Transcript of Public Hearing Vincennes
BEFORE THE
INDIANA FAMILY AND SOCIAL SERVICES ADMINISTRATION
OLMSTEAD PLAN
DRAFT PLAN FOR COMMUNITY INTEGRATION
FOR PERSONS WITH DISABILITIES
PUBLIC HEARING
TRANSCRIPT OF PROCEEDINGS
PETER SYBINSKY, HEARING OFFICER
CONFERENCE ROOM
HILLCREST BUILDING
2758-B E. PINEHALL DRIVE
VINCENNES, INDIANA
APRIL 20, 2001
ACCELERATED REPORTING AGENCY
2766 NORTH 600 EAST
FRANKLIN, INDIANA 46131
317/736-6115
TABLE OF CONTENTS
Opening Remarks by Hearing Officer Sybinsky
Public Comments:
Myrna Brown
Lori Hadlock & Larry Cullop
Dale Helmerich
Marth Libby
Mark Hill
Larry Marchino
Linda Witsman
Frances Donaldson
Laura Holtsure
Angie Lines
Norene Swartzentruber
Barbara Beaman
Pat Stewart
Adjournment
PROCEEDINGS
HEARING OFFICER SYBINSKY: Good afternoon. I'm Pete Sybinsky. I'm Deputy Secretary of Family and Social Services. I'd like to welcome you here to this meeting.
To begin with is there anyone in the audience who needs an interpreter or interpreter services?
(No response.)
If not, thank you very much. Today we're coming out to listen to what you have to say about the principles and ideas that we've put out in our draft plan for community integration for persons with disabilities.
I'd like to mention that I'm not the only here from Central staff or from FSSA. I think a lot of us have come to listen and hear what you've said, and we're making sure that some of our top administrators are at every meeting so that people do get an understanding of what you are telling us.
I'd like to first thank Larry Marchino, who is our Knox County Director for the Division of Family and Children. He helped us set up today and we really appreciate him and his folks being here. I'd also like to identify Ms. Alison Becker, who is Deputy Director for Division of Disability, Aging and Rehabilitative Services. Mr. Lee Witt, who is our consultant for another part of DDARS, Bureau of Aging and In-Home Services, and also Tom Rich, who's the Assistant Deputy of Mental Health, who is here with us today.
I would especially like to recognize our partners in the Independent Living Centers, Pat Stewart, and ATTIC not only for making this happen but also coordinating our meetings across the whole state and helping the folks who can't get in or folks who need to get input to us for this effort.
They have been real great partners along with the committee Governor's Planning Council on persons with disabilities who have provided some funding for this effort to get folks out to these meetings. So it's been a partnership and we look forward to working with ATTIC and the Independent Living Centers and the Planning Council as we move ahead in these efforts.
I'd like to spend just a couple of minutes giving a bit of background for the draft plan and telling you how it was put together, and then the meeting is yours.
In 1992 Central State Hospital was closed. It was the first big institutional closure in Indiana's history and looking at Central State as kind of a key point, because it really began in a real way to move to community integration in Indiana.
In 1997 and 1998 two state developmental centers, New Castle and Northern Indiana both closed and the folks who lived there were moved into community living. This started the trend, started the activity for persons with developmental disabilities. Large scale across the board since then actions have happened to bring people into community integration. In our mental health programs we have moved people out into the community so that they are actually 500 fewer beds in our institutions because people are living in the community more successfully.
There's 74,000 people who are being treated in the community through our mental health programs. There's 700 fewer persons in institutions in our Developmental Disabilities Program, and 4400 total people receiving community services in their own homes and the community.
We've tried in Indiana to use various funding mechanisms to pay for this. Medicaid waivers and Medicaid funding has been very critical to this effort. Very recently we completed two new Medicaid waivers, one for assisted living and another for adult foster care to broaden the array of options that can help people to move into community living or stay in the community as opposed as going into an institution.
In 1999 the legislature appropriated $39 million to assist 1300 people at risk of going into institutions to stay in the community and have community life. The mental health division has had a special effort to try to reach even the toughest persons to be institutionalized, long-term patients, and has moved 23 patients out of the hospitals who were in there for eight, ten, twelve or more years and now they're living in the community.
But this just the beginning. We all know that's there much more to do. An awful lot begins with planning. Governor O'Bannon's executive order, issued last fall, made it very clear that he wants the state to build on what it's done already, but thoroughly to involve the elderly and persons with disabilities throughout the process of planning a new system. One that will provide community integration for everyone who can benefit from it.
