MIME-Version: 1.0
Content-Type: multipart/related; boundary="----=_NextPart_01C9B200.5037FB40"
This document is a Single File Web Page, also known as a Web Archive file. If you are seeing this message, your browser or editor doesn't support Web Archive files. Please download a browser that supports Web Archive, such as Microsoft Internet Explorer.
------=_NextPart_01C9B200.5037FB40
Content-Location: file:///C:/06471E08/RACOHENABLENH.htm
Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"
Right to Prompt and Quality Services for Individuals with Intellectu=
al
and Developmental Disabilities
This presentation contains content that your browser may not be able to =
show
properly. This presentation was optimized for more recent versions of Micro=
soft
Internet Explorer.
<=
u>RSA
171-A, State Developmental Service =
Law-Enacted in 1975
ØState must “maintain” and supervise a
“state<=
span
style=3D'position:absolute;top:35.75%;left:6.92%;width:85.58%;height:5.75%=
'>service delivery system” (SDS)
Ø=
SDS includes community living arrangements, day services, training, therapeutic employment, =
;
service coordinat=
ion,
Area Agencies, and all components
necessary to ensure appropriate care, protection from harm, opportunities for a quality =
life in the normal domains of community living.
ØRSA 171-A establishes rights to those services in =
the SDS
------=_NextPart_01C9B200.5037FB40
Content-Location: file:///C:/06471E08/RACOHENABLENH_files/slide0002.htm
Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"
Right to Prompt and Quality Services for Individuals with Intellectu=
al
and Developmental Disabilities
=
Rights
under State Law, RSA 171-A include:
A.Individuals with developmental disabilities have a=
right
to “adequate … habilitation
and treatment, including such psychological, medical, vocational, social, education or rehabilitative se=
rvices
as his condition requir=
es to
bring about an improvement in condition within
the limits of =
modern
knowledge.”RSA 1=
71-A:13
[QUALITY]
=
B.
=
B.Right to services that are individualized to perso=
ns
needs interests and abilit=
ies.
[INDIVIDUALIZED]
=
C.
C.Right to services in the least restrictive
environment.[LRE]
D=
.
D.Right to timely provision of services [NO WAITING =
OVER
90 DAYS as of 7/10]&=
nbsp;
=
E.
E.Right to be free from harm, abuse, neglect &#=
13;
=
F.
F.Right to be deemed competent to manage affairs unl=
ess
court declares incapa=
ble
=
G.
------=_NextPart_01C9B200.5037FB40
Content-Location: file:///C:/06471E08/RACOHENABLENH_files/slide0003.htm
Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"
Right to Prompt and Quality Services for Individuals with Intellectu=
al
and Developmental Disabilities
Examples of More
Specific Rights in Regulations<=
/span>
<=
span
style=3D'font-size:44%'>Ø503.8(b)All services shall be designed to:
̶=
6;
̶=
6; (1)Promote the individual’s pe=
rsonal
development and quality of life in a manner that is =
determined by the individual;
̶=
6;
•(2)Meet the individual’s needs=
in
personal care, employment, adult education and leisure =
activities;
̶=
6;
̶=
6; (3)Promote the individual’s he=
alth
and safety;
̶=
6;
̶=
6; (4)Protect the individual’s ri=
ght to
freedom from abuse, neglect and exploitation;
̶=
6;
̶=
6; (5)Increase the individual’s
participation in a variety of integrated activities and settings;
̶=
6;
•(6)Provide opportunities for the
individual to exercise personal choice, independence and autonomy withinthe bounds of
reasonable risks;
̶=
6;
̶=
6; (7)Enhance the individual’s ab=
ility
to perform personally meaningful or functional activities;
̶=
6;
•(8)Assist the individual to acquire =
and
maintain life skills, such as, managing a personal budget, <=
span
style=3D'position:absolute;top:72.5%;left:7.3%;width:84.45%;height:3.25%'>=
participating in meal preparation, or traveling sa=
fely
in the community; and
̶=
6;
•(9)Be provided in such a way that the
individual is seen as a valued, contributing member of his <=
span
style=3D'position:absolute;top:80.5%;left:7.3%;width:84.45%;height:3.25%'>=
or her community.
