Federal agencies ignore realities of care of the developmentally disabled

Some agencies within the Obama administration have an ideological bias against congregate care for the developmentally disabled that has apparently blinded them to the damage done to countless lives in the name of deinstitutionalization.

That bias, which is held as well by the Patrick administration in Massachusetts, is on display in an article written by a key former Obama administration official about the deinstitutionalization movement from the 1960’s to the present.

The article is by Samuel Bagenstos, former principal deputy assistant attorney general in the Obama Justice Department’s Civil Rights Division and a key litigator in deinstitutionalization cases.

Bagenstos acknowledges in the article, published in the Cardozo Law Review, that the past and pending closures of institutions such as the Fernald Developmental Center in Massachusetts have not resulted in adequate funding for community-based care.  But Bagenstos declines to acknowledge the role his own former agency has played in the often checkered expansion of the largely privatized community system that followed the closures of state-run Intermediate Care Level facilities for individuals with intellectual and developmental disabilities (ICFs/IID).

Instead, he argues that if only families of developmentally disabled individuals see fit to team up with advocates of further deinstitutionalization, they can work together somehow to ensure that care will be adequate in the community.  We aren’t buying it, and the VOR, our national affiliate, isn’t buying it either.

In a response to Bagenstos’s article, the VOR contends that:

Bagenstos shows no willingness to take responsibility for the tragedies that he and the other advocates caused to these highly vulnerable individuals. Nor have past failures moved Bagenstos to take a more reasoned approach to deinstitutionalization efforts, one that insists on building quality, community placements and adequate oversight before displacing fragile individuals from ICFs/IID.

Instead, closure advocates are turning to new “battlegrounds” (private facilities, nursing homes and adult care homes), without apparent concern for the hundreds of thousands of individuals on waiting lists for community services or the history of abuse, neglect and death that has befallen countless community-based individuals.

In an article this month in The Nonprofit Quarterly, Tamie Hopp, VOR’s director of government relations and advocacy, adds that among the results over the past 30 years of deinstitutionalization of the developmentally disabled are waiting lists in states for residential care that now number nearly 317,000 people, emergency rooms that “have become de facto urgent care clinics” for developmentally disabled people, and correctional facilities that are “replacement treatment centers” for some individuals who have both mental illness and developmental disabilities.

As Hopp points out, U.S. Senator Chris Murphy (D-CT) has called for a U.S. Department of Health and Human Services Office of Inspector General investigation to “focus on the prevalence of preventable deaths at privately run group homes across this nation and the widespread privatization of our delivery system.”  The VOR has catalogued hundreds of media reports of abuse and neglect in privatized group homes around the country in recent years.

Yet key current and former officials in the Obama administration seem oblivious to all of this, and so does the Patrick administration in this state.  As we have noted, the Obama administration’s National Council on Disabilities (NCD) now labels any facility with four or more residents an “institution,” and has called for the closure of all such facilities.  The NCD does not appear to have put any thought into what would replace the care provided in those settings.

Meanwhile, the federal Centers for Medicare and Medicaid Services (CMS) has written new regulations to terminate Medicaid funding for any facilities that happen to be located on the grounds of state-run or private ICFs/IID or even near to them.  And just this past week, President Obama signed a bill into law limiting placements for people in sheltered workshops, which the CMS considers to be inappropriate centers of congregate care.  Fortunately, the Massachusetts Legislature acted last month to preserve sheltered workshops in this state for those who choose to remain in them.

For some within the Obama administration, the wishes and preferences of the individuals and families most affected by deinstitutionalization do not appear to be of importance.  Since 2009, the Justice Department, while at least partly under Bagenstos’ leadership, has filed, joined, or participated in more than 40 lawsuits in at least 25 states to provide individuals what it considers to be “full community integration.”  As a result, hundreds of people have been moved from ICFs/IID homes, regardless of whether they or their families or guardians wanted to close the facilities they were living in or not.

In his article, not only does Bagenstos neglect to acknowledge the suffering and damage that has been caused by these institutional closures, but he does not appear to understand the financial corruption that pervades the largely privatized system of care that has replaced the large institutions.

