recent death of a resident in a group home that is both licensed and run by the state. 

He said the department plans to hire a chief operating officer and an employment specialist to fill out an administrative team in the developmental disabilities unit. Those moves, he contended, will help ensure continuity as BHDDH complies with a 2014 federal consent decree. 

Another position created by BHDDH to respond to the consent decree is that of chief transformation officer. 

Reached by phone, Andrew McQuaide, the transformation officer, declined any comment on whether he will stay with the department. 

BHDDH must comply with a series of strict deadlines in the coming months to start helping more persons with intellectual or developmental disabilities find regular jobs and enjoy activities in their communities, or face possible contempt hearings in U.S. District Court over violations of the Americans With Disabilities Act. 

Title II of the ADA, reaffirmed by the 1999 Olmstead decision of the U.S. Supreme Court, is a sweeping mandate requiring states to offer services to people with intellectual or developmental disabilities in the least restrictive environment appropriate for each individual.  

The developmental disabilities division also faces scrutiny of 25 group homes that are both licensed and run by BHDDH. In addition to supervising the developmental disabilities division, Williams heads the residential unit, called Rhode Island Community Living and Supports (RICLAS.) 

A native of Connecticut, Williams had worked as head of preventive services in mental health, behavioral healthcare and developmental disabilities for the state of Missouri before coming to BHDHHD to take a similar position.  

Montanaro put Williams in charge of developmental disabilities when she became Department director, in February, 2015, but did not select a new chief for RICLAS. 

Since early April, it has become evident that Jennifer Wood, Deputy Secretary of Health and Human Services, has taken the lead on the state’s response to the consent decree, providing much of the state’s testimony during a day-long evidentiary hearing on compliance issues in U.S. District Court. 

More recently, when state Senator Louis DiPalma (D-Newport, Middletown, Tiverton and Little Compton) asked for information about BHDDH, he said he was invited to a meeting hosted by Wood; transformation officer McQuaide; the Consent Decree Coordinator, Mary Madden; and Dacia Reed, policy director of the Rhode Island Children’s Cabinet. 

Madden’s job was created at the insistence of the court monitor in the federal case as a secretary-level position with authority to enforce cooperation among three agencies responsible for compliance with the consent decree. Madden reports to the Secretary of Health and Human Services, Elizabeth Roberts, who is also head of the Children’s Cabinet, which was revived by Governor Gina Raimondo in 2015. 

The Children’s Cabinet has an interest in the consent decree because the decree is designed to protect teenagers with developmental disabilities as well as adults. Teenagers often struggle with the transition from special education in high schools to the adult system of developmental disability services. 

Asked about Wood’s future role in connection with developmental disabilities, a spokeswoman for EOHHS issued this statement today: 

“We remain fully committed to meeting the goals of the Consent Decree to provide integrated, community based services for Rhode Islanders living with developmental disabilities. Compliance with the Consent Decree has improved significantly under Director Montanaro’s tenure, and EOHHS Deputy Secretary Jennifer Wood will continue to work with Secretary Roberts and the team at BHDDH, under the leadership of Interim director Becky Boss, to ensure all requirements are met going forward. 

Additionally, Governor Raimondo has included significant funding in her proposed budget, including investments in integrated services. In the weeks ahead, Director Montanaro is committed to working with leaders in the General Assembly to secure the additional funding that Governor Raimondo has recently advocated for to provide higher-quality services for Rhode Islanders living with developmental disabilities.”

DOJ: No Merit to Rhode Island's Objections to Compliance Fund

By Gina Macris

Saying Rhode Island’s objections have no merit, federal lawyers for a second time have urged a U.S. District Court judge to set aside state dollars to fund the so-called “sheltered workshop” consent decree – or to fashion whatever remedy he sees fit.

“The State’s objection to funding the Consent Decree is concerning and brings into questions its commitment to making the changes required,” lawyers for the U.S. Department of Justicewrote in a May 16 filing with the Court.

“Thus this Court must act to provide adequate incentive to the State to fund theConsent Decree, which it undoubtedly has the power to do,” the DOJ lawyers wrote to Judge John J. McConnell, Jr.

The DOJ’s plan would require the state to pay $5,000  each day it misses various compliance deadlines, and an additional $100 a day for each person whose services are delayed or interrupted as a result of inaction, with a cap of $1 million a year.

As an alternative to paying into the proposed Consent Decree Compliance Fund , the DOJ lawyers suggested that McConnell  come up with his own remedy.

The government’s remarks came in a filing in which it expressed surprise that the state is now offering “meritless objections” to paying into the proposed fund to  fulfill its responsibilities under provisions of the Americans with Disabilities Act (ADA).

In 2014, a DOJ investigation found the state for decades had illegally segregated adults with disabilities in sheltered workshops that paid sub-minimum wage, and in day programs cut off from the community. Rhode Island then agreed to federal supervision over a ten-year period to transform its system to emphasize supported employment in the community, adopting an “Employment First” policy.

The 2014 agreement marked the first such consent decree in the nation aimed at turning around daytime services that violate the 1999 Olmstead decision of the U.S. Supreme Court.

But the decree is just one part of a much broader, aggressive push begun by the Obama administration in 2009 to enforce the  Olmstead order, which said that Title II of the ADA requires agencies to serve individuals with a variety of disabilities, day and night, in the least restrictive environment that is appropriate.

In Rhode Island, the DOJ’s civil rights division earlier in May asked McConnell to put the court monitor in the case in charge of a Consent Decree Compliance Fund, citing the state’s continued failure to implement reforms.

The court monitor, Charles Moseley, would decide how to spend the money to benefit adults with disabilities.

Marc DeSisto, the state’s lawyer, objected, saying, in part, that the proposal amounts to a contempt order without the procedural rights enabling a defendant to show it made its best efforts to comply but was thwarted by forces beyond its control.

On May 16, the DOJ replied that “a finding of contempt would be appropriate at this juncture,” but its proposal does not ask for that. Instead, the Consent Decree Compliance Fund is envisioned as a vehicle for funding the consent decree, something the state said it wanted to do, according to the latest DOJ arguments.