He also wants us to assess the state's compliance with the Supreme Court's Olmstead decision and ensure that we are going to be moving forward in the direction as the state is certainly legally required to, but also to continue the good work and the good activity that has been going on already.
We've gone out already to get consumer input. We've done everything we could to get input from consumers, families, advocates and providers.
In November we went out and had three public meetings across the state to get information, to get input on our planning process, on how we plan to do this.
Then in January and February of this year we called together three subcommittees. One appointed to help us with mental health issues, one with developmental disabilities issues, one with issues for persons who are elderly or physically disabled. And these subcommittees met and gave us quite a lot of direct input and feedback that have already gotten into this plan.
We also called together focus groups, consumers, families, advocates, providers from across the state to get their input, even people beyond these subcommittees and interviewed a good number of folks to get their input as well. So we've done a lot of spade work, we hope, to gather information and to gather feelings so that we could put this set of directions together.
Now we're at the standpoint of where we want to run those up the flag pole and get the public's input. This is one 12 meetings that we're going to be holding across the state to gauge people's ideas and reactions to what we've put down.
In June we will submit our final report to the Governor and that report will basically send to him our recommendations on what we should be doing from now on.
This plan is not meant to be a detailed focus on specifics. It is supposed to be a road map with system goals we can work on together and ways we can work together and directions we can go together to better serve persons with disabilities and the elderly.
I think the focus that we've gotten from a lot of the input already is that we need to really emphasis our efforts to assist consumers and their families in making choices about their care and particular care in the community. While the emphasis is community-based care, we do have to take care of people who are in institutions as well. Their needs are not going to be lost or overlooked in all of this.
There are basically six policy directions, and I'm going to go just very lightly over them because you have them in the brochures, you've looked at them in the plan.
First of all, increasing consumer choice is a very, very high priority so that people across the state, whether they're in an urban area or a rural area, will have choices that are meaningful to them about service, the location they take the service in and who gives them the service.
The second policy direction is to improve access to information and assistance. We want to emphasize informed choice. Unless people know what the options are there won't be any informed aspect and there won't be any choice aspect. So we really have to do a better job at informing people of what's available and how they can access those services.
Third, we need to support an informal network of families, friends, neighbors and communities, in general, helping them to take care of people in their charge. The informal caregiver network is such an important one and so many people have testified about their personal experience that they really need help. This is a key area where we really need to focus.
The fourth direction is to strengthen quality assurance, complaint systems and advocacy efforts. We need to have a quality system. We need to make sure that people are getting the services that they need in a respectful and complete manner. And we also have to have ways, if they aren't getting those services, that they can complain to us and let us know so that we can rectify the matter. We need to do better in that.
The fifth direction is to increase our capacity for high quality care. We've heard many, many statements from across the state from varieties of people about the additional services that are needed and the things we have to do to strengthen our service delivery system.
The final policy direction is to create a coordinated work force development system. Again we've heard from all over the state that there aren't enough workers, there isn't enough training, there isn't enough in the way of people to provide the services that are needed, and sometimes even those that are funded. That's the overview of what we've done and what we've said.
It's now time for us to listen. We've got a court reporter here that's taking down everything we say and it's going to be public document. It will be on the FSSA internet site so you'll be able to get it in about 10 days from now I expect. We will basically have these documents available to people so that they can see what was said across the state. We are going to use this information and take it back and crank it into our planning process and use it to improve our plan.
I'd like to ask, at least initially, that you try to focus your comments and limit them to make sure that everybody says what they can say and what they have to say. If you need to you can say more at the end, because we'll give you a chance to do that too. Letters, written comments and e-mails can be forwarded to us with testimony or comments up until April 27, 2001. We're going to read and look at and work with every comment that is made.
If you don't feel comfortable at standing up and saying something today, please feel free to write it down. In fact, please write it down and send it to us, because we really want to hear what you have to say.
I'm now going to take my seat, and give you all a chance now to speak and say what you want to say in terms of your reactions to this plan and your thoughts about what we need to do.
I'm going to go along first of all to the sign-up list and then after that it will be an open floor and I'll call on whoever raises their hand.
Myrna Brown.
MYRNA BROWN
My name is Mynra Brown, and I have been in public service all of my life. But today I want to talk about my aunt. If it weren't for the home care programs offered by Generations, my aunt would be in a nursing home. Aunt Louise is 89 years old, nearly blind, in a wheelchair and cannot walk, very strong willed and knows what she wants and when.
