“Something Smells Fishy”

Last year, HDR Architects, Inc. along with Plan One Architects, completed a study of the health facilities owned and operated by the State of Wyoming under the auspices of the Department of Health.  This study was commissioned by the Joint Labor, Health and Social Services Committee.  Upon completion of the study, the Department of Health advised against moving the residents of the Wyoming Life Resource Center (WLRC).  The Committee wanted the WLRC to operate more efficiently to cut costs. 

As a result, during the 2014 Budget Session of the Wyoming State Legislature, a Joint Executive and Legislative Task Force on Department of Health Facilities was established.  Appointed to this Facilities Task Force were Senator James Lee Anderson, Senator Dan Dockstader, Representative Lloyd Larsen, and Representative Matthias Greene.  Governor Matt Mead appointed Joe Gallagher, CEO of Wyoming Behavioral Institute, Thomas Forslund, Director of Wyoming Department of Health, Shirley Pratt, CEO of Ark Regional Services, and Bryan Merrell, Executive Director of Life Care Center of Cheyenne.

After seven meetings, three of which were held in conjunction with tours of the Wyoming State Hospital (psychiatric facility), the Pioneer Home (an assisted living facility for seniors) and the Wyoming Retirement Center (nursing home),and the Wyoming Life Resource Center.  The Facilities Task Force formed four options for the Joint Labor, Health and Social Services Committee to consider.  These options are being presented in the order of the Task Force’s preference.

The first two options are versions of the same concept.  This concept is titled, “One Campus Long Streets.”  These options would change the population mix to focus on core clients:  DD/ABI with exceptionally difficult behaviors, Title 25 and Title 7 commitments, “gero-psych”, high medical, and “hard to place” and emergency placements.  The State Hospital would focus on acute crisis stabilization.  Where the two options diverge is in the missions of the Wyoming Retirement Center (WRC) and the Wyoming Life Resource Center.  Option 1a would close or privatize the WRC and the WLRC would focus on intermediate and long-term care.  Option 1b would keep the WRC open and focusing on long-term care. In this option, the WLRC would focus on intermediate care (i.e. discharge to place in a community program).

The third option is basically a “status quo”.  It would not change the populations served or the missions of the facilities but would implement the upgrades recommended in the HDR Facilities Study.

In the fourth (and least popular) option, a single facility would be constructed.  The existing facilities would be closed.  The new, single facility would mix the population and serve the core clients:  DD/ABI with exceptionally difficult behaviors, Title 25 and Title 7 commitments, “gero-psych”, high medical, and “hard to place” and emergency placements.

Just five days after the Facilities Task Force’s Interim Report was published, the Wyoming Department of Health (WDH) announced a new facilities administrator for the WLRC and Wyoming State Hospital (WSH).   The facilities administrator will work with the superintendents of both facilities, align their operations, and improve practices.  The public information officer for the WDH denied that the WDH’s move to create a new administrative position was a direct result of the Task Force’s findings.  “This will provide additional help to the administrator of the behavioral health division, but the move will also help to align the two facilities in aligning their processes,” said Kim Deti. “There are some connections, but what may or may not happen with that still has some steps to work through,” Deti said.  “But it has brought some new awareness to how aligning the way the facilities do things can be beneficial.”

The Facilities Task Force was very gracious and allowed generous time for public comment at each of their meetings.  Members also asked questions of the public in order to clarify statements made.   They also provided for public comment online.  This would lead one to believe that their findings were not a foregone conclusion.  The WDH’s move to create this new administrative position creates the question, once again; has this been an exercise in futility and the WLRC’s future pre-determined?

 

References

https://sites.google.com/a/wyo.gov/wdh-ftf/members

https://sites.google.com/a/wyo.gov/wdh-ftf/timeline

https://drive.google.com/viewerng/viewer?a=v&pid=sites&srcid=d3lvLmdvdnx3ZGgtZnRmfGd4OjQ3OTM4NDc3ZTFkOGI5ODk

http://trib.com/news/state-and-regional/wyoming-health-department-restructures-leadership-for-its-medical-facilities/article_809ba8ff-2481-57c9-91e5-d08efb0677a8.html

http://www.health.wyo.gov/main/about.html

Welcome

Welcome to my blog!  This is a picture of my mom and my aunt, Tracy.  Tracy is profoundly developmentally disabled and medically fragile.  She is a resident of the Wyoming Life Resource Center; a state-run Intermediate Care Facility in Wyoming.

 

My name is Shawn Humberson.  I am a State Coordinator for VOR; a national organization that advocates for high quality care and human rights for people with intellectual and developmental disabilities.  I also serve as President of the Board for Friends of WLRC; a group of parents, guardians, family, friends, concerned citizens and businesses who have come together to support clients residing at WLRC in Lander, WY. The Friends of WLRC is a non-profit organization formed to help provide support and a voice for those who can not speak for themselves.

 

Tracy is the inspiration for my work as an advocate.  I was seven years old when Tracy was born.  She was a long-awaited, very loved addition to our family.  Tracy has taught us all to be open-minded and accepting.  She is a beautiful human being. I am her voice.  And in being her voice; I am also the voice for all citizens of Wyoming who cannot speak for themselves.