During the last few months, all sides have agreed – in open court – that the developmental disabilities system does not have enough money to meet the consent decree requirements.  

Moseley, the monitor, told McConnell at one point that if the state didn’t meet certain benchmarks now, it would be impossible to achieve overall compliance by the time the decree expires on Jan. 1, 2024.

It was the state’s lawyer, DeSisto, who initially approached the DOJ and the monitor to ask for an evidentiary hearing so that the judge could gauge the state’s progress on compliance and decide what yet needed to be done to put the state on track to meet long-term goals.

At the hearing, held April 8, the state could not provide an accurate census of the individuals covered by the consent decree, the DOJ noted, but it did present evidence about a plan for achieving compliance going forward.

Now, the state is objecting to its own plan,  the DOJ lawyers said.

“After two years of noncompliance,” federal lawyers wrote, “it is appropriate and necessary, in the absence of commitment by the State to the basic compliance measures outlined in the Proposed Order, for the Court to take action.”

Group Home Inspections Show Deficiencies; Need for Ombudsman to Add Transparency

In the RI Senate Lounge, Maria Montanaro, director of the RI Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, left; listens to the report on group home  by Elizabeth Roberts, Secretary of Health and Human Services.

Click Here for Report  

By Gina Macris                               

A random inspection of 30 Rhode Island group homes for adults with developmental disabilities did not show systemic problems as severe as the ones at a state-run facility where a resident suffered an unexplained injury and died in February.

But the Executive Secretary of Health and Human Services, Elizabeth Roberts, told the Rhode Island Senate Committee on Health and Human Services that the inspections revealed many operational lapses at individual homes, including medication errors. She said accountability and transparency must improve in all the group homes in the state.

Roberts said she favors legislation that would create an ombudsman for individuals with developmental disabilities and their families, similar to the Child Advocate and the Mental Heath Advocate. 

Roberts also said there is a need to remove the conflict now inherent in the Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals (BHDDH) licensing and investigating its own group homes.

BHDDH director Maria Montanaro said she has learned that during a previous administration, management did not always follow the professional recommendations of the investigatory unit.

While the recent inspections found no life-threatening situations, they did raise medical concerns, including numerous overdue physical exams and various medication errors. For example, in 10 of the 30 homes, there were medication orders that weren't filled. There was also a lack of documentation of numerous other requirements, including many related to communications with residents and guardians.

According to a summary of the findings, 17 of the 30 homes were not carrying out all provisions of behavioral support plans written for residents with behavioral problems.

In 15 homes, residents were not receiving all the services required by the individual service plan, the “master plan” of activities and supports. 

Another 10 homes have participants who do not have these “master plans” at all.

 In 14 of the 30 homes, inspectors heard about “staffing issues” that were not described in more detail in the report given to the committee.

Low pay and high turnover are pervasive problems in the developmental disability system. Governor Raimondo has asked for higher pay for workers in this field in her budget for the next fiscal year. 

The report did not specify where the deficiencies occurred, but listed the names of all the group homes surveyed and the agencies which operate them. In the report, RICLAS homes are operated by the state, and the remainder are privately operated.

All the group homes will be notified of specific violations and given 30 days to file corrective action plans, according to the report.

The unannounced inspections were prompted by the death Feb. 15 of Barbara A. Annis, 70, who lived in College Park Apartments in Providence – a state run group home that operated more like a nursing home.

Five of the 27 staff members have been put on paid leave and the facility’s license has been revoked. The Rhode Island Attorney General’s Office and the Rhode Island State Police are conducting criminal investigations.

At the Senate HHS briefing Tuesday, Roberts said, “We have responsibility for the care and well-being of some of the most vulnerable Rhode Islanders. I take that responsibility very seriously and I hold the entire Health and Human Services Secretariat accountable for delivering high-quality services.”

Roberts said an ombudsman would bring a new level of transparency to the state’s developmental disability system, serving as a conduit for releasing information of public interest.

“Public reporting on investigations is extremely limited by current statute and regulation,” she said. “Current statutes restrict BHDDH from releasing information most other – if not all other – licensing bodies would be obligated to release,” Roberts said.

She suggested she would support new laws that would “protect residents’ privacy and ensure that the public – especially families who count on these residential services – are aware of issues with resident safety.”

Roberts said she has asked Montanaro to begin a review of the department’s licensing and investigatory procedures.

Montanaro said during initial remarks at the hearing that her department has a “robust” investigatory arm, but she later acknowledged that three of the five investigative  positions have been vacant sometime in the last fiscal year.

Two of the vacancies were due to the fact that the positions were on loan from the Department of Human Services, but funding for those positions did not come through, Montanaro said. She said Secretary Roberts straightened out that problem. Interviews are now underway to fill the last remaining vacancy, she said. 

BHDDH had two investigators working at the time Annis died. The head of the investigatory unit told Montanaro she had noticed a pattern of problems at College Park dating from the previous year, Montanaro recalled. That was one of the factors that led to the three week-long series of group home inspections, performed with assistance from inspectors from the Department of Health.

After the hearing, Roberts acknowledged that unless an investigator notices a pattern of problems and notifies a supervisor, it is not easy to for management to spot system-wide concerns.

“We haven’t had an organized database to do that,” she said, repeating her contention that part of the problem is overly restrictive state confidentiality laws. She said public reporting is one of “a number of ways to focus on consumers’ needs and public accountability.”  

Judge in Disabilities Case to Mull Costly Sanctions Against RI

By Gina Macris

U.S. District Court Judge John J. McConnell, Jr. said May 2 he is prepared to take “swift and dramatic action” if the state of Rhode Island fails to adequately fund a 2014 consent decree intended to correct longstanding  violations of the Americans with Disabilities Act.

U.S. District Court RI

Nicole Kovite Zeitler, lawyer for the U.S. Department of Justice, said she plans to file a formal request  asking the judge to order the state to contribute to a “consent decree compliance fund” unless adequate funding is secured by “a date certain” through the budgetary process, now underway in the General Assembly.

