Fraud and abuse in home healthcare for the elderly and disabled

The Boston Globe reports that the Massachusetts Medicaid program has significantly increased spending on home healthcare in the last decade, while reports of fraud, abuse, and neglect have tripled. This raises new concerns about the lack of training, certification, and criminal background checks for personal care attendants as well as minimal oversight for the low-paid healthcare workers.

Federal investigators from the Government Accountability Office have also found rampant abuse in the Medicare home healthcare program for the elderly, including $200 million paid for care that was never provided. Between 2002 and 2006, spending for the program increased 44%, while the number of patients rose by only 17%.

The union representing personal care attendants, the director of the state's Medicaid program, and the Director of the Boston Center for Independent Living defend the program as meeting the demands of consumers who are elderly and disabled as well as being cost efficient.

Bill Henning, from the Boston CIL says,

"This is a program with inherent risks, and we would be happy to overhaul it in a lot of ways. But there's a lot of turnover in this field, and there's a real concern that we could choke off the supply of attendants."

Tom Dehner, the director of the state Medicaid program, is reluctant to increase regulation:

"We believe that consumer control of this program and service is intensely personal...We think consumers are in the best position to direct when and how to receive these services and train people and supervise them."

A woman with severe spastic cerebral palsy who has been bullied, threatened, and intimidated by personal care attendants (she has hired and fired scores of them), thinks otherwise:

"You can never be sure who you hire, and I check all their references...It would be nice, at the least, for the state to allow us to do a free criminal background check."

Obama's gaffe on Special Olympics vs. delusional thinking

President Obama made a really stupid remark on the Jay Leno show about his bowling abilities and Special Olympics. He should not have said it and I'm sure he wishes he hadn't. But after reading the reactions to it, I'm not so sure which is worse - the Obama gaffe or the delusional thinking that generated some of the responses.

Patricia Bower's blog (Patricia E. Bower: News and Commentary on Disability Issues) highlights the angry reaction to Obama's gaffe from the Massachusetts Down Syndrome Congress that met last week. Her blog post includes statements by Madeleine Will, a parent of an adult with Down syndrome and the vice president of public policy for the National Down Syndrome Society:

“Intellectual disabilities mean delays. It means things might come more slowly, but it doesn’t mean lack of competence.”

Will says she believes denigrating language is not only disrespectful, but it can impede the efforts of people with Down Syndrome from getting jobs and being independent:

“There’s research that shows that the average person does not believe someone with an intellectual disability and Down syndrome can read, that they can’t be employed, live independently, follow directions, handle an emergency...All of that is wrong. It’s false.”

In my own informal research conducted over a span of 32 years with my two sons who have severe cerebral palsy and profound mental retardation, I can attest to the fact that physical and mental disability can result in incompetence, even in children and adults with Down syndrome.

At the risk of impeding the efforts of people who have disabilities and are capable of working and being independent, I will say it now:

My sons will never learn to read, be employed, live independently, follow directions, or handle an emergency. Nor will they be able to feed themselves, talk, or play the guitar. On the other hand they will never say, "I hate you and I wish I was never born into this family" and for that I will always be grateful. This is a matter of belief based on fact rather than delusion.

I love my sons. They possess an abundance of charm, good will towards others, and many other redeeming qualities, but they lack competence in even the most basic skills of daily living.

I'm sure Madeleine Will knows about people like my sons - she is not lacking in intelligence or experience. I do not know what motivates her to dismiss the possibility of their existence, but I wonder if she might understand the disrespect and denigrating experience it may be to families of children like mine to hear that what we know about our own children is wrong and false.

MDCH promotes its plan for CMH agencies

Last night, March 25th, 2009, the Michigan Department of Community Health held a meeting in Lansing for consumers, families, and advocates about the “Application for Renewal and Recommitment to Quality and Community”. This is not a religious manifesto, but a bureaucratic nightmare being visited on local Community Mental Health agencies under the guise of giving more control to people using mental health services.

This judgment may seem harsh, considering the amount of time, energy, and expense that went into writing the A.R.R., as it is called, but the document reveals little, while hiding much about the pickle we are in as a state in economic free-fall. It is like presenting a plan to improve life in Detroit without acknowledging that the unemployment rate is over 22%.

Community Mental Health agencies are being asked to expand services, to expand the numbers of consumers served, and to improve the quality of services without sufficient support from the state other than the admonition to local agencies that they should achieve more administrative efficiencies. Long-standing inequities in per-capita funding among Community Mental Health Agencies are not addressed.

CMH’s are given their marching orders, however:

“It is expected that, as one of the highest priorities, public mental health agencies will actively assist adults served to obtain competitive work in integrated settings and provide the supports and accommodations that are necessary.”

No, this is not a cruel joke. This is your state at work, oblivious to the extraordinarily high unemployment rates among disabled and mentally ill citizens, even in good times and even for those who are willing and able to work. The MDCH might as well be scattering pixie dust on Community Mental Health agencies to wish the problems away.

Families of people with severe developmental disabilities should store up some reserves for the battles ahead. The government-funded advocacy groups that have had the ear of our elected officials and our state agencies for far too long, are ready to help the state dismantle and eliminate all so-called “disability-only” programs. Programs designed specifically to help and support severely disabled people in their communities conflict with the advocates philosophy that everyone can and will be fully integrated into the community no matter how severe the disability or how high the risk to life and limb. Group homes and other residential facilities, center-based school programs, social and recreational activities, respite care, sheltered workshops – all are targets.

With the cover and support the advocacy groups give to the state, the state will be in the enviable position of slashing necessary programs in the name of “doing the right thing” for people with disabilities.

