Public Comment — DADS Council State Supported Living Center Long-term Plan

TCDD Letterhead

Public Comment
Department of Aging and Disability Services Council
State Supported Living Center Long-term Plan
September 11, 2014

Good morning. My name is Jessica Ramos and I am the Public Policy Director with the Texas Council for Developmental Disabilities. Thank you for the opportunity to provide input to the Department of Aging and Disability Services (DADS) 10 year plan for the provision of services to persons residing in State Supported Living Centers (SSLCs). TCDD is established by federal law and is governed by 27 board members, appointed by the Governor, 60% of whom are individuals with developmental disabilities or family members of individuals with disabilities. The Council’s purpose in law is to encourage policy change so that people with disabilities have opportunities to be fully included in their communities and exercise control over their own lives.

TCDD continues to commend DADS for implementing proposals from community advocates that we believe are improvements to the SSLC system. Specifically, we’re very pleased with the significant commitment made by DADS to provide Person Centered Thinking training at all of the SSLCs and the opportunity provided to the Texas Advocates to train and support SSLC residents so that Self Advocate Voices are Engaged (Project SAVE) to create change for themselves and their community. DADS support of the enhanced transition work being done by Austin Travis County Integral Care at the Austin SSLC has been lauded by many and we would be remiss if we did not acknowledge the tremendous outcomes for individuals and the promising practices that we believe should be expanded throughout the system. We hope that the SSLC long-term plan will include and expand all of these practices.

TCDD has been making recommendations for the last several biennia to rebalance the system that serves persons with intellectual and developmental disabilities by expanding cost-effective policies that honor the choices of individuals to live in the most integrated setting to meet their needs, identifying and providing supports and services to meet the needs of persons when and where they need them, and transferring the anticipated savings so that more persons with disabilities have the opportunity to be included in their communities. The Sunset Advisory Commission Staff Report recommendations regarding the consolidation and closure of six SSLCs are consistent with our longstanding rebalancing recommendations and provide substantial supporting evidence that should be used as a primary resource in the preparation of the State Supported Living Center Long-term Plan.

The Council continues to support a moratorium on new admissions to SSLCs based on the circumstances necessitating the U.S. Department of Justice’s (DOJ) involvement in the SSLC system and the lack of substantial compliance with about 70 percent of the agreement’s provisions. The Council also supports the position that people with developmental disabilities should have access to high-quality services and supports wherever they live. Planning for substantial compliance with all of the provisions in the settlement agreement should be a central feature of the State Supported Living Center Long-term Plan.

The Sunset Advisory Commission recommends that the State Supported Living Centers should have the authority to be paid to provide services to community based waiver participants. The State Supported Living Center Long-term Plan should be explicit that resources should not be diverted or expanded to serve persons in the community until the state can demonstrate substantial compliance with the DOJ settlement agreement. The plan should lay out the circumstances that need to exist before undertaking a project that would require resources for a new billing infrastructure, program rules, monitoring and staff. The SSLC system has enough priorities to occupy the next decade without developing a new business model.

The DOJ settlement agreement regarding the 13 SSLCs in Texas sought to: increase protections of SSLC residents; bring supports and services up to generally accepted professional standards of care; provide the most appropriate level of care to SSLC residents; and provide residents with information about and the choice to transition to the most integrated community placement possible. The settlement agreement with the DOJ required the monitors to provide an assessment of the status of compliance. It was released in June and provides explicit recommendations about how to improve SSLC services. It is notable that the monitors recommended that the state hire consultants to bring the state into compliance in only three of the 20 substantive provisions: Section C — Protection from Harm — Restraints; Section T — Providing Services in the Most Integrated Setting Appropriate to Meet a Person’s Needs; and Section U — Consent.

In Section T, Providing Services in the Most Integrated Setting Appropriate to Meet a Person’s Needs, of the Four Year Report, the monitors question whether the state has the capacity to develop an acceptable community living discharge planning process and specifically recommends that the state hire consultants to work with all facilities on the development and implementation of adequate process. The monitors affirm that some transitions were significantly delayed and that some people who should have been recommended for transition were not. The State Supported Living Center Long-term Plan should include the expectation that DADS hire consultants to work on the discharge planning process so that people who can transition to the community do so with all deliberate speed.

In Section U, Consent, of the Four Year Report, the monitors identified the conflict relating to facility directors making decisions for individuals without guardians and considered to be incapacitated. It should be noted that federal case law finds that persons in institutions without guardians or involved family members who can live in the community but cannot express a preference should be provided with community-based services. TCDD supports the monitor’s recommendation for the state to employ an expert to focus on alternatives to guardianship that will support community living for people with disabilities. These alternatives should include the supported decision making methods that were reported to be working well in at least one SSLC.

To address both Section T and Section U, the State Supported Living Center Long-term Plan should require that DADS develop and implement a peer support program for individuals with IDD by individuals with IDD which will be a significant way to encourage more empowerment and choice. Peer support is currently being used by DSHS at state hospitals. TCDD recommends that DADS and the Department of State Health Services to collaborate to develop and implement a Medicaid funded peer support program to assist with supported decision making and community transition.

The State Supported Living Center Long-term Plan requires an objective review of census trends, consumer preference and quality of care. All of the other objective reviews have resulted in the acknowledgment that the profile of the system far exceeds demand and that people prefer to receive services in the community. The plan should lay out an expectation for fewer institutions and to bring services up to generally accepted professional standards of care for those remaining.

Thank you for the opportunity to provide input on behalf of the Texas Council for Developmental Disabilities.

Jessica Ramos
Public Policy Director