I serve as her caregiver and with the help from my daughter and son, I am able to meet most of her needs. Because of family support and home care services, she is able to stay at home. This is her choice. She has lived in her home almost 65 years and could not function in different surroundings.
We were fortunate that she was able to have her needs met by family members and Meals on Wheels while she waited over a year for services. She would have had to go to a nursing home if family and Meals on Wheels were not available.
My aunt is blessed to have family. But what would her fate have been had she not had family? How much would her care have cost? Would she have options?
It is difficult for me to accept that many individuals are forced into nursing homes because they lack family support and minimum services to meet their needs in the home.
On behalf of myself and the many individuals in our community, I encourage you to offer options in location of care.
These options should include a case management system that includes adequate staff with reasonable caseloads. Services available in less than 90 days. Funding for caregiver support including, but not limited to, training and respite. Funding for adult guardianship programs and money management services. Volunteers who could visit with individuals on waiting lists two to three times a week for a half hour. The elderly who have no family and no one to look in on them worry that something will happen and they will not be found for days. And funding to cover weekend visits by home health care staff.
I have seen the CHOICE program develop since it was piloted in Vincennes by Generations. This model is an excellent example of partnership with family, formal services and case management.
I would encourage this model be the basis for the expansion of services under the Olmstead Plan. And finally, I encourage you to share with the public the final plan, which I hope will include timelines, funding plan and other key components to make sure options for care become a reality, not just words.
Thank you.
HEARING OFFICER SYBINSKY: Thank you. Lori Hadlock and Larry Cullop.
LORI HADLOCK & LARRY CULLOP
MR. CULLOP: We have about 14 pages of constant reading here so it's going to take both of us. We were told to bring prepared remarks.
Lori and I are with Guardian Angel Home Health Care, and we do have a three-page document here that we developed for this discussion and I'll try not to go through each and every word, but I'm going to highlight some of it and then Lori and I can switch places or if you want us to sit down or leave, we can do that.
Basically, the Olmstead ruling is consistent with American values and supports the notion that everyone should have the right to live in the community of their choice. We firmly believe that this ideal extends to those persons with disabilities, possibly more so than persons who can fend more easily for themselves.
We find it wrong and intolerant that persons with disabilities are assumed to have lost the right to live in a community setting. Often they are considered unworthy of experiencing everyday life activities and a candidate that must be exiled to an institutional environment.
In that the Olmstead ruling provides interpretation of Title II, Americans with Disabilities Act, we suggest that ongoing challenges to the constitutionality of ADA immediately be addressed by the Supreme Court.
Subsequently, upon recognition of the constitutionality of ADA roadblocks will be cleared, the tenants of Olmstead acknowledged and subsequent events developed without challenge.
Funding for Olmstead seems to be a choking point issue that restricts development. Instead of an open unbiased look at the need to support the disadvantaged the uninformed only address additional taxation and often establish partisan political positions.
Educational endeavors by advocates of Olmstead may improve both the federal and state legislative understanding that more must be done to improve existing slow-paced efforts of implementation.
In place state-operated Medicaid and CHOICE programs function most efficiently. They should be utilized as organizations to implement Olmstead. Again, federal support in this area through existing channels to supplement state support funding is sorely required.
MS. HADLOCK: The state needs to follow a plan that specifies the means to provide the funding required to provide quality care to those with disabilities at above poverty levels for home based service caregivers.
This plan needs to provide specific time lines and goals to measure progress. There is need to provide increased training for case managers to ensure accurate assessment and management of these individuals.
Ongoing training for caregivers, guardians and medical professionals is required. At present, Indiana state government reports shortages in the state budget. It is reported Indiana has scrutinized the state funding of the already established CHOICE program and did not increase funding. Therefore, it remains well below known requirements.
Indiana home care providers have closed their doors or reduced their services to reduce losses in this area because they are unable to continue to provide services at below cost. Medicaid waiver slots are few and far between. Daily our agency turns down clients that do not qualify for Medicare based services, but are in need of assistance to remain in their home and cannot otherwise pay privately for these services.
Home health agencies struggle with the decision to maintain services to Medicaid, waiver and CHOICE, clients at below cost levels. It is possible that care for these clients in a community setting, versus an institutional setting, will continue to decline because the providers of these agencies will be out of business.
Federal and state governments must provide funding and commit to: Letting professionals provide the care in the community that they have been trained to do and desire to do; improve access to already established services by reducing the long waiting lists; increase the funding for community-based services to assure quality care; establish a mechanism to assure the continuance of quality; improve rates so that direct care workers are paid a living wage.