Neither Zeitler nor the judge put a specific dollar amount on the cost of the consent decree, although McConnell said he wants to see the money in Governor Gina Raimondo’s budget proposal enacted “at a minimum.”

Zeitler and the state’s lawyer, Marc DeSisto, will take one week to decide whether they can jointly submit a proposed order to McConnell, according to an informal schedule the judge approved from the bench.

If the two sides cannot work together, the DOJ will draft its own proposal. McConnell will hear arguments and then make a decision. The date of the next hearing has not yet been set.

The developmental disability system in Rhode Island has been underfunded for a decade, Zeitler said.

Moreover, she said she is concerned that the cost of the consent decree is being misrepresented in budgetary discussions. 

Families fear that the state is shutting sheltered workshops and providing nothing in their place, and “we share those concerns,” she said.

Zeitler, meanwhile, said the cost of the consent decree is being characterized in budget hearings at the State House as $1.8 million, but the consent decree requires changes throughout the developmental disability system.

The sum of $1.8 million happens to be one line item in the budget of the state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) for subsidizing one-time start-up costs incurred by direct service providers who convert to community-based services from the segregated employment and day programs that the DOJ found in violation of the ADA.

Impact of Budget Plan Unclear

In the next 14 months, Raimondo wants to put an additional $24.1 million into private agencies that provide most of the direct services to adults with developmental disabilities, but whether her budget actually will achieve that goal remains open to question.

The way the budget document is now written, $19.3 million of that sum would come from savings in residential costs as occupants of group homes move into less costly shared living arrangements with individual families throughout the state. The proposal counts on 100 group home residents making the transition by June 30 on a strictly voluntary basis and another 200 moving in the next fiscal year, which runs from July 1 to June 30, 2017.

In the last ten months, however, only 21 individuals have entered shared living arrangements, accounting for a projected savings of about $200,000 in the current fiscal year, according to BHDDH figures.

There are other uncertainties about the budget.

The independent monitor in the case, Charles Moseley, and the DOJ are looking for a reconfigured method of reimbursing service providers that would allow them flexibility to individualize community-based services while requiring that they meet performance targets.

The new reimbursement model would come with increased funding to the agencies, but BHDDH director Maria Montanaro told the Senate Finance Committee last week there isn’t enough money in the Governor’s budget plan to extend this methodology to all the service providers. Instead, Montanaro proposed a pilot program involving a “subset” of the service providers.

A spokeswoman for the provider agencies, Donna Martin, said she “respectfully disagreed” with Montanaro’s  approach. 

“If we target certain agencies (for pay hikes), we will not be able to recruit staff for any other program,”  said Martin, executive director of the Community Provider Network of Rhode Island (CPNRI) .

“We are facing an incredible staffing crisis,” she told the Senate Finance Committee.

 “Our staff are working minimum wage jobs. We are competing with McDonald’s” for workers, Martin said.

According to the current reimbursement rules, BHDDH pays service providers only for the time clients spend in direct contact with daytime support staff. That person-to-person interaction must be reported for each client and each worker, in 15-minute increments, throughout the day. Agencies are not paid when clients are absent, for whatever reason.

Job-scouting activities, in which a service provider might meet with a potential employer, are not part of the standard funding allocation package for individual clients.Clients who want employment supports must give up some hours in another category to get this funding. 

Until 2011, service providers received a set per-person allocation for a bundle of services that could be individualized, depending on a client’s needs.  Martin indicated that providers need a similarly flexible arrangement going forward to meet their obligations under terms of the consent decree.

Montanaro, meanwhile, said during the Senate Finance Committee meeting that a recent planning exercise came up with a $30 million price tag for applying a redesigned reimbursement model to all the service providers. She said that price tag was “impossible,” at a time when the department faced a $7 million deficit in the current budget.

Delays in Eligibility Decisions

Meanwhile, a backlog of applications for adult services that has caught the attention of the court could put additional strain on the budget that is not yet defined.

A BHDDH official told parents last week that there is a “very significant backlog” of pending applications for eligibility. At an average annual cost of $50,000 per client, an increase of 100 to the BHDDH caseload would add $5 million to the BHDDH budget.

BHDDH has been under pressure from the court to determine eligibility for young people promptly as they approach their 18th birthday, when they are defined by law as eligible for adult developmental disability services as long as they meet certain criteria.  

Since March, the Consent Decree Coordinator, Mary Madden, and other state officials have met with representatives of applicants for adult services who have experienced “inordinately long delays” in getting eligibility determinations as well as “receiving inadequate communication about the progress of their applications,” according to a report to the court submitted by the state last week.

“Those individual cases have been resolved,” the report said, but Madden told the court Monday the backlog still exists. She could not say how many applications are stuck in the pipeline.

Action Items Long Past Due

Many of the questions put to Madden and to Jennifer Wood, Deputy Secretary of the Executive Office of Human Services, had to do with pending consent decree action items that are long past due.

The state and the monitor were to have settled on a protocol for reporting compliance by Oct. 1, 2014, but it became common knowledge to dozens of individuals following the implementation of the consent decree that Moseley was having trouble getting access to BHDDH data throughout 2015.

Wood reported Monday that a confidential electronic data base allowing the monitor to track compliance according to each individual affected by the consent decree will go online in 2017, although an interim solution, in a quarterly report, will be available July 1.  

A Quality Improvement initiative was to have been launched by Nov. 1, 2014, but it is still waiting for the appointment of a quality improvement director. Funding for the position has been authorized. Each individual affected by the consent decree was to have an individual career development plan by Jan. 1 of this year, but those are not all in place.

The performance-based contracts that Montanaro said would be part of a new pilot reimbursement program with a portion of the service providers were to have been implemented system-wide by Jan. 1, 2015. 

A public education plan to explain the requirements and the philosophy of the consent decree was to have been up and running Sept. 1, 2014.

BHDDH officials submitted what they believed was the final version of the public education plan to the monitor on April 1, but Madden told the monitor Monday that “events of late have caused us to think how many more people need to be involved.”

She did not elaborate. BHDDH officials who hosted a “town hall” meeting with families and consumers in Warwick last week were met with a wave of hostile comments about the consent decree and disability services.