̶=
6;
=
̶=
6; (10)The environment or setting in whi=
ch an
individual receives services shall promote that =
individual’s freedom of movement, ability to make informed decisions, self-=
determination, and participation in the communi=
ty.
------=_NextPart_01C9B200.5037FB40
Content-Location: file:///C:/06471E08/RACOHENABLENH_files/slide0004.htm
Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"
Right to Prompt and Quality Services for Individuals with Intellectu=
al
and Developmental Disabilities
Rights to
Services in Lay, Non-Legal Terms (include)
A.Individualized Service Agreement spelling out serv=
ices
based on assessments of nee=
d,
interests, abilities, aspirations
=
B.
B.Timely Initiation of New or Modified Services
=
=
C.
C.Residential living supports (with the presumption =
that
most young adults will be abl=
e to
move into residential arrangement in the community)
=
D.
D.Rewarding employment for most individuals, often w=
ith
supports or rich day or
avocational activities (and usually both)
=
E.
E.Community and Quality of Life Opportunities genera=
lly
available to all folks
<=
/span>
=
F.
F.Assistive Technology and Reasonable Accommodations=
•
•
------=_NextPart_01C9B200.5037FB40
Content-Location: file:///C:/06471E08/RACOHENABLENH_files/slide0005.htm
Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"
Right to Prompt and Quality Services for Individuals with Intellectu=
al
and Developmental Disabilities
<=
u>Services’
Rights in Lay, Non-Legal Terms (continued)
•
=
G.Right to choice, self-determination and to be as
independent as pos=
sible
(with an environment, approach, and services that promotes those rights)
=
H.
H.Funding to pay for the supports or services but wh=
ere possible and desirable reliance on natural supports
=
I.
I.Direct support and professional workforce that is
qualified and suited &=
#13;
=
J.
J.High quality service coordination to make it all
happen
•
=
•
------=_NextPart_01C9B200.5037FB40
Content-Location: file:///C:/06471E08/RACOHENABLENH_files/slide0006.htm
Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"
Right to Prompt and Quality Services for Individuals with Intellectu=
al
and Developmental Disabilities
§For past 15 years for existing client services, on=
ly
about two yearly rate incre=
ases
have been given totaling 3-4%, yet costs have risen over about 50%.
§Direct support staff, supervisory staff and service
coordination wages =
very
low making recruitment, retention of qualified workforce, turnover a huge problem
------=_NextPart_01C9B200.5037FB40
Content-Location: file:///C:/06471E08/RACOHENABLENH_files/slide0007.htm
Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"
Right to Prompt and Quality Services for Individuals with Intellectu=
al
and Developmental Disabilities
Dimensions of the
Funding Problem (cont.)<=
br>
̶=
6;
§<=
span
style=3D'font-size:63%'>More reliance on families to provide care, and wit=
h less
supports and funding.
