Montana non-profit service providers echo funding problems found in other states.

In an opinion piece from 9/26/16, from a Montana news site Missoulian.com, Jesse Dunn and five other co-signers from non-profit organizations, make a case for the difficulties of providing quality services to people with developmental disabilities when funding has not kept pace with requirements for maintaining and improving care:

Funding needed to responsibly care for individuals with developmental disabilities

“The Montana Department of Public Health and Human Services administers a variety of programs funded by state and federal appropriations to pay for the services provided by the nonprofit direct care providers. Sadly, the funding levels for disability services have lagged over the past decade and failed to meet the rising costs of providing essential services to this special population. Consequently, hiring and retaining qualified, experienced direct care providers has become a near crisis situation. Vacancies, high turnover rates and inadequately experienced care givers plague human service nonprofits, obstructing the mission to enhance our clients’ quality of life. Nonprofits need an adequate number of qualified staff to responsibly care for eligible individuals. Further, the laws regulating support services for people with disabilities mandate staff-to-client ratios to ensure safe and effective client care.

"However, those staffing challenges are getting worse as inflation, mandated government regulations and rising standards of care all keep driving up the cost of providing services. Those of us who belong to the Montana Association of Community Disability Services wish to highlight this issue on behalf of those with developmental and intellectual disabilities whom we serve. For us, it is unconscionable to watch our nonprofit agencies slip further behind and sacrifice quality care for those who are severely disabled. We believe we must educate the public and lawmakers to the plight of these nonprofit agencies that represent an otherwise voiceless community for whom we advocate.

"It is our wish that those who care about the quality of life and safety of individuals who experience disabilities will join us in calling for a review of the current funding mechanisms…

"The funding deficit is not limited to direct care staff but also, with such complex billing and reporting obligations that go along with state and federal programs, there is a crucial need for sophisticated financial management and internal controls. The level of expertise and experience needed to track, control, report and manage the range of different government-financed programs that fund the services nonprofits provide is expensive. Thus, we need adequate funding for both direct care services and for the required financial management and accountability that nonprofits seek.

"…Please join us in getting this message out on behalf of those who do not have a voice in the public policy process."

*************************

Well-said, Montana service providers!

Read the full article here...

Crisis in Care: Direct Support Workers earn poverty wages; solutions needed to stabilize support services

"The Cost of Compassion" from the Oregon Rehabilitation Association

In Michigan, a 2015 survey by the Partnership for Fair Caregiver Wages shows that employers can't attract Direct Service Providers with the current reimbursement rates:

"In the spring of 2014, the Michigan Legislature passed a law to increase the standard minimum hourly wage, via annual increases, from $7.40 to $9.25 by January 1, 2018. The Legislature did not provide any additional funding for the wages of direct-support workers, the employees of state-funded programs that care for and support some of the most vulnerable people in our state. 

"An estimated 44,000 direct-support jobs are funded through Medicaid appropriations to support and serve people with intellectual and developmental disabilities, mental illnesses, and substance use disorders. Employers of these workers depend on Medicaid funding provided through the Michigan Department of Health and Human Services, and unlike other businesses, have little or no ability to increase revenues to meet increased staff costs. 

"Even before the increases in the minimum wage, staffing shortages tied to low wage rates were creating soon-to-be-crisis-level consequences."  [Emphasis added]

High Turnover Rate: "Among those surveyed, a 37 percent turnover rate = loss of 6,308 employees in a single year. "

Direct-Support Workers Earn Poverty Wages 

2,600 direct-support workers are needed now.

*****************************  
The Partnership for Fair Caregiver Wages is a coalition of state-wide organizations advocating for persons with disabilities, direct support staff, and employers as well as regional community mental health boards and individual employers. This coalition is seeking sufficient public dollars to raise the wages of direct support staff in Medicaid-funded programs supporting people with intellectual and developmental disabilities, mental illness, and substance use disorders.

For more information, please contact Hollis Turnham at hturnham@PHInational.org or Robert Stein at rstein@miassistedliving.org.
*****************************  
What is a "Living Wage" in your state? Find out here.  

Friends of the Developmentally Disabled, Washtenaw County, MI

Friends of the Developmentally Disabled, (aka Friends of DD) began as a group of families of people with developmental disabilities more than 10 years. Initially, our purpose was to support people with DD in local group homes and in the day program at Washtenaw Community Mental Health. We never organized formally, although we once may have elected a treasurer. This turned out to be unnecessary, because we never had any money. 
 
We have managed for a long time without a formal organization, although, at least until recently, we have met regularly, and we have cranked out a newsletter to go along with the (almost monthly) meeting notices. We tend to have family members whose loved-ones are on the more severe end of the range of people with developmental disabilities, but everyone is welcome to attend our meetings and sign up for the newsletter.
 
When we started, we came up with a set of principles. We rarely refer to this document, but we adhere pretty closely to it. Here it is:

• People with developmental disabilities have diverse needs based on the nature and severity of their disabilities, their experiences, and family circumstances.
• For people with developmental disabilities who cannot speak for themselves, the best advocate is a parent, other family member, or close friend who is aware of the individual’s needs and cares about the welfare of that individual.
• To meet the long-term needs of people with developmental disabilities, a full range of services, programs, and living arrangements, designed to meet their unique needs, must be available and the availability communicated to people with DD and their families.