Aide abuse case counter attack

A Washtenaw Intermediate School District aide who was accused of abusing students in a class for autistic children has filed a lawsuit against the WISD for discrimination and sexual harassment. In the complaint the aide, Michael Beasley, said he believes he was discharged because of his gender and race, which he described as biracial/multiracial, and in retaliation for making complaints.

Beasley has pleaded not guilty to two counts of child abuse.

Respite House for youth with behavioral problems and developmental disabilities

From the Democrat and Chronicle, Rochester, N.Y.

In Rochester, NY, a respite house is being built for young people 11-21 years old with behavioral and developmental disabilities. The adolescents would spend one week every two months at the respite house under the 24-hour care of house managers, nurses, behavioral therapists and other workers. They would practice social skills and daily habits during their stays, while their parents and siblings get some time off from the stresses of life with a disabled family member.

The Mary Cariola Children's Center will rotate eight groups of six young residents through the house. The respite program will be free to families.

A Different Path - A voice for families raising children with special needs

A Different Path is a newsletter for and by families of special needs children and adults in Washtenaw County. For many years, the volunteers who write and produce the newsletter have done so on a shoestring, while managing to come up with interesting, heartfelt essays on life with disabilities. Now they need your help.

Expenses (which are kept to a minimum) are outpacing revenues. If you would like to donate to keep them running, they could use every penny; no amount is too small. They are also looking for some help to obtain funding through a grant. If you know of anyone who could help, please let them know. Volunteers for the newsletter are always welcome!

A Different Path is a 501(c)(3) non-profit organization - all donations are tax deductible. The newsletter is published four times a year and is distributed to about 550 families. In 2008, they started offering A Different Path electronically as an email attachment and they encourage more families to switch to this method of distribution to save on mailing and printing costs.

To send donations, to offer help, or to receive a copy of the newsletter, contact:

Different Path
P.O. Box 8276
Ann Arbor, MI 48107-8276
Phone: (734) 395-5555
Email: beestange@comcast.net

Abuse charges against a WISD special education teacher's aide

The Washtenaw Intermediate School District operates special education programs in Washtenaw County, Michigan, for students with moderate to severe disabilities. In January 2009, a WISD teacher's aide was arraigned on two counts each of child abuse and assault and battery. He was accused of slapping and shoving two special education students under his care.

The incidents leading to the arraignment were brought to light in October 2008, when parents reported them to the WISD. The WISD conducted an internal investigation and placed the aide on disciplinary leave for failure to follow behavior plans. He was later transferred from Scarlett Elementary School where the incidents occurred to a special education classroom at High Point School. Both schools are in Ann Arbor, Michigan.

The parents were not satisfied with the response of the WISD and reported the incidents to the police for investigation. They felt the aide should have been removed from working with children. The charges of child abuse and battery came out of the police investigation.

In December, 2008, William Miller, the WISD Superintendent reopened the investigation and put two administrators on leave.

An internal investigation revealed that the WISD Director of Special Education failed to investigate other allegations that had occurred and told a teacher and teacher's aide to keep quiet and not to document incidents while she investigated them.

In February, 2009, the WISD Director of Special Education resigned under an agreement that she is barred from working for the district again. School district employees who suspect child abuse must report these allegations to the state. The incidents were not reported.

The aide was fired by the WISD and bound over for child abuse charges in February.

Here are links to the coverage in the Ann Arbor News:

Washtenaw Intermediate School District aide charged with child abuse
Posted by David Jesse | The Ann Arbor News January 22, 2009 15:59PM

2 WISD administrators placed on leave; district investigating whether child abuse laws followed
Posted by David Jesse | The Ann Arbor News January 28, 2009

Ex-school district staffer told others to stay mum, then botched probe of allegedly abusive aide
Posted by David Jesse | The Ann Arbor News February 14, 2009

Ex-WISD teacher's aide accused of assaulting students ordered to stand trial
Posted by David Jesse | The Ann Arbor News February 18, 2009

WISD special ed chief will be paid until April 30
Posted by David Jesse | The Ann Arbor News February 20, 2009 12:08PM

Investigation Report submitted to the WISD Board of Education, February 10, 2009

Forum on Mental Health Policy in Lansing: March 25th, 2009, 5 - 7:30 p.m.

The Michigan Department of Community Health (MDCH) will hold a forum on policy for mental health services for people with developmental disabilities, mental illness, substance abuse, and serious emotional disturbance. The forum will have two parts: the first will focus on the role that consumers, families, and advocates will play in the "Application for Renewal and Recommitment" process and the "Program Policy Guidelines". The second part will focus on the renewal of Michigan's 1915(b) Medicaid waiver. The state's application for this waiver is due June 30, 2009.

The notice for the forum gives complete information on where and when the forum will be held.

If you do not have the foggiest idea what the ARR, PPG, or the 1915(b) waiver are, you are not alone. Although this forum is specifically for consumers, families, and advocates, it appears to be aimed at the usual advocacy and consumer groups that have the resources and time to show up at meetings in Lansing. Which is exactly why ordinary people who use mental health services and their families should make an effort to go or at least to stay in touch with someone who will be there to find out what the state is up to.

At the MDCH Website, you can access some of the documents that will be the subject of the meeting.

The State has adopted a philosophical approach that holds that every consumer, including people with the most severe developmental disabilities, can and should live independently, work at a "real" job, and be totally integrated into the community with individual supports. Group homes, day programs, and other disability-only programs are considered to be segregated and therefore unacceptable, although there is nothing illegal or immoral about providing these programs to people who need them. Indeed, appropriate services and placements, including those that are "disability-only", are rights under the federal Developmental Disabilities Act. Many advocacy groups philosophically agree with the MDCH and provide cover for the state as they work to eliminate and narrow available options for people with disabilities.

Want to know more? Then you have to participate and make your voice heard.