<=
/span>
<=
span
style=3D'font-size:63%'>§Reduced licensing staff by about 40%
̶=
6;
§Availability of Professional Capacity particularly=
to
address individuals with c=
omplex
health, behavioral, communication, or assistive technology or community risk needs great=
ly
diminished
------=_NextPart_01C9B200.5037FB40
Content-Location: file:///C:/06471E08/RACOHENABLENH_files/slide0008.htm
Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"
Right to Prompt and Quality Services for Individuals with Intellectu=
al
and Developmental Disabilities
=
Renewing
the Vision, prepared by BDS for =
Legislature
and Governor Shaheen (2001)
<=
span
style=3D'font-size:56%'>•Held forums around the state
̶=
6;
•Catalogued the huge problems and stresses associat=
ed
with the waitlist familie=
s and
individuals endured
̶=
6;
•Vast majority of parents saw their children moving=
out
when they were grown&#=
13;
̶=
6;
•Documented need for a variety of housing options, =
not
just enhanced family care=
3;
̶=
6;
<=
span
style=3D'font-size:56%'>•More employment options for individuals
̶=
6;
<=
span
style=3D'font-size:56%'>•Address wages of workforce
̶=
6;
<=
span
style=3D'font-size:56%'>•More efficient and responsive quality improvement systems
=
------=_NextPart_01C9B200.5037FB40
Content-Location: file:///C:/06471E08/RACOHENABLENH_files/slide0009.htm
Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"
Right to Prompt and Quality Services for Individuals with Intellectu=
al
and Developmental Disabilities
=
Governor’s
Commission on the Area Agencies (2005)
̶=
6;
•Broad based group appointed by Governor Lynch of A=
rea
Agency and Government
Officials, Provides, Family members, self advocate, =
DD Council, DRC, business community
̶=
6;
<=
span
style=3D'font-size:63%'>•Made many of the same findings in Renewing the Vision, plus others=
3;
̶=
6;
<=
span
style=3D'font-size:63%'>•Made 35 recommendations, pertaining to
̶=
6;=
--Waitlist
issue (no one should wait more than 90 days)
̶=
6; --Salary
issues, training and supervisory and professional HR issues
̶=
6; --Infrastructure
issues
̶=
6; --Quality
Assurance, need for standardization
------=_NextPart_01C9B200.5037FB40
Content-Location: file:///C:/06471E08/RACOHENABLENH_files/slide0010.htm
Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"
Right to Prompt and Quality Services for Individuals with Intellectu=
al
and Developmental Disabilities
=
2006
Amendment to RSA 171-A: 1.P=
olicy
of =
the
state that service delivery system should =
be based on:
I.Participation of people with developmental disabil=
ities
and their families in decisio=
ns
concerning necessary, desirable, and appropriate services….
II.
II.Serv=
ices
that offer comprehensive, responsive, and flexible support as =
individual and family needs evolve over time.
=
;
III.
III. Individual and family services based on full
participation in the=
community, sharing ordinary places, developing
meaningful relationships, and
learning things that are useful, as well as enhancing the social and economic status of persons served.
IV.
IV.Services that are relevant to the individual's age,
abilities, and life goals, including
support for gainful employment that maximizes the individual's =
potential for self-sufficiency and independence. &=
#13;
V.
V.Services based on individual choice, satisfaction,
safety, and positive outcome=
s.
VI.
VI.Services provided by competent, appropriately trai=
ned
and compensated staff.&=
#13;
•
------=_NextPart_01C9B200.5037FB40
Content-Location: file:///C:/06471E08/RACOHENABLENH_files/slide0011.htm
Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"
Right to Prompt and Quality Services for Individuals with Intellectu=
al
and Developmental Disabilities
<=
u>Major
SB 138 Statutory Requirements <=
u>(applies
to DD and ABD)(passed 2007)=
ØEffective July 1, 2009, New Requirements regarding=
service initiation and funding allocation.
̶=
6;=
3;
§<=
/span>For children exiting school who are clients of AA,
funding must be allocated=
to
them early enough so that new or modified
services start upon graduation or exit from school
̶=
6;
§<=
/span>For others, funding for new services cannot exceed=
90
days from development =
of
service agreement
§<=
/span>For clients already receiving services, new or mod=
ified services trigged by significant life changes, must=
be
started no later than 90 =
days
from service agreement amendment.
------=_NextPart_01C9B200.5037FB40
Content-Location: file:///C:/06471E08/RACOHENABLENH_files/slide0012.htm
Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"
Right to Prompt and Quality Services for Individuals with Intellectu=
al
and Developmental Disabilities
=
Major
SB 138 Statutory Requirements (cont.)
§Law requires that the “Legislature shall appropriate sufficient
funds to meet such costs=
and
requirements.”
§
§Legislative Oversight committee to track other timelines from point <=
/span>of application to eligibility and from funding
allocation to start up of services
§Pay/rate incr=
eases
for direct support staff and enhanced family care
•
------=_NextPart_01C9B200.5037FB40
Content-Location: file:///C:/06471E08/RACOHENABLENH_files/slide0013.htm
Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"
Right to Prompt and Quality Services for Individuals with Intellectu=
al
and Developmental Disabilities
=
Major
SB 138 Statutory Requirements (cont.)