Our purposes are:

• To ensure the availability and delivery of appropriate services to people with developmental disabilities while protecting the rights and preserving the dignity of those individuals.
• To provide information so that people with developmental disabilities and their families or friends can advocate for themselves to obtain the services they need.
• To communicate with public officials charged with the responsibility for providing services and protecting the rights of the developmentally disabled and to ensure the accountability of public agencies to people with developmental disabilities and the public.

And furthermore, Friends of DD does not dictate to you what is best for your family member or browbeat you into conforming to a particular ideology or belief.  

This year, we have not met as often as we have in past years, but I have been sending out more information by e-mail with frequent updates on issues affecting families and people with disabilities. Friends of DD has joined ddAdvocates of Michigan, an Internet-based network of community organizations and family members. The purpose of ddAdvocates is to provide information to families and friends and apprise them of opportunities to comment on local, state, and national policies affecting people with developmental disabilities.

Jill Barker
Friends of DD
Ann Arbor, MI

Michigan Home Help Services for people with disabilities

The Home Help Services Program is administered by the Michigan Department of Human Services and is paid for by Medicaid. It allows adults with developmental and other disabilities to receive help so that they can stay in their own homes or their family's home. Home Help funding is also given to people in supported living homes to supplement other services provided by the local Community Mental Health agency.

Home Help Services include preparing meals, clean-up and feeding, toileting, bathing, grooming, dressing, moving around the house, taking medicine, shopping, laundry, and light housework. People enrolled in the Home Help Services program employ their own provider who may be a friend or relative (including a parent if the adult-child is over 18 years old).

The number of hours paid for depend on a functional assessment of Activities of Daily Living and Instrumental Activities of Daily Living. The maximum amount of money available under regular home help services is $549/ month. Expanded Home Help Services for people who need more help pays up to $1300/month depending on the need for more services. Funding over $1300/month is possible with approval by the Michigan Department of Community Health.

To learn more about the program and to apply for benefits contact your local Department of Human Services. For Washtenaw County, contact:

Department of Human Services
22 Center St.
Ypsilanti, MI 48198
Phone: (734) 481-2000

If your funding for services is decreased or denied, you must be given an Advance Negative Action Notice (a notice that tells you why the action was taken and your right to appeal the decision). You have the right to appeal the decision through a Medicaid Hearing. If you ask for the hearing before the date the action is to go into effect, the service and funding must continue until a decision has been made by a Medicaid hearing officer.  Here is a brochure explaining the basics of Medicaid Hearings.

As a guardian of a person in the Home Help Program, you may file for a Medicaid Hearing on behalf of the person, but you must send a copy of the Court Order from the probate court granting guardianship with your hearing request.

More information on Home Help Services is available in the Adult Services Manual. Click on the Independent Living Services Program Overview, Requirements, and Procedures (ASM 361, 362, and 363) for much more information on Home Help Services.

Update on the homeless shelter option in Indiana

It seems there is more substance than I thought to the charge that Indiana has a policy  that recommends homeless shelters as an option for people with developmental disabilities. According to a report from TV Channel 6 in Indianapolis, a discharge plan form is given to people who are either not eligible for services or who choose not to receive services. The form lists a Homeless Initiative Program as a resource and refers to a list of homeless shelters.

My guess is that people who "choose not to receive services" do so not because they are particularly fussy, but because the services offered make no sense for their family member or are of such poor quality that nothing is better than something. As for people who are not eligible for services, we might be surprised at the severity of the problems people have who have been rejected by the system of care for people with developmental disabilities.

A spokesman for the Indiana Family and Social Services Administration acknowledges the existence of the discharge form, yet still denies that homeless shelters are offered as an option.

So the real scandal is all those things listed below, plus evidence that Indiana has a policy of offering homeless shelters to at least some families as options for their developmentally disabled family members.

Indiana homeless shelters: an option for severely disabled?

An AP article reports that parents of severely disabled children and adults in Indiana have been told to drop their family members off at homeless shelters, if they can no longer care for their children at home.

As it turns out, this is not an official state policy and there are no confirmed cases of parents actually following through with that suggestion. It appears it was more of a threat by frustrated employees of Indiana social service agencies to get parents to back off from their complaining about the unavailability of Medicaid waivers that could pay for services at home.

The real scandal is this:

• 20,000 people are on waiting lists with some people waiting 10 years for services.
• Governor Mitch Daniel ordered budget cuts that eliminated 2,000 Medicaid waiver slots since July.
• Foster children with disabilities have been moved to a less costly program that doesn't provide services for special needs and they had a food benefit taken away.

Almost everyone agrees that we should help the "truly needy", but doing it and paying for it are something else altogether.

Florida parents plan communities for developmentally disabled

In Florida, there are more than 18,000 developmentally disabled people waiting for services and residential placements. That translates to a 10 -15 year wait for most people. Parents have taken this dilemma into their own hands and have begun developing planned communities for their family members. Noah's Ark of Central Florida has plans to create communities modeled on retirement communities that are home to seniors all over the country.