Attorney General Identifies Group Home Resident Whose Death Prompted Investigations

Rhode Island Attorney General Peter F. Kilmartin has named Barbara A. Annis as the 70 year-old woman whose Feb. 15 death has triggered criminal investigations and unannounced inspections of hundreds of group homes for persons with developmental disabilities. 

Kilmartin’s spokeswoman released Annis’ name April 1, but gave no additional information, according to the Providence Journal. 

Annis lived in the now-closed College Park Apartments at 612 Mount Pleasant Avenue, Providence, a state-run facility built to accommodate patients who have chronic medical conditions as well as intellectual or developmental challenges. 

She was admitted to Roger Williams Hospital Feb. 9 for what the College Park staff reported as a bad bruise, but which the hospital found to be a broken thigh bone that had become infected. After she responded to initial treatment, she was transferred to a nursing home, according to an official of the state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH).  But her condition soon worsened and she was readmitted to the hospital, where she died. 

There have been a total of six allegations of abuse or mistreatment at College Park since January, 2015, including an incident that occurred after Annis died. The State Police and the Attorney General’s Medicaid Fraud and Patient Abuse Unit have begun criminal investigations, and 5 of 27 state employees who worked at College Park were placed on paid leave. 

In addition, surprise inspections have begun of all licensed group homes in the state, about 278 private and state-run facilities, according to a spokesman for Elizabeth Roberts, Secretary of Rhode Island’s Executive Office of Health and Human Services. Nine of the 278 homes are vacant. 

Residents who remained at College Park – a total of 14 people – all have been moved, according to BHDDH, which ran the home. The Rhode Island Disability Law Center has opened an investigation into the welfare of those people.   

After College Park closed March 25, Roberts said, “I remain outraged by the alleged incidents at the College Park Apartments group home.” 

"Mythbusters" Have Fun Delivering Facts About Consent Decree to Audience of Peers

Natalie Bacon, left, and Meghan O'Leary, right, singing "I'm the Boss of Me," with original lyrics set to the tune Folsom Prison by Johnny Cash. In the background, Christopher Pawlyk plays the guitar. 

By Gina Macris

About a dozen adults with developmental disabilities and their helpers combined hard facts and fun as self-styled “Mythbusters” Monday, March 28 to counter rumors and half-truths about the complicated federal consent decree that demands they - and thousands of others - be more fully integrated into their Rhode Island communities.  

The narrated show, put on by the current leadership class of Advocates in Action, played at the Crowne Plaza in Warwick before a crowd of about 200 people, many of whom receive state services, just like some of the presenters. Family members, support staff, and friends also attended.  

The spring statewide meeting, an annual event, offered the students a chance to practice emerging skills in advocating for themselves and others as they wove together videos, music, and live speaking parts. The leadership class, which concludes in June, offers a 10-month learning experience for Rhode islanders with developmental disabilities every year. 

The first myth on the agenda, as explained by Amy Ethier, was that “Department of Justice came to Rhode Island and said that everyone who has a dd (developmental disability) has to work. If we don’t work, we’ll lose our services.”  

That statement is not true, said Andrew Whalen, who works part-time at Advocates in Action.     

According to the consent decree, “those people who want to work will get the support they need to work” in jobs paying at least minimum wage, he said. “People can choose not to work, but it needs to be an informed decision.”  

To make the point that life experience is at the heart of an informed decision, Deb Kney, the administrative director of Advocates in Action, presented  a take-off on the long-running Life cereal television commercial, in which three-year-old “Mikey” finally tries the food that is “supposed to be good for you” after his two friends refuse to take a bite.    

courtesy advocates in action

In the video, Keith Wilcox takes on the role of “Mikey,” who is flanked by friends egging him on to eat the cereal. The final message, delivered poster-style on a mock cereal box: ” Real Life Tastes Great! Sample Some Today!”  

Though it was emphasized during the presentation, the state does not now have enough resources in place to readily help everyone with a developmental disability who wants to get a job, or to immediately offer real life experiences to everyone who needs to make an informed decision about applying from a waiver from work.  

The way the state will pay for implementing the consent decree is one of the key issues that has been unfolding since January in hearings in U.S. District Court in Providence.  

Another thing the court wants to see is an assurance that services will fit an individual’s needs.  

It’s not one-size-fits-all, the leadership class impressed upon its audience.  

Those receiving services, according to the consent decree, are entitled to an individualized service plan that places each person’s needs, strengths and interests at the heart of planning and delivering services.   

Jim Petrone, who uses a motorized wheelchair and a communication device, demonstrated that point in a pre-recorded video which shows him listening for a minute while several people talk about his likes rather than asking him directly. Then Petrone conspicuously turns up the volume on his communication board and a deep voice booms: “Attention! Excuse me. This is my meeting and I need to talk now.”   

courtesy advocates in action

At the other extreme,  a video clip dispelled the myth that the mandate for individualized supports includes luxuries. Christopher Pawlyk donned a lei, oversized sunglasses and a flower-topped hat trimmed with halo of fake fur to deliver this line: “Well, this person wants to take an individual vacation to Hawaii two to three times a year.”

Medicaid does not pay for “stuff,” but for the supports and services needed for people to have access to experiences in their communities, the leadership class emphasized.  

The group also busted the myth that Rhode Island is closing all its group homes AND moving everyone into shared living arrangements with individual families.  

Class member Amanda Campbell followed up with the facts. “It is true that the state wants you to become more educated and informed on shared living, but it’s your choice. You have the right to live where you want to live,” she said.  

Advocates In Action invited an expert on shared living, Joanne Malise, to speak on that housing option. She described it as a “mutual choice” involving a family and the individual looking for a place to live.  

“You get to know each other and both people decide to live together,” she said. Malise is director of Living Innovations, an agency that specializes in supporting shared living arrangements.  

For those seeking a different option, financial realities make house-hunting a bit more complicated. Questions from the audience indicated people with developmental disabilities are having a difficult time securing subsidized apartments for which they are eligible.  

People living in group homes who may not be candidates for shared living arrangements may have to move anyway if their home is closed during the state’s shift to shared living.  