For instance, Bagenstos maintains that “deinstitutionalization advocates now are fighting to expand the amount of state money spent in the community—and, especially in tight budget times, to defend existing community services against cuts.”    But this doesn’t appear to recognize that the most potent force for deinstitutionalization advocacy today is to be found among the corporate providers that have moved in to the vacuum created by the disappearance of ICFs/IID.  They are actually fighting to expand the amount of state money going into their own pockets, particularly the pockets of the huge bureaucratic layer of corporate executives that run these companies.

Hopp points out that between 1977 and 2010, as ICFs around the country were being closed, the number of residential settings serving people with developmental disabilities increased by more than 1,500 percent, with most of these new settings being small and privately operated.

Bagenstos and many within the current administration also seem not to understand that the federal Americans with Disabilities Act (ADA) and the Olmstead v. L.C. U.S. Supreme Court decision both recognize the need for a range of services for the developmentally disabled, including institutional care for those who desire it. Bagenstos discusses the ADA and Olmstead only as potential legal avenues to boost funding for the community-based system. And he starts with an unproven assumption that community-based care is better in all respects than institutional care.

“Over time, an evidence base has developed that has both refined and demonstrated the superiority of these (community-based) service models,” Bagenstos states in his article. He includes no citation for this claim.  In fact, in addition to the problems cited above of abuse and neglect in the privatized system,  academic experts have drawn mixed conclusions as to whether people who have transferred from institutional to community-based settings have experienced improvements in the quality of their lives or care.

Bagenstos also appears off base in what he writes about the history of the litigation over the closure of Fernald.  He writes:

When Massachusetts responded to fiscal concerns by seeking to close the Fernald Developmental Center, its oldest institution for people with developmental disabilities—even though it offered residents and guardians a choice of transferring to another state institution—Fernald parents sought to reopen a long-closed pre-Olmstead case [Ricci v. Okin] that had been settled in 1993.  The parents argued that the closure actually violated Olmstead, because it deprived them of the opportunity to oppose placement in the community.

Bagenstos’s statements about the reasons for the reopening of the Ricci case are overly simplistic at best.  The Fernald families alleged in 2004  that by instituting staffing reductions and budget cuts at Fernald, the then Romney administration was violating U.S. District Court Judge Joseph Tauro’s 1993 disengagement order in the Ricci case that required the maintenance of high standards for care at Fernald and in other ICFs.  The families also alleged that the administration was re-writing residents’ care plans and failing to certify that the residents would receive equal or better care elsewhere.

Secondly, while the Patrick administration did offer the Fernald residents a choice of a different ICF, the concern among the families, starting prior to the Patrick administration, was that the ICF they moved to from Fernald might itself subsequently be closed, leaving them with the prospect of multiple moves. That concern proved to be well-founded in 2008 when the Patrick administration announced it was closing three additional ICFs in the state, out of six then remaining.  Only one of the two remaining ICFs in the state was listed by the administration as not being on the closure list.

Bagenstos also mischaracterizes a bill filed by then Massachusetts Congressman Barney Frank that would have given guardians of persons with developmental disabilities the right to opt out of those lawsuits supposedly filed on their behalf by the Justice Department and federally funded legal aid agencies to close facilities in which those disabled individuals happened to be living.  Frank’s bill would also have  required the Justice Department to consult with the guardians in any investigations undertaken of those facilities. Bagenstos writes:

Evidently blaming the Massachusetts government’s decision (to close Fernald) on the pressures caused by the threat of litigation, Representative Barney Frank, who represented the district in which Fernald was located, responded by introducing legislation that would limit the ability of federally funded Protection and Advocacy agencies—the source of much Olmstead litigation—to bring cases that could lead to the closing and downsizing of institutions. Both VOR and AFSCME (a state employee union) have vocally supported this legislation. Though the legislation has not moved in Congress, the support by one of its most stereotypically liberal members for a bill that would limit public interest lawsuits highlights the unusual political alliances that continue to surround deinstitutionalization litigation.

In our opinion, Frank’s bill would not have limited any organization’s ability to bring cases to close institutions.  As noted, it would only have given guardians a choice as to whether to participate in those suits.