The communities will include families and caregivers of their primary residents, people with developmental disabilities. They will be a blend of apartments, villas, group homes, and single-family homes with spaces for socializing, recreation, and vocational and educational activities. One village, Noah's Nest, has three homes near downtown Lakeland, Florida.

One obstacle the parents faced was a state law that prevented group homes from being established within 1,000 feet of each other, so they lobbied the Florida legislature to change the law. According to an article in the Miami Herald, April 27, 2010, they were opposed by advocates who claimed that the planned communities are institutions that segregate people from the rest of society:

"In our society, we call places like this institutions," said Kingsley Ross, who represents Sunrise community, a nonprofit organization catering to the developmentally disabled and the elderly. "People with developmental disabilities have to be in contact with good models of behavior. If you surround them with people that don't have normal types of behavior, what we are going to see is more people with bad behavior."

[Kingsley Ross, who worries so much about other people's behavior, is a registered lobbyist for the Autism Society of Florida and Sunrise Community, Inc., a non-profit provider of group homes and other services for people with disabilities and seniors.]

The family members, however, have a different view . Many of their loved-ones have already experienced "community living" and have found it to be isolating, not fulfilling, and even dangerous. Families are not trying to compete with options that work well for many people with disabilities, but to offer more options and choice based on the needs and preferences of their loved ones.

The law to rescind the restriction on group homes was passed and signed by Governor Crist on June 3rd, 2010. Well done, Florida parents!

[See also: Michigan group homes for severely disabled]

MACMHB and DD policy

The Executive Board of the Michigan Association of Community Mental Health Boards met Monday night, May 17, 2010, at the Hyatt Regency hotel in Dearborn, Michigan. It was the first night of the organization's Spring conference.

The reason it is important to know what the MACMHB is up to is because this is one of the venues where state mental health policy gets discussed, hashed out, and sometimes handed over or taken up by the Department of Community Mental Health (MDCH) to be recirculated through all the CMH agencies in the state.

I was most interested in the Board's reaction to the Choice Resolution , a policy/value statement that shores up the right of developmentally disabled consumers to services and placements suitable to their needs and preferences. It is intended to counteract an alarming push by some advocates and the MDCH to limit and eventually eliminate specialized services for people with DD that are provided in group settings, which the advocates and MDCH consider to be segregated and discriminatory. They support choice, of course, but they want to limit choice to the services and settings they want our DD family members to have.

Three public comments (mine included), all supporting the Choice Resolution, got the ball rolling, so to speak. After a few routine agenda items were taken care of, Michael Head, Deputy Director of the Mental Health and Substance Abuse Administration for the MDCH, gave his report to the Board along with his comments on the Choice Resolution. During his report, he mentioned that he does not like to be demonized. So I will say upfront, that he did not have horns and if he had a tail, he hid it well.

Michael Head obviously did not like the criticism of the MDCH. The Board had received many e-mails from families objecting to the "Vision for All People with Developmental Disabilities", a draft policy paper coming out of The Standards Group, a strange little quasi-subcommittee of the MACMHB that I will try to explain at another time. In an odd attempt to both defend the Vision statement and disavow it, Michael. Head said that it was important to have a dialectic on these issues, but he didn't pay much attention to it and had never read it!

He feels he has been misrepresented and that his primary concern is for people with high vulnerabilities in the system whom he has decided do not do as well in larger facilities. He does not like the wording of the Choice Resolution and says it gives "a wink and a nod" to isolation and segregation. He also said the genesis of the wording for the statement came form MARO , a Michigan training and employment association that he said is trying to save the jobs of its members. Fortunately, parents from Western Michigan who were involved in the original wording of the statement on Choice, were sitting behind me at the meeting. They said the wording came from parents and had nothing to do with MARO.

In a display of confusion and general wimpishness, the Executive Board decided to table the Choice Resolution for another time. Michael Brashears from Ottawa County CMH and Jan Plas from Livingston County CMH, both supporters of the Choice Resolution, voted against tabling it and 19 others voted for tabling the resolution.

Later, in a report from The Standards Group, Laura Vredeveld said they had lots of calls from parents and advocates about the DD Vision statement and that no consensus had been reached on the document. Some advocates felt the document should be even more restrictive of services available. She said the most polarizing aspects of the Vision statement will be removed including value judgments on specific services and settings.

There was both passion and bluster in the discussion of the Choice Resolution and very little was resolved. There is no doubt that e-mails and phone calls from families voicing their opinion on choice and the vision statement had an impact on the Board members and the MDCH.

If you don't say anything, you don't have a say.

The WCHO, the Governor's budget, and DD services

The Washtenaw Community Health Organization (WCHO) board met last night. The Executive Director Patrick Barrie summarized the Governor's proposed budget for the Department of Community Health for fiscal year 2011. It shows an increase in Medicaid funding for MDCH of about 3% and a small decrease in General Fund allocations. This sounds much better than the dire predictions of up to 20% cuts in DCH programs, but the proposals are based on some shaky assumptions:

• that the tax system will be restructured to lower the sales tax and imposes a tax on services;
• that large numbers of teachers and state employees will retire and be replaced with new hires at a lower pay rate and decreased benefits;
• that physicians and hospitals will be taxed to generate more federal funds that will go back to physicians and hospitals;
• and that federal Medicaid stimulus funds will be extended for another six months.