MR. CULLOP: In summary, the Olmstead ruling is consistent with American values; institutional exile or persons with disabilities without consideration of place in a community setting is wrong; any legal challenges to the Olmstead ruling or ADA must be quickly resolved so that positive development of the ruling can move forward; existing state-operated Medicaid and CHOICE programs should be used as a conduit to implement Olmstead; the state must put in place a plan to fund Olmstead, provide required training and oversight review; funding to Medicaid and CHOICE programs should be revisited by the legislature; positive consideration to increasing funds should be an objective; also rates for services require intensive review; and home health care providers cannot continue to lose revenue when serving Medicaid and CHOICE clients, constant revenue loss for these providers is driving them out of business, and the result is an escalation of a crisis because the service providers eventually will not be available, and without that particular ability to provide the in-home services, the services to anyone in the community requiring them will be not be able to get them.
So it's like a couple of snakes trailing one another.
We thank you for the opportunity to speak here.
HEARING OFFICER SYBINSKY: Thank you very much Lori and Larry.
Dale Helmerich and you're going to be giving testimony for someone else.
DALE HELMERICH INDIANA COMMISSION ON AGING
My name is Dale Helmerich. I'm on the Commission on Aging. I am the Chair of the Commission and I represent the Commission as an at large member.
I appreciate Dr. Sybinsky and staff for being here and giving us an opportunity to testify.
The Indiana Commission on Aging provides the following comments relative to the draft plan entitled Comprehensive Plan for Community Integration and Support of People with Disabilities, Policy Options to Support Individualized and Person Centered Services and Funding.
Reference is made to the Adult Guardianship Program on page 37, Appendix E of the draft plan. The Adult Guardianship Program is a valuable program. 284 individuals received adult guardianship services last year, fiscal year 2000.
Only 23 counties are covered by six providers, four area agencies on aging and two community mental health associations. Additional guardianships are needed on a statewide basis.
The Commission on Aging recommends that the Guardianship Program be expanded statewide to eliminate the present waiting list and to serve all counties of the state.
The program expended $390,376 in FY 2000. An additional $600,000 is needed each year. Reference is made to the state's CHOICE program on pages 37 through 43, Appendix E of the draft plan. Indiana's statewide in-home services program, of which CHOICE is a part, has been recognized by the National Governor's Association as a national model for its flexibility and responsiveness to consumer input.
12,338 individuals received services under the CHOICE program in FY 2000. An additional 7,400 individuals were on the waiting list for CHOICE services.
The present CHOICE funding is $42,623,785 per year, each year of the biennium. The Commission on Aging recommends that an additional $32 million per year, for each year of the biennium, is needed to meet the growing demands for services.
Reference is made to the need to redesign the home and community-based service waivers to incorporate the flexibility currently exhibited by the CHOICE program, page 43, item 17 of the Appendix of the draft plan.
The Commission on Aging agrees with this statement. On page 37, Appendix E of the draft plan, reference is made to the need of a unified vision across state agencies. Several groups have created vision statements including the CHOICE board of which the Commission on Aging chair is a member.
The Commission recommends that the CHOICE board vision statement be used as the beginning point in establishing a vision across state agencies.
The CHOICE board's vision statement is: The citizens of the State of Indiana shall have a full array of long-term care services that includes a range of individual options based on the principles of independence, quality, dignity, privacy and personal choice as directed by the consumer.
Note long-term care includes in-home care, community and facility based services including assisted living.
Reference is made to funding for community-based services being currently very limited, page 38, item 2, Appendix E of the draft plan. The Commission on Aging agrees with this statement and recommends that the state fund the 10,000 aged and disabled Medicaid waiver slots that have been approved by HCFA but have not been funded.
The state is currently only funding 2,500 individuals versus 12,500 approved slots. The Commission on Aging further recommends that the funding of Medicaid waiver slots be through a separate appropriation for the Medicaid waiver program and the utilization of CHOICE funds as a match for the Medicaid waiver program be eliminated, $4.9 million per year.
Reference is made to the Ombudsman program, the money management program, adult protective services program on page 37, Appendix E of the draft plan.
These programs are under funded. The Commission recommends that an additional $500,000 is needed for the Ombudsman program, presently $477,922, to allow Indiana to add more local Ombudsman to bring the state closer to the standard of one Ombudsman for every 200 nursing home residents.
An appropriation of $400,000 is needed each year for the money management program statewide, presently zero funding. It depends on volunteers. And approximately 200 individuals are served each year.
