Ed's Newsletter
ONLY A FRACTION OF PARTICIPANTS RETURN TO CDS . . .
CONSULTANT FINISHING RATE STUDY . . .
SECRETARY HOU CONDEMNS TRUMP . . .
McMANUS CONSULTING
DISABILITY SERVICES
847.256.0456, [email protected], Facebook, LinkedIn
ED’s NEWSLETTER
No. 162 – Nov. 17, 2020
FUTURE OF CDS IN DOUBT . . .
It’s a hot mess.
That’s how one provider agency CEO described the situation with DDD’s Community Day Services program, and I don’t disagree.
In February, before we all realized we were in the midst of an enormous pandemic, there were more than 20,000 individuals enrolled statewide in CDS. This fall, only a fraction of them have returned to their programs, leaving the directors of those programs in a quandary about the future of day services.
Director Stark reported Oct. 28 on a survey the Division conducted:
“In February we had 343 CDS sites. Data from the CDS Survey accounts for 310 sites (90%). 224 of the 310 (72%) are open. 14 providers reported consolidating 22 sites. 4 providers have reported they are closing indefinitely, and we do not have reopening self-assessments on file. We have only received official closure notification for 1 provider.”
No SODC residents returned, and many ICFDD residents were restricted by the Dept. of Public Health from leaving their facilities. However, providers report 1,713 persons are being served on site at ICFDDs.
It was unclear from the report how many CILA residents and Home-Based participants have returned to CDS. A survey of 37 CDS agencies in September by McManus Consulting found only 23.5% of their participants returned. In a survey in August by the Institute on Public Policy for People with Disabilities—on behalf of the six statewide provider associations—54 agencies reported that they anticipated a 46% return rate. But, of course, both of these surveys were only of a portion of the providers.
“Providers cited many challenges to reopening their CDS,” Stark said, “but the top issues are failure to know when and if an individual will attend and balancing staffing considerations with this uncertainty. Transportation was another big factor. Additional challenges include complying with smaller cohort sizes, the costs associated with modifying the environment, staffing, PPE, disinfection, and supporting individuals to comply with safety measures.
“CDS is an important part of our service system. Over the past 6 months, the Division has issued retainer payments to support CDS sites that were not able to provide services, created a new Virtual Day Services program option, tried to provide more flexibility to service rules as well as increasing CDS rates by 15%. I know our CDS stand-alone organizations are doing everything possible to make ends meet in a challenging environment.” (This refers to agencies that provide only CDS, not residential services.)
‘BARELY HANGING IN’ . . .
As we said, it’s a mess. A lot of individuals and their families are simply not inclined to go back to congregate settings. But the providers say they are not able to keep their doors open unless enrollment increases.
Many participants in the Home-Based program use their monthly allotment to pay for attending CDS. If they are going full-time, that takes roughly two-thirds of the $2,349 allotment. When CDS shut down last spring, most of them simply switched that money over to hiring more personal support.
Some families of CILA residents brought them back to the family home when Covid began; many of them have now gone back to their CILAs, but some of them are still with their families.
The Division several months ago began reimbursing CILA agencies for providing services to residents in their CILA homes during the day. They also continued to pay “retention” payments to CDS providers, but those payments ended Sept. 1.
Most agencies operating both residential and day programs have been able to stay afloat, if just barely, but the stand-alone agencies are hurting.
“We are barely hanging in here with fewer and fewer clients coming each day,” one provider told me. “It’s becoming pointless to keep the whole program open unless the State sends some help.”
Another pointed out that the Dept. on Aging has said they will continue to send retention payments to their Adult Day Services providers through next June. “Why not DDD?”
VOTERS TURNED DOWN TAX PROPOSAL . . .
Providers I have spoken to are getting increasingly discouraged. A number of them are echoing a comment made by a provider in August when the Institute on Public Policy for People with Disabilities conducted a survey on behalf of the six statewide provider associations: “We are troubled by the State's apparent willingness to let this critical capacity be destroyed. Millions of taxpayer dollars have created this valuable system, supporting the needs of thousands of individuals. While it’s far from perfect, it's the best starting point for a re-invented system. Letting that starting point go fallow will be a tragic, and hopefully avoidable, outcome of the pandemic.”
Of course, that statement implies that DHS has lots of money to throw around, and we know that is not the case. If voters had approved the proposed change from a flat income tax to a progressive tax, it would have pumped a huge amount into the State’s coffers, but they didn’t. Alternatively, as IARF’s Josh Evans states below, DHS might be able to shift funding from elsewhere in their budget, or they might be able to talk the legislature into giving them an additional appropriation.
Director Stark said there has been an increase recently in the number of individuals testing positive for Covid, and “I am not surprised that individuals and residential providers are deciding the risk is too great to return to a congregate CDS setting when the State is also bringing back restrictions to keep everyone healthy.”
But she emphasized that the issue of CILA residents returning to CDS should be a joint decision with the individual, guardian, residential provider, CDS provider and ISC. “We’re hearing from CDS providers that this is not always the case. CDS providers should reach out to the ISCs of the individuals, and if not resolved, the Division, if you believe individuals are not being allowed a choice.”
LONG-AWAITED RATE STUDY COMING OUT . . .
The consulting firm Guidehouse is finally winding up its study of DDD rates and will be making recommendations to the Division by the end of the month. (The State originally hired Navigant to do the study, and in the meantime Navigant has been taken over by Guidehouse.)
Judge Sharon Johnson Coleman, who oversees the Ligas Consent Decree, pushed the State to take the rate issue seriously, and that is what led to the hiring of Navigant. Coleman declared the State out of compliance with the decree in 2017, finding that DSP wages had stagnated, “causing a staffing crisis that is inhibiting care and negatively impacting the individuals protected by the consent decree.”
The Arc has announced that it will be hosting a webinar Dec. 4 featuring Director Stark discussing the consultant’s report. The webinar is entitled “The Real Cost of Services: Understanding the New Rates Survey with Director Stark”.
IARF: PREVENTING COVID IN I/DD SETTINGS . . .
The Board of Directors of IARF has submitted an extensive list of recommendations to DHS to try and prevent further spread of COVID-19 in I/DD service settings. Here are some of the highlights from a letter to Secretary Hou written by Josh Evans, CEO of IARF (IL Assn. of Rehabilitation Facilities):
“Given the rapid increase in the spread of the virus, out of abundance of caution, and cognizant of our provider staff vacancy rates, we believe the time is now to implement this series of recommendations. . . . We believe these are rational next steps that should be taken to prepare for what may be a very difficult late Fall and Winter.”
Principal Rate Recommendations:
“These recommendations are based on the experiences of providers, lessons learned with staffing models utilized over the past several months, overtime utilization, current staffing vacancies, and projections on staff modeling into the next several weeks. It is believed that these adjustments still place the reimbursement rate well below the real costs to provide these supports in a non-COVID environment.”
--Increase the current 5% bump to CILA rates back to 10% and extend the rate adjustment through the end of FY21;
--Re-institute the 20% increase in children’s group home rates;
--Re-institute the 20% increase in ICFDD rates. With most regions in increased mitigation, many ICFDD residents are receiving 24/7 support from their residential providers;
--Increase the At-Home Day Program (Code 37U) rate by 15% to establish parity with the current 31U (Community Day Services) rate adjustments. Providers report 37U to be more costly to provide than 31U;
“We understand the Division has significant flexibility in its appropriations authority . . . . To the extent these rate recommendations may exceed the Department’s appropriations authority, we stand ready to discuss ways we could work together to seek additional authority with the General Assembly.”
Principal Policy Recommendations:
“These recommendations stem from what providers have learned during the early weeks and months of the pandemic. Again, as the signs are evident that the late Fall and Winter months will experience dramatic increases in positivity rates (as well as potentially hospitalization rates), we believe these recommendations are crucial to granting fair and appropriate flexibilities to service providers in what will be a very trying environment with expected extreme difficulties in staffing.”
--Authorize nurses working in CILAs to decide whether DSPs can pass medications across multiple group homes;
--Allow for the temporary increase in setting sizes of adult and children’s group homes and/or the rapid consolidation of setting sizes and appropriate staffing needs;
--Allow for waiving of staffing ratios or staffing requirements outlined in personal plans due to staffing shortages;
--Temporarily re-extend all associated deadlines and reviews with respect to certification, licensure, life safety code, quality assessments, audits, year-end reporting, etc.
Testing of Clients and Staff for COVID-19:
“The Association is aware the Department has worked diligently with DPH and the Governor’s Office to vet as many approaches as possible to increasing the capacity to perform COVID-19 testing with individuals receiving services in the community and staff. We thank Director Stark for her diligence on this matter, and we are hopeful these efforts will yield up broader and more frequent testing capabilities, as we believe this will be crucial to mitigating the introduction of and spreading of the virus into our service settings.”
HOU BLASTS TRUMP ON RACE ISSUES . . .
DHS Secretary Grace Hou has issued a statement condemning an attempt by President Trump to prohibit training that advances equity and racial justice, and also condemning any attempts to ignore the impact of institutional and systemic racism. The statement, issued Oct. 27, was in response to an executive order issued by the president in September to affect the ability of federal grant recipients to conduct diversity, equity and inclusion training.
“DHS believes it is more important than ever to conduct the kinds of training that this order seeks to prohibit,” Hou said. “The Illinois Department of Human Services condemns the attempt to prohibit training that advances equity and racial justice, and any attempts to ignore the impact of institutional and systemic racism. Training and education are the first important steps in the process to eliminate barriers to equity and inclusion.”
Hou said DHS has already begun to conduct the trainings, and the Pritzker Administration has charged every state agency to create a diversity, equity and inclusion plan to address racism.
The executive order appears to have no immediate impact on federal grants, Hou said. “Rather, it requires federal agencies to report to the federal Office of Management and Budget within 60 days of the order, to list grant programs to which the order might ultimately be applied.
“If the federal executive order were ever to actually be applied to recipients of federal grant funds, like DHS and its federal grant recipients, DHS’s reading is that it would not affect the ability to use non-federal funds to conduct these important trainings.
“Please know that DHS will not allow this federal executive order to have a chilling effect on our own diversity, inclusion, equity and racial justice work and training. And, while providers will need to make their own determination, DHS encourages providers to begin or to continue to provide the same.”
The NAACP and other groups have filed a lawsuit alleging the executive order violates free speech rights in an "extraordinary and unprecedented act by the Trump administration to undermine efforts to foster diversity and inclusion in the workplace."
IN OUR INBOX . . .
Commenting on our story last month about a CILA resident who died of Covid in an acute-care hospital. The hospital refused for several weeks to allow her parents to be with her for more than a couple of hours a day, contrary to a directive issued by the Dept. of Public Health in May. . . .
FROM KIM KOSLOVICH, one of the key advocates who persuaded DPH to issue the directive: “My heart is broken. I thought this fight was over for Illinois.”
FROM ELLEN GARBER BRONFELD, co-director of IPADDU: “What the hospital did was reprehensible. They should be sued. I am so sad for this family. This must be changed. It is unconscionable.”
FROM DARLA STEWART: “It is stories like this that have caused me to clearly state to any hospital that my sons have been in that I WILL be staying with them, rule or no rule. We must demand that our rights as guardians be respected. We know our people, their medical reactions, better than any doctor or government agency.”
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FROM RODNEY PATTERSON, member of the quality assurance committee for a provider: “When the stay-at-home order was first initiated we worried about an increase in behavioral issues. Quite the contrary, there was a dramatic decrease. For a variety of reason, some folks preferred staying home. I am thinking that it would be very valuable if some organization would research this. It would give great insight into ways to improve day services.”
FROM ELLEN GARBER BRONFELD: “My heart just keeps breaking for the families encountering problems with isolated loved ones in group homes. Not sure what to do about it. Some agencies are totally locked down because of a resident in a couple of their homes testing positive. Much as I want everyone to be safe, this is just not right in my opinion. People with disabilities are being treated uniformly like old and fragile people and I would say their civil rights have been usurped by misguided policies that could be less restrictive with proper oversight and individual and family choice being front and center.”
COMMENTS . . .
Send me your opinions, tips, suggestions, criticisms, or responses to articles. I like feedback.
PEOPLE . . .
FRANK DiBARTOLOMEO has been hired as CFO at Provisio Partners, a company that assists human services agencies with software issues. Frank was the CEO of Service Inc. in Joliet for seven years. He left there last year to become exec director of UCP’s Center for Disability Services in Joliet, and switched to Provisio 11 months later. Replacing him at UCP is MIKE HENNESSEY, formerly CEO at United Way of Will County.
JAMES DIMAS, former DHS Secretary, has set up his own business, Dimas Advisors, in Sykesville, MD, to assist state agencies in the development of human services transformation strategies, especially in child welfare. Jim was a consultant on child welfare for 9 years before joining DHS.
FAYE MANASTER, director of the Arc’s Family to Family Health Information Center for 14 years, is retiring. Replacing her will be MARY DIXON, currently a family advocate at the Arc.
DAN DAHLKE is the new CEO at DayOne Pact, replacing Steve Boisse, who retired in June. Dan formerly was vice president of people and philanthropy at Aspire. DayOne Pact lost its contract as an ISC last year but continues to operate the Child & Family Connections program for DuPage, Kane and Kendall counties and the Life Management Services program, providing trust and guardianship services.
DENNIS DEANY has been hired as a program specialist at the Illinois Council on Developmental Disabilities. Dennis has been on the staff of the Division of Rehabilitation Services as a Vocational Rehabilitation and Home Services Case Coordinator since 2010. He began his career at Shapiro Center in 1989 and has also worked at Ludeman Center.
COMING UP . . .
NOV. 16-20: Speak Up Speak Out Summit, https://www.speakupspeakoutsummit.org/
NOV. 18: Webinar: Update on Ligas Consent Decree, Court Monitor Ronnie Cohn, 1:30 p.m. Sponsored by IL Guardianship Assn. https://illinoisguardianship.org
NOV. 24: Beginning of bi-weekly statewide provider calls, hosted by Arc, IARF and Institute. 11 a.m. Discussing the resumption of delivery of day services and other Covid-related issues. All I/DD providers welcome. Further calls on Dec. 8 and 22. CLICK HERE TO REGISTER FOR THE MEETING(S)
DEC. 8: Arc Life Span program webinar, at noon, Your Rights in the Vocational Rehabilitation Process, presented by the Client Assistance Program of Div. of Rehab Services. https://www.thearcofil.org/
OTHER STUFF . . .
SSI AND HOME-BASED: The Social Security Administration says benefits will increase 1.3% in January, based on the cost of living. The maximum SSI payment will grow from $783 per month to $794. Adults in Illinois’ Home-Based Services program are entitled to a monthly allotment of three times the SSI amount, so their new allotment will be $2,382. Children are entitled to two times the SSI, so their new allotment will be $1,588.
REBALANCING: Medicaid officials are encouraging states to accelerate efforts to “rebalance” long-term care offerings for people with disabilities to favor home- and community-based services over institutions. The Centers for Medicare and Medicaid Services has released a toolkit featuring examples of how states have expanded home- and community-based services and decreased reliance on institutional care.
DHS: ‘IF IT IS IMPOSSIBLE, WE HAVE TO DO IT’: The latest edition of DHS’s Stakeholder Newsletter, “All In”, has an introductory message from Secretary Grace Hou which, in my opinion, is beautifully written and very inspiring, and I want to share it with you. . . .
Dear colleagues,
Help Is Here at the Illinois Department of Human Services. This is our aspiration.
We want people across our state to come to us and our community partners for respite, helping hands, ladders up, and for comfort in trying times. It has never been more important for our organization to lead by example, be strong, compassionate, bold, and swift in the delivery of human services to Illinois communities and to serve as an essential safety net in the State’s COVID-19 response.
If it is impossible, we have to do it.
When COVID-19 hit Illinois, at that moment, we knew that we had to believe this if we were to effectively respond to the pandemic. In many ways, with you, we have accomplished the impossible. The COVID-19 pandemic forced us to change the way we did everything. Things that we could never have dreamt of doing within decades – happened in moments, days, weeks.
IDHS was in a state of transformation prior to this unprecedented global pandemic. Before onboarding as Secretary of this resilient organization, we began reconstructing and rebuilding the agency. We had federal corrective action plans – looming penalties for backlogs and delays – under-enrollment and under-utilization. In that first year, we recruited an amazing, diverse leadership team and worked hard to earn the trust that had been lost between us and our stakeholders, providers, families, staff, partners, and legislators. I am thankful and feel grateful that we had that first year to strengthen our system – little did we know that we would be in for the fight of our lives with the coming virus.
The COVID-19 disparities, the police killings of Black men and women followed by weeks of social unrest amplified inequities in our country and affirmed our key value as an administration: equity. We need to be present for those who need us most and must be a place for healing and for hope.
Illinois is confronting a troubling increase in our COVID-19 numbers, and I know that many of us are trying to rally strength to continue the fight. We know that our actions prevent infection and save lives. United as mission-driven organizations, we know that retreat is not an option.
I have hope. I have hope, because despite the monumental challenges that have presented themselves – we have made tangible, remarkable strides. We have come into compliance with SNAP timeliness benchmarks and, with HFS, have busted the backlog on Medicaid applications. . . .
Thank you. We are grateful for your tenacity and commitment to the people of Illinois.
Sincerely,
Grace
THE CONSULTING PRACTICE . . .
Larry Manson, CEO of Progressive Careers & Housing, invited me to meet with his board of directors Oct. 13—virtually, of course. Progressive has a very engaged board and they asked me a lot of good questions, particularly focused on the future of the I/DD system (which is hard to predict). Progressive operates CILAs, ICFDDs and CDS in the south suburbs and in southern Illinois.
I’m getting pretty good at Zoom. LOL! If you want me to conduct a training for your agency’s staff on how the DDD system works, I can do that virtually. Can also meet with parent groups.
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McManus Consulting was founded in 2011 by Ed McManus, who worked for the Dept. of Human Services for 18 years--as an attorney in the Office of Inspector General, state coordinator of the Home-Based Program and facilitator of the DDD North Suburban Network--and before that as a reporter and editor for the Chicago Tribune in Springfield and Chicago. We have provided services to more than 75 agencies, including staff training on how the system works and phone consultation on a retainer basis when issues arise. We also can arrange for consultations with families or provide pro bono assistance to them over the phone.
Ed's Newsletter is published approximately once a month, made possible by the support of the following affiliates who are on retainer: Access Living, Active Visions, A New Age Human Services, A+ Autism Solutions, Arts of Life, Aspire, At Home Mission, Avenues to Independence, Bethesda Lutheran Communities, CCAR Industries, Center for Enriched Living, Center for Independent Futures, Champaign County DD Board, Clearbrook, Douglas Center, Encompass/Jewish United Fund, Friendship House, Garden Center, Gateway Services, Gateway to Learning, Glenkirk, Good Shepherd Manor, Helping Hand, Individual Advocacy Group, KCCDD/Knox County, Lambs Farm, Leeda, Little City, McHenry County MH Board, Malcolm Eaton Enterprises, Misericordia, Mulford Homes/Diane Home Care, Orchard Village, Pioneer Center, Progressive Careers & Housing, Rimland, Riverside, Royal Living Center, St. Coletta WI, Sheltered Village, Trinity, UCP Seguin, Warren Achievement, The Workshop/Galena. Independent Service Coordination agencies: Central IL Service Access, Community Alternatives Unlimited. Disability-related law firms: Cahill & Associates, Chamberlin Law Group, Matt Cohen & Associates, Monahan Law Group, Rubin Law, Whitted Takiff.