Charles Williams, director of Social Services for the Division of Disabilities in the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH), said the group homes must give residents 30-days’ notice before a house closes. The agency is obligated to continue to provide support until alternate housing is found, he said.   

While people with developmental disabilities have the right to choose the agency which serves them, the state does not reimburse them for all their costs. That issue is also embedded in the federal court case. Financial constraints have prompted the state’s private providers to refuse new clients, particularly if the individuals have extensive, costly needs. 

Unannounced Group Home Inspections Begin in Rhode Island

By Gina Macris

Unannounced inspections of Rhode Island group homes for adults with developmental disabilities began Monday March 28 in the wake of the recent death of a woman who lived in the College Park Apartments in Providence, according to a spokesman for the Executive Office of Health and Human Services.

College Park closed March 25, the day after the last of the 14 people still living in the apartments were moved to new housing. Since the beginning of 2015, College Park had been the subject of a total of six complaints of patient abuse or mistreatment, according to a spokeswoman for the state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH). 

In addition to criminal investigations underway by the State Police and the Attorney General’s Office,  Elizabeth Roberts, the Executive Secretary of Health and Human Services, has ordered a “comprehensive review” of all licensed group homes in Rhode Island whether they are privately owned or run by the state, according to her spokesman, Michael Raia. He clarified previous indications from BHDDH that the inspections were to target only state-run group homes.

Raia said March 29 that Roberts had asked BHDDH Director Maria Montanaro and Department of Health Director Nicole Alexander-Scott to work together on the review, starting with inspections of the homes with the “highest risk assessment.” 

Inspectors and investigators from both the health department and BHDDH are working as a team on the inspections, which are being prioritized according to “incident reports and complaints for a set period of time,” Raia said. He could not immediately elaborate on the time period in question, although he said the initial round of inspections includes both private and state-operated facilities.  

Updating previously available statistics, Raia said there are 27 licensed state-run group homes, excluding College Park, and 251 licensed homes owned by private agencies.

Nine of the privately-run group homes are vacant, leaving 242 homes that house a total of 1,162 people as of Feb. 29, he said.  Raia said 156 individuals live in state-run group homes, and 284 people are with families in shared living arrangements.   

DD Agency Faces Scrutiny From RI Law Enforcement, Governor and Federal Court

By Gina Macris

With criminal investigations underway into the death of a woman with developmental disabilities in its care, the Rhode IslandDepartment of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) is gearing up for an important deadline on another front.

April 1 is the date by which BHDDH must submit a court-ordered fiscal plan for complying with a 2014 consent decree that enables people with developmental disabilities to get jobs and enjoy other  activities in their communities as required by the Americans With Disabilities Act. Judge John J. McConnell, Jr. has scheduled an evidentiary hearing on the state’s plan for April 8 in U.S. District Court, Providence.

The federal monitor in the case has expressed doubts that the state will be able to rearrange its budget in the next year to make the needed changes.

The Rhode Island consent decree, the first of its kind in the nation, also has received high-level attention from the U.S. Department of Justice in Washington. On Friday, March 18, the Acting Assistant Attorney General for the Civil Rights Division, Vanita Gupta, met with Governor Gina Raimondo to discuss the consent decree.

Coincidentally, the meeting occurred the same day that state human services officials announcedthe death of a 70 year-old woman with developmental disabilities, who had succumbed to a massive infection as a result of a leg fracture that had gone untreated for several days at the College Park Apartments group home on Mount Pleasant Avenue, Providence. Her death on Feb. 15 is under investigation by the Attorney General and the State Police.

The Attorney General’s Office is conducting a total of three investigations in connection with College Park, according to spokeswoman Amy Kempe. She declined to elaborate.

 Including the woman’s death, there have been a total of six incidents of patient abuse at College Park since January, 2015, according to a BHDDH spokeswoman.

 The remaining 14 College Park residents all had been moved elsewhere by the end of the day Thursday, March 24, and the state-owned facility closed March 25, according to Michael Raia, communications director for the Executive Office of Health and Human Services.

He said Governor Raimondo gets regular updates on the investigations related to College Park and is “very focused” on reviewing those findings and receiving an assessment of any systemic problems that health and human services officials may identify.

The Executive Secretary of Health and Human Services Secretary, Elizabeth Roberts, has ordered spot-checks of state-rungroup homes beginning next week, Raia said on Friday , March 25. These checks are to be cooperative efforts between the Department of Health and BHDDH, which currently only has two investigators in Quality Assurance/Quality Improvement.

Raia described the meeting between the Governor and the DOJ’s civil rights chief as a “courtesy call.”

The DOJ requested the meeting, Raia said. The two discussed the state’s appointment of a Consent Decree Coordinator, funding, and the collection of data, he said.

“The meeting was an opportunity for the Governor to listen to the U.S. Department of Justice’s thoughts, opinions and concerns,” Raia said.

The court monitor in the case, Charles Moseley, expressed his concerns in a report to Judge John J. McConnell, Jr. that was made part of the court file on March 18.

The report that the state must turn into the Judge by April 1 is to contain evidence that there is a defined consent decree budget, including a per-person allocation based on the actual costs of implementing community-based activities required by the consent decree.

Moseley, however, said he is concerned the state will not be able to free up enough money in the next year or so to satisfy the consent decree.

According to Raimondo’s budget, the bulk of the funding for mandated services would come from moving a total of 500 people with disabilities, 38 percent of Rhode Island’s entire group home population, into less costly “shared living arrangements” with families by June 30, 2017. 

In the past ten years, a total of 267 people have gone into shared living.

The shift of 500 people would realize a total of $15.5 million in savings by June 30, 2017, but Moseley said he is worried that those targets are “too optimistic” and that BHDDH will not be able to achieve them in a little more than a year’s time.

Moseley also wrote that he is concerned BHDDH will not be able to clearly identify a per-person cost as a foundation for projecting the budget needed to help people obtain supported employment and access to community-based activities.

The state now pays below-cost rates to more than 20 private agencies providing most of the services to more than 3,600 Rhode Islanders with developmental disabilities. The agencies either operate at a loss or depend on outside grants as well as income from programs not dependent on BHDDH funding.

