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DMR Facts and Figures that all CABs Should Have
SAC reTREAT
January 12, 2008
Governor and Lt. Governor
Deval Patrick
Timothy P. Murray
EOHHS OrganizationThe Secretariat
Secretary EOHHS
JudyAnn Bigby, MD
General CounselEOHHS
Cynthia Young
Chief Operating Officer
Fred Habib
Chief of StaffJill Bassett
DirectorOffice of Medicaid
Tom Dehner
Assistant Secretary CYF
Marilyn Chase
Assistant secretary Disabilities
Jean McGuire
Assistant secretary Health Services
Vacant
Deputy Assistant Secretary, CYF Kathleen Betts
Deputy Assistant Secretary, DCS
Laurie Burgess
Deputy Assistant Secretary, Health
Vacant
Undersecretary EOHHS Vacant
Commissioner DMR
Elin Howe
EOHHS
The Department of Mental RetardationStructure, Services, Programs
Commissioner
Revenue
Human Resource
Civil Rights
Deputy Commissioner
Assistant Commissioner
ForFacilities
Assistant Commissioner For
Quality Management
Assistant Commissioner
For Field Operations
Asst. CommissionerFor Policy, Planning
and Children’s Services
Assistant
Commissioner For Systems
Integration Mgt.
ChiefFinancialOfficer
GeneralCounsel
Fernald Developmental Center Glavin Regional Center Hogan Regional Center Monson Developmental Center Templeton Developmental Center Wrentham Developmental Center Central Residential Services Metro Residential Services
Central West Regional Office
Northeast Regional Office
Southeast Regional Office
Metro Regional Office
Area Offices
Commonwealth Community
Services
BerkshireFranklin/HampshireHolyoke/ChicopeeNorth CentralSpringfield/WestfieldSouth ValleyWorcester
Area Offices
NortheastResidential
Services
Central MiddlesexLowellMerrimackMetro NorthNorth Shore
Area Offices
SoutheastResidential
Services
BrocktonCape Cod/IslandsFall RiverNew BedfordPlymouthSouth CoastalTaunton/Attleboro
Area Offices
Charles River WestGreater BostonMiddlesex WestNewton/So. Norfolk
Department of Mental Retardation Organizational ChartApril, 2006
DMR Organizational Chart – More Detail
Demographics
Who receive services?
DMR Consumers November 2007 (Approximately 32,800 Adults and Children)
Female41%
Male59%
Demographics Continued
DMR Consumers By Age Group
0
1000
2000
3000
4000
5000
6000
7000
0-8
9-17
18-2
122
-30
31-4
041
-50
51-6
061
-70
71-8
081
-90
91+
DMR Class Members
Ricci Class: 3,834 class members 2995 reside in the Community 779 reside in ICF/MR Facilities (22 in Marquardt SNF) 60 reside outside of Massachusetts
Brewster Class: 36 class members Rolland Class Members 2,951
836 reside in Nursing Facilities There are approximately 400 nursing facilities in
Massachusetts, 250 of these facilities have Rolland Class Members
Boulet Class Members original class 2,439
How are individuals supported?
Families and Informal Caregivers State supported services
DMR statewide employs 7523 Contracted Services
220 providers 18,182 employees
What are the DMR funded services?
Service Coordination Family Supports Individual Supports Residential Supports Facility Supports Day Supports Employment Supports Transportation
Service Coordination
What is it? Service Coordinators arrange, coordinate, and monitor the supports that DMR provides, purchases or arranges for an individual.
Who provides it? DMR staff
How many receive it? 32,445 individuals
(23,459 Adults & 8,986 children)
Caseload Ratio: Adults: 1 to 53
Children: 1 to 279
Family Supports
What it is? Family Supports is a flexible array of services that enable children and adults to live with their immediate family and be welcomed, contributing members of their communities.
Who provides? A network of 72 Family Support Provider Agencies under contract with DMR.
How many receive? Approximately 4600 adults and 8,650 children and families in 2007.
Individual Supports
What it is? Individual Supports consist of assistance with a variety of community activities, such as, help with money management, food preparation, food shopping, cooking, banking, and housekeeping.
Who provides? Provider Agencies under contract with DMR
How many receive? Approximately 3,000 individuals
Employment Supports
What it is? Employment Supports provide supervision, training, and/or transportation that enable individuals to get paid jobs. It includes help with career planning and job development as well.
Who provides? Providers Agencies under contract with DMR.
How many receive? Approximately 4,400 individuals
Community Day Supports
What it is? Day supports help individuals to build and maintain their ability to
participate in community activities by focusing on important skill areas that include communication, self-care, relationship building and community involvement.