ØSet up a=
Task
Force
Ø
•
§To recommend further sa=
lary
increases and otherhuman resource enhancements
§
§To develop quality outcome and performance standards and reliable methods to measure whether standards =
are being met
§
§To make recommendations on AA being sole provider and <=
span
style=3D'position:absolute;top:76.0%;left:14.04%;width:79.96%;height:4.75%=
'>performing all functions
•
------=_NextPart_01C9B200.5037FB40
Content-Location: file:///C:/06471E08/RACOHENABLENH_files/slide0014.htm
Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"
Right to Prompt and Quality Services for Individuals with Intellectu=
al
and Developmental Disabilities
------=_NextPart_01C9B200.5037FB40
Content-Location: file:///C:/06471E08/RACOHENABLENH_files/slide0015.htm
Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"
Right to Prompt and Quality Services for Individuals with Intellectu=
al
and Developmental Disabilities
BDS General Fund
Requests For DD and ABD Wait Lists
2.It is a law that has a strong moral and societa=
l underpinning.
̶=
6;
§<=
span
style=3D'font-size:71%'>Serving individual with DD is a long recognized so=
cietal
obligation, codifi=
ed in
state & federal law in this state and part of the promise of closing Laconia.
=
§<=
span
style=3D'font-size:71%'>All people need supports at various points in their
life, most people with
developmental disabilities, just need it on a more long term & intensive basis
=
------=_NextPart_01C9B200.5037FB40
Content-Location: file:///C:/06471E08/RACOHENABLENH_files/slide0017.htm
Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"
Right to Prompt and Quality Services for Individuals with Intellectu=
al
and Developmental Disabilities
Points in =
Favor
of Full Funding of Waitlist and =
Rest
of Bureau of Developmental Service Budget =
(cont.)
3.The
consequences of individuals not receiving community supports are more painful and costly, resulting
in:
=
4.
§<=
span
style=3D'font-size:57%'>Regression, loss of skills, increase in challenging
behaviors for graduates, who will
now lack needed activity, instruction, and structure
§<=
span
style=3D'font-size:57%'>The expectation of continued growth, full or suppo=
rted
employment and indepe=
ndent
living for many (indeed most) will be substantially delayed or in <=
/span>lost.
§<=
span
style=3D'font-size:57%'>For parents who now must stay home with their adult
child there will be loss of income,
health care, and maybe their home and more reliance on state or local public assistance.
§<=
span
style=3D'font-size:57%'>The stress on families will increase stress
exponentially, creating mental health issues for caretakers, and siblings.Studies show increased abuse, div=
orce
rates, etc.
§<=
span
style=3D'font-size:57%'>For =
elderly
caregivers whose aging adult children desperately need residential =
placement, the hardship is enormous creating safet=
y and
health risks for both parents
adult children
•
------=_NextPart_01C9B200.5037FB40
Content-Location: file:///C:/06471E08/RACOHENABLENH_files/slide0018.htm
Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"
Right to Prompt and Quality Services for Individuals with Intellectu=
al
and Developmental Disabilities
=
Points
in Favor of Full Funding of Waitlist and =
Rest
of Bureau of Developmental Service Budget =
(cont.)
̶=
6;
ØFor those families who cannot deal with the stress=
and
don’t have the sav=
vy to
obtain services, institutionalization of their adult children will result in highly inappropriate and
generally more expensi=
ve
facilities.
§<=
span
style=3D'font-size:64%'>Facilities like New Hampshire Hospital and Glencli=
ff,
which both have increa=
sing
DD populations, nursing homes, ICF-MRs, nursing homes generally cost $100,000 to $225,000 annually vs. $=
15,000
to $100,000 for mo=
st
community alternatives, $43,000 average.&=
nbsp;
̶=
6;
ØMore funding provides economic stimulus, putting m=
oney
into the economy, resulting=
in
more individuals being employed, both individuals with disabilities and direct support, supervisory and =
professional personnel.