The largest reductions proposed are in funds for people with substance abuse problems. These are often the same people who end up in emergency rooms and hospitals at greater cost to the health care system and the community than if they had received treatment before they reached a crisis situation. There has been much discussion at the WCHO board and committee meetings of plans to provide better access to services for people with mental illness and substance abuse problems. Early access saves money in the long run and generally improves the quality of life for these consumers.

So far in this budget crisis, there has been almost no discussion by the WCHO board of services for people with developmental disabilities other than to say that most people with developmental disabilities qualify for Medicaid and are therefore entitled to services. It helps that Medicaid funding is available and will probably increase.

We know, however, that the Michigan Department of Community Health is targeting for elimination programs for people with the most severe disabilties - group homes, sheltered workshops, and day programs. One might logically think that the state is motivated by a desire not only to save money, but to shift more of the responsibility from serving people with severe and complex disabilities from the state to local mental health agencies. But the state claims to have a higher moral purpose: specialized programs that serve only people with disabilities discriminate against them by isolating and segregating them from people who are not disabled. By eliminating these programs the state serves the noble purpose of rescuing people with disabilities from discrimination.

The mental health system fully supports people with mental illness and substance abuse problems in joining together in clubhouse programs and recovery and support groups. Other parts of the system encourage a full array of options for senior citizens, including group living in independent and assisted living facilities. But when it comes to people with severe developmental disabilities, the state is set on saving them from the horrible fate of having to associate with people like themselves. Now that's discrimination!

Washtenaw County: CHS Vocational Services Contract Reinstated

This is an update to another blog entry from 11/19/09.

At the December 2009 WCHO Board meeting, the Board voted to rescind an earlier decision to discontinue a contract with CHS, an agency that provides supported employment and other vocational services to people in Washtenaw County. The initial decision to discontinue the contract was based on a misunderstanding regarding CHS's financial status. After CHS reported to the Board about its financial stability, the contract was reinstated.

CHS will continue to serve the same client base and provide the same skill building/supported employment services as they have been doing.

Update on WCHO vocational programs

See update here.

Developmentally disabled consumers in vocational and skill-building programs in Washtenaw County can expect these programs to continue, although some consumers receiving supported employment services will be working through another provider.

At the November 17, 2009 meeting, the Washtenaw Community Health Organization (WCHO) Board voted to discontinue the contract with CHS, a provider of supported employment services, and reassign consumers receiving supported employment services to Workskills, another supported employment provider, and Community Supports and Treatment Services (CSTS). The CSTS skill-building programs (day programs and PACE groups) will continue as is. No consumers will lose vocational and skill-building services.

The programs provided by CSTS were threatened earlier in the year by drastic lay-offs and cuts by the Washtenaw County Board of Commissioners in order to plug a $30 million hole in the county budget. The County renegotiated labor contracts with county employee unions, saving $5.2 million over the next two years and 120 - 150 county jobs at CSTS.

The WCHO, which contracts for services from CSTS, will be able to fund the vocational and skill-building programs by consolidating some programs and using increased Medicaid funding from the federal government.

All three of the supported employment service providers (CSTS, Workskills, and CHS), had few complaints from recipient rights or customer services, but CHS is having serious financial problems. [It was noted at the meeting that there have been complaints about the choice of jobs available through supported employment programs.] The WCHO Board decided that the option of maintaining the contract with Workskills and CSTS would least disrupt consumers and still be cost-effective.

Changes are expected to be implemented by March 1st, 2010, which will allow time for adequate communication and negotiation with providers and adjusted work at CSTS.

Update on Washtenaw County programs and other budget news

Donna Sabourin, the Director of Community Supports and Treatment Services, attended the last Friends of the Developmentally Disabled meeting on September 24th, 2009 and was able to give us an update on CSTS vocational services to people with DD.

Without knowing how much the Washtenaw Community Health Organization will be getting from state general funds, the WCHO granted an extension of the contract with CSTS for 90 days. Some cuts to CSTS were made final by the Washtenaw County Board of Commissioners, but these cuts did not affect vocational and skill-building services.

According to Donna, the WCHO would like CSTS to continue providing vocational services and to take in two other programs that were contracted to other providers. A work skills program that has provided supported employment services to one group of consumers for 10 years would go to CSTS along with a program for another group of consumers that has has had three providers in 5 years. By taking in these two programs, there will be less choice in providers for employment programs, but it will give the second group of consumers more stability. CSTS has also said that the agency can provide these services without increasing staffing, saving money for the WHCO.

At the time of the Friends meeting, Donna said that a tentative agreement on concessions from the employees union had been reached. According to Annarbor.com, October 7, 2009, Washtenaw County workers union gives up raise to save jobs, the membership of AFSCME Local 2733 has indeed agreed not to take a previously agreed on 3% raise in 2010 and to forgo a salary adjustment in 2011. The agreement will save $5.2 million over the next two years and 120 - 150 county jobs. The union has also agreed to take 8 "bank days", similar to furlough days.