We are glad to see that Bagenstos at least believes that the closures of ICFs will not necessarily save money in the long run.  He states that:

Although studies of deinstitutionalization have found that people who move from institutions to the community can achieve better outcomes at lower cost, it is reasonable to expect that the cost gap will shrink as people in the community receive more services. This may be especially true because a significant part of the cost gap reflects differences in the wages paid to workers in institutional and community settings.

In the final analysis, we think, the major problem that the developmentally disabled face is not the threat of institutionalization, it is the lack of adequate care and services in the supposedly deinstitutionalized system.   As Hopp notes:

The legal framework is in place to support individualized care and choice. Advocates must set aside efforts to eliminate options of care and work together to expand options. This begins with a commitment to serving each individual: true person-centered planning.

The problem with the approach advocated by Bagenstos and many within the Obama administration is that it advocates the elimination of options for people with disabilities.  It is a one-size-fits-all approach to care and services, and that size appears to be steadily shrinking as Bagenstos and others in the administration promote smaller and smaller residential settings that no longer meet high standards of care.

The Sherlock Holmes-style mystery of the secret switch of the ‘Real Lives’ bill versions

How exactly does it happen in the state Legislature that a good piece of legislation gets “lost” just as a bad piece of legislation has been substituted for it?

That seems to be exactly what happened with the ‘Real Lives’ bill this spring in the state Legislature.  There has long been a heavy dose of game-playing by corporate providers to the Department of Developmental Services in their years-long quest to gain passage of this bill; but the secret substitution of their preferred version for another, much better, version of the bill this spring may take the proverbial cake.

In this case, the sleight-of-hand move may bring the DDS providers as close to winning passage of their version of the bill (H. 4237) as they have ever been.  We understand H. 4237 is going to be sent to the Senate very soon from the House for final passage.

This is a badly flawed piece of legislation. The much better redraft of this bill was approved in early May by the Children, Families, and Persons with Disabilities Committee (H. 4063).  But somehow, as noted, that redraft, which was done by Senator Michael Barrett’s office, got lost one month later in the legislative process.  Somehow, H. 4237 was substituted for H. 4063 in the Health Care Financing Committee.

When I talked a few weeks ago with a staff member of the Health Care Financing Committee, I was told the substitution was a mistake.  But if it was a mistake, it’s one that has yet to be corrected; and it may soon be too late to correct it.  (Maybe we can engage a modern-day Sherlock Holmes to find out what really happened to Senator Barrett’s version of the bill.  Maybe it has been hidden away in a State House attic, a la Holmes’s Adventure of the Norwood Builder.)

The Real Lives concept is intended to serve the laudable goal of providing intellectually disabled persons and their guardians with greater choice and “self-determination” in obtaining services from the Department of Developmental Services. But as currently drafted, H. 4237 is little more than a vehicle for the financial benefit of DDS corporate providers.

As we have pointed out in numerous blog posts and in our July newsletter, the current text of H. 4237 would inappropriately place DDS provider-based organizations on an advisory board that would help design the self-determination program. These same providers were involved in drafting this legislation, and stand to benefit financially from any program they help create.

In addition, the current draft of the bill would establish a “contingency fund,” which would further compensate DDS providers financially if and when residential clients leave them for other providers. These and other provisions in the current draft of the legislation create unacceptable conflicts of interest.

In contrast, Barrett’s redraft of the legislation, which was approved in May by the Children and Families Committee, would have removed the contingency fund and all references to provider-based organizations on the advisory board. That redraft (H. 4063) would, moreover, have required that more than 50 percent of this board be made up of individuals who are financially independent of any provider.

But as noted, when H. 4063 was sent by the Children and Families Committee to the Health Care Financing Committee in early June, the redraft was removed, and the provider-friendly version of the legislation was re-inserted as H. 4237. As unacceptable as this bill has become, the process under which the redraft was removed from it is equally unacceptable.

Please ask your senator to vote against H. 4237 in its current form, and to send it back to the committees it came from so that Senator Barrett’s redraft can be found and restored to it.

Sheltered workshops for the disabled win big reprieve in Massachusetts

July 14, 2014 5 comments

A major effort by advocates of sheltered workshops in Massachusetts to persuade state legislators and the Patrick administration that the workshops provide invaluable skills and activities for their loved ones with intellectual disabilities has paid off.