“Although the state has not yet provided the needed financial data, it should be noted that it is, reportedly, meeting consent decree placement targets” for supported employment, Moseley said.

“This must be confirmed, however. From my discussions with providers and state BHDDH staff it appears that these placements are being funded by providers through existing resources, and, as such, may not be sustainable over time. I will be tracking this in the months to come.” 

Moseley noted several positive developments, including staff appointments within state government that he expects will aid implementation of the consent decree.  Among the new positions is the Consent Decree Coordinator, Mary Madden. The full scope of her authority is not yet clear, and Moseley said he has requested a copy of her job description.

In the two years the consent decree has been in effect, both the DOJ and the monitor have cited a lack of interdepartmental leadership and coordination as one of their primary concerns. They have sought appointment of a high-ranking state coordinator who has the authority over n BHDDH and two other agencies responsible for some portion of the reforms, the Rhode Island Department of Education (RIDE) and the Office of Rehabilitation Services of the Department of Human Services (ORS).  

In other developments noted by Moseley, BHDDH has:

• Hired a Chief Transformation Officer. Andrew McQuaide previously served as consent decree coordinator within BHDDH, but he did not have authority outside that agency.

• Advertised for a supported employment coordinator to work with private service providers

• Received approval to hire a chief operations officer and quality improvement coordinator.

“These positions are important to provide leadership and guidance over the systems changes that need to take place,” Moseley said.

Raia said the quality improvement coordinator’s post has been advertised and applications are being accepted.

The new positions, funded in the Governor’s budget for the next fiscal year, reflect the fact that she is “committed to achieving the reforms outlined in the consent decree,” Raia said. He also cited a $2 million increase in funding for community-based daytime activities and an additional $5 million that would provide a raise of 45 cents an hour to staff of private agencies who work directly with people with disabilities. Model progams showcasing community-based services would receive a $1.9 million boost.  

Moseley said BHDDH, RIDE, and ORS are working together on implementing a quality improvement plan in keeping with the consent decree requirements.

Moseley concluded that “the Court’s close oversight over the state’s progress on meeting the terms and conditions of the consent decree is having a very positive impact on both the quality and the pace of change in the state.”  McConnell began holding status conferences on the case in January.

RI Found Six Cases of Abuse Cases Before Moving to Close Group Home In Providence

College Park Apartments at 612 Mount Pleasant Ave., Providence, is to close by March 25.

By Gina Macris

The recent death of a 70-year old resident of the College Park Apartments in Providence was one of six incidents of patient abuse reported at the same state-run group home for people with developmental disabilities since January, 2015, according to the Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH.) 

On Monday, March 21, a department spokeswoman declined to answer questions about the nature of each investigation or shed light on four “corrective action plans” put into place in 2015 in an effort to halt the abuse. Two more allegations of abuse were reported this year, including the death of the unidentified woman Feb. 15.  

Spokeswoman Linda Reilly cited confidentiality concerns – even when declining to release statistics about the number of investigations handled by the BHDDH Quality Assurance/Quality Improvement unit. 

Reilly did confirm unrelated allegations of patient mistreatment at Zambarano Hospital in Burrillville, where two state employees have been put on paid leave. 

Five of 27 staff members at College Park Apartments are also on paid leave, she said.  Criminal investigations are underway at both locations. 

 Reilly was asked why BHDDH decided to close the College Park group home for people with developmental disabilities rather than changing the staff. The department is under a federal court order to put the needs and wishes of people with developmental disabilities at the heart of all long-range plans devised for their benefit.  So-called person-centered planning is one of the central provisions of a 2014 consent decree aimed at giving people with disabilities  opportunities for integrated work and leisure activities in their communities. 

Reilly said each of the 14 residents atCollege Park indicated a desire to move rather than stay at the facility. The family members and guardians of the residents reviewed the individual plans for their loved ones, Reilly said. 

Reilly did not elaborate on reasons for closing the home, except to say that the BHDDH director, Maria Montanaro, called on an outside agency to investigate “in order to corroborate the decision to close College Park.” 

That agency, Day One, “completely agreed that the house should close,” Reilly said. 

Day One was consulted after the 70 year-old College Park resident died at Roger Williams Medical Center and another resident of the same home subsequently was found to have “unexplained injuries” March 8, Reilly said. The dead patient had a fracture of the thigh bone that had not been treated promptly and became infected. 

Day One was consulted because of its expertise in dealing with people with limited verbal ability, Reilly said. The agency is better known for its expertise in sexual abuse and domestic violence, although there were no allegations of sexual abuse at College Park Apartments, Reilly has said.

Budgetary considerations had nothing to do with the decision to close the home, Reilly said. All residents are to be moved by Friday, March 25. 

Governor Gina Raimondo’s budget would cut an overall $15.5 million in non-salary operating expenses for 23 state-run group homes, about 46 percent of the current budget of $33.2 million, in the next fiscal year to help make money available to help fund the 2014 consent decree mandating integration. 

Reilly also clarified previous comments  by Health and Human Services Secretary Elizabeth Roberts about “targeted investigations” of group homes for people with developmental disabilities to be made by BHDDH and Department of Health officials. 

Reilly said the term referred to “spot checks” to be made of the 23 homes run by BHDDH itself through the Rhode Island Community Living and Supports  (RICLAS) unit of the division of developmental disabilities, “because we will not tolerate any neglect or mistreatment of people in our care.” 

RICLAS houses 210 of of a total of about 1300 with developmental disabilities who live in group homes in Rhode Island. The other people live in homes run by private service agencies that are not part of Roberts’ “targeted” spot checks.

Woman in RI State-Run Group Home Dies, Prompting Criminal Investigation

By Gina Macris

The death of a 70 year-old woman with developmental disabilities in February has prompted the state of Rhode Island to order the group home where she lived to close in the next seven days,  health and human services officials announced March 18. 

The death of the woman, who had an untreated leg fracture, occurred after several allegations of abuse during the last year at the state-run home, College Park Apartments at 612 Mt. Pleasant Ave., Providence.