Bob Guenzel, Washtenaw County Adminstrator, according to Annarbor.com, had high praise for the union:

I want to give a special pat on the back to our labor partners...They really came through and, remember, they didn't have to sit down to the table with us at all. They stepped up and, in my mind, really put the county first and put services first.

The Washtenaw County Board of Commissioners also voted unanimously to restore over $442,750 in human services funding in exchange for $450,000 in capital expense reductions. It appears that the county is on the verge of having a balanced budget for the next two years.

The state is operating on a continuation budget for 30 days while the legislature continues to negotiate a balanced budget. At the September WCHO meeting, there was discussion of the likelihood of severe and unprecedented general fund cuts to the Michigan mental health budget. The state seems unwilling or unable to come up with a long term solution to deficits in mental health funding. The impact of reduced general funds for mental health will be felt more by people with mental illness than by those who are developmentally disabled.

The WCHO October meeting is scheduled for Tuesday, October 20th, 2009 from 6 - 8 p.m. at the LRC, 4135 Washtenaw Ave, Ann Arbor. For a schedule of official meetings in Washtenaw County, you can view the calendar of events here.

Washtenaw County funding cuts for DD services

The Washtenaw County Board of Commissioners (BOC) met on September 2, 2009. During public participation at the beginning of the meeting, at least five people, some with their disabled family member, made statements to the commissioners opposing proposals to reduce funding to Community Supports and Treatment Services' (CSTS) vocational and skill-building programs. The BOC was genuinely moved by the family members who talked about how much they rely on these programs for their loved ones and the distress it causes when programs are abruptly changed or terminated. The commissioners appeared not to be aware of the heartfelt opposition to these proposals.

The meeting was covered by AnnArbor.com and the Ann Arbor Chronicle .

Part of the meeting that was not covered by local on-line news, were comments and questions by Ronnie Peterson, a commissioner from Ypsilanti. He has personal experience with a disabled uncle whom his family cared for and was especially sympathetic to the concerns of families. First, he emphasized that the BOC has not taken any steps on CSTS funding. He was surprised by the opposition from families concerning cuts in funding by the county that could result in CSTS losing many programs that families rely on. He wondered what steps CSTS had taken to involve and inform families of possible funding cuts, before the BOC was notified of the impact these cuts would have on CSTS programs. He said he would not want to approve something opposed by consumers.

Donna Sabourin, the director of CSTS, spoke much later in the meeting to update the BOC on CSTS funding. She said the Washtenaw Community Health Organization (WCHO) contracts with the CSTS to provide the vocational and skill-building programs that serve a large number of people with developmental disabilities. She presented three options for the future of these programs:

1. The WCHO receives Medicaid funding for the vast majority of people participating in these programs and expects increases in Medicaid funds to help pay for services. The WCHO might increase funding to CSTS to make up for the cuts in funding from Washtenaw County and keep current programs, if funding permits.
2. The WCHO could contract with other entities to provide the same services at less cost.
3. The WCHO already uses other contractors to provide some vocational services. There has been a problem with some of these programs having to switch providers every year. The CSTS could bring these programs back to CSTS without increasing CSTS staffing, thereby saving money and maintaining their current programs with WCHO funding, including the increases in Medicaid funding.
   

The 3rd option may be the best, but it would require approval of the WCHO based on that agency’s estimate of future funding.

BOC meetings are available for viewing by webcast here. Past meetings are found in the archives. Under the viewing screen, there is a place where you can select an agenda item (such as Public Participation) and go directly to viewing that part of the meeting.

Important meetings coming up:

WCHO Board Meeting: Tuesday, September 15, 2009, 6 – 9 p.m. at the LRC building at 4135 Washtenaw Ave., Ann Arbor. Contact information: Suzanne Gondek at (734) 544-3014 or gondeks@ewashtenaw.org .

Washtenaw BOC Meeting: Wednesday, September 16, 2009, 6:30 p.m., Board Room in the Administration Building at 220 N. Main St., Ann Arbor.

Jill Barker
Friends of the Developmentally Disabled
jillrbarker@sbcglobal.net

Cuts to Mental Health Services: Survival of the Fittest?

This letter appeared in AnnArbor.com on Sunday August 30, 2009:

When I read the article about slashing services to Washtenaw County's Community Support and Treatment Services in the news, I thought: "Yep, here we go again with the survival of the fittest."

The (relatively young and healthy) people in power (elected to represent us, NOT resent us) could survive a cut in pay or hours, but the seniors and handicapped and mentally ill, WILL surely suffer to varying but great degrees.

Advocates must constantly remind these decision makers that the level of a community is determined by how well we take care of those who cannot take care of themselves (in all the myriad different ways).

Please put your heart before your head or wallet.

Jane Mariouw, Ann Arbor

August 18th WCHO board meeting with public comments on proposed cuts to CSTS

The Washtenaw Community Health Organization (WCHO) Board met on August 18, 2009. Since the WCHO's last Board meeting, the Washtenaw County Board of Commissioners met to discuss the possibility of cutting County services, including mental health programs. This is a summary of parts of the Board meeting that relate to that issue:

Patrick Barrie, the WCHO Executive Director, and Board members reiterated that the WCHO has a responsibility to provide services written into person-centered plans for people with developmental disabilities and that, in any case, those services will be provided whether it is through Community Supports and Treatment Services (CSTS) or through other contracted providers.