Last week, Governor Patrick signed the Fiscal Year 2015 state budget, which contains language protecting the workshops from closure.  The language states that the state must not “reduce the availability or decrease funding for sheltered workshops serving persons with disabilities who voluntarily seek or wish to retain such employment services.”

The passage of this language appears likely to cause at least a slowdown in the administration’s plans to close all remaining sheltered workshops in the state as early as next June.   The administration has contended that sheltered workshops “segregate” people with developmental disabilities from their non-disabled peers in the mainstream workforce. Supporters of the workshops, and we are among them, argue that the workshops provide needed skills and fulfilling work for people with intellectual disabilities, and do not prevent them from contact with peers in the community.

The protective workshop language survived a House-Senate conference committee late last month, and Gov. Patrick had until last Friday to line-item veto it, and chose not to do so.  So, it’s now the law.

The legislative victory is largely due to an intensive effort by workshop supporters to get the word out to key legislators — particularly to Rep. Brian Dempsey, chair of the House Ways and Means Committee — of the value of the workshops, and of the contention that the administration and corporate provider-based organizations such as the Arc of Massachusetts were spreading misinformation about them. Dempsey, in particular, has turned out to be a strong supporter of the workshops, particularly in the budget conference committee.

It remains to be seen whether the protective language will help people like Tom Urban, a 55-year-old man with Down Syndrome, who had been employed in a sheltered workshop for the bulk of his adult life, according to his brother and guardian, Richard.   Richard said that last December, he was informed that all sheltered workshops were being closed and that Tom would no longer be employed, as of the very next day, in his workshop, operated by Work, Inc., a Department of Developmental Services provider.

“To put it mildly, this was a rather disruptive change in Tom’s life with no opportunity to prepare him for this shocking development,” Richard Urban wrote in an email to Rep. Dempsey in late May.  “Moreover,” he said, “no chance was provided for me, as his brother, guardian and caretaker, to voice any opposition, or input, to this policy change imposed by (DDS).”

Richard said that although Tom “has limitations in a variety of areas, his work ethic and paycheck (from his sheltered workshop program) were two constants that allowed him a place on a playing field of equality with his peers, family and friends.”   Since his “forced exit from his workshop,” Richard added, Tom “has grown distant, is very confused, and expresses continued sadness over his job loss.  His identity, and work community, have been lost, through no fault of his own but by virtue of a policy shift for which I am at a complete loss to understand.”

The effort to close the workshops has been driven by an extreme anti-congregate care ideology that the Patrick administration subscribes to.  Simply because a group of disabled people work together in sheltered workshops, the administration considers it to be a “segregated setting.”  As a result, we are concerned that despite the budget language allowing those who are currently  in workshop programs to remain in them, people like Tom Urban, who have lost their workshop programs or are seeking for the first time to get into one will find not be able to do so.  Last year, the administration announced it would no longer allow new referrals to sheltered workshops in the state as of this past January.

In addition, the FY 2015 budget contains at least two reserve funds totaling $3 million to support the transfers of persons from sheltered workshops to provider-run day programs and unspecified job training programs.  While the administration contends that intellectually disabled people will all be able to reach their potential in mainstream or “integrated” work environments, there is  uncertainty over how many mainstream jobs really exist for most people with developmental disabilities, and many questions about what integrated employment really means.

Sheltered workshops have won a welcome reprieve in Massachusetts, but their future still remains uncertain; and also uncertain are the long-term prospects of fulfilling work activities for thousands of people with developmental disabilities in the state.

 

 

 

The endless shuffle continues for the DDS national background check bill

Does anyone in the state Legislature or the Patrick administration really want to set up a national background screening process for people hired to work with the intellectually disabled in Massachusetts?

Apparently not.

Everybody likes to talk about how important it is to protect the most vulnerable among us from abuse and neglect. Yet the Legislature has been unwilling for years to pass national background check legislation, and the administration has been unwilling even to apply for federal funds that are available under ObamaCare to implement a national background check program.

So far this year, there’s not much reason to think anything is going to change, though there is always a faint hope.  This year’s version of the national background check bill (H. 4125) was approved by the Judiciary Committee in late May after the measure had languished there for nearly a year and a half. But it was sent as usual to the House Ways and Means Committee. Every time the bill has been sent to House Ways and Means, it has died there.  For years, the bill has been on an endless shuffle between these two committees.