Health and human services officials have called in the state’s attorney general and the Rhode Island State Police to investigate.

The state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) has placed five employees of the group home on immediate paid leave and will provide strict supervision of the rest of the staff as they work to resettle other residents,  according to a statement from the Executive Office of Health and Human Services.

The remaining 14 residents at College Park Apartments are all to move to other housing before the group home closes next week.

The woman, who was not identified, was sent to  Roger Williams Hospital Feb. 9 for  what the staff reported was a bad bruise, but an x-ray determined that it was a broken thigh bone. The wound was infected, according to a BHDDH spokeswoman. . 

Linda Reilly, the spokeswoman, said the woman improved in the hospital and was sent to a nursing home, but the infection became worse and she was readmitted to the hospital, where she died Feb. 15.

An autopsy has been done but a report has not yet been completed, Reilly said in an email. 

College Park Apartments is both licensed and operated by BHDDH. Its internal investigation unit had responded to multiple reports of mistreatment and abuse in the past year, the department director, Maria Montanaro said at a press conference. .

“We will not tolerate mistreatment of patients anywhere in Rhode Island, including and especially inside group homes under our management. And we will not hesitate to close a group home when residents are at risk,” Montanaro said.

Health and Human Services Secretary Elizabeth Roberts said, “Injuries and mistreatment at the College Park Apartments are unacceptable.”

Going forward, she has ordered the state Department of Health to work with BHDDH on “targeted investigations” of group homes throughout the state.

The state-run network of group homes and apartments for people with developmental disabilities, called Rhode Island Community Living and Supports (RICLAS), houses 210 individuals. That number is 16 percent of about 1,300 people with intellectual challenges living in group homes in Rhode Island. The majority of the group home residents are served by private agencies.

Consent Decree's Community Task Force Airs Worries

By Gina Macris

Nicole Zeitler

While a federal judge is poised to compel the state of Rhode Island to comply with a federal consent decree intended to benefit people with developmental disabilities, the General Assembly, which holds the purse strings, does not appear to have a full understanding of the matter.

Donna Martin, executive director of a network of private disability service providers, expressed that concern March 15 at a meeting of the Employment First Task Force (EFTF), created by the 2014 consent decree to reach out to the community and to make recommendations as the state tries to implement the federal court order.

More than two dozen people, including Nicole Zeitler and Peter Stephan, lawyers for the U.S. Department of Justice, attended the task force meeting at Martin’s office at the CommunityProvider Network of Rhode Island (CPNRI) on Jefferson Boulevard in Warwick. The task force is chaired by Kevin Nerney, assistant director of the Rhode Island Developmental Disabilities Council.

The two DOJ lawyers had appeared at a hearing in Providence the previous day before U.S. District Court Judge John J. McConnell, who displayed a growing impatience with the state’s piecemeal compliance and affirmed a schedule for considering remedial action in April. 

Martin said, “I’m concerned about what’s going to happen after the evidentiary hearing and how the executive branch moves from the fallout of that without the full understanding of the legislature.“

McConnell is to hear evidence on compliance April 8 to help him shape a new court order for a remedial action plan.

“It concerns me that the consent decree is silent” on funding, Martin said. “That puts the onus on the advocacy community. The burden the developmental disability community is facing far predates the consent decree,” she said. “When the dollars are not appropriated, our hands are essentially tied.”

Martin was alluding to a 13 percent cut in the developmental disabilities budget the General Assembly made in the early hours of the morning on the last day of the 2011 session. The budget has not recovered the lost funding, while the caseload has grown in the last five years.

“While I understand that there are separate branches of government, I’m concerned that there is not a stronger coordinated voice with the legislature,” Martin said. 

Ray Bandusky, executive director of the Rhode Island Disability Law Center, said, “I think it’s important to emphasize that the overwhelming majority of legislators abhor consent decrees. I don’t see it being a big motivator.” 

The DOJ’s Zeitler said that “the consent decree doesn’t specify how it is to be funded,” but it does say that it will be “fully funded.”  The agreement was signed in 2014 by former Governor Lincoln Chafee and DOJ officials. 

In January, state officials acknowledged that the budget does not now contain enough money to implement the court order.

Zeitler said that the state promised McConnell it would show him budget numbers that are linked to compliance results for specific individuals affected by the consent decree. “We didn’t come up with that out of nowhere; It came from the consent decree,” Zeitler said.

 “We are waiting for a usable summary” of Governor Gina Raimondo’s proposed new budget; something that goes beyond the executive summary she included in her budget message to the General Assembly in early February, she said. 

The consent decree says funding is supposed to be built around the needs of the individual. In that context, Zeitler said it is “helpful to hear” from consumers who might say, “I ended up getting my tier (funding level) changed and it didn’t have anything to do with my needs.”

In between their appearances in court and at the public EFTF meeting, Zeitler and Stephan have met privately with people receiving services and with family members.

Funding hinders individualized services

The current funding structure hinders the community integration and personal choice that is at the center of the consent decree, because it is driven by ratios and has no flexibility to accommodate people’s needs,  Martin said.

To illustrate her point, Martin gave a hypothetical example of a day facility with a staff-to-client ratio of 1 to 8. If one staff member accompanies a person with a disability somewhere, that leaves another staff member with a double ratio of clients, Martin said. .

In other words, one person’s integration comes at the expense of another’s need for staff attention.

One parent said pressure from the consent decree to close segregated day facilities like the one in Martin’s example is resulting in groups of people with disabilities riding around in a van or car when one of them has to go somewhere.

“The day center has become mobile,” said Mary Beth Cournoyer.

“It looks like we’re following a path (toward community integration) on paper, but we don’t get there,” Cournoyer said.

She also indicated that the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) continues to determine an individual’s funding level through an assessment that was never designed for that purpose.

The consent decree specifically prohibits the state from using the assessment, called the Supports Intensity Scale, as a funding tool. 

Cournoyer said it would be “enormously helpful  to identify the roles and responsibilities of the task force.” 

The group, hampered by fragmented communication from state agencies and a lack of data needed to formulate policy recommendations, has struggled to define its role over the last two years.