An additional $1 million is needed for the adult protective services program in order to expand the hours of operation, from five to seven days and 24 hour access to service. It presently serves approximately 12,000 individuals per year with an $856,224 budget per year.
Reference is made to the 16 Area Agencies on Aging serving as the single point of entry for in-home and community-based services, page 37, Appendix E of the draft plan.
The Commission recommends the continued support and the expansion of the single point of entry for services to older adults and individuals with disabilities of all ages to include new services as they become available in the State of Indiana, and to enhance the infra-structure of the Area Aging network as necessary to stay current. Reference is made to assisted living and adult foster care on page 43, Appendix E of the draft plan.
Full funding is needed for both of these programs that are scheduled for implementation in fiscal year 2002.
The Commission on Aging established the following priorities through year 2006, along with the governor's task force on Alzheimer's disease and related senile dementia, CHOICE board, and money management advisory council.
The Commission on Aging recommends that these priorities be addressed in the integration plan: Education, in the areas of health, aging, financial planning; health care; assisted living; transportation; and employment volunteerism.
I want to just add a few comments. I see the word elderly in here and I think that should be done with and say the aging network is what we need to look at. But I'm very pleased that the Commission is going to testify on all of the 20 areas that are under this program to have them appear, and provided they have a chance.
My second letter is from Red Roberts. Red has had a major surgery this past Monday and is in the hospital here in Vincennes and couldn't be with us. And I'm going to read his name so don't look at me as Red Roberts, please.
My name is Red Roberts and I have been a citizen of Knox County in Vincennes, Indiana, for over 79 years. I have established five successful businesses. I also serve on the advisory boards for both the Bettye J. McCormick Senior Center and Generations.
I would like to take this opportunity to address concerns I have regarding the Olmstead plan.
As a businessman, I understand the importance of defining what needs to be done, when it will be done, and how it will be financed. I see none of these critical components in your plan.
The vision is defined, but the meat of the plan to be implemented is not there. Our local senior center has provided adult day services for over 18 years through funds provided by Generations and private pay individuals.
We have seen marked health improvement in individuals because of the regular and on-going support and assistance received at the center. The Olmstead plan does not address how to build community capacity such as we have in Vincennes.
On a personal note, my brother-in-law is in need of assistance. Generation's case management program is very visible in the community and highly respected. However, they do not have adequate dollars available. The waiting list is over one and a half years long. The caseloads are too high and there are not enough case managers to be able to assist individuals on the waiting list prior to service dollars being available.
I encourage you to continue to develop partnerships with other state departments such as the department of commerce and transportation. This area has been fortunate to have public transportation available in five of the six counties Generations serve. The ability to choose to remain at home requires the ability to get to local businesses, work and medical facilities.
The Olmstead plan is a good beginning, but it lacks the detail, the structure needed to assure success. If the State of Indiana is committed to community options for individuals more planning must be put into the documents.
Thank you.
HEARING OFFICER SYBINSKY: Thank you, Dale, and give our thanks to Red.
Martha Libby.
MARTHA LIBBY LEAGUE OF WOMEN VOTERS
I want to read a letter going out to Dr. Peter Sybinsky.
Dear Dr. Sybinsky: I would like to introduce myself. My name is Martha Libby and I am a long-time member of the League of Women Voters.
The league supports in-home care and specifically the CHOICE program. In my opinion, the Olmstead plan does not adequately address some public policy issues.
Indiana must find a way to fund long-term care, both in nursing home facilities and community based options that allows an individual their choice of care. The present system makes nursing home placement an entitlement program and not community based.
Change the system, make community based entitlement. Our present method for defining options begins too late in the system. Individuals are already in need of extensive assistance by the time they are notified about community options.
Change the system, make point of entry at the earliest point of need. Pre-admission screening must be at the time of medical crisis, when options can be given. With pre-admission screening include the array of options.
Knox County has several options for care. We are blessed. We have adult day services, public transportation and assisted living. Even though we have these services, they are not available as options for many individuals.
As an example, our adult day services close at 3:00 p.m. because of limited resources and provides no services on weekends, therefore, adult day care services is not an option for family members caring for their older adult during these times.
We have two assisted living facilities in our community. Individuals with adequate financial resources have this option. If you are on Medicaid, you do not.
Individuals do not understand where to go for assistance. Too many offices and an alphabet soup of names confuse consumers and add to the stress they already have in their lives.
A single point of entry for all community-based services would eliminate the hunt and find game. The Area Agency on Aging, Generations, has operated a comprehensive system for over 15 years.