Another piece of bad news for the legislation this year is that the only elected official in Massachusetts who has ever made a recognizable and visible effort to promote it is Martin Walsh, who is now mayor of Boston and no longer in the House of Representatives.   For years, as a state representative, Walsh filed legislation to enact national background checks for Department of Developmental Services employees and employees of DDS corporate providers; and as recently as last July, Walsh testified in favor of his bill before the Judiciary Committee.

COFAR and a wide range of other advocacy groups for the developmentally disabled have long urged passage of the legislation.  But other than Marty Walsh, we see no elected officials who seem particularly interested in enacting this legislation.  You have to wonder why.  Is there a special interest group out there that we’ve never heard of that is working to keep this legislation bottled up?

The administration claims to be in support of the bill, but they have not testified in favor of it in recent years, and, as noted, have never applied for available federal funding to implement a national background check program in Massachusetts.  That funding, as noted, has been available under the Affordable Care Act since 2010.  In that time,  the federal Centers for Medicare and Medicaid Services has awarded more than $50 million to 24 states to design national background check programs.

National background checks involve matching a job applicant’s fingerprints against a federal database maintained by the FBI.  Every advocacy group for the disabled that we know of agrees that state-only background checks — which is what DDS currently does in Massachusetts — are not sufficient in screening applicants for direct-care jobs because those checks do not turn up convictions for criminal activity in other states.

Massachusetts has apparently not been a leader in background screening of people who work with other vulnerable groups either.  In January 2013, Massachusetts did enact a law requiring national background checks for school teachers and early education employees, but it was the last state in the nation to do so.

By the way, where are the candidates for governor and attorney general on this matter?

Please call the House Ways and Means Committee and ask them to finally approve H. 4125 and get it enacted;  and please call the governor’s office and ask them to apply for funding available to implement the program.

You can reach the Ways and Means Committee at (617) 722-2990, and the governor’s office at (617) 725-4005.

Parents prohibited from even discussing a visit home with their son

June 30, 2014 2 comments

When Stanley and Ellen McDonald tried to share and discuss a COFAR Blog post with their son, Andy, during a visit to his group home on June 22, the residential manager told them to stop, or their visit would be terminated.

The post was about Andy’s 47th birthday party, which was held at Carbone’s Restaurant in Hopkinton on June 6, and it quoted Andy’s wish as he blew out the candles on his birthday cake to someday be allowed to visit his boyhood home in Sherborn where his parents still live.   Apparently, even expressing that wish was against the house rules.  Andy and his parents are prohibited by a probate court order and by his residential provider and other authorities from even discussing the prospect of Andy ever visiting his hometown, even under supervision.

A probate court judge ruled in 2006 that Andy is sexually dangerous, but Stan McDonald maintains the ruling is based on misinformation and a misinterpretation of a police report from an incident in 1990 in which Andy threatened a neighbor.  Andy has never been charged with a sexual offense; the neighbor has long since moved away, and clinical records indicate Andy has not exhibited aggressive behaviors in more than a decade.

Placing restrictions on subjects families can discuss with their loved ones in the Department of Developmental Services system is apparently not unusual. As we have reported, the family of Sara Duzan, another DDS group home resident, was cut off from all contact with her after they allegedly violated a prohibition on discussing care and conditions in the group home with her.

Stan McDonald, who is 78, maintains that Andy had not been expressing a wish on his birthday to return to his home to live, but just to visit his parents, and possibly to hear Stan play with his jazz band at the Sherborn Inn.   But while Andy is allowed under his care plan to hear Stan’s band in other locations, not only can he never return to his hometown, he cannot even talk about his wish to do so.

Stan says that after Andy had finished reading the COFAR Blog post with Stan’s and Ellen’s help, the assistant residence manager “expressed what seemed friendly interest, so we gave her a copy.”  A few minutes later, he says, the assistant manager handed him a phone with a call from the residence manager, “who told me to desist from talking with Andy about this or she would terminate the visit.”    Stan says he reluctantly agreed to stop discussing the post, but “Andy and Ellen and I were deeply offended by the ignorance and insensitivity that was exemplified.”