Washtenaw County is obligated to fund 10% of the WCHO budget, but it has gone well beyond that in the past in supporting mental health programs. It is the discretionary part (above their 10 % contribution) that can be cut.

The Impact Statement of program cuts from Donna Sabourin, CSTS director, is laid out on pages 11 - 22 of this document .

Public Participation:

During public participation at the beginning of the WCHO Board meeting, I noted that Donna Sabourin had presented Washtenaw County with an impact statement of possible cuts to CSTS and asked if there had been any attempt to consider consumers and family members’ views regarding possible cuts? (Board members agreed that they need to improve communication with families and consumers.) After I became aware of the possibility of cuts from the County, I heard more specifically that this could mean laying off 60 people from CSTS jobs in vocational, training, and day programs.

One of my concerns is that these types of programs (day programs, workshops, PACE programs, and enclaves) are easy targets for elimination by the state with support from advocates who would tell you that everyone can work at a paying job and live in the community like everyone else and that these programs are isolating and discriminatory. For people who need these programs, they are a lifeline for both consumers and their families and are a useful and necessary part of the system of care and services.

Another family member commented that contracting out services (which is a possibility if the County makes severe cuts to CSTS) is not always the best plan for the long term. He works for a car company that did that. They found that workers had a lower level of skills and that they saw a general degradation of services. They went back to hiring their own people rather than outsourcing the work.

More information on the WCHO and County and state budgets:

• The WCHO has a fiscal year that begins on October 1st. The County' s fiscal year begins on January 1st. The cuts the county is contemplating would go into effect on January 1st, 2010.
• Everyone is awaiting the State budget. At this time the strongest and most reliable funding will be from Medicaid. The Medicaid match from the federal government will be going up, based on the state’s financial problems. The state will be paid under the old rates until the state files a new agreement with the federal government.
• The state got an increase of $1 billion in Medicaid stimulus money. With state revenues declining precipitously, the state used up the stimulus funds in three months. The state would have been in even worse shape without it.
• Barbara Levin Bergman who is a County Commissioner and WCHO Board member said the WCHO needs a better method of explaining budget problems and offered her phone number for anyone who had questions about it. Here is her email address: bergmanb@ewashtenaw.org .

After the meeting, I asked Barbara Levin Bergman which of the Commissioners meetings are the most important to attend. She said all of them. I will try to attend as many as possible and will pass on what I find out. I would love to have company at these meetings if any of you can attend.

Here are the meetings through the month of September:

• 8/26 Administrative Briefing 5:00 p.m. Administration Conference Room
• 9/2 Ways & Means Committee 6:30 p.m. Board Room, Administration Building
• 9/2 Board of Commissioners 6:45 p.m. Board Room, Administration Building
• 9/3 Board Working Session 6:30 p.m. Board Room, Administration Building
• 9/9 Administrative Briefing 5:00 p.m. Administration Conference Room
• 9/16 Ways & Means Committee 6:30 p.m. Board Room, Administration Building
• 9/16 Board of Commissioners (Annual Meeting) 6:45 p.m. Board Room, Administration Building
• 9/17 Board Working Session 6:30 p.m. Board Room, Administration Building

The other thing that Barbara Bergman suggested for us to do is for anyone with concerns about these proposed cuts to contact their own County Commissioner.

• Here is a map of the County so that you can determine who your Commissioner is.
• Here is a list of all the Commissioners with their contact information.

It is important for the County to understand that these programs, whether or not they are mandatory as far as the County is concerned, are essential for many people with developmental disabilities who have very few options available. Both they and their families are adversely affected by abrupt changes in their lives more than most people.

If you would like more information about the WCHO Board and what it is doing, you may ask to be put on an email list to receive the packet of materials sent out to the Board before every meeting. Email Suzanne Gondek at gondeks@ewashtenaw.org

Jill Barker
jillrbarker@sbcglobal.net

Seeing Red - More on cuts to CSTS

Here is a statement dated August 10, 2009, from Bob Guenzel, the Washtenaw County Administrator on budget reduction options for programs that receive county funds. One thing that is important to understand is that when Guenzel talks about non-mandated services, he means that the county is under no obligation to fund certain programs but has done so in the past because of the benefit to the community. The WCHO does have an obligation to continue providing services written into person-centered plans for people with developmental disabilities, even if they are no longer provided by Community Supports and Treatment Services (CSTS).

Guenzel says:

At last Wednesday's Ways and Means meeting I presented the Phase II 2010/11 budget reduction options to the Board of Commissioners. These options included the reduction or elimination of many worthwhile programs, and undoubtedly will directly impact the community and the organization.

It's important to remember, however, that these are only options at the present time -- not my recommendation. No decisions have been made. There are no easy choices, and over the next few months the Board will deliberate the proposed alternatives and determine where the necessary budget reductions will be necessary.

The largest amount of money to be saved, however, comes from mental health programs provided by Community Supports and Treatment Services (CSTS). According to Sally Amos O'Neal from customer services, up to 60 jobs may be cut from vocational and training programs such as day programs, enclaves, PACE programs, and job coaching.