------=_NextPart_01C9B200.5037FB40
Content-Location: file:///C:/06471E08/RACOHENABLENH_files/slide0019.htm
Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"
Right to Prompt and Quality Services for Individuals with Intellectu=
al
and Developmental Disabilities
=
Points
in Favor of Full Funding of Waitlist and =
Rest
of Bureau of Developmental Service Budget =
(cont.)
4.Wi=
th
respect to the issue of the need to sacrifice because of the financial crisis
<=
/div>
•
§<=
span
style=3D'font-size:67%'>Waitlisting individuals would be like turning away
eligible children seeking enrollment
in school or someone acutely ill being denied hospital admission.
• =
<=
span
style=3D'font-size:67%'>§NH can and should do more. Consider—
• =
§<=
/span>The DD system had been grossly underfunded for at =
15
years causing an erosion of service
quality, poverty level wages for staff, high turnover etc.
•
§<=
/span>Entry level wages for direct support staff are $8 =
to $10
hourly comparedstate hospit=
al which is at about $14.
§<=
span
style=3D'font-size:57%;display:none'>
§<=
/span>NH&#=
8217;s
level of fiscal effort(base=
d on
per capita wealth) is 34th in U.S.down from 10th=
13 <=
/span>yearsago.
§
§<=
/span>NH’s $43,000 per person expenditure is well =
below
all other New England States.Maine, the highest, is at $84,000 per person
•
------=_NextPart_01C9B200.5037FB40
Content-Location: file:///C:/06471E08/RACOHENABLENH_files/slide0020.htm
Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"
Right to Prompt and Quality Services for Individuals with Intellectu=
al
and Developmental Disabilities
Fiscal Effo=
rt
Regarding DD Services Spending For Services Per $1,000 Personal Income
§<=
span
style=3D'font-size:64%'>Asking families of adults to shoulder more burden
unfair, contrary to princi=
ples
of independence, choice, what most families and adult children want.
§<=
span
style=3D'font-size:64%;display:none'>
§<=
span
style=3D'font-size:64%'>Rate of individuals in out of home community place=
ment
is less than the peak o=
f the
institutional placement era at Laconia (1970). Are we going =
backwards?
------=_NextPart_01C9B200.5037FB40
Content-Location: file:///C:/06471E08/RACOHENABLENH_files/slide0023.htm
Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"
Right to Prompt and Quality Services for Individuals with Intellectu=
al
and Developmental Disabilities
=
Points
in Favor of Full Funding of Waitlist and =
Rest
of Bureau of Developmental Service Budget (cont.)
•6. With
respect to the issue that too much waitlist funding goesto individuals with forensic issues
̶=
6;
§<=
/span>Only about 1-2% of person receiving services have
forensic issues
------=_NextPart_01C9B200.5037FB40
Content-Location: file:///C:/06471E08/RACOHENABLENH_files/slide0024.htm
Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"
Right to Prompt and Quality Services for Individuals with Intellectu=
al
and Developmental Disabilities
=
Points
in Favor of Full Funding of Waitlist and =
Rest
of Bureau of Developmental Service Budget (cont.) <=
u>
ØReal Solutions
•
=
§Stop the erosion; invest and restore the infrastructure which will =
lead to more independence and employment and creat=
ive
use of natural and generic
resources
§
<=
span
style=3D'font-size:75%'>§Improve education to children in special education system. For =
many this will mean less reliance on the AA system=
; for
some it may mean no need for AA
services.
State must “maintain” and supervise a “stateservice delivery systemR=
21;
(SDS)
SDS includes community living arrangements, day services, training,
therapeutic employment, =
;
service coordination, Area Agencies, and all components neces=
sary
to ensure appropriate care, protection from harm, opportunities for a
quality life in the normal domains of community living.
RSA 171-A establishes rights to those services in the SDS
![3D"DRC](3D"slide0025_image003.jpg")
![](3D"slide0015_image005.gif")
![](3D"slide0020_image007.gif")
![](3D"slide0021_image009.gif")
![](3D"notes_flag.gif")
No=
tes![](3D"buttons.gif")
![](3D"slide0025_image001.gif"){kind=link}
![](3D"slide0025_image002.png"){kind=link}