Andy wants to believe he is a good person, Stan says, so forbidding him even from talking about a wish of great importance to him has affected his self-esteem. Andy’s resulting anxiety, Stan adds, is manifested in certain behaviors such as bolting his food until he sometimes chokes, and rapid and slurred speech.

Yet, even Andy’s psychiatrist will not discuss his desire to return to his childhood home with him.  The group home’s solution to Andy’s anxiety is to medicate him, Stan maintains.  The situation, he contends, amounts to “emotional abuse” of Andy.

“Andy has been given a life sentence for a crime he never committed – and with no opportunity to appeal,” Stan maintains.

Stan contends that it is the group home management and DDS itself that do not want to discuss the real issues in Andy’s care.  At a meeting on June 20 to discuss Andy’s annual care plan, Stan says the meeting was abruptly terminated by a DDS official when Stan tried to discuss written comments he had handed out at the end of the meeting about what he views as issues in Andy’s care that have not been adequately addressed.  Those issues, according to Stan’s written comments, include the following:

    • Andy’s “extreme anxiety…(which is) directly related to 17 years of refusal of his wishes for visits home — wishes which he is denied even to express,” and the consequent medication to control that anxiety.
    • A failure to implement provisions in Andy’s care plan for regular visits to his friend, Tom.
    • Sub-standard dental care.  His gums are bleeding. He has gingivitis and periodontal disease.
    • A need for more regular exercise
    • The group home is over-crowded with five residents.

Apparently DDS doesn’t want to discuss any of that.  It’s bad enough that the DDS officials in charge of the care and services for Andy would not take the time to listen to his father’s concerns at Andy’s annual care plan meeting.  But we particularly do not understand the policy that DDS and its providers apparently have of prohibiting clients in the system from talking about their deepest wishes and concerns, apparently even with clinicians and family members.

How can it serve someone’s therapeutic interest to keep a deep-seated wish or desire bottled up through an enforced order that they not even talk about it?   Is it the clinical approach to care in the DDS system to forbid people from talking about sensitive subjects and then to medicate them to control their resulting anxiety?  Clearly, that policy is not working in Andy’s case, and we don’t think it’s working in Sara Duzan’s case either.

 

 

 

Does the administration have a double standard in the care of the disabled?

June 26, 2014 1 comment

As The Boston Globe reported last week, Governor Patrick has “unveiled an ambitious and potentially costly plan” to reform the way the state’s criminal justice system handles mentally ill people.

The governor has proposed both a major increase in staff at Bridgewater State Hospital and a new facility there where potentially violent patients could receive care, according to the Globe.

We support the administration’s commitment to expanding care at Bridgewater State.  But we wonder whether this is yet more evidence of what appears to be a double standard on the part of the administration with regard to care of the mentally ill versus persons with developmental disabilities.

The administration appears to believe that congregate settings are necessary and appropriate for the mentally ill, but not appropriate for the developmentally disabled.  In fact, we think Governor Patrick will be known as a builder of major institutional facilities for the mentally ill, yet as a closer of facilities for the developmentally disabled.  This appears to us to reflect the absence of a comprehensive plan by this administration for care of all disabled people in the commonwealth.

Why are we building new state facilities and expanding state-run care for one group, yet tearing facilities down, eliminating an intensive care model, and privatizing most services for another group?

In addition to the plans for expansion of Bridgewater State for the mentally ill, the administration has taken major credit for the construction of the new Worcester Recovery Center and Hospital.  That facility, which opened in August 2012 at a cost of $302 million, has 320 beds for persons with mental illness.  The administration has billed it as “the largest non-transportation construction project (the state has) undertaken in more than 50 years.”

The administration has also apparently realized that intensive treatment models are necessary for the mentally ill.  According to the Globe, the administration has declared that mentally ill people “should receive the appropriate care in the appropriate setting.”   The Bridgewater proposal includes a plan for spending $10 million for an additional 130 full-time mental health clinicians at the complex. Patrick administration officials told the paper that if the Legislature approves this funding promptly, the additional staff could be working at Bridgewater by September.

The Bridgewater proposal further calls for $500,000 to study the possibility of retrofitting an existing state facility such as Taunton State Hospital or building yet another a new facility to treat and evaluate potentially violent people accused of committing crimes, according to the Globe.  The plan gives no cost estimate for the new facility.

