Contingency Planning and Congregate Settings: Is This Ohio's Future?
BRS Newsletter Article #8
Contingency Planning and Congregate Settings, Is this Ohio’s Future?
Last month we took a quick look at Ohio’s compliance and progress with the rulings of the Olmstead Act since 1999. I did say that I would share some of my experiences with the current Autism study I am involved with at Case Western Reserve University this summer. In similar fashion to the two prior studies I have been involved in, 1990 and 1998, parents groups continue to be the driving force behind most of the Spectrum legislation in Ohio. Yes, I was very lucky, my son was diagnosed and in a KSU experimental classroom at the Trumbull Campus by the age of three. Those days are gone. Children on the Spectrum fail to be integrated into current service delivery models in Ohio due to two factors; fiscal caps and numbers served. In similar fashion, when the Washington D.C. babies born with Crack Cocaine addictions first required service provision, we hit the panic button in Cleveland. They will overwhelm the system, we cried. We thought we would have to restructure Early Intervention, Early Childhood and Help Me Grow. The subsequent panic never became manifest. Yes, the babies were born addicted but with the existing intervention programs, they were able to meet their developmental milestones. Our state legislators are still hearing, (and have for the past twenty years), that the Spectrum parents are going to fiscally exhaust the system. So, this current Autism study is looking at transitions: Early Childhood to mainstreamed elementary, high school to vocational transitions and age ranges from six to thirty. My son is twenty-four and is a participant. The qualitative interviews are wrapping up and next year we shall see what the state gleans from the numbers shared. The control group is 140. Again, we shall see. There are the 2019 and 2021 benchmarks before the 2024 compliance deadlines and it is highly likely we’ll be looking at block grants by then.
The pendulum swings in Ohio and the mantra continues to be: it’s fiscal. Period. That is simply a fact, I don’t know how to state it more clearly. Ohio agencies, both non-profit and for profit are doing contingency planning for the end of ICFDD and a few other programs as we know them. What will be next? How can we meet the 2024 compliance deadlines? Let me adjust my tin hat before continuing, ahem. If the current administration remains in office for a second term, Ohio will likely be operating under a system of block grants with significantly fewer strings attached, except for the caps. If Ohio wishes to travel the road of creative compliance, the pendulum may well swing back toward congregate settings. The sub-minimum wage certificates will be long gone, thank you Sixth Circuit Court of Appeals, but congregate living in the community may meet a low bar legal standard. That couldn’t happen in Ohio, could it? It already is, HLF has their own carve-out on the state house floor due to the disproportionate costs of serving medically fragile children in skilled nursing homes. Remember, ICF beds are currently capped and subject to a litmus test for exit waivers. Is it an institutional setting? You decide, it is however legal in Ohio and most likely will continue to be.
In 1991 I returned to Broadview State Hospital with two state peers to shoot a couple rolls of slide film for a doctoral project I was doing. We unlocked the main doors which were secured with a chain. I shot the slides I needed to, looked in on my old office and felt a little sad. The only activity on the whole grounds was Phoenix still operating some of the cottages with their contracted adult DD population. I was still conditioned to be a good soldier, I had 740 hours of state training and 1500 licensure contact hours. We were well trained on HIPAA compliance, so, I was shocked to see that many of the client files had not been removed to safer storage. Wasn’t somebody supposed to be in charge of that? By 1991, the hospital building itself had been broken into many times and client files were littering several rooms on the first and second floors. What about identity theft, exploitation, protected health information etcetera? The State was responsible one day and the next, the doors were chained shut, and no longer was anyone responsible. That is the lesson, I took from it. If you’re funded, one moment you are entitled to cradle to grave service provision and legal protections from the state. The next moment, if you are not funded, you are joe average citizen and if you choose to live under a bridge, that’s your choice. No more legal protections, no MUI to call in, no follow-up, no case management, no healthcare, no recourse to justice or service provision if you’ve been on the wait list for ten years. This is today’s reality, let’s see what things look like in 2024. I’m taking off my tin hat now, but remember: It’s fiscal in Ohio and that’s a fact.
See you next month. –Dr. Paul 330-608-6941