They are limited in what they can do because of funding to adequately staff the system and maintain a resource directory. Funding would address this. There is no need to add another player to the system. Why not strengthen what we have in existence.
Thank you for allowing me this opportunity to share my opinions. If I can be of any assistance, please let me know.
Sincerely, Martha Libby.
HEARING OFFICER SYBINSKY: Thank you, Martha. Who would like to speak next? Would anybody like to speak next? State your name and come on up.
MARK HILL CHILD AND ADOLESCENT SERVICES
I'm Mark Hill. I direct the child and adolescent services for the Good Samaritan here in Vincennes.
As I was overlooking the Olmstead act and the state's response to it, I guess I'm here speaking for the future adults and particularly have concerns about the transitional population.
I apologize I don't have a written statement to submit to you, but I'll try to do that over the internet.
The population I'm concerned about is the growing number of older adolescents that are coming out of residential treatment that may fall between the cracks. These, particularly, are young men and young women who do not meet the developmental disabilities criteria for placement or assistance through Medicaid waiver services.
And also seem to have the types of behavior that makes them difficult to be served in the adult mental health group homes or supported living, in that area. The needs have changed considerably over the last 10 or 15 years and include increased substance abuse, immaturity, history of aggression and other behavioral problems.
While it may seem like a small number to you in this room, I've been doing those for about 20 years and over the past two years I've had at least five individuals of this type that have come from the four counties that we serve, and as Mr. Marchino would attest to these are very challenging young people who really take multiple agencies to serve.
The other concern I would like to address since I received a fax today stating that the new admissions to the Madison State Hospital were being frozen including teenagers. While hospitalization and residential treatment for adolescents is a last resort I would say we make considerable efforts in this area to try to deflect or defer any type of hospitalization or residential treatment, and some of those efforts include increases in home-based services, offering of services at school and other sites, wrap around services, and parent consumer support programs.
But it's important to note that hospitalization and residential services are a part of the full continuum of care that needs to be considered by the state.
If you look at what's happened in our area, the Evansville Children Psychiatric Center for example, only accepts youth up to age 12, with LaRue Carter which is another state-operated facility, the waiting list for teenagers in that facility is at least six months. And the other closest state-operated facility is in Richmond, which is a considerable distance, obviously, for families. Certainly the Madison State Hospital is.
We have one young person currently there at that facility. I would encourage FSSA do the following: Wider support of wrap-around type services, to include money for planning, training and additional case management.
Thank you.
HEARING OFFICER SYBINSKY: Thank you.
LARRY MARCHINO KNOX COUNTY DIRECTOR DIVISION OF FAMILY AND CHILDREN
I didn't come prepared to speak but after listening to Mark and he brought up the subject, I'd like to piggyback on to what Mark said.
Much of the cost for these type of children that he's speaking of comes from county -- in fact all of it comes from the county up front and then it is possibly reimbursed if that child is eligible for some of the federal funding. But after that child turns 18, if that child is still under the care of the office of Family and Children, that directly impacts on county property tax, and that's something right now that I know is near and dear to very many people's hearts including those in the state legislature.
So I would like to second what Mark said we do need some additional transitional services for kids transitioning from adolescent services into older adolescent and adult services.
Thank you.
HEARING OFFICER SYBINSKY: Thank you, Larry. Does anyone else want to speak? Yes, please.
LINDA WITSMAN
My name is Linda Witsman. I'm from Loogootee, Indiana, Martin County, actually I live 13 miles north of Loogootee.
I'm particularly interested about the assistance available in all geographic areas. It seems like people in the state think that rural means -- you know, Franklin is rural to people in Indianapolis, and they really don't know what rural is. I can't even get on the internet where I live.
Behavior consultants for some of the children on the waiver is a real necessity. It makes their progress through life much better, much easier for the school to deal with when they have behavior consultants.
There are very few choices as I have seen as an advocate for the children with disabilities. I, myself, have two children with disabilities. A daughter 14 with Downs syndrome and a son 13 with autism.
Autism consultants are few and far to come by too, good ones that will come south of Bloomington. Please address this.
Also the adult day care center in Loogootee when we had it, it wasn't much to speak of. It closed very early like other people have noted. It wasn't even very excisable. If they had a fire I don't know how they would have gotten some of those people out of there, but at least they had some sort of an option. Now, it's totally gone.
I have much more testimony but I left it on the table at home. It's been one of those weeks. Thank you very much and I will be mailing that in.
HEARING OFFICER SYBINSKY: Please come up.