 

I invite you to join me on my journey.  This blog will have information and opinions that will, hopefully, empower other advocates as we strive for high-quality, client-centered, integrated care for persons with developmental and intellectual disabilities, acquired brain injury, and traumatic brain injury. Please note:  the opinions expressed in this blog are mine and do not necessarily reflect the opinions of the organizations to which I belong. Follow me on Twitter @wyo_advocate

Has Deinstitutionalization Failed?“

“Has Deinstitutionalization Failed?”

Deinstitutionalization

In the 1980’s, Senator John Chafee (R., RI) introduced legislation that would have defunded Medicaid Intermediate Care Facilities (ICFs). Since then, the push to de-institutionalize has gained momentum.  As of 2011, twelve states had no large ICFs; AL, AK, DC, HI, MI, MN, NH, NM, OR, RI, VT, WV; and three states had no ICF of any size; AK, MI, and OR.

Today, despite the objections of guardians and advocates, many states are closing or redefining their ICFs; forcing individuals from their homes and into community services or leaving them without services. Nationally, there are 317,000 individuals on waiting lists for Medicaid Waiver services.  There seems to be a direct correlation between deinstitutionalization and waiting list numbers.  Alabama requires capacity to grow by 69.3% to meet needs.  Alaska requires 50.3%, New Mexico requires 144.4%, and West Virginia requires 114.4% growth in capacity. 853,000 persons are living with caregivers age 60 or older.

Community Tragedies

 “Community tragedies are widespread and now well-publicized. The stories are haunting and made all the more tragic and unacceptable given just how predictable they have become,” Tamie Hopp, VOR. 

 Georgia has aggressively deinstitutionalized and transitioned individuals from facilities to community  settings.  According to the Georgia Department of Behavioral Health & Developmental Disabilities “2014 Interim Quality Management Report,” published in August 2014, there have been 72 deaths, hundreds of hospitalizations, injuries, elopements, encounters with law enforcement, and alleged abuses among all constituencies.  Community developmental disability providers reported 1,443 deaths and critical incidents; 69% of all incidents during this report period.  These incidents occurred despite a federal court monitor placing a temporary halt on transitions.

An audit by Tennessee’s state comptroller and federal court monitor’s report tracking individuals transitioned from three of the state’s facilities found:  257 reports of abuse, neglect, and exploitation in 2013 (87 of those reports were validated by the state); delays in doctor recommended treatments and lack of adequate dental care; and an increase in deaths of persons formerly institutionalized (nearly doubled from 2009 to 2013).  Some former residents of institutions have landed in jail while others cannot be found. ”While the state saves millions of dollars each year by serving people outside institutions, officials at private agencies concede that a lack of adequate state funding has at times hampered their efforts to help people achieve the best quality of life,” Anita Wadhwani, reporter.

In New Jersey, state facilities are being closed while individuals receiving care out of state are being forced to return to New Jersey or lose their funding.  The individuals being served out of state were allowed to receive services in other states because New Jersey had no facilities which could provide the services they required.  After the deaths of two state facility residents transferred to group homes, the New Jersey Legislature passed a bill creating a moratorium on the Return Home New Jersey Initiative but Governor Christie vetoed the measure.  Family groups have claimed that the state is bringing people back without having the services and group homes in place for their arrival. One young man has been jailed and hospitalized because the group homes he moved to were not able to handle his behaviors; he was thriving in the out of state facility where he lived and even worked part-time. 

Oklahoma has had seventeen deaths over a period of twenty-two months.  These individuals were either transferred or in the process of being transferred from two of the states ICFs.  State Senator Patrick Anderson has called for a review of these deaths to determine “whether the impending closure of the facilities and the residents' transition into community homes contributed to the deaths.”

“Has deinstitutionalization failed?”

At a recent Facilities Task Force Meeting, Senator James Anderson, Senate District 28, posed the question, “Has deinstitutionalization failed?” 

Yes, Senator Anderson, deinstitutionalization has failed.  The preceding examples are only part of the answer to that question.  There are numerous stories from across the nation illustrating the negative outcomes of deinstitutionalization.  These are just a few.    It has failed the displaced residents of the institutions they called home.  Individuals have the right to choose where to live and receive services; however, deinstitutionalization has eliminated that choice.  Deinstitutionalization has denied individuals the integrated, client-centered care they have received in these facilities.  Overall, it has attempted to put persons with intellectual and developmental disabilities into one category.  This “one size fits all” approach to caring for the intellectually and developmentally disabled affects each individual regardless of the severity of their disability. 

References

 https://www.youtube.com/watch?v=Tvmw7Ej5ubE

Larson, S.A., Salmi, P., Smith, D., Anderson, L. and Hewitt, A.S. (2013). Residential Services for Persons with Intellectual or Developmental Disabilities: Status and trends through 2011. Minneapolis: University of Minnesota, Research and Training Center on Community Living, Institute on Community Integration.

http://dbhdd.georgia.gov/sites/dbhdd.georgia.gov/files/related_files/document/2014%20Interim%20QM%20Report%20Final.pdf

http://www.tennessean.com/article/20140210/NEWS0201/302100033

http://www.mycentraljersey.com/story/news/local/middlesex-county/2014/06/13/moratorium-sought-relocating-disabled-residents/10499527/

http://www.nj.com/politics/index.ssf/2014/10/christie_plan_to_return_disabled_to_nj_leads_one_man_to_hospital_jail.html#comments

http://www.newson6.com/story/27183441/17-deaths-raise-questions-about-care-of-oklahoma-developmentally-disabled