Important dates in the Washtenaw County Board of Commissioners budget process include:

• September 11th - 2010/11 Budget Adjustment Recommendations Phase II will be posted to the web
• September 16th - Guenzel will present his 2010/11 Budget Adjustment Recommendations Phase II to the Board
• November 18th - The Board is scheduled to adopt a balanced budget

Another document worth looking at if you want the gory details on possible cuts to various programs, how much money will be saved and how many people will be laid off, look here. Those specifically involving mental health are on pages 11 - 22.

Slashing of mental health services begins

AnnArbor.Com reported last week in an article entitled "Washtenaw County Board has tough decisions to make; 181 county jobs on the line", that the Washtenaw County Board of Commissioners is on the brink of cutting 181 county jobs. The County is facing a $30 million deficit.

While many other cuts are being considered, the largest are in Mental Health services:

The county could realize up to $2.4 million in savings through reductions to mental health services, which would eliminate 91.4 full-time jobs.

Employees of Community Supports and Treatment Services, the public agency in Washtenaw County that provides mental health services to people with developmental disabilities, mental illness, and substance abuse problems, work for Washtenaw County. The County's proposal so far is to eliminate over 90 positions at CSTS. ALL vocational programs, including several day programs, PACE groups, job coaches, and enclaves will either be eliminated or contracted out in this proposal.

The exact impact of this is uncertain. The WCHO gets about 10% of its funds from the county. At a Washtenaw Community Health Organization Board meeting earlier this year, it appeared that county cuts would not have much impact because the WCHO relies mostly on state and federal funds and the agency has been successful in obtaining grants that make more funds available.

The WCHO has sent out a letter to consumers with the following paragraph:

At the request of the County, Donna Sabourin, Executive Director of CSTS, submitted an impact statement to the Washtenaw Board of Commissioners showing the possible impact of cuts in county funding. The proposal listed possible position reductions, and potential outsourcing, cutbacks and/or elimination of various CSTS operated programs. While it is necessary for CSTS to clearly identify reduction options and scenarios for the Board of Commissioners, the WCHO has an obligation - under state law and federal waiver requirements - to make available certain services to particular priority groups and eligible beneficiaries, within the constraints of the funds appropriated by the Legislature for these purposes and populations. To meet these obligations, the WCHO’s contract with CSTS for the budget year that begins October 1st may stipulate provision of programs/services that are different from those currently prioritized by CSTS for retention, reduction or elimination.

No final decisions have been made with regard to program, provider, or service changes.

At this point, questions about the letter to consumers should be directed to Sally Amos O'Neal from WCHO Customer Service: Phone: (734) 544-6807 Email: amoss@ewashtenaw.org

In the meantime, most of the groups that are being affected by the cuts have raised Holy Hell at recent meetings of the County Commissioners. I think it's time to make the concerns of people with developmental disabilities heard, but we need more information. The next Board meeting of the WCHO is on Tuesday, August 18, 2009 from 6:00 pm to 8:00 pm at the Learning Resource Center at 4135 Washtenaw, Ann Arbor, MI (enter from Hogback Road, near the Washtenaw Ave. Interstate 23 overpass).

There is time for audience participation at the beginning and end of the meeting.

Other meetings coming up are the County Ways and Means committee on 9/2/09 6:30 to 6:45 followed by the Board of Commissioners from 6:45 - 8:00 pm. Check the calendar here for information on the location of these meetings and contact information.

I am not sure yet which are the most important meetings to attend, but let's begin with the WCHO Board meeting on Tuesday August 18, 2009 so that we can ask some pertinent questions about what is happening. Even if all the services are outsourced, these kinds of cuts will gut the CSTS of experienced employees, which can't help but have a huge impact on our family members.

I will send updates when they are available. If any of you have any information or questions about this, let me know.

This and further information will be posted on my blog at theddnewsblog.blogspot.com

Jill Barker
Friends of the Developmentally Disabled
jillrbarker@sbcglobal.net

Michigan Conference on Medicaid Waivers

Home and Community Based Waivers are available to provide a wide array of services to people living at home or in other community settings including group homes. Your developmentally disabled family member may already have a waiver - if that is the case, you were asked to give consent to use waiver services instead of placement in an Intermediate Care Facility for the Mentally Retarded (ICF/MR).

Families usually don't receive much information about the waivers, the services they pay for, and how your local Community Mental Health agency is spending the money from the waiver. But access to HCBS waivers is often vitally important to getting all the services your family member needs to live safely and comfortably in whatever setting is appropriate.

This conference may help you to fill in the gaps in your knowledge about Medicaid waivers and how it might help your family. I'm hoping that's the case. As always, these mental health people are in love with acronyms and funny language ("wrap-around facilitators"???) Here is the the text of the flyer sent out by the MACMHB and the Michigan Department of Community Health:

MI Association of Community Mental Health Boards, in partnership with the MI Department of Community Health presents:

Annual Home & Community Based Waiver Conference
September 9 & 10, 2009

Kellogg Hotel & Conference Center
MSU, East Lansing, Michigan

3 Featured Waivers:

• Children's Waiver Program (CWP)
• Habilitation Supports Waiver (HSW)
• Serious Emotional Disturbance Waiver (SEDW)

Workshop Goals and Objectives: Learning objectives for each educational activity are identified within the body of the brochure.