Cournoyer said individuals with disabilities either are not being informed or are misinformed about changes that affect them. “Parents are screaming that they are going to take the money away,” she said.

Zeitler said, “There are amazing people in this room. I have heard all of you talk. I have every belief you can use the power you have.”

The consent decree says the Employment First Task Force “should include certain people, and more than half of you are advocates and parents,” Zeitler said, scanning the room. “Our position is that the state should be taking information from the task force and using it to change systems,” she said. 

Coordinator Introduced

The group welcomed Mary Madden, the interim consent decree coordinator, who spoke about her approach to the newly created secretary-level position.  

Madden, with 30 years’ professional experience in developmental disabilities in Rhode Island, has become widely respected in that field.

She said that while she will work toward the compliance goals spelled out in the consent decree, “the greater goal we should care about is inclusive lives for people in the community.”

She said she hopes to bring people from various departments of state government together“to work seamlessly as a team.”

The DOJ and the court monitor have argued that the consent decree calls for a coordinator with the clout to require cooperation from department heads.

Martin of CPNRI said her organization is pleased that the coordinator’s position has been moved outside any department of state government. “It’s difficult to effect change in departments that continue to be very siloed” when the coordinator’s position remains within one department, she said.

Before Madden’s appointment, the coordinator’s position was assigned to BHDDH. The former coordinator, Andrew McQuaide, now serves as Chief Transformation officer at BHDDH.

Madden said, “I want to do a job that matters and has impact. I’m an action-oriented person. I’ve never worked for state government; just the private sector. When something needs to get done, you just do it,” she said.

Even so, Madden said, she is sure she will encounter bureaucratic situations.  She also said “there are a lot of things about this position that are unknown and haven’t been hammered out.” 

Judge to Consider Remedial Plan

 By Gina Macris

U.S. District Court Judge John J. McConnell, Jr. is poised to consider a remedial action plan to hasten Rhode Island’s compliance with a two- year-old federal consent decree requiring the state to provide community-based daytime services, including employment supports, to people with developmental disabilities.

The U.S. Department of Justice (DOJ) and the state have “jointly determined that, in order to facilitate compliance with the consent decree in this matter, the parties would benefit from a court ordered remedial action plan,” according to a proposed order filed with McConnell in Providence March 1.

 The judge is scheduled to hear the status of the case on Monday, March 14 in Providence, although a spokeswoman for the Court indicated March 8 that the hearing date may be rescheduled. (Update: March 14 at 10 a.m. confirmed as date and time) 

 The proposed Court order, along with a supporting joint motion submitted by the DOJ and the state, spell out a road map for the Court to proceed in considering the facts in the case over the next two months.

In a telephone conference Feb. 24 requested by the state, all sides agreed that three issues stand in the way of full compliance, according to the proposed order. The order and the supporting motion both cite money, the number of integrated, community-based placements, and leadership.

Both sides committed to compliance

"Both Plaintiff and Defendant remain committed to resolving the above listed issues and any other issues identified by the court," according to the joint motion, signed for the DOJ by Vanita Gupta, head of the civil rights division, and for the state by lawyer Marc DeSisto.

DeSisto and lawyers for the DOJ, as well as a Court monitor in the case, have told McConnell that the state budget does not now have enough money allocated to implement the consent decree. The monitor, Charles Moseley, also has said that if the state does not meet certain benchmarks now, it will not be able to comply with the final requirements of the order once the decade of federal oversight concludes in 2024. 

The joint motion and proposed order both call for an evidentiary hearing on April 18 that would require the appearance of the head of the state Office of Management and Budget as well as the directors of three agencies responsible for carrying out the consent decree: the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH), the Office of Rehabilitation Services (ORS) of the state Department of Human Services and the state Department of Education (RIDE). 

 A week before the hearing, the state would provide the judge with a written report on the status of compliance. During the hearing itself, “Defendant will provide the court with the information necessary to issue an order for remedial action to spur prompt compliance,” according to the proposed court order.

 The parties would reconvene May 2 so that the state can report on “progress relating to funding, placements, and the leadership required for full compliance,” as well as any other court order that may be outstanding at the time.

The monitor has sought the appointment of a secretary-level Consent Decree Coordinator who would have the authority to oversee compliance efforts of the three state agencies involved.   A secretary-level coordinator has been appointed only on an interim basis in recent weeks. 

RIDE is involved because it is responsible for providing transitional services, including school-to-work opportunities, for youth in special education as they approach their 21st birthday. These youth are of particular concern, according to the consent decree, because they are “at risk of entering sheltered workshops and facility-based day programs” when they reach adulthood.” 

Origins of the Consent Decree

The federal case started with a U.S. Department of Labor investigation into sub-minimum wages paid to people in one sheltered workshop. An expanded DOJ inquiry found that (Cut: found) teenagers and adults with developmental disabilities were being segregated from the general population in violation of the Americans with Disabilities Act (ADA).

The U.S. Supreme Court clarified the ADA’s mandate for integration in a landmark 1999 decision that many say struck down segregation for people with disabilities in the same sweeping way that Brown V. Board of Education banned “separate but equal” education for black students.

 The 2014 consent decree in Rhode Island, the first of its kind in the nation, spells out a series of specific deadlines for achieving an increasing number of supported job placements and individualized daytime activity plans over the 10-year period of federal oversight. 

Meanwhile, Governor Gina Raimondo has proposed a net increase of $8 million to the developmental disabilities budget now in place, with the total going from $229.7 million to $237.7 million for the period ending June 30. In the next fiscal year, developmental disabilities would receive a total of $235.2 million. 

Over the next 16 months, the governor’s plan would redirect more than $23 million within the developmental disabilities budget toward private agencies providing integrated daytime services. The state would create this financial boost largely by moving people out of group homes into shared living arrangements with families in communities throughout the state. 

This housing shift would involve 500 of 1300 people now in group homes moving into so-called shared living arrangements voluntarily by June 30, 2017, according to a BHDDH spokesman.  

Donna Martin, who represents an association of private agencies that support families offering shared living in their homes, has called the goal “very ambitious.”