At the same time, the administration is closing or has closed four of six developmental centers for people with profound levels of intellectual disability and severe medical conditions, contending these centers are too institutional.  Developmental centers provide an intensive level of care that must meet federal Intermediate Care Facility (ICF) standards.  ICF rules specify more staffing and monitoring than do federal and state requirements for privatized, community-based care in group homes.

Even sheltered workshops are considered by the administration to be too institutional for the intellectually disabled, and the administration has announced plans to shut those down by June of next year.  The administration is, at the same time, pouring additional funding into privatized group homes for the intellectually disabled, scattered in communities throughout the state.

The argument could be made that the administration views institutional care as appropriate for people with mental illness who are violent, and that’s why it is expanding facilities such as Bridgewater State.  But that doesn’t explain the construction of the Worcester hospital center; and it doesn’t explain why the administration is eliminating the ICF care model at facilities for the developmentally disabled such as the Templeton Developmental Center, where many people with behavioral problems live.

The alleged assault by a Templeton resident that caused the death last year of Dennis Perry shows that even that facility may not be fully equipped to meet the needs of all the people who live there, and keep them safe.  And yet, the administration is closing Templeton as an ICF and converting the facility to group homes, which will only reduce the level of staffing and supervision there.   Also, the attempted rape of a woman by a resident of a group home in Chelmsford in 2011 shows that there are intellectually disabled persons with potentially violent impulses who live in the DDS community system.

It has been argued that another difference between facilities for the mentally ill, such as the Worcester hospital center, and developmental centers for the developmentally disabled is that the Worcester facility is meant to help people make a transition to independent living in the community, whereas developmental centers are not intended to do so.  Therefore, according to this argument, the developmental centers should be closed, and the remaining system will be devoted either to serving all disabled people in the community or helping them get there.

Our response to that argument is that we have consistently stated that residents of developmental centers who want to benefit, or can benefit from community-based care should be encouraged to do so.  As far as we know, there has never been any rule or policy that prevented anyone who wanted to leave a developmental center from doing so and moving into the community system.

As we argued in connection with the Chelmsford group home incident, the real issue is the care model.  The administration wants to eliminate the intensive, ICF care model for people with developmental disabilities.  The administration does acknowledge that people with mental illness should receive the appropriate care in the appropriate setting.  And they appear to understand that the community system is not the appropriate setting for all mentally ill people.  But for some reason, the administration hasn’t yet figured out that the community system isn’t the appropriate setting for all people with intellectual and developmental disabilities either.

We do believe that one day, the state will come to realize that institutional care for a certain segment of the developmentally disabled is needed, and there will be an effort to reconstruct our institutional facilities for them.  Unfortunately, we’re making that future job much more difficult and expensive by tearing down the system that we have had in place and which we spent so much money to upgrade from the 1970’s onward.

 

Abuse and neglect found to have caused serious injury to group home resident

June 18, 2014 4 comments

The state Disabled Persons Protection Commission has substantiated charges of abuse and neglect against a staff worker in a Bedford group home in which Paul Stanizzi, an intellectually disabled man, was seriously injured last August.

Stanizzi was at least partially paralyzed in the incident in the residence, which is operated by The Edinburg Center, Inc.,  a corporate provider to the Department of Developmental Services.  According to a DPPC report on the incident, Stanizzi was found lying on his back in his room by the staff worker on the morning of August 27.  The staff worker, who had been on the overnight shift, told investigators he had heard noises in Stanizzi’s room during the night, but never investigated them and then fell asleep for several hours during his shift.

After finding Stanizzi unresponsive on the floor at 6:30 in the morning, the staff worker admitted he lifted Stanizzi up, in violation of his First Aid training, and put him in his bed.  He then waited approximately 25 minutes prior to calling 911.

Stanizzi, who is non-verbal, was taken to Lahey Clinic in Burlington, which was planning to discharge him, according to the DPPC report.  But the hospital then admitted him for immediate surgery when it became apparent that Stanizzi had a spinal injury.  No group home staff accompanied Stanizzi to the hospital, according to the report.