Who Should Attend: Case managers, supports coordinators, wrap-around facilitators, clinicians, administrative staff, providers, consumers, and family members.

Consumers & Family Members: A special rate is available for consumers and family members. [The special rate is $50 for the whole 2-day conference.]

Continuing Education Credits: The Michigan Association of Community Mental Health Boards (MACMHB), provider #1140, is approved as a provider for social work continuing education by the Association of Social Work Boards (ASWB) through the Approved Continuing Education (ACE) program. MACMHB maintains responsibility for the program. Social workers participating in this conference (9/9/09-9/10/09) may receive a maximum of 10.5 continuing education clock hours.

Evaluation: There will be an opportunity for each participant to complete an evaluation of the conference and the instructor. If you have any issues with the way in which this conference was conducted or other problems, you may note that on your evaluation of the conference or you may contact MACMHB at 517-374-6848 or through our webpage at www.macmhb.org for resolution.

Includes Plenary Sessions such as:

• “Asperger’s and the Five Senses”and Concurrent Workshops such as:
• "Medication and the Child and Teenage Brain: What do Psychiatrists do? What do Medications do? Can we all Work as a Team?"
• "Getting Started in Self-Determination"
• "Benefits and Community Supports for Persons with Developmental Disabilities and Mental "Illnesses
• "Increasing Independence for Children with Autism through Visual Supports"
• "Project ImPACT: Teaching Parents of Children with ASD Strategies to Enhance Their Child’s Social Communication"
• and much more

Other MACMHB Trainings here.

WCHO Oversight of Provider Agencies

In May 2009, the WCHO Board asked for a report from the Organization Operation Committee (that is an awkward name, but that really is what they call it) to give the Board a better understanding of how the WCHO carries out its oversight and monitoring responsibilities of the provider agencies that are contracted to provide services to WCHO consumers.

This request was motivated in part by problems with Community Residence Corporation, an agency that provides community living supports to consumers in unlicensed settings as well as staffing for licensed group homes. According to a report to the OOC on Provider Oversight & Monitoring (June 2009), since Michigan was granted the Medicaid 1115 Waiver, Community Mental Health agencies have created opportunities for more consumer choice, resulting in the growth of the contractor provider network. Many consumers have moved out of licensed settings into smaller supported living sites. Currently there are over 220 individual service delivery sites that must be monitored. This rapid growth in the number of sites has strained the capacity of the WCHO to assess the services being provided and to oversee and monitor contracted providers.

The June 2009 report goes on to discuss "risk management" and the current "monitoring framework".

I did not attend the July WCHO Board meeting, but at the August 5th, 2009 OOC meeting there was further discussion of continuing problems with oversight of provider agencies. Community Residence Corporation has been given provisional status to continue to provide services. Although there has been staff training, there was a question as to whether training included a "competency component" - did the training make the staff more competent at handling situations that have caused problems in the past?

There was also a discussion of two contracts that WCHO was recommending be approved:

One was to add residential services for a consumer with predatory sexual behaviors who is leaving Mount Pleasant Center to a contract with Spectrum Community Services. Spectrum has experience with this population and has a licensed home in Wayne County that will cost the WCHO $188,106 per year. (There are three other residents who live in the home at the same cost per person.)

Leila Bauer, a WCHO Board member and OOC member, had questions about the ability of Spectrum to provide the services. She has been in contact with families whose family members live in a supported living situation managed by Spectrum. Even though staff are there 24 hours per day, the police have had to be called several times, and there have been some serious incidents. Families do not know what their rights are or who to complain to and Spectrum has not been responsive.

The OOC decided to recommend the contract for additional services by Spectrum. In addition, a recommendation was made by the committee for the WCHO Board to file a recipient rights complaint on behalf of the consumers at the supported living site and for recipient rights to begin an investigation into the quality of services being provided.

The second contract was for the CHC Group, LLC that currently provides services in Monroe County. The proposal is to add CHC to the community living supports panel to provide Supported Employment services in Washtenaw County. The OOC has been discussing the problem of having too many providers to oversee, and the question came up as to why they should add another provider? The OOC recommended approval of the contract, but was not entirely comfortable with the decision.

These particular items on the OOC agenda were the ones I paid attention to because they affected people with developmental disabilities. There were other items involving other WCHO consumers, but those groups will have to get their own blog.

The Committee had many thorny issues to deal with and I had the impression that they lacked all the information necessary to feel comfortable with their decisions, but they are expecting to recieve more information and to be kept informed by WCHO staff.

Helpsource Announces it will close by September 30th

Helpsource is the largest nongovernmental service agency in Washtenaw County. According to an article in the Ann Arbor News, the agency's United Way contributions were cut by 25%. Since its creation in 1996, the staff has been cut from 400 to 122, its client base has fallen from 5,000 to 600, and its budget dropped from a high of $11 million to $4.9 million.

Board members decided that HelpSource no longer can afford to provide the services its clients deserve.

The agency provides numerous youth services along with services for seniors, mental health counseling, and substance abuse programs. Developmentally disabled adults participate in the adult day care program.