FRANCES DONALDSON
My name is Frances Donaldson and my daughter is here. She has a very mild disability. She holds down a full-time job. But housing -- we're trying to find her an apartment and there is nothing out there that she can afford. They say first and last month's rent, who can come up with $800 or $900 when you work in a factory like what she's doing.
We need low income housing for young people so they don't have to go in with the senior citizens. So they can have an apartment of their own where they can be with people they can enjoy activities with, but there is just no housing out there whatsoever for young people. So that's something we really need to work on, do some funding for that.
Right now she's doing great but we're still trying to find an apartment.
HEARING OFFICER SYBINSKY: Thank you very much, Frances.
Would anyone else like to testify?
LAURA HOLTSURE GENERATIONS
First of all I have a written testimony to submit on behalf of Bill Ficks from Good Samaritan Hospital. I won't read it because I know it will be included in the larger document.
I also have written testimony to submit on behalf of Beulah Memering, a concerned citizen. I won't read it because I know it will be a part of the document.
And another concerned citizen is Janet Daugherity. I am submitting written testimony on her behalf as well. And I have written testimony to submit on behalf of Melanie Oxmann at Riverfront American Nursing Care.
The one that I will read is testimony on behalf of Generations. My name is Laura Holtsure (phonetic). I am with Generations. And we want to thank you for allowing us this opportunity.
And I'll go over it briefly because basically it reiterates the comments of others. It is our belief, however, that the present Olmstead plan lacks the details and funding to accomplish these proposed public policy changes.
First of all in the Olmstead hearings it was clearly identified by both consumers and providers that PAS needs to be the first step in accessing services, and that consumers need a more effective single point of entry. This will allow them to choose services appropriately when they need them. At this time their choices are institutional placement or a waiting list. This was not clearly addressed in the plan.
Secondly, the present single point of entry includes information and assistance and waiting list management, as well as the gatekeeper to services through CHOICE, waiver, et cetera.
Information and assistance is an established program of Generations and it's a cornerstone service to long-term care. It is currently under funded. With adequate resources we could maximize the impact on individuals. Expansion could include 24 hours per day, seven days a week.
Access to a case manager would be available. That way we would be able to provide the potential to maximize both formal and informal services.
Third, quality improvement is a process that requires an action plan, clarity of expectation and clear definition on accountability. The Olmstead plan lacks all of these components. We need a plan that defines standards, not philosophies, and includes consequences for poor quality.
We need a real plan that has real meat. The Olmstead plan does not. Over the last few years, the coordination of roles in the field continues to duplicate or conflict with each other. We must develop a plan that maximizes the roles of BDDS, AAA, and the state bureau department.
Finally, quality assurance is not a free service. It takes funds and training to make sure we are monitoring outcomes. We must develop a system that looks at results of clients' choices.
Four, this is the fifth year this agency has attempted to get rate increases for the waiver. When will our cries for help be heard? We all need an adequate salary to be able to provide a decent standard of living for our families and ourselves. When the economy becomes competitive for workers, human services must become competitive as well. People are leaving their jobs because of pay, not because of dissatisfaction with what they are doing. Providers cannot attract and retain workers without adequate rates from Medicaid waiver and all funding sources. Nor can they address enhancing quality assurance without adequate resources for training and skill development.
We thank you for this opportunity, and if you have any questions, please feel free to contact us.
Thank you.
16 HEARING OFFICER SYBINSKY: Thank you.
ANGIE LINES
My name is Angie Lines and I'm community guide at ATTIC, and I work to advocate and provide resources to people with disabilities. My desire for Indiana to have an effective comprehensive state plan for our community integration is based on wanting everyone in Indiana to be able to live in the community as they choose with all the support that they need in order to be successful.
That's basically pretty much our motto where I work, in fact it's very close to our agency motto.
My concerns for this plan are as follows: Under the policy direction of the working plan the process which must occur in order to ensure the promotion of community integration are listed as options. And these processes should not be listed as options. They should be listed as recommendations or some other wordings which denotes that these processes must be implemented and not just that one has a discretion to implement them as is meant by the word option.
Although not stated in the plan there needs to be a commission established under the governor to address issues relating to disability, and that's not stated in the plan.
How we finance the implementation of the plan, that needs to be addressed. How do we find out who wants to move out of an institution?
There is nothing written in the plan to say how that will happen. And how will the time frame and specific goals for moving people into the community be set, measured and reported, that's not stated.
Thank you.
HEARING OFFICER SYBINSKY: Thank you, Angie.
NORENE SWARTZENTRUBER
I have written letters that I want to submit for other people.
My name is Norene Swartzentruber. I am an advocate for people with disabilities. My interest in Indiana's comprehensive plan for community integration and support is that everyone who chooses to will be able to assert their civil right to live in the community they choose with the necessary supports to be successful.
Some of the concerns I have for this plan include: I am working with people who live in group homes and nursing homes that do not want to live in an institutionalized setting. They have some understanding of what they want and need to live in their communities. But what about the people who don't know or understand that they do not have to live in group homes, nursing homes or large institutions. How will we find out who wants to move out. How will this process be financed. Also, will the dollars that provide services in an institution follow the individuals into the community.
The question I am asked most frequently is how long do I have to wait to move out. We need to know how time frames and specific goals for moving people into the community will be set, measured, and reported. Who will oversee the plan? If a commission is established to implement the plan, who will be on that commission. Will it be state agencies only or will knowledgeable consumers, provider agencies who have a good history of promoting community inclusion, advocates, independent living centers, transportation, employment and housing organizations be included.
Another concern is the language used in the plan. Using the word recommendations or points of compliance would be more effective language than the word options.
In closing, I support a unified vision across state agencies to provide community integration. We all must work hard to bring together the fragmented services that we have now.
We must change our way of thinking in terms of social services and approach this in the manner of civil rights for all people including those with disabilities.
Thank you.
HEARING OFFICER SYBINSKY: Does anyone else want to speak? Does anyone want to add to anything they've said?
VOICE: Can I do it from here?
HEARING OFFICER SYBINSKY: Sure.
BARBARA BEAMAN
I go along with Myrna 100 percent on what she was saying. I have been an in-home healthcare worker for 13 years. I also took care of her aunt. I have found -- and I need help myself now. The training that these people need to go in and help take care of these people is important.
There are a lot of people who don't know how to move a kitchen chair and sweep under it. I'm having that problem in my own home now with the help I'm receiving. I could see a lot of stuff that needs to be addressed. They just need some of these people to go in and help these people, they do need training to clean and cook and maybe wash dishes.
I had to go back behind somebody and wash dishes all over again and wash the stove down in my own house. So the training is important, that's what I'd like to address.
HEARING OFFICER SYBINSKY: Could you tell us your name?
MS. BEAMAN: Barbara Beaman. I might add too, I done that work for 13 years and then I got cancer and got down. Then I had, at the time, a 35-year-old mentally handicapped daughter who had a stroke and real bad diabetic, and then it just seemed like our health problems has went down, down, down constantly and we have to have help now. I have osteoarthritis in my knees. I'm just tired all the time from chemotherapy and them things seem to drag a person down and there's no getting back up.
HEARING OFFICER SYBINSKY: Thank you very much. You've given the need for help a very good example. Does anyone else want to testify?
PAT STEWART
I don't really want to testify but I never neglect a teaching moment and one of the things that I've heard a lot of testimony today and lot of angst is the fact that there's not really a developed plan. Please let me tell you that's exactly the intent. Because of your comments, what you're saying you need, and what we need to see developed is what the consultants will take back to put together so that we will have a plan I guarantee you by June -- is it -- that we will see something written.
Now, along that line I would like to add publicly that I would too like to see time lines on this and also who is going to be held responsible for making sure that they're implemented. And I only add that because I know that's what we are mandated to do.
Thank you.
HEARING OFFICER SYBINSKY: Is there anyone else?
(No response.)
If there are no more comments or testimony, I'm going to bring this meeting to a formal close. But I and the other folks from FSSA will stick around in case anybody wants to talk to us, wants to give us any informal input. And again, I would like to remind you to please, if you do have comments that you want to submit in writing, please send them to us by April 27th.
Thank you very much for coming. We really appreciate the time you spent with us.
(Hearing concluded at 3:10 p.m., April 20, 2001.)
STATE OF INDIANA )
) SS:
COUNTY OF JOHNSON )
I, Linda R. Merkl a Shorthand Reporter and Notary Public, in and for the County of Johnson, State of Indiana, do hereby certify that the foregoing hearing was taken on behalf of the Olmstead Plan in Vincennes, Indiana, beginning at 1:00 p.m. on the 20th day of April, 2001; That said hearing was taken down in stenograph notes and afterwards reduced to typewriting under my direction; and that the typewritten transcript is a true record, to the best of my knowledge and belief;
IN WITNESS WHEREOF, I have hereunto set my hand and affixed by notarial seal this 27th day of April, 2001.
______________________
Linda R. Merkl
Notary Public
Residing in Johnson County
My Commission Expires:
January 27, 2009