The name of the group home staff worker is redacted in the DPPC report, which is dated February 20 of this year.  COFAR had requested a copy of the report in September and was provided by the DPPC with a redacted copy yesterday.  The report concluded that Stanizzi was seriously injured as a result of an “act or omission” on the part of the staff worker, and that a charge of abuse against the worker “was substantiated.”

When Fox25 TV news first reported this incident, the chief executive officer of The Edinburg Center maintained that Stanizzi may have injured himself.

According to the DPPC report, the staff member reported that when he found Stanizzi on the floor of his room, he had a black eye, bloody nose, bruises, and a gash on his knee.  The report also stated that Stanizzi was seen to have “other older injuries that did not appear to be self-inflicted,” and footprints on the back of his shins.  “It is believed that staff at the group home used extreme force on (Stanizzi),  resulting in the injuries,” the report stated.  Another client was observed in the past tied up in a chair, according to the report.

The incident involving Stanizzi has reportedly been under investigation since September by the Middlesex District Attorney’s Office.  I placed a call this morning to the DA’s office, seeking information on the current status of the case and whether criminal charges are expected to be filed.  Fox25 reported in November that a Middlesex grand jury had been impaneled in the case.

The staff worker, who was the only staff on duty in the group home during the overnight shift from August 26 to 27, told the DPPC that at about 4 a.m., he had heard noises from Stanizzi’s room, but he did not check on him.  Instead, he admitted that he fell asleep and woke up about 6:30, and then found Stanizzi lying on the floor on his back, not moving.

The staff worker told the DPPC he tried to get Stanizzi to stand up, but he could not, so he “lifted him off floor, put him over his shoulder and placed him back in bed.”  Instead of calling 911, the staff worker tried to have Stanizzi drink juice, the report stated.  The staff worker also said he tried unsuccessfully to contact two supervisors. According to the report, there was testimony that the act of moving Stanizzi without first immobilizing his spine may have worsened his injuries.  The report stated that Stanizzi was “expected to be a quadriplegic,” as a result of the spinal injury.

The DPPC report noted that a police officer who responded to the home noticed that the staff worker had a fresh scratch on right side of his face and that the staff worker told the officer he had no idea how it happened.  The officer said he found that suspicious.  There were four residents in the home, all non-verbal, and none had aggressive or assaultive behaviors, according to the report.

The DPPC report stated that documents indicate that Stanizzi had no history of an unsteady gate or falling out of bed.  The day before the incident, at a day program, the same staff worker had refused, according to testimony, to allow staff there to examine apparent abrasions to Stanizzi’s legs.

According to the report, the staff worker’s testimony changed in a number of instances.  He initially denied that he had fallen asleep and later admitted that he had done so.  He also admitted to having given false statements about the day program incident and about Stanizzi having hit himself in the face. The report states that the staff worker denied that he physically assaulted Stanizzi, but it concluded the truthfulness of that statement “is called into question” by the staff worker’s admission that he had lied about the other issues.

The DPPC report recommended retraining for staff and regular checks by the provider to make sure staff are awake on overnight shifts, as well as documented bed checks.  While the staff worker implicated in this case has reportedly been terminated, the report recommend he not be rehired in the future.

As COFAR previously reported, an online DDS licensing report on the Edinburg Center stated that Edinburg’s two-year license to operate residential group homes was being “deferred” because of problems with medication administration.  Other problems were noted in the report that required a 60-day follow-up by DDS, although there were no references to specific problems with abuse or neglect there.  (As of today, the latest licensure report on DDS’s website is still dated December 2010, which would make it about a year and a half out of date.  DDS licensure reports and operating licenses are valid for two years, meaning that a new report should have been posted on the website in December 2012.)

The 2010 licensure report also stated that Edinburg had been experiencing growth since 2008 and yet was “dealing with economic decline and its ongoing impact on agency services.”  The report added that the provider had lost clinical and emergency services and yet had opened two new 5-person homes in FY 2010.  As we noted, it seems strange that a provider would be cutting services and yet opening new homes at the same time.  Opening new facilities at the same time that services are being cut may indicate that this provider may be stretched thin on its staffing, or was stretched thin as of December 2010.

The Stanizzi family has apparently filed suit against The Edinburg Center.  Yesterday, I received a subpoena from an attorney for the provider, seeking all records COFAR possesses relative to the case.

 

 

 

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