Who provides? State and Provider Agencies under contract with DMR
How many receive? Approximately 1,700 individuals
Residential Supports
What it is? Residential Supports provide care, supervision and basic life skills and community living skills training in various residential setting for up to 24 hours a day, 7 days a week. Who provides? State and Provider Agencies under
contract with DMR
How many receive? Approximately 9,200 adults
Facility Supports
What it is? Facility Supports is provided in 6 large state owned and operated facilities that are certified by the federal government as intermediate care facilities for the mentally retarded (ICFs/MR). They are: Monson Developmental Center, Glavin Regional Center, Templeton Developmental Center, Hogan Regional Center, Wrentham Developmental Center Fernald Developmental Center
Who provides? The Department of Mental Retardation How many receive? 946 individuals
DMR Consumer Service Types
Supports include family supports, individual supports, transportation, respite, clinical services, etc.
Day includes DMR Community Based Day Services and MassHealth Day Habilitation
Community Residential Services includes DMR Community Based Residential Services and MassHealth Adult Foster Care
Facilities include ICF/MRs (Monson, Glavin, Templeton, Hogan, Fernald, Wrentham) and and Marquardt Skilled Nursing Facility.
DMR Services (Type of Service Provided)
Day16%
Community Res20%
Supports40%
Transportation8%
Center Based Work5%
Employment9%
Facilitie s2%
MassHealth Funded Services
Day Habilitation: provides individualized assistance to 6338 DMR consumers to acquire and maintain life skills, such mobility training, social behaviors, communications, basic safety skills, health skills and personal care skills.
Adult Day Health: community based program providing a variety of health, social and related services that is serving 851 DMR consumers.
Adult Foster Care: provides residential placement, health and social supports for 791 DMR consumers with various needs, such as, help with medication, ADLs, and ambulation.
DMR Programs
Waiver Programs
DMR program that provides home and community-based services through the federal Medicaid Home and Community-Based Services (HCBS) waiver program.
The Waiver Program helps fund community services with federal dollars.
DMR operates 2 Waiver Programs: 1. Comprehensive Waiver serving 12,500 adults 2. Autism Waiver serving 80 children (ages 0 through 8)
Waiver Services
Adult Waiver Services: Family Supports, Individual Supports, Residential Supports, Supported Employment, Community Based Day Supports, Respite, Transportation, Personal Agents, Transitional Services, Assistive Technology
Autism Waiver Services: Habilitation-Community Integration, Habilitation – ADL/ Independent
Living Skills, Expanded Habilitation Service-Education, Respite, Family Training, Adaptive
Aids, Vehicle Adaptations, Homemaker
ISO (Intermediary Service Organization)
Consumer driven program that allows individuals and families to actively participate in the design and manage their services ISO helps support self determination goals by
enabling participants to have individualized budgets and control their services.
The ISO helps individuals and families directly select and arrange for supports and services with community providers.
In FY 2008, there are 281 ISO participants
DOE/DMR Program
Provides specialized intensive home, community and education supports.
Serves children: Ages 6 through 21 Enrolled in Department of Education (DOE)
approved special education residential school OR school district determines child is at risk of needing a more restrictive out of home placement
eligible for DMR services In FY 2007, 366 special education students were
served in the DOE/DMR Program
Turning 22 Program
The Ch. 688 law establishes a transitional planning process for students with severe disabilities during the final two years of special education (before high school graduation or turning 22 years of age, whichever happens first)
The goal for the student is to: 1) Plan for appropriate adult service delivery 2) To gain a level of independence The Ch. 688 law does not require the continuation of
the special educational entitlement nor does it automatically secure funding for adult services
The FY 2008 Turning 22 class for DMR is 608 individuals.
Quality Assurance
How does DMR assure Quality?
A strong quality management and improvement system (QMIS) that looks at quality at 3 levels: the individual, the provider the system
QMIS measures quality outcomes important to stakeholders
QMIS consists of 22 different processes involving DMR staff, consumers and families on all levels of service delivery
What are the Quality Outcome Measures?
Health Protection from Harm Safe Environments Human & Civil Rights Decision-making & Choice Community Integration & Membership Relationships Achievement of Goals Work Qualified Providers
Licensure and Certification Processes
Public and private providers are evaluated on the level of quality of supports provided
Certification process assures that the quality outcomes and health and safety are present in people’s lives.
Licensure process assures that essential safeguards regarding health, safety, and rights are in place.
The evaluation uses observation, interviews and review of documentation for a sample of individuals served by a provider.
Residential, day, employment & respite providers are subject to
licensure and certification. Individual supports are subject to certification.
Investigations – Fiscal Year 2007
Category of Abuse Substantiated Unsubstantiated
Physical Abuse or Assault by Caretaker 59 142
Emotional Abuse by Caretaker 35 48
Sexual Misconduct, Abuse or Exploitation by Caretaker 3 17
Death 0 3
Unconsented to or Inappropriate Physical Contact 2 11
Verbal Abuse 17 20
Financial Misconduct 6 5
Omission on the Part of the Caretaker, Placing Individual at Risk 137 144
Injury(s) of Unknown Origin 4 102
Failure to Provide Basic Needs 15 25
Denial of Medical Treatment, Medical Neglect 25 27
Medication Incident or Error 13 9
Inappropriate or Illegal Use of Restraints 5 9
Retaliation for Filing 0 1
Failure to Report 5 3
Other Legal/Human Rights Violations 5 6
Failure to Follow DMR Regulations or Policies on Records 9 2
Fiscal 2007 Cases
Complaint Resolution Team (CRT)
Each Area Office and Facility has a CRT
Brings citizen perspective regarding prevention of abuse and mistreatment
Reviews all investigated cases and cases subject to administrative review and develops Action Plan for all those cases
Investigations and CRT Action PlansFiscal Year 2007
Disposition Cases Require Action Plan by CRT
Administrative Review 1,244 1,244
Defer to Law Enforcement - DMR to Investigate 155 155
Defer to Law Enforcement - DPPC to Investigate 3 3
Defer to Law Enforcement (Tracking Only) 80
Dismissed 425
DMR to Investigate 903 903
DPPC To Investigate 51 51
No Dispute to the Facts 56 56
Refer to Other Agency 107
Resolved Fairly and Efficiently 49 49
Total 3,073 2,461
Family Citizen Monitoring
A CAB managed quality assurance activity 20 of 23 CABs conduct monitoring 2 to 6 residences are visited monthly per CAB Focus varies by CAB: safety, nutrition, relationships,
etc. Area Director follows up on problems and concerns
identified.
Human Rights Committees
Every Provider and DMR program have a Human Rights Committee (HRC).
HRC educates consumers and staff regarding human rights (e.g. privacy, self-determination and freedom of choice, free from exploitation, enjoyment of basic goods & services)
HRC monitors compliance through visits, reviews of mistreatment and abuse complaints, restraints and other reports.
Oversight provided by DMR Human Rights Advisory Committee
Quality Councils
4 regional and 1 statewide Quality Council that meet quarterly
Comprised of self-advocates, family members, providers and DMR staff
Charged with reviewing data from all sources regarding the quality of DMR services and supports
Identifies service improvement targets and monitors progress towards achieving targets
The Budget Process
DMR to EOHHS September
Governor’s House 1 Budget: January
House Ways & Means: April
Senate Ways & Means: April – May
Conference Budget: June - July
Governor Signs Budget: June - July
DMR Budget – FY 2008
5911-1003 DMR Administration & Operations $77,144,454 5911-2000 Transportation $14,137,324 5920-2000 Community Residential $547,716,905 5920-2006 Residential Rate $2,000,000 5920-2010 State Ops $135,018,927 5920-2020 Boulet/Waiting List $87,870,762 5920-2025 Day/Employment $122,669,711 5920-3000 Family Supports $55,044,228 5920-3010 Autism $3,277,672 5920-5000 Turning 22 $7,700,000 5930-1000 State Schools $184,933,044 5982-1000 Templeton Retained Revenue $150,000 1599-6901 EOHHS Salary Reserve $10,826,454 5948-0012 DOE/DMR $8,000,000
TOTAL $1,256,489,481
SAC & CAB on DMR Web Site: www.mass.gov/dmr
“Role of Individuals, Families & Volunteers”
SAC & CAB Section on DMR Web Site
SAC & CABs can post and publicize on the DMR Web Site!
SAC & CABs can Collaborate Using PACE’s Team Room
The PACE Team Room is an internet based tool that the SAC & CABs can use to:
Share information
E-mail each other
Have on-line
discussions
Getting into Team Rooms I'm happy to report that PACE is now accessible via a link on the home page on the Internet – see lower
left hand side under the heading of “Key Resources" which looks like this: KEY RESOURCES · Find a DMR Office · DMR Offices and Facilities · After Hours Emergency Phone Number (781) 894-3600 · PACE Training Login Once you click the link above "PACE Training Login" you will automatically link to this page (see
below) next scroll down to the Department of Mental Retardation and click on that link: PACE Login Please find your agency and login properly. Thanks. Human Resources Division
- Municipality/Non-State Government Department of Conservation and Recreation
- Municipality/Non-State Government Department of Revenue
- Municipality/Non-State Government Office of Health and Human Services
- Center Staff Development - Virtual Gateway
Department of Mental Health - Municipality/Non-State Government
Department of Mental Retardation - Municipality/Non-State Government
PACE questions?
For further questions about PACE please contact:
Valarie OrestoStaff Development and Training Director
500 Harrison AvenueBoston, MA 02118
617- [email protected]
DMR Resource for SAC and CABs
Ralph Edwards, Director
Office of Citizens Leadership
500 Harrison Avenue
Boston, MA 02118
617- 624-7755
